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The article was translated into English using automatic translation. The editors are working on its improvement.

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<hr />
Alexey Vizer, teacher at the Estetista massage art school, kinesiotherapist, author of massage techniques (Russia, St. Petersburg)

<hr />
Unfortunately, the use of many methods only aggravated the course of cellulite and led to hypertrophy of adipocytes, development of intoxication in the intercellular space, circulatory disorders and hypoxia. Studying the problem, specialists came to the conclusion that the causes of cellulite formation, along with circulatory disorders (usually venous insufficiency), can be hormonal factors. In particular, estrogens promote the formation of &quot;cross-links&quot; between collagen fibers, which, in turn, leads to stagnation and creates the prerequisites for the development of cellulite. Hormones - insulin, catecholamines, thyroid hormones, pituitary hormones - participate in the regulation of lipogenesis processes. Hormonal disorders in post-pubertal age provoke the debut of cellulite. In addition, the development of diffuse lipodystrophy is influenced by factors such as genetic and racial predisposition, food culture and cooking, low physical activity, intoxication, stress and bad habits.

One of the effective methods of correcting the manifestations of cellulite is lipoefferent massage (from the Greek lipos - &quot;fat&quot; and the English efferent - &quot;removal&quot;).

The essence and main idea of ​​this method is physiological validity and cyclical conditioning, i.e. performing massage at certain periods, in accordance with the client&#39;s hormonal cycles. This approach allows to increase the effectiveness of massage, reduce the duration of the course and the time of one session. Particular attention during the massage is paid to the painlessness and atraumatic nature of the techniques performed, as well as the ergonomics of the massage therapist&#39;s work. 
Lipoefferent massage has a pronounced drainage and lipolytic effect on various forms of cellulite. At the same time, the effect on the lymphatic system, carried out within the framework of the procedure, does not replace full-fledged hemolymphatic drainage, recommended for carrying out at the beginning of the correction course.

Massage has a variety of effects on the body: the lymphatic system, interstitial, adipose, and muscle tissue.

 
Stage 1. Impact on the lymphatic system

At this stage, the vascular system is activated by accelerating hemolymphatic outflow and tissue drainage, and the body is prepared for subsequent exposure.

<ul>
	<li>Stand at the client&#39;s head and perform the &quot;pump-wave&quot; technique at a slow pace (one movement for 4 seconds): place your hands on both sides of the neck and, using your fingers, imitate the movement of a wave, moving in the direction from the corner of the jaw to the collarbone (photo 1).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/1-2%283%29.png" style="height:270px; width:650px" />

<ul>
	<li>Perform the same technique in the area of ​​the subclavian (photo 2), axillary (photo 3) and inguinal (photo 4) lymph nodes.</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/3-4%284%29.png" style="height:270px; width:650px" />

<ul>
	<li>Form a longitudinal skin fold on the abdomen and lift it, simulating a pump effect. Grasp the fold alternately on one side and then the other from the white line of the abdomen, thereby creating negative pressure in the abdominal cavity. The movement ensures drainage of the deep lymph nodes of the abdominal cavity (photo 5).</li>
	<li>Place your hands under the costal arch on both sides, ask the client to breathe with her stomach, at the end of the exhalation, move your palms back towards the spine and up to the sternum, gradually squeezing the lower part of the chest. The technique allows you to affect the thoracic lymphatic duct (Peckett&#39;s cistern) (photo 6).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/5-6%282%29.png" style="height:270px; width:650px" />

Bowel drainage

<ul>
	<li>Use a special massage product that enhances the lifting and lipolytic effect.</li>
	<li>Perform circular (photo 7-8) and longitudinal (photo 9) stroking followed by a change in the depth of action.</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/7-8.png" style="height:270px; width:650px" />

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/9-10%281%29.png" style="height:270px; width:650px" />

<ul>
	<li>Combine stroking with circular, spiral, rotational drainage movements (photo 10-11), performing them with the back and palmar surfaces of the hand along the intestines, adding vibration techniques at moments of deeper impact (immersion). Manipulations help stimulate intestinal peristalsis, relieve tension and eliminate bloating, prevent constipation, etc. The techniques do not cause discomfort, help relax the abdominal wall and help prepare the client for performing kneading techniques at the level of subcutaneous fat.</li>
	<li>Complete abdominal drainage with circular and longitudinal stroking, perform the &ldquo;pumping-wave&rdquo; technique in the area of ​​the inguinal lymph nodes, as well as thoracic duct pulsation.</li>
</ul>

Stage 2. Working out the subcutaneous fat tissue (lipolytic effect)

Abdominal area

At this stage, the choice of zones, intensity of impact, and techniques depend on the morphological type of the client and the localization of aesthetic defects. Most often, correction of fat deposits is performed in the area of ​​the lateral surfaces of the abdomen and in the &quot;half-moon&quot; zone under the navel.

