Cosmetic Medicine | Dr. Enrique Etxeberria, Plastic Surgery in Bilbao


Cosmetic Medicine - Cellulitis - Cellulitis


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Cellulitis is an alteration of the subcutaneous cellular tissue which is accompanied by changes in the micro-circulation of the conjunctive tissue, leading to morphological, histochemical and biochemical changes in the tissue.  There is no know cause for cellulitis but rather a group of factors which predispose one to it, with it being a real problem in almost 95% of women.

It is a pathology which, in order to combat it effectively, requires a global action plan: adequate diagnosis, medical treatment, exercise, cosmetics and a little time. Hormonal factors (may predispose or aggravate a cellulitic process and are especially important during adolescence. Oestrogen is the hormone which in a woman can initiate, aggravate and perpetuate a cellulitic process), endocrine, biochemical, hereditary and even racial factors may all predispose women to suffering from it. In addition, if we do not have good bowel habits or we have bad habits that can favour venous return, there will be a venous insufficiency which clears the way for the appearance of cellulitis.

Cellulitis has an effective treatment, but not a cure.  This is why, to help ensure that the techniques we resort to have the very best results it is advisable to follow a series of healthy living guidelines.  Maintain a healthy diet.  It is also advisable to exercise, to avoid wearing high heels for any length of time or wearing very tight clothing which obstructs blood flow and, above all, control stress, the malaise of our times, as it can act at endocrine level, altering the distribution of fat.
Even bearing in mind all these preventive measures we will continue to suffer from cellulitis to a lesser or greater degree. We must therefore get to work and realise that there are treatments that can reduce its degree and achieve a body free of the much-feared orange peel skin.

To a greater or lesser degree, 90% of women suffer from cellulitis, and although it is a female epidemic, men are being increasingly affected by it. Determination, constancy and prevention are the keys to a strategy that aspires to achieve resounding and long-lasting results.  It must be borne in mind that, beyond the aesthetic, the growth of fat cells causes other disorders for our health, as important as poor lymphatic and blood circulation.
When the lymphatic circulation is slowed down and the cleaning mechanisms of the organism are limited, a massage technique such as lymphatic drainage becomes a great ally in moving and getting rid of toxins and retained fluids.
Although genetic predisposition must be evaluated, there are a series of factors that can be perfectly controlled: amongst them we could mention the following:

•    EXCESS OF FEMALE HORMONES: the use of contraceptives and hormone replacement therapy generates capillary fragility and favours the accumulation of fluids and toxins.
•    NUTRITIONALLY POOR DIET; the selection of foods rich in enzymes, vitamins, minerals and fibres will facilitate the solution of this problem, amongst others things because it will improve circulation and avoid constipation.
•    LIVER DISORDERS; good hepatic function is more important to our health than we generally give it credit for. Numerous herbs, whether in infusions, concentrated or capsules, will be of great use to this effect; amongst these plants of note is the artichoke, milk thistle or boldo.
•    LIFESTYLE; being sedentary and remaining long periods of time in one position, standing or seated, slows down the return circulation; if you have a profession which requires you to remain static, try to have breaks ever hour to move around, use the stairs instead of the lift and avoid any unnecessary excessive comfort.
•    ADDICTIONS; smoking and alcohol promote the oxidation processes that deteriorate the tissues and in the case of the latter, contribute empty calories which turn into fat.


•   Stage 0: There are no dimples when standing or lying supine and when you pinch the skin, they remain absent.(SUBCLINICAL)
•   Stage 1: There are no dimples when standing or lying supine but if you pinch the skin, there are dimples. (EDEMATOUS)
•   Stage 2: Dimples are spontaneously present when standing, but not when lying down. (SOFT)
•   Stage 3: Dimples are spontaneously present when standing and also when lying down. (HARD OR FIBROUS).

Clinically it tends to be classified as hard cellulitis (appears in young women who are physically active; flaccid (due to brusque weight loss or in women over 40 with no physical activity), and edematous (causes inflammation or oedemas on the legs).


•    Type, stage or phase I
Circulatory stasis; venous, lymphatic and dilatation of dermal vessels. Periadipose interstitial oedema.
Clinically: heaviness of the legs, the cellulitic area feels thick, infiltrated, less elastic and colder.  The cellulitic area is the site of painful tension which increases when pinched and makes the skin roll, thereby manifesting the phenomenon of “orange peel skin”.  Some telangiectasias may appear.

•    Type, stage or phase II
Exudative: vascular dilatation increases.  The oedema drives the conjunctive fibres.  There is Hyperplasia, hypertrophy of pericapillary and periadipose reticular fibres.
Clinically: the phenomena are emphasized with the installation of padding: there is pain when palpating the cellulitic area.  Under pressure “orange peel skin” appears.

•    Tipo, estadio o fase III
Fibrous proliferation: the fibres of the dermis and hypodermis suffer degeneration of the collagen, amorphous blocks are formed with cause the imprisonment of adipocytes full of triglycerides.  Cellular metabolism is altered and “micro-nodules” formed.
Clinically:” Spontaneous orange peel skin”. The skin is cold, and has multiple varicosities, including varicose veins.  It may be linked with flaccidity and pearly stretch marks.

