What is cellulite?

Cellulite is a condition in which the skin appears dimpled, bumpy and “orange peel-like.”

Cellulite occurs when underlying fat deposits push through layers of connective tissue fibers. The fibers become weak allowing more fat to push through.

Thin skin also increases the risk of cellulite as fat “popping out” is more easily seen.

Cellulite is more common in buttocks and thigh areas.

Cellulite affects women of all shapes and sizes, you do not have to be overweight to have cellulite.

“Cellulite affects about 80-90 % of post-pubertal women.”

Reference Am J Clin Dermatol. 2015 Aug;16(4):243-56. doi: 10.1007/s40257-015-0129-5. Cellulite: an evidence-based review. Luebberding S1, Krueger N, Sadick NS.

What causes cellulite?

Why people develop cellulite is still unclear, it is most likely multifactorial.

Decreases in circulation may increase the risk of cellulite.

Inactive lifestyles may increase the risk of cellulite.

Prolonged periods of sitting are thought to reduce blood flow to the buttocks and hips, two areas that cellulite commonly affects.

Cellulite may be associated with inflammation.

Refined carbohydrates and sugar increase inflammation which may lead to an increased risk of cellulite.

What increases the risk of cellulite?

Age increases the risk of cellulite. As we age our bodies produce less collagen which affects the quality of our skin.

Estrogen may play a part in cellulite formation. Cellulite is more common in women than men. It is also more common when estrogen levels decrease during menopause.

Menopause may increase the risk of cellulite. Decreased estrogen levels are thought to reduce new collagen production and encourage the breakdown of older connective tissue.

Genetics play in part in cellulite formation.

Certain medications such as steroids thin the skin which can lead to stretch marks and cellulite.

Certain foods like refined carbohydrates and sugar may increase the risk of collagen breakdown through inflammation.

Lack of exercise can increase the risk of cellulite.

Being overweight increases the risk of cellulite as there is more tissue or fat stretching the connective tissue fibers.

Smoking can decrease blood flow which may increase the risk of cellulite.

Any factors or medical conditions that decrease blood flow increases the risk of cellulite.

The appearance of cellulite can be made worse by the accumulation of fluid in the surrounding tissues.

Lighter colored skin may make cellulite more noticeable.

Self-skin tan lotions may make cellulite less noticeable

Treatments for cellulite 

Regular exercise cannot cure cellulite but it can help prevent or reduce its appearance.

Weight training can help tone which can help reduce the appearance of cellulite.

What type of exercises should you be doing to improve cellulite?

Researchers at the South Shore YMCA in Quincy, Massachusetts, found that those who did three 30-minute aerobic workouts each week for eight weeks lost four pounds but cellulite did not change.

When they paired strength training people lost additional weight and had greater improvement in body composition.


Skin creams

No topical cream has been shown to permanently reduce the appearance of cellulite.

According to the American Academy of Dermatology,

“Products containing caffeine may dehydrate cells, which can make cellulite less obvious. To maintain the results, you’ll have to apply the product every day.”

Aminophylline is a medication that reduces smooth muscle, it is a combination of ethylenediamine and theophylline. This medication has been used to treat asthma. It can jitteriness and increased heart rate.

These ingredients will dehydrate the skin, making the appearance of cellulite.

Ann Pharmacother. 1996 Mar;30(3):292-3.Aminophylline for cellulite removal. Dickinson BI1, Gora-Harper ML.
Diabetes Obes Metab. 2007 May;9(3):300-3. Topical fat reduