## 1 Introduction
### Influence on the Skin
compared endermologie with manual lymphatic drainage and showed that both MLD and endermologie plus compression bandaging applied over a minimum of two weeks (but preferably four weeks) were beneficial for the treatment of secondary arm lymphoedemam with endermologie having a 33% shorter treatment time than MLD [13; 14]. [PERSON] et al. validated a reproductive endermologie protocol dedicated to upper limb lymphedema secondary to breast cancer. It could be  
Figure 5: Effects of mechanical stimulation on adipocytes and adipogenesis. Source: [12]. proposed as a maintenance treatment for lymphedema, but only for patients who do not have fragile skin. It can be used by all physiotherapists, thus reducing variations between manual lymphatic drainage practitioners [15]. This effect is likely due to the enhanced lymphatic flow facilitated by mechanical stimulation. Supporting this, a study by [PERSON] indicated that endermologie not only decreases limb volume but also improves range of motion (including flexion and abduction) while reducing pain levels [16]. Consequently, endermologie contributes not only to the reduction of lymphedema-related limb size but also to an overall improvement in patients' quality of life. Additionally, a study by [PERSON] et al. analyzed the physiological impact of vacuum therapy on various skin layers, including the epidermis and dermis. The findings revealed that vacuum therapy increases tissue strength and skin elasticity by stimulating fibroblast proliferation and collagen synthesis. These effects not only enhance skin quality but also contribute to better lymphatic drainage, which may explain its effectiveness in lymphedema treatment [3]. In research on scars, it was found that the apoptosis of myofibroblasts may occur, which reduces the cohesion of scars. A beneficial effect on the layers of the epidermis was also demonstrated, i.e., the thickening of the epidermis (expansion of the layers of the live epidermis) and an increase in the adhesion of the dermis to the epidermis under the influence of an increase in the surface of the skin's native limit (increase in the number of warts (dermal papilla) and epidermal ridge). The exfoliating effects of the epidermis and the effect on the sebaceous glands, resulting in the adjustment of the lubrication and hydration of the skin, were also mentioned [2; 17]. Mechanical stimulation affects the vascular bearing of the skin and also increases microcirculation parameters. The action of rollers and flaps, combined with suction, favors effective tissue and lymphatic drainage. Treatment has an effect on the activation of neovascularization and angiogenic processes. This occurs as a result of arterial tension, which affects the walls of the vascular endothelium, determining the release of vascular endothelial growth factors (VEGFs) and the proliferation and migration of cells responsible for angiogenesis. This is evidenced primarily by the greater number of vascular structures in the superficial vascular plexus. Data from videocapillaroscopic measurements indicate increased capillary blood flow rate values and an increase in capillary density. Mechanical stimulation increases microcirculation, vascularity, skin oxygenation, and, hence, skin oxygenation, cellular exchange, and nutrition [9; 18]. The superficial fascia is responsible for numerous aesthetic alterations of the skin surface. It is a kind of net that is formed from horizontal septa of collagen and elastic fibers separated by fat lobules crossed vertically by fibers that organize the superficial adipose tissue. The superficial fascia is considered a systemic bandage. The elevations and depressions of the contour of the body are connected with the fascia and its relationships with muscles, fat, and skin. Endermologie is essentially the traction and stretching (activation) of the superficial band and the superficial muscular fascia [2].