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Normal Skin Physiology The skin is divided into two main regions, the epidermis, and the dermis, each providing a distinct role in the overall function of the skin. The dermis is attached to an underlying hypodermis, also called subcutaneous connective tissue, which stores adipose tissue and is recognized as the superficial fascia of gross anatomy. The subcutaneous tissue is a layer of fat that lies between the dermis of the skin and underlying fascia. Subcutaneous fat insulates the body, absorbs trauma, and is a reserve energy source. The pathology observed in Cellulite lies in the subcutaneous tissue, as will be described further. How Does Cellulite Occur? Cellulite is a complex problem involving the microcirculatory system and lymphatics, the extracellular matrix and the presence of excess subcutaneous fat that bulges into the dermis. The deterioration of dermal vasculature causes oedema and tissue hypoxia with thickening and sclerosis of the fibrous septa. Chronic inflammatory processes with diffuse infiltration of macrophages and lymphocytes into the fibrous septa also take place in the formation of Cellulite. Another approach to the genesis of cellulite is a connective tissue disorders, which result from the action of estrogen on fibroblasts to produce MMP (matrix metalloprotease), which damages connective tissues. This process is driven by the reproductive cycle causing sex hormone levels to surge. In skin of men the septa of subcutaneous connective tissue are thick, parallel to the surface and criss-crossing, causing the polygonal fat-cell chambers be small. In contrast, in women’s skin the septa of the subcutaneous connective tissue are thin, perpendicular to the surface resulting in formation of large standing fat cell chambers. CELLULITE ANATOMY MALE Epidermis Dermis or Corium Upper zone of subcutaneous layer & fat chambers In contrast, full blown cellulite recognized by a dimpled skin surface represents subjugation of the hypertrophic response of the hypodermal connective tissue strands when the resistance is overcome by progressive fat accumulation that protrudes into the lower reticular dermis. Several strategies are being pursued for cellulite treatment: • Invasive procedures: liposuction and cellulite lift (also known as lower body lift) are the primary cosmetic surgery procedures presently available • Injections: several branded injections Lipo-dissolve, Mesotherapy Lipozap, Flab-Jab, Mesotherapy, Lipotherapy and Lipolysis • Different technology devices e.g. Ultrasonic, RF, Vacuum, Electrotherapy, Laser, Deep Oscilation, Hydro-therapy: large and heavy machines which usually combine 2-3 technologies for several applications; all partial solutions that are performed along with the recommendation to a heathy nutrition and exercise • Lymphatic massages: therapeutic deep manual massage performed by trained practitioner • Machine-aided massage: endermologie treatment, the practitioner uses a handheld device with rollers that draws up skin folds and rolls the skin • Cellulite creams: many cellulite topical remedies, primarily containing Caffeine, are available in the market; partially disolve fat cells and envigorate the blood flow. The creams introduce humidity into the upper layer of the skin and give the patient a pleasant feeling • Diet: the loss of weight doesn’t make the cellulite disappear but it improves its appearance • Exercise and sufficient water drinking: leading a healthy lifestyle reduces the cellulite by a better drainage of the lymph and building bigger mass of muscle Elettronica PAGANI., specializing in the development of Shock Wave Therapy based medical equipment, developed the EXPERT device , for focused and un-focused applications for cellulite & skin tightening treatments. EXPERT is a non-invasive, painless, compact and user friendly system. It is reliable and effective, granting significant clinical results and great satisfaction to the customers. EXPERT treatment is non-invasive, painless, safe and effective in alleviating cellulite symptoms. The wave is transferred into the tissue effecting a large and deep treatment area. It is successfully adapted to the clinical requirements for cellulite therapy, by allowing an excellent coverage of the cellulite area, as the subcutaneous layer depth is only 6-8 mm beneath the skin. Shock-waves were adapted to efficiently treat dermatologic and cosmetic conditions. The low energy unfocused waves scientifically proved to have a large impact on collagen structure and the skin connective tissue, improving the blood circulation and the metabolism of the fat cells. The mechanical massage effect reduces the oedema and improves the lymphatic drainage of the toxins, it stimulates collagen formation, while the skin becomes more elastic and its firmness is visible after only a few treatments. Treatment Method A complete treatment consists of 12 sessions conducted over a 6 week period. Each session is aprox. 