Women's Health

 

Hormone Replacement Therapy

 

 

Restoring Hormonal Balance


Customized Hormone Replacement Therapy (HRT) is the replacement of deficient hormones with hormones that are chemically identical to those that the body naturally produces, but which have declined due to aging or illness.

Customized HRT has improved the quality of life for millions of women who suffer from hormonal imbalance. The ideal process for achieving hormonal balance includes an assessment of hormone levels and complete evaluation of signs and symptoms, followed by replacement of the deficient hormones in the most appropriate dose via the most effective route for each woman, and monitoring to fine tune the therapy.

Estrogen is prescribed to relieve menopausal symptoms and treat postmenopausal problems such as vaginal dryness and tissue breakdown, painful intercourse, and various urinary disorders. Estrogens have been shown to decrease the risks of osteoporosis and colorectal cancer.

Progesterone is commonly prescribed for perimenopausal women to counteract “estrogen dominance”, minimizes the risk of endometrial cancer in women who are receiving estrogen, and may enhance the beneficial effect of estrogen on lipid and cholesterol profiles.

Published research has shown that the risk of breast cancer is increased by long-term use of conjugated equine estrogens, which are the most commonly prescribed form of commercially available estrogen, and the risk is further increased when the synthetic progestin medroxyprogesterone acetate is added.4,5 Conjugated estrogens are derived from pregnant mares’ urine, but most estrogens from horses are NOT naturally produced by humans. Additionally, synthetic medroxyprogesterone acetate does not confer all of the benefits of natural progesterone. That is why we recommend the use of natural estrogen and progesterone.

Androgens are a class of hormones that include DHEA and testosterone, which are normally produced in a young healthy woman, and are important for libido as well as integrity of skin, bone, and muscle. When women enter menopause, testosterone and DHEA levels may decline. Experts now recognize the importance of supplementing androgens for women who are deficient.

While women have benefited from therapy with estrogens, progesterone, and androgens that are “chemically identical” to the hormones produced naturally by the human body, researchers and health care professionals realize that this is just the “tip of the iceberg” when it comes to achieving hormonal balance. Thyroid and adrenal function, as well as nutritional status, should also be evaluated and treated when indicated.

Women Prefer Natural Hormones

Mayo Clinic researchers surveyed 176 women taking natural micronized progesterone who had previously taken a synthetic progestin (medroxyprogesterone acetate, or MPA) to see if progesterone improved the women’s overall quality of life, menopausal symptoms, and satisfaction with HRT. After one to six months, the women reported an overall 34% increase in satisfaction on micronized progesterone compared to their previous HRT, reporting these improvements: 50% in hot flashes, 42% in depression, and 47% in anxiety. Micronized progesterone was also more effective in controlling breakthrough bleeding. In other studies, women using micronized progesterone had specific improvements in the areas of cognition, sleep, and menstrual problems.

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Adrenal Fatigue/Thyroid Imbalance

The analogy has been used that while the thyroid gland is the accelerator, the adrenal glands must provide the gas. Unfortunately, today, many individuals suffer from Adrenal Fatigue, and can not respond appropriately when they receive the signal. Dr. James L. Wilson, author of Adrenal Fatigue: The 21st Century Stress Syndrome, notes it is impossible for a person with tired adrenal glands to achieve optimal hormonal balance. Anti-inflammatory and anti-oxidant adrenal hormones like cortisol help to minimize allergic and negative reactions, such as cancer and autoimmune disorders. These hormones closely affect the utilization of carbohydrates and fats, the conversion of fats and proteins into energy, and cardiovascular and gastrointestinal function. Recommendations to improve adrenal health include eating wholesome food, getting plenty of sleep, regular moderate exercise, stress management, slowing down to regain a proper perspective on life, taking appropriate supplements for adrenal support, and replacement of deficient hormones.

The adrenal glands secrete hormones such as cortisol, estrogen, and testosterone that are essential to health and vitality and significantly affect total body function. After mid-life, the adrenal glands gradually become the major endogenous source of sex hormones in both men and women. Intense or prolonged physical or emotional stress commonly associated with modern lifestyles or chronic illness can lead to Adrenal Fatigue, which is an important contributing factor in health conditions ranging from allergies to obesity.

