title: The effectiveness of massage treatment on cellulite as monitored by ultrasound imaging.
abstract: OBJECTIVE
  The visual appearance of cellulite or the'orange peel'look of skin is a common cosmetic problem for many women. Cellulite, or more correctly lipodystrophy, is a modification of the adipose tissue, whereby the fat lobules are swollen as the result of a disturbed blood and lymph micro-circulation and fibrosclerose of connective tissue. In the wealthy diversity of products against cellulite, objective methods to measure their efficacy are of growing importance. The purpose of this study is to establish the effectiveness of a skin massage treatment by quantifying the changes in the skin via ultrasound imaging, during and following treatment.
  
  
  METHODS
  Using 20 MHz C-mode ultrasound scanning, a three-dimensional subsurface is constructed that represents the dermis-hypodermis tissue interface. In normal cellulite-free skin, this interface is smooth. In the case of cellulite, however, the dermis-hypodermis junction appears as an irregular surface. Qualitatively, the effect of cellulite treatment is inferred from changes in the shape of this junction. In order to quantify the effect, we chose to monitor the junction area. For the treatments, we used a specially designed handheld electro-mechanical massage device that was moved along the thigh. Treatments were conducted for 3 months, three times a week, during 15 min on each upper leg of 20 healthy female volunteers with moderate symptoms of cellulite (Curri's classification 1-2). Ultrasound measurements were performed monthly, and continued for 2 months after the treatments were stopped.
  
  
  RESULTS
  The results, on average, indicate a significant smoothening of the dermis-hypodermis surface (relative surface area reduction 34+3%, 50±3% and 56±2% after 1, 2 and 3 months of treatment, respectively). The smoothening can be described by a mono-exponential function with a time constant of 1.1 month. After the treatments were discontinued, the relative surface area gradually increased (with a time constant of 2.6 month), which indicates that the effect of massage is not permanent.
  
  
  CONCLUSIONS
  Treatment of cellulite by means of an electro-mechanical skin fold massage apparatus significantly smoothens the structure of the dermis-hypodermis interface. Three-dimensional ultrasound imaging of the dermis-hypodermis junction could serve as an objective method to monitor the effectiveness of cellulite treatment.
authors.affiliation: Personal Care Institute, Philips Research, Eindhoven, The NetherlandsLaboratory of General and Biological Chemistry, Faculty of Physical Education and Physiotherapy, Tree University of Brussels, Brussels, Belgium.
authors.forename: G W
authors.initials: GW
authors.lastname: Lucassen
authors.affiliation: Personal Care Institute, Philips Research, Eindhoven, The NetherlandsLaboratory of General and Biological Chemistry, Faculty of Physical Education and Physiotherapy, Tree University of Brussels, Brussels, Belgium.
authors.forename: W L
authors.initials: WL
authors.lastname: van der Sluys
authors.affiliation: Personal Care Institute, Philips Research, Eindhoven, The NetherlandsLaboratory of General and Biological Chemistry, Faculty of Physical Education and Physiotherapy, Tree University of Brussels, Brussels, Belgium.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Herk
authors.affiliation: Personal Care Institute, Philips Research, Eindhoven, The NetherlandsLaboratory of General and Biological Chemistry, Faculty of Physical Education and Physiotherapy, Tree University of Brussels, Brussels, Belgium.
authors.forename: A M
authors.initials: AM
authors.lastname: Nuijs
authors.affiliation: Personal Care Institute, Philips Research, Eindhoven, The NetherlandsLaboratory of General and Biological Chemistry, Faculty of Physical Education and Physiotherapy, Tree University of Brussels, Brussels, Belgium.
authors.forename: P E
authors.initials: PE
authors.lastname: Wierenga
authors.affiliation: Personal Care Institute, Philips Research, Eindhoven, The NetherlandsLaboratory of General and Biological Chemistry, Faculty of Physical Education and Physiotherapy, Tree University of Brussels, Brussels, Belgium.
authors.forename: A O
authors.initials: AO
authors.lastname: Barel
authors.affiliation: Personal Care Institute, Philips Research, Eindhoven, The NetherlandsLaboratory of General and Biological Chemistry, Faculty of Physical Education and Physiotherapy, Tree University of Brussels, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Lambrecht
keywords: cellulite; dermis-hypodermis interface; lipodystrophy; skin massage; ultrasound imaging