•    Type, stage or phase IV
Cicatricial fibrosis: the progressive compression of vessels and nerves, produces the nutritional alteration of the conjunctive tissue, without real alteration of the adipose tissue which remains normal in its chemical composition.  The union of micro-nodules forms the macro-nodule.
Clinically: “Padded or quilted” to the touch.  Palpation manifests the hard, deep and painless nodules.


Medical electro-stimulation and ultrasounds of diverse strengths and frequencies are useful techniques which cause the stimulation of the venous and lymphatic systems, helping to reduce cellulitis, activate the adiposity of the fatty tissue to increase its energy expenditure, and in post surgical recovery from interventions such as liposuction. It is usually used in conjunction with Mesotherapy, ultrasound and vibrotherapy.

Presotherapy is indicated for disorders of Vascular Insufficiency, Varicose veins, Cellulitis, Obesity, Oedemas, or lymphedema amongst other pathologies.
The treatment consists in wearing some “boots” which reach up to the mid-waist and which are inflated by stages, achieving an improvement in the corporal detoxification process, through the venous and lymphatic systems, and stimulating and toning the skeletal muscular system.

Used in the treatment of cellulitis and above all in the treatment of Flaccidity.
It activates the tissue through a new electrode larger in size than the facial one and through the action of the heat.

This increase in heat is produced by the energy that the radiofrequency exercises upon the collagen in the deepest layers of the skin.  The heat immediately manages to tighten the cutaneous tissue and the skin, simultaneously activating the cells that form it, stimulating the creation and neo-formation of collagen.

With the use of medical vibratory platforms an alternative vibration is provided, together with the appropriate frequency and strength, depending on the individual and personal characteristics of each case.

Its effects reside at the level of toning and muscular rejuvenation, anti-cellulitic, lymphatic drainage, increase in peripheral microcirculation, reshaping of the corporal musculature, muscular postural rebalancing.
It consists of vibrational platforms which stimulate the muscles, producing reflex muscular contractions which activate the metabolism, increase blood flow and improve venous return and muscular tone. This technique, which must always be performed under the supervision of a professional, is also indicated for people with fluid retention problems in the legs, as it opens the capillaries, favouring venous return. Two weekly sessions tend to be required of 30-45 minutes/session, with one or two days rest in between.  Although depending on the pathology, an individual, supervised and personalised protocols would be designed.

It is based on massage using rollers whilst simultaneously aspirating the skin surface.  It is a procedure which acts upon the venous return, improving the elasticity and softness of the skin.
Its definitive selection will depend on the characteristics of each patient and the indications of the specialist.
Vela smooth is a new device for the treatment of cellulitis.  It is based on ELOS technology and uses a combination of four modalities: controlled infrared light, vacuum suction, mechanical mobilization and bipolar radio frequency.

ELOS means ELECTRO OPTICAL SYNERGY and combines bipolar radiofrequency with optical energy.
The treatment is safe for the skin when we use it in accordance with the manufacturer’s instructions. There are many discoveries in the new ELOS technology to make it one of the safest systems for any type of skin.  There are no known long-term risks/complications: light and electrical energy have been used without a problem for many years in medicine, surgery and aesthetics.
In different studies, all patients demonstrated an improvement in the appearance of their cellulitis as well as a reduction in the circumference of the hips. The average improvement in the appearance of cellulitis was of 65%.  The perimeter of the hips was reduced by an average of 3,2cm, with all the patients mentioning an improvement in flaccidity. There were no complications and no discomfort either during or after the treatment.

This treatment consists in the microinjection of diverse homeopathic substances.  It is a very precise procedure which permits the specialist to control the insertion point at all times.  It is a technique that must be combined with other medical treatments such as electrotherapy, in order to achieve more effective and long-lasting results.
It is amongst the most effective techniques when it comes to treating cellulitis. It consists of injections of 2-3 millimetres under the skin in the vascular lines, through which homeopathic formulae are infiltrated, personalised for each patient and the type of cellulitis they suffer from. The procedure is simple, quick and with few contraindications.
Despite advances in this field, most people continue to associate mesotherapy with intradermal infiltrations and with needles and injections, however its practice is increasingly common without infiltrations, percutaneously through the skin, via sonophoresis (ultrasonic energy), electrophoresis (electrical impulses) or pulsed light.
As the form taken by the application of the treatment is simple, the secret lies in the technology or in the quality of the aminoacids which are applied and which are difficult to identify for the layperson, which is why one must attend certified clinics and qualified professionals.


Is VELA-SMOOTH recommended to improve the appearance of sequelae on the abdomen and legs caused by pregnancy?
Yes, it is very much indicated for this type of problem, as it will help to reduce the contours of the waist, helping to improve the tone and the texture of the skin as well as reducing cellulitis and improving blood flow, which are some of the disorders that occur after childbirth. In the event that you are pregnant, we advise you to read the myths and truths about pregnancy.

Is the Vela Smooth treatment painful?
It can cause a little discomfort, depending on your sensitivity.  After the treatment you may notice a sensation of heat or mild irritation and at the very least you will have some reddening of the skin.

How long does a VELA-SMOOTH session last?
It tends to last some 60 minutes.

How many VELA-SMOOTH sessions are necessary?
We normally recommend some 12 to 15 sessions and the results begin to be noticed from the 6th to 8th sessions, although it all depends on the personal characteristics of each person.

What is the real effectiveness of the VELA-SMOOTH treatment?
Its effectiveness is proven by numerous studies which back it and by millions of people, the majority of them women.