Ask us for more information and recommendations to put you on the pathway to optimal health.

Thyroid Hormone Therapy

Thyroid Hormone helps the body convert food into energy and heat, regulates body temperature, and impacts many hormonal systems in the body. Thyroid hormone exists in two major forms: Thyroxine (T4), an inactive form that is produced by the thyroid gland and converted to T3 in other areas of the body, and Triiodothyronine (T3), the active form. The role of thyroid hormone and consideration of its impact on multiple body systems is emerging as a critical component of balanced hormone replacement for men and women.

Symptoms of hypothyroidism (low levels of thyroid hormone) include fatigue, cold and heat intolerance, hypotension, fluid retention, dry skin and/or hair, constipation, headaches, low sexual desire, infertility, irregular menstrual periods, aching muscles and joints, depression, anxiety, slowed metabolism and decreased heart rate, memory impairment, enlarged tongue, deep voice, swollen neck, PMS, weight gain, hypoglycemia, and high cholesterol and triglycerides. Yet, more than half of all people with thyroid disease are unaware of their condition.

Although both T4 (thyroxine, an inactive form that is converted to T3 in other areas of the body) and T3 (triiodothyronine, the active form) are secreted by the normal thyroid gland, many hypothyroid patients are treated only with levothyroxine (synthetic T4). For example, T4 preparations are often ineffective for patients with Chronic Fatigue and Immuno-Deficiency Syndrome (CFIDS) and Fibromyalgia (FM). The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all CFIDS/FM patients.

A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable to T4 alone. However, the only commercially available form of T3 is synthetic liothyronine sodium (Cytomel®) in an immediate release formulation which is rapidly absorbed, and may result in higher than normal T3 concentrations throughout the body causing serious side effects. Research indicates there is a need for sustained-release T3 preparations in order to avoid adverse effects. Ultimately, it is the expertise of the prescriber, use and interpretation of appropriate tests, dosing of the T3 or T4/T3 combinations, and the formulation of the medications that determines the success of treatment.

N Engl J Med 1999 Feb 11;340(6):424-9

Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.

A randomized, double-blind, crossover study found inclusion of T3 in thyroid hormone replacement improved cognitive performance, mood, physical status, and neuropsychological function in hypothyroid patients. Two-thirds of patients preferred T4 plus T3, and tended to be less depressed than after treatment with T4 alone. Patients and their physicians may wish to consider the use of sustained-release T3 in the treatment of hypothyroidism, particularly when the response to levothyroxine (T4) has not been complete.

J Endocrinol Invest 2002 Feb;25(2):106-9
Levothyroxine therapy and serum free thyroxine and free triiodothyronine concentrations.

John M. Lee, M.D., an Australian physician, points out that any thyroid function problem should be examined in the larger context of adrenal fatigue, hormone imbalances such as estrogen dominance, nutritional deficiencies, liver dysfunction, and digestion and absorption problems. Many vitamins, minerals and amino acids are needed to convert T4 to T3, and to get T3 into the cells. Dr. Lee believes that conservatively, 40% of women in the U.S. have measurably low thyroid and as a result are suffering from fatigue, depression, cold hands and feet, dry skin and hair and many other symptoms associated with hypothyroidism (low thyroid). Dr. Lee has a unique approach to treating patients with low thyroid function and advocates using only T3 for thyroid hormone replacement, and because the use of commercially-available T3 (liothyronine) is associated with serious problems such as rapid heart rate, Dr. Lee uses a slow-release T3 and reports the therapy is successful.

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Chronic Fatigue Syndrome and Fibromyalgia

Chronic Fatigue Syndrome (Chronic Fatigue and Immuno-Deficiency Syndrome, CFIDS) and Fibromyalgia (FM) are illnesses that often coexist and affect millions of Americans. Symptoms vary but commonly include severe fatigue, sleep disturbances, cognitive problems commonly called brain fog, muscle pain and multiple infections. CFIDS and FM often seem to begin after an infection or a severe shock (physical or emotional), and the symptoms are very similar. The difference seems to be that for some people the fatigue element is the most dominant while for others the muscular pain symptoms are more severe.

