Hardware lipolysis: selection of procedures and construction of programs for the correction of fat deposits

Adipose tissue is a type of connective tissue whose main functional role is to store fat in the form of triglycerides. In the human body, adipose tissue comes in two forms: white and brown.

White adipose tissue has three main functions. One of them is the mechanical protection of internal organs from damage. In addition, adipose tissue is involved in the process of thermoregulation, or more precisely, it provides thermal insulation. And the most significant role of white adipose tissue is to store energy. Adipose tissue regulates the imbalance between energy consumed and energy expended. Moreover, storing energy in the form of fat is much more efficient than, for example, in the form of carbohydrates and proteins. (That is, one gram of fat stores 9 kcal G/m, while per gram of carbohydrate or protein stores only 4 kcal G/m). Based on this, the average woman with an energy reserve of 20% fat can ensure her functioning for one month.

Brown adipose tissue mainly performs the function of thermogenesis, so it is well developed only in newborns and is found along the upper back, in the neck, and on the shoulders. In adults, the deposition of brown adipose tissue is also observed, but in much smaller quantities. In addition, its activity is observed exclusively during the thermoregulation process.

Histology of fat cell

In a mature body, adipose tissue is an association of lipid-filled adipocyte cells in a framework of collagen fibers. In addition to adipocytes, it includes fibroblasts, leukocytes, macrophages and preadipocytes. At the 30th week of embryonic development, adipose tissue begins to develop from the mesenchyme. The mesenchymal cell turns into a lipoblast, which in turn turns into an adipocide. There are only two periods of active increase in the number of adipocytes: the period of embryonic development and the period of puberty. During other periods of life, progenitor cells do not reproduce. An increase in the volume of adipose tissue occurs only due to an increase in the size of fat cells.

White adipose tissue is characterized by the presence of one large lipid droplet with a size of 25 to 200 microns. The lipid droplet does not contain any intracellular organelles. Approximately 60 to 85% of the weight of white adipose tissue is lipids in the form of triglycerides. In addition, small amounts of free fatty acids, diglycerides, cholesterol and phospholipids are present. The remaining fat tissue weight consists of 5 to 30% water and 2 to 3% protein.

Brown adipose tissue is made up of cells that contain more fat droplets, but are smaller in size. These cells can reach a diameter of 60 microns, and the lipid droplet inside the cell is 25 microns in diameter. The brown color of the tissue is given by rich vascularization, much more pronounced than in white adipose tissue.

It is generally accepted that adipocytes originate from fibroblast-like cells that differentiate into adipocytes under appropriate stimulating conditions. Contrary to earlier belief, hyperplastic growth can also occur in adulthood. When the adipocyte is filled with lipids and reaches a critical size, the precursors are stimulated to differentiate and the number of adipocytes increases. In addition, there are likely to be discrete differences in size that will result in the formation of new adipocytes. Once new adipocytes are formed, they remain for life, and the cell can only decrease in size. This increase in adipocyte numbers has far-reaching implications for the treatment and prevention of obesity.

Metabolism of adipose tissue

Energy in excess of that needed for current needs is stored as fat. Carbohydrates and proteins can be converted into fat. Carbohydrates can also be stored as glycogen in the liver and muscles and converted to triglycerides in the liver and transferred to adipose tissue for storage.

Fatty acids in the form of triglycerides come from food or are synthesized by the liver. Triglycerides, composed of long-chain fatty acids as chylomicrons (from intestinal absorption) or lipoproteins (from hepatic synthesis), are hydrolyzed into glycerol and free fatty acids by the enzyme lipoprotein lipase (LPL). Lipoprotein lipase is synthesized in adipocytes and secreted into neighboring endothelial cells. Free fatty acids are taken up by adipocytes, combined with coenzyme A and re-esterified in stages to triglycerides.

Insulin, a hormone secreted by beta cells of the pancreas, plays a dominant role in the lipogenic process. It blocks fatty acid oxidation, stimulates LPL, and also provides glucose transport, which is necessary for triglyceride re-esterification.

When additional energy is required, the process of fat breakdown - lipolysis - begins to prevail over lipogenesis. If fat undergoes beta-oxidation to produce ATP, fatty acids move from adipocytes into the blood and are transported to tissues that can use them as an energy source.

Distribution of adipose tissue

The distribution of adipose tissue is always a strictly individual process that does not obey certain patterns. But it is generally accepted that the distribution of fat is predominantly in the upper sections - android, male type, or “apple-shaped”, and in the lower sections - gynoid, female type, or “pear-shaped”.