15 to 25 minutes long. Two treatments are performed every week, without the need of special setting such as special clothing or preparations and it has no side effects or downtime after the procedure. Clinical Benefits • Deep mechanical massage instantly causing increased blood circulation in the treated area • Enhanced blood supply to the supportive connective tissue of the skin • Improved lymphatic drainage and acceleration of the lymphatic system activity • Increased metabolic activity which reduces the fat tissue oedema • Collagenogenesis and formation of stronger skin connective tissue skeleton EXPERT Advantages • Highly effective solution for a specific aesthetic condition – the cellulite, effecting up to 90% of adult women • Non invasive treatment, with no reported side effects and no downtime • Clinically established medical technology with Medispec's flawless reputation • Fast return on investment (ROI) • Complies to all international standards (CE, FDA) About Elettronica PAGANI Founded in 1947, Elettronica PAGANI develops, manufactures and markets high-tech medical equipment for the fields of Physiotherapy, Orthopedics, cosmetic as well as veterinary applications. PAGANI provides advanced, high quality products that comply with the worldwide standards of today's marketplace. PAGANI has a proven track record of delivering high performance shockwave and radial wave therapy products to international medical institutions. We customize solutions that meet our clients' specific medical and business requirements, ensuring that they receive the highest quality, reliability and cost efficiencies available. PAGANI is active in over 80 countries around the world and is continuously expanding into new territories and therapies. Background Cellulite describes a condition that occurs mainly in women, and may affect up to 90% of them in the post-adolescent period. Its external characteristics are its location (lower buttocks, outer and posterior thighs and hips), tissue lumpiness and dryness and flabbiness of the skin. Although not defined as a pathologic condition, the presence of cellulite is an aesthetically unacceptable cosmetic problem for most adult women and can cause significant psychological and self-worth issues. Cellulite develops when connective tissue between fat cell chambers, and between the chambers and the skin, become thinner and weakened. The elastic fibers that give these connective tissues strength are diminished. Since the septa of subcutaneous fatty tissue in women are often very taut and run perpendicular to the surface of the skin, as the fat cells in the subcutis increase in size, they are not held in place by the perpendicular septa, but rather press in the direction of the dermis/epidermis and are visible as dimples on the surface of the skin (cellulite). In addition to this, these often very stiff, inelastic septa are largely incapable of accommodating the increase in volume in the subcutaneous connective tissue, thus causing further dimpling. Additional important factors in the formation of cellulite are the deterioration of dermal vasculature (alterations of the pre-capillary arteriolar sphincter) causing edema and tissue hypoxia with thickening and sclerosis of the fibrous septa. Chronic inflammatory processes with diffuse infiltration of macrophages and lymphocytes into the fibrous septa also take place in this process. Treatment methods Both time and efforts are spent in search of the optimal treatment of this aesthetic problem. Iontophoresis, ultrasound, thermotherapy, pressotherapy (pneumatic massaging in the direction of the circulation), lymphatic drainage (massage technique to stimulate lymphatic flow), electrolipophoresis (application of a low frequency electric current) have all been tried. Yet, none of these techniques provides an effective solution. PAGANI, a highly estimated international medical equipment company, specializes for years in the development of Shock Wave Therapy medical equipment, has developed the EXPERT device, for focused and unfocusued Wave Therapy aesthetic treatment device, which is non-invasive, compact and user friendly. Method PAGANI treatment protocol includes twelve treatment sessions during six weeks of twenty five minutes each. Radial Wave Treatment with the PAGANI is combined with Slimcream – a unique anti-cellulite cream, specially developed for integrated treatment with the PAGANI. Slimcream is spread on the treatment area prior to treatment, and the radial wave enhances the penetration of the anti-cellulite active ingredients into the cellulite area. Based on clinical studies, 66% of treated patients will observe a visual improvement of cellulite condition. Also the skin elasticity will improve over the course of SWT therapy and will reveal a 74% improvement at the end of therapy. At 3- and 6month follow-ups, skin elasticity will be improved by 95% and 105%, respectively.