The medical literature is now clear that these are legitimate diseases and individuals with CFIDS/FM have measurable hypothalamic, pituitary, immune and often thyroid dysfunction. The hormonal dysfunction results in multiple deficiencies that are often not detected with standard blood tests. Neurotransmitter abnormalities and nutrient deficiencies have also been shown to occur with CFIDS/FM.

Due to their complexity, these conditions often have been inadequately treated, partly due to the intensive evaluation and follow-up that is required, which can not be addressed in a short office visit. When multifaceted treatment addresses the entire spectrum of these diseases, truly remarkable success can be obtained. Treatment needs to be individualized, ultimately each patient should have a maintenance program with the minimal medications and supplements that are necessary to remain symptom-free.

Treatment for infections and enhancement of immune function is key. Komaroff et al. of Brigham and Women's Hospital, Harvard Medical School, have concluded that CFIDS “is an illness characterized by activation of the immune system, various abnormalities of several hypothalamic-pituitary axes, and reactivation of certain infectious agents.” Multiple infections either may cause or contribute to CFIDS/FM. Immunological defects may underlie CFIDS/FM, and if a poor immune system is not addressed, successful eradication of the organisms is not likely. Also, if an infective organism produces neurotoxins, these substances can remain in the body and continue to cause symptoms long after the infection is gone.

Hormone balance is essential for optimal therapeutic outcomes. Therapy should be individualized with multiple hormonal deficiencies addressed concurrently to assure successful treatment. Studies have reported that there is an altered hypothalamic-pituitary-adrenal axis (HPA axis) in CFIDS/FM, leading to altered function that is often overlooked when interpreting standard blood tests.

Adrenal insufficiency is very common in patients with CFIDS/FM, and is often the cause of serious fatigue. Sophisticated tests are required for an accurate diagnosis. Proper supplementation can often have profound effects. However, if only the adrenal deficiency is treated without addressing deficiencies of other hormones, results will be disappointing. And, if poor adrenal function is missed, it can mean the difference between treatment success and failure.

Thyroid Problems/Pituitary Dysfunction often requires treatment with several hormones. Normally, Thyroid Stimulating Hormone (TSH) is secreted by the pituitary in the brain, telling the thyroid to secrete T4, which must then be converted in the body to the active thyroid hormone T3. When T4 and T3 levels drop, TSH should increase indicating hypothyroidism. This is the standard way to diagnose hypothyroidism. There are, however, many things that result in hypothyroidism but are not diagnosed using the standard TSH and T4 and T3 testing. Standard methods and interpretation often miss thyroid problems with CFIDS/FM patients. Pituitary dysfunction in CFIDS/FM may have a variety of causes, including viruses, bacteria, stress, yeast, inflammation, toxins, pesticides, plastics and mitochondria dysfunction. These problems result in low normal TSH levels along with low normal T4 and T3 levels. Low normal values are significant, and can cause fatigue, depression and difficulty losing weight and also increase the risk of heart disease.

In addition, most CFIDS/FM patients do not adequately convert T4 to the active T3, resulting in low levels of active thyroid hormone; therefore, they suffer from low thyroid despite having a normal TSH. Another problem is that T4 is converted to reverse T3, which is inactive and blocks the thyroid receptor. The conversion of T4 to reverse T3 is increased in times of stress and illness. Reverse T3 causes fatigue, difficulty losing weight, brain fog, muscle aches and all the other symptoms of hypothyroidism. Reverse T3 can be increased by chronic illnesses such as CFIDS/FM, yo-yo dieting (often responsible for the quick weight gain after losing weight), stress, heavy metals and infections commonly present in CFIDS/FM. There are only a few labs that can accurately measure reverse T3, and interpretation of results can be difficult.

Thyroid resistance is present in many CFIDS/FM patients, so endogenous thyroid hormone does not appropriately stimulate thyroid receptors. A study published in Clinical Rheumatology in May, 2007 showed that although basal thyroid hormone levels of FM patients were in the normal range, 41% of the patients had at least one thyroid antibody. Treatment for thyroid resistance can include eliminating the cause, such as an infection or toxin, or overcoming thyroid resistance by giving higher doses of thyroid while monitoring the effect.