The determining factor in fat distribution is genetic background, similarities can be noted by looking at same-sex family members. The second factor mentioned above is gender. And, of course, a person’s age plays an important role. For example, after menopause, there is a change in the distribution of fat in the upper region. Finally, rapid and cyclical weight gain can increase fat content in the upper layers of the body.

Causes of excess weight

Several physiological factors may be involved in the accumulation of excess fat in the human body. These include disorders of adipose tissue metabolism. Lipoprotein lipase has been found to increase in obesity and this leads to increased storage of triglycerides in adipose tissue. Hormonal changes that may influence obesity include hyperinsulinemia and changes in pituitary or adrenal function. Hormonal changes during pregnancy also promote fat storage. In addition, errors in areas of the brain that control satiety, especially the hypothalamus, may be important.

Environmental influences, including food intake and degree of physical activity, play a huge role in the development of obesity. Studies of food intake reveal that many obese people underestimate the amount of food they eat. The composition of the diet also determines the prerequisites for the formation of excess weight. It has been shown that overweight people consume more high-fat foods than people of normal weight.

And finally, lack of physical activity has a major impact on the development of obesity. In addition to the energy deficit that occurs during physical activity, metabolic changes in people who are physically active are greater than in people who lead a sedentary lifestyle. An important benefit of physical activity is weight loss while maintaining fat-free mass that is equal to or greater than the weight lost.

Hardware technologies for eliminating fat deposits

With the growing demand for body contouring procedures, the market for hardware lipolysis technologies is developing. Each of them works independently or depending on the individual needs of the patient; complex programs can be created, providing a holistic approach to solving each of the nosologies.

Among the most effective and popular technologies for hardware lipolysis, there are a number of techniques.

RF lipolysis. Radio Frequency (electric current in the radio frequency range) is a method of non-invasive stimulation of neocollagenesis in the dermis and connective tissue fibers of the hypodermis. In aesthetic medicine it is used to reduce the appearance of cellulite, eliminate local fat deposits, and tighten the skin. The principle of radio wave tissue lifting is based on the contact effect of high-frequency electric current for the purpose of controlled heating of subcutaneous fat tissue. As a result, a certain temperature regime is created, which accelerates the process of fat breakdown into glycerol and fatty acids, with their subsequent evacuation from the body.

Thermocontrast lipolysis. Contrast liposuction is an innovative, painless and non-surgical technique that allows you to get rid of fat deposits under the influence of alternating heating and cooling. This combination of modes, as studies have shown, increases and speeds up the effectiveness of the procedure by 33% compared to the cryolipolysis procedure. During the lipocontrast procedure, adipose tissue is subjected to simultaneous and continuous triple thermal shocks: deep heating, sharp cold, and final heating. Up to 20% of fat cells are destroyed immediately during the procedure, the remaining 80% are gradually eliminated over 20 days due to the body's metabolism. The procedure is physiological, does not pose any harm to the body and the skin, is easily tolerated and effective from the first procedure.

Vacuum roller massage. The technology is based on the vacuum-roller massage method. Allows you to effectively eliminate fat deposits and cellulite, models body contours, stimulates microcirculation of the vascular and lymphatic systems, removes toxins without damaging the skin, and increases the elasticity of connective tissues. Vacuum roller massage is most effective for cellulite, fat deposits, sagging muscles and skin.

Pressotherapy. The operating principle of the device consists of an automatically controlled sequence of compressed air supply into a double-walled sealed cuff, divided into sections. The operation of the device imitates muscle contractions: wave-like movements created by air pressure help improve lymph and blood flow through massage from the periphery to the heart. The effect of segmental barotherapy is created.

In aesthetic medicine, this method is effective when carrying out lymphatic drainage programs (removal of metabolites and excess fluid), cellulite correction programs, silhouette modeling, tissue strengthening (improving tone and turgor). It is also used to intensify the removal of fat cell breakdown products during complex weight correction programs.

Ultrasonic cavitation. Cavitation is the process of formation of bubbles filled with gas. In medicine, the method of acoustic cavitation is used. The method is based on the action of a high-intensity acoustic wave, which easily passes through the tissues of the human body. As a result, the cavities increase in size, emulsify fat, and then displace it through the adipocyte membrane into the intercellular space. 90% is excreted through the lymphatic system and only 10% is absorbed into the blood, turning into glucose.

First published: Cosmetologist No. 4, 2017