HOW IS IT DIAGNOSED?
a) Clinical evaluation and localization
The first signs of cellulite should be addressed by a complete clinical history with respect to the form and moment of appearance, associated illness and a search for predisposed factors for cellulite.
The fundamental diagnostics for cellulite are then done through a clinical inspection. With this the grade, location, associated processes (postural disorders, enema, vascular disorders, etc.) can be determined, or the establishment of a differential diagnosis of other processes.
Cellulite appears primarily in the neck, deltoid region, the internal face of the arms, in the trochanterian and supertrochanterian regions (the zone of the flabby tummy area and sadddleblocks) in the stomach and butt cheeks, and the internal face of the thighs and knees.
Whatever the aetiology, location and characteristics, as well as various symptoms and signs these are found in cellulite: the engrossment of tissue and the appearance of nodules (orange skin) and pain because of excessive tissue tension. A direct physical exam and through a method of pinching of the subcutaneous tissue, allows for the establishment of the simple classification of cellulite into phases:
In addition, according to the predominance of one or the other of the etiopathogenic factors (infiltration, fibrosis and adiposities), there is a proposed classification of cellulite into infiltrative cellulite (superficial hydrolipodistrophy), fibrosis cellulite (fibrolipodistrophy superficial), and adipose cellulite (superficial lipodistrophy).
b) Ecographic evaluation - Ultrasound evaluation
Ecography, as a diagnostic method is not routinely done. It is however useful in determining the different structures of the skin and those people that are affected and those who are not. It is also a method of objective validation of the efficacy of available treatments.
High frequency ecography allows for the differentiation of fat tissue into coetaneous, muscular, and adjacent bone structures and is capable of establishing an index of water retention in the tissue. In respect to cellulite, it is possible to differentiate the relative significance of an overload of fat, fibrosis and water in the explored coetaneous tissue; the differentiation between which kind of the three types of cellulite described above is also possible using this technique. The images obtained by affected women reveal a diffuse pattern of protrusion in the adipose tissue surfacing towards the dermis. The connective tissue at the derma-hypodermic border is irregular and discontinuous. It has been shown, as well, that the irregular pattern is diffuse in affected women, and not located exclusively in the areas affected by cellulite.
c) Other complementary techniques
Thermography: thermography was widely used to elaborate a locating map of the areas of cellulite and for a physiopathological study of the same area. Ghis manifested a thermographic imaging pattern for cellulite with an alternate pattern of hyperthermal marks, with hypothermal marks in "leopard" or "mosaic" skin. Hipolito and col. Han defined the different evolutionary patterns of cellulite in relation to different thermograpic images as an evaluation of the therapeutic activity of different treatments.
Magnetic Resonance: the skin and the subcutaneous fat tissue are well visualized through magnetic resonance imaging. In addition to the perceived changes in the cellulite zones (protrusion of the fat tissue in the dermis) they are clearly seen and can then be correlated to the grade of cellulite. It is also capable of showing other parameters like the percentage of adipose and connective tissue and the determined volume of hypodermis and of the invaginations that directly correlate to the grade of cellulite in the patient.