The combination of pituitary dysfunction, high reverse T3, and thyroid resistance, leads to inadequate thyroid effect in most, if not all, CFIDS/FM patients. T4 (levothyroxine) preparations are often ineffective for CFIDS/FM patients. A T4/T3 combination preparation or straight T3 (triiodothyronine) may be preferable. T3 works the best for many of these patients, but Cytomel®, a very short acting T3 available at retail pharmacies, is also a poor choice because the varying blood levels cause problems such as heart palpitations. Compounded, sustained-release T3 may be the best treatment. However, standard blood tests may lead one to dose incorrectly and not obtain significant benefits. Ultimately, it is the expertise and dosing of the T3 or T4/T3 combinations and the makeup of the medications that determines the success of treatment.

Natural Therapies: Proper nutritional supplements, proteins, and hormones can protect and enhance the immune system. Antioxidants may also be beneficial because free radicals play a role in causing damage to the immune system.

Vitamin B-12 levels are often low in patients with CFIDS/FM. A malfunctioning thyroid or adrenal gland can decrease the ability of the body to absorb and utilize vitamin B-12. Vitamin B-12 is necessary for a healthy nervous system; it has been known for many years that depression and fatigue can be caused by low B-12 levels.

Co-Enzyme Q-10 (CoQ10) plays a vital role in the production of energy in the cells of the body. Many patients with chronic fatigue and muscle pain have found this supplement to be very beneficial. Higher doses of 100mg to 200mg two to three times daily may be necessary and the dosage form is important.

D-ribose significantly reduced clinical symptoms in patients suffering from fibromyalgia and chronic fatigue syndrome, with an average increase in energy on the VAS of 45% and an average improvement in overall well-being of 30%.

Ask us how individualized hormone replacement therapy and proper supplementation can be integrated into a comprehensive treatment program for Chronic Fatigue Syndrome or Fibromyalgia. We can also recommend quality formulations of beneficial nutraceuticals.

Osteoporosis -The Silent Disease

Osteoporosis is a painful, crippling disease characterized by low bone density, but it is both preventable and treatable. Osteoporosis occurs when not enough new bone is formed or too much bone is lost, or both, and therefore bone is brittle, weak and more likely to fracture. Osteoporosis is often called "the silent disease" because it can progress painlessly until a strain or fall causes a bone to fracture, and many times people don't know they have the problem until the first fracture occurs.

Bone is not a hard and lifeless structure; it is complex, living tissue. Bones provide structural support for muscles, protect vital organs, and store calcium which is essential for bone density and strength.

Signs and symptoms of osteoporosis include:

  • Pain in the back, ribs and abdomen.
  • Loss of height is normal as people age, but is increased by osteoporosis.
  • Fractures of the hip, spine and wrist, as well as ribs, humerus, and pelvis.
  • Humped back, known as "Dowager's Hump."

Of the individuals who fracture a hip, one-half will be permanently disabled, and almost 20% will require long-term nursing care. One in five individuals with hip fractures die within one year, usually from complications such as pneumonia or blood clots in the lung related to either the fracture or subsequent surgery.

Osteoporosis affects approximately 25 million Americans and 250 million people worldwide, predominately women. Osteoporosis can strike at any age. Significant risk has been reported in people of all ethnic backgrounds. However, whites and Asians are more susceptible.

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Menopause is a known risk factor for osteoporosis. Osteoporosis is most common in older women, occurring in about 25% of those over 60 years of age. Women who have either had their ovaries surgically removed before age 45 or undergone early menopause, without receiving hormone replacement therapy, are also more likely to develop osteoporosis. Other female risk factors are small body frame and excessively strenuous exercise that stops menstrual periods.

Additional risk factors for osteoporosis include:

  • Family history of osteoporosis
  • Smoking
  • Excessive use of alcohol
  • Low body weight (less than 127 lbs)
  • Sedentary lifestyle
  • Low dietary intake of calcium
  • Use of corticosteroids, anticonvulsants, certain cancer treatments and aluminum-containing antacids
  • Certain hormonal disorders such as hyperthyroidism, hyperparathyroidism and Cushing’s Disease
  • Other diseases such as chronic liver and intestinal disorders

Prevention

Although there is no cure for osteoporosis, these steps may slow or stop its progression.

