## 1 Introduction
### Influence on the Skin
The mechanical simulations act on the mechanoreceptors such as the corpuscles of Meissner (touch corpuscles are tactile receptors responsible for feeling light, superficial, vibrational sensations), corpuscles of Water-Pacini (sensitive to deep pressure, localized in the deep dermis and subcutaneous tissue), corpuscles of the Golgi (sensitive to the pressures, provoke revascularization and the restructuring of connective tissue), and the corpuscles of [PERSON] (situated in the epidermis, sensitive to pressure and vibration; they act on cellular metabolic activity). Most of these mechanoreceptors stimulate the activity of the fibroblasts and the regeneration of collagen and connective tissue [2]. Research shows changes in the number and surface of fibroblasts, blood vessels, the thickness of the epidermis (basal to granular layer), and the area of the dermal-epidermal junction. At the level of the epidermis, mechanical stretching causes DNA synthesis and keratinocyte proliferation [9; 11]. The reconstruction of connective tissue (increasing the number of fibroblasts) and a decrease in the interstitial space of the skin result from the remodeling of collagen and its reorientation [11]. After mechanostimulation, fibroblasts proliferate by increasing DNA synthesis and changing their phenotype (Figure 4). The release of growth factors induced by mechanical forces is associated with the remodeling of the extracellular matrix, in particular, type I, III, IV, and XII collagen and fibronectin [9]. Mechanical stimulation (MS) influences fibroblast activity, leading to the increased synthesis of extracellular matrix (ECM) components such as collagen, elastin, and fibronectin, which contribute to tissue integrity and elasticity. MS also plays a crucial role in matrix remodeling, regulating the activity of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) to maintain ECM homeostasis. Additionally, mechanical cues stimulate cellular proliferation, migration, and differentiation into myofib, which are essential for tissue repair and wound healing. These processes are accompanied by the enhanced synthesis of cytokines and growth factors, further supporting fibroblast-mediated tissue remodeling and regeneration. The main purpose of the procedure is to stimulate blood and lymph circulation, which accelerates metabolism and facilitates the removal of unnecessary metabolic byproducts. This, in turn, promotes further processes such as lipolysis stimulation, swelling resorption, and collagen and elastin production in the skin and subcutaneous tissue. Vacuum kneading makes it easier to replace the fluid between the cell and extracellular space and their discharge. This also promotes the removal of proteins that cause water retention. Addi  
Figure 4: The impact of mechanical stimulation on fibroblast function. tionally, the negative pressure from suction and the positive pressure from rolling cause an improvement in the distribution of subcutaneous fat [11]. As described by [PERSON], the dynamic mechanical forces applied by Endermologie could lead to the inhibition of adipogenesis (Figure 5) and the subsequent reduction in adipose tissue. Mechanical stimulation can influence adipogenesis--the transformation of pre-adipocytes into mature adipocytes--either by promoting or inhibiting the process, depending on the type of mechanical force applied. Static stimuli, such as stretching and compression, activate signaling pathways involving Rho kinase and COX-2, which are associated with the enhancement of adipogenesis. In contrast, dynamic mechanical forces, including cyclic stretching and vibration, stimulate pathways mediated by TGF-81, MEK 1/2, ERK 1/2, Smad 2, and \(\beta\)-catenin, leading to the inhibition of adipogenesis. These mechanical signals deform the plasma membrane and trigger intracellular responses that regulate fat cell differentiation, metabolism, and tissue remodeling. Moreover, endermologie has been recognized for its beneficial effects on lymphedema management. [PERSON] et al.