<ul>
	<li>After making sure that there is no significant swelling or pain in the problem area, rub (photo 12) along the oblique abdominal muscles, changing the strength and depth of the impact: first, perform slow strokes of medium depth, and then, moving on to rubbing, increase the pace and intensity of the technique.</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/11-12.png" style="height:270px; width:650px" />

<ul>
	<li>Rub the ribs of your palms with undercutting (photo 13-14) in the area of ​​the lateral surface of the abdomen, in the space between the iliac crest and the lower ribs. The technique helps to increase peripheral blood circulation and increase oxygenation of problem areas.</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/13-14.png" style="height:270px; width:650px" />

<ul>
	<li>Form a skin-fat fold and perform kneading with rolling in the longitudinal and transverse directions relative to the problem area (photo 15).</li>
	<li>Perform kneading with rolling, as in the previous technique, rolling the skin-fat fold onto the edge of the palm. Work in this way all problem areas (photo 16).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/15-16.png" style="height:270px; width:650px" />

<ul>
	<li>Perform the &quot;screw&quot; technique: fix the skin-fat fold with one hand and move it with the base of the thumb of the other hand. Changing the position of the fingers relative to each other, &quot;rotate&quot; the fold around its axis and perform a repeated pick-up. The manipulation can be performed with rotation both clockwise and counterclockwise (photo 17-18).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/17-18%281%29.png" style="height:270px; width:650px" />

<ul>
	<li>Press the bases of your palms to the surface of your body and perform deep kneading with the distal phalanges of your bent fingers. In this case, the thumbs work in the same or opposite direction to the other fingers (photo 19-20).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/19-20.png" style="height:270px; width:650px" />

<ul>
	<li>Perform the &quot;roll-back and roll-back with the phalanges&quot; technique, adding kneading with the phalanges to the technique (photo 21).</li>
	<li>Finally, perform stroking and the &quot;pumping&quot; technique in the area of ​​the inguinal lymph nodes and sternum in the projection zone of the thoracic duct.</li>
</ul>

The total time for working out the abdomen is 20-25 minutes.

Hip area

<ul>
	<li>Perform the &ldquo;pumping&rdquo; technique in the area of ​​the inguinal and popliteal lymph nodes, as well as in the Achilles tendon area (photo 22).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/21-22.png" style="height:270px; width:650px" />

<ul>
	<li>Use your palms, bases and fingertips to rub the inner, front and outer thighs in the direction of the inguinal lymph nodes, gradually increasing the pressure. Perform the procedure until hyperemia and a feeling of warmth under your palms appear (photo 23).</li>
	<li>Perform the same kneading as in the abdominal area, using techniques that allow you to relax the muscles without damaging the capillary network. Next, perform the &quot;pumping&quot; technique and stroke along the vessels of the anterior thigh. Due to this effect, cellular metabolism increases, blood and lymph circulation increases, and metabolic products and fluid are removed from the tissues (photos 24-25).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/23-24.png" style="height:270px; width:650px" />

<ul>
	<li>Perform the same manipulations on the back of the thigh (photo 26-27).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/25-26.png" style="height:270px; width:650px" />

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/27-28.png" style="height:270px; width:650px" />

<ul>
	<li>Perform the &quot;tunneling&quot; technique - parallel squeezing longitudinal movements from the bottom up with the fingertips of both hands, positioned at an angle of 35&deg; to the surface of the thigh. The movements can be performed with both hands or with one hand with a weight (photo 28).</li>
	<li>Perform the &quot;squeezing&quot; technique: place your hands on the thigh perpendicular to the longitudinal axis of the body and, without changing the position of the upper hand, move the skin-fat fold with the lower hand in the direction of the upper hand until it stops. Then move the upper hand to the width of the palm, and continue the movement with the lower hand. Alternate squeezing and stroking movements (photo 29).</li>
</ul>

Buttocks area

For greater effectiveness, the gluteal region is worked on separately from the massage of the back of the thigh.

<ul>
	<li>Perform kneading in a direction perpendicular to the gluteal fold, from the bottom up and from the periphery to the midline of the body (photo 30).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/29-30.png" style="height:270px; width:650px" />

<ul>
	<li>Perform the &ldquo;kneading dough, or heart&rdquo; technique: move the skin-fat fold toward the fingers fixed on the skin surface, giving the fold the shape of a heart (photo 31).</li>
	<li>Perform the &ldquo;collecting modeling movement&rdquo;: place your thumbs on the sacrum, spread the rest of your fingers as far apart as possible and, grasping the skin-fat fold with all your fingers, roll it in the direction of the sacrum (photo 32).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/31-32.png" style="height:270px; width:650px" />

Toning techniques are usually used towards the end of the standard course (8-12 procedures), however, in case of pronounced atony of the skin and superficial muscles, they can be used in the abdomen, thighs and buttocks from the first sessions. It is recommended to use both classical toning techniques and their variations: pinching &ndash; direct and with a turn of the hand, whipping, performed with all fingers or with selection, as well as &ldquo;twisting&rdquo;, which imitates the launch of a top.

<ul>
	<li>Perform the &quot;fan&quot; technique: move your fingers over the skin, placing the hand first with the palm surface facing up and then down. This technique helps to achieve a pronounced lifting effect (photo 33).</li>
	<li>Perform the &quot;cashier&quot; technique: form a skin fold on the side of the abdomen and move it toward the center with all fingers except the thumbs, alternating the technique with whipping.</li>
	<li>Perform the &quot;knitting&quot; technique: form a skin-fat fold with the first and third fingers of both hands, and move the second fingers over it and, &quot;diving&quot; under the formed fold, move it away from you (photo 34).</li>
</ul>

<img alt="" src="https://pro.bhub.com.ua/cosmetology/upload/images/33-34.png" style="height:270px; width:650px" />

<ul>
	<li>Perform the &quot;pumping&quot; technique on the back of the thigh and in the lumbar region. Perform the final modeling movements for the buttocks area - vibrations and dotted touches.</li>
</ul>

The purpose of the massage is to locally enhance blood circulation and metabolic processes at the level of subcutaneous fat tissue in classic hormone-dependent areas (hips, abdomen, buttocks). It is not recommended to significantly increase the area of ​​impact within one session (for example, to perform a general massage) or change the intensity of the techniques performed.

First published: KOSMETIK international journal, №3/2013, pp. 34-38

Lipoefferent massage in the fight against cellulite