  • Eat a balanced diet - Nutritious food is important in maintaining an appropriate weight, also a factor in preventing osteoporosis. Avoid caffeine and carbonated beverages which can cause calcium to be eliminated from the body.
  • Exercise - Daily weight-bearing exercise helps to reduce bone mineral loss.
  • Stop smoking and limit alcohol.
  • Have bone density baseline testing in your 30’s and then every one to three years.
  • Take quality nutritional supplements.

Testing & Diagnosis: Early Detection is Key

Specialized bone density tests can measure bone mineral density (BMD) in various sites of the body. Bone density testing is painless, noninvasive and safe. Test results can help you and your doctor decide the best course of action for your bone health.

A bone density test can:

  • Detect osteoporosis before a fracture occurs
  • Predict your chances of fracture in the future
  • Determine your rate of bone loss and/or monitor the effects of treatment

Treatment

Customized Hormone Replacement Therapy (HRT) - Replacement of declining hormones slows the loss of bone and increases bone density, which helps to decrease the risk of fractures. Estrogen can prevent bone loss, and many practitioners report increased bone density following progesterone administration. Testosterone therapy may also be utilized to improve bone health. Thyroid hormone is required for normal bone remodeling to take place. If thyroid hormone is deficient, old bone that is not as strong and is abnormally thick tends to accumulate. However, excessive thyroid hormone may cause osteoporosis.

Calcium supplements, and other vitamins and minerals (including magnesium, manganese, folic acid, boron, zinc, strontium, copper, silicon, and vitamins A, B6, C, D, and K) are important to bone formation and maintenance.

Ask our health care professionals for more information.

Hormone Testing

Urine Testing

Urine testing has long been considered an excellent way to test hormones with two significant draw backs. First, the typical 24-hour urine sample collection is cumbersome and undesirable. Additionally, adrenal (stress) hormone testing is best when the daily pattern of cortisol (requires multiple tests throughout the day) can be tested. This cannot be accomplished in a 24-hour urine collection. Both of these issues have recently been overcome with advanced technology by Precision Analytical. Using 4 easy-to-use dried urine samples, the collection has been made easier than saliva, serum or a 24-hour urine sample. This advanced test can offer the most accurate methods (GC-MS/MS, LC-MS/MS) of testing hormone levels and also measures metabolites that cannot be measured in saliva or blood. These metabolites add valuable information, for example measuring estrogen metabolites can help patients reduce risks associated with estrogen and HRT. Nutritional intervention can help your body metabolize hormones in more favorable ways, and testing these metabolites is the first step.

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Skin Care

Skin Care and Cosmeceuticals for Anti-aging

Cosmeceuticals

After a proper analysis reveals areas of dry, oily, or aging skin, we can provide the appropriate correction for each skin type in a cosmetic base containing the exfoliants, emollients, and micronutrients necessary for cellular repair.

Antioxidants such as Alpha Lipoic Acid (ALA) and Ascorbyl Palmitate (Vitamin C Ester) are vital to the energy production of skin cells and formation of collagen. Alpha Lipoic Acid promotes optimum efficiency for production of energy and removal of intracellular waste products, essential for cellular healing and elimination of wrinkles and facial scars. Ascorbyl Palmitate also inhibits the body’s production of inflammatory arachidonic acid, which plays a role in the development of psoriasis and the micro-scarring that leads to the formation of wrinkles. Molecular biologist Olga Marko, Ph.D., found that Ascorbyl Palmitate stimulates the growth of fibroblasts which help to produce collagen and elastin in human skin. Studies have shown that antioxidants can be delivered percutaneously to directly supplement the skin’s antioxidant reservoir. Oral supplementation has not been successful in raising levels of antioxidants in the skin.

Retinol assists in the rejuvenation process that leads to a more youthful appearance and provides the same benefits to skin as retinoic acid, but in a more gradual, gentle manner. Retinol works with Alpha Lipoic Acid to provide maximum benefits, effectively and gently. Alpha and beta hydroxyl acids may be used to exfoliate the skin, increase cell turnover, and reduce fine wrinkles and mottled pigmentation.

Amino acids such as DMAE (2-dimethylaminoethanol; deanol) tone and add firmness to the skin, prevent age spots, and aid in healing the micro-scarring which causes wrinkles. The benefits of DMAE include a potential anti-inflammatory effect with possible improvement in underlying facial muscle tone. In a randomized clinical study, 3% DMAE facial gel applied daily for 16 weeks was shown to be safe and efficacious in the mitigation of forehead lines and periorbital fine wrinkles, and in improving lip shape and fullness and the overall appearance of aging skin. These effects did not regress during a 2-week cessation of application. Long-term application of DMAE gel for up to 1 year was associated with a good safety profile.
Am J Clin Dermatol. 2005;6(1):39-47

Cosmetically appealing preparations

Compounding pharmacists continue to develop new bases to improve both the aesthetic and therapeutic aspects of compounded medications. For example, anhydrous gels deliver medications which facilitate rapid absorption of the active ingredient into the skin and prolonged retention of the drug in the stratum corneum and epidermis, with minimal systemic transport of active drug. These cosmetically appealing gels are very stable and well accepted by patients.

Chemical peels

Chemical peelings with kojic acid, glycolic acid, and trichloroacetic acid (TCA), alone or in combination, are available for treatment of hyperpigmentations. Research has concluded that dermatologists should have a choice of formulations to satisfy individual patient needs.

Sunscreens

We can compound sunscreen formulations with low-allergenicity UVB protectors in combination with chemicals such as oxybenzone that extend protection to UVA wavelengths. For broad spectrum coverage that blocks or reflects UVA and UVB, physical sunscreens containing titanium dioxide or zinc oxide may be preferable. When vitamin C or a combination of vitamin C and E is formulated with a commercial UVA sunscreen (oxybenzone), an apparently greater than additive protection is noted against the phototoxic damage.

Skin Discoloration

Increases or decreases in skin pigmentation can be due to many conditions (such as acne, pregnancy, cirrhosis, chronic renal failure, celiac disease) or use of medication. Most types of skin discoloration are harmless from a medical viewpoint, but they may be cosmetically unacceptable. The goal of therapy in hyperpigmentation disorders is to lighten the skin so it blends into the surrounding normal skin. Most preparations that are used to lighten the skin contain the drug hydroquinone. Other commonly used medications include azelaic acid, glycolic acid, hydrocortisone, kojic acid, and tretinoin. Our compounding pharmacy can prepare customized dermatologics to meet each person’s specific needs. It may take three to six months of therapy before improvements in pigmentation are noticed. These preparations may increase sensitivity to the sun, so ask our pharmacist about an effective sunscreen.

Customized Topical Therapy for Cellulite

Cellulite describes dimpling of skin, caused by the protrusion of subcutaneous fat into the dermis. "Cellulite is hereditary, so much so that the indications of who will get it, and to what degree, are present almost from birth," noted dermatologist Amy Newburger, MD, director of Dermatology Consultants of Westchester in Scarsdale, N.Y. Newburger says that creams and lotions whose key ingredient is a methylxanthine such as caffeine may be beneficial. "Caffeine creams work great to pull fluids out of the spaces between cells and induce lipolysis - fat burning in the layer just below the skin's surface." Newburger says a good delivery system to drive the creams into the cells, like liposome technology, is also important.

Caffeine is effective in reducing the appearance of cellulite, improving micro circulation, and strengthening skin tone and firmness. Researchers have found that caffeine creams reduce fat cells in skin, with visible results in about eight weeks. In a double-blind, single-center, placebo-controlled study, a liposome-encapsulated caffeine-based cream was found to significantly reduce the thickness of the adipose tissue in all areas of the body. In addition, the more concentrated cream was significantly more effective than the less concentrated cream in the areas of the hips and the triceps.

Dermatol Surg. 1999 Jun;25(6):455-62

Gotu Kola (Centella Asiatica) has a long history as a traditional medicine for improving skin tone and firmness. Studies show that Gotu Kola can reduce the appearance of cellulite by preventing and reversing the formation of fibrous connective structures that "trap" fat. Grape Seed extract is well known for its antioxidant properties and has been shown to improve circulation, strengthen connective tissues, and reduce the effects of aging on the skin. It also inhibits the enlargement of fat cells and the accumulation of fat tissues, thus improving the appearance of cellulite.

It is very important that preparations are massaged into the skin. Hygroscopic moisturizers are also recommended.

Additional reference:
Harry’s Cosmeticology, 8th Ed. (Rieger)

 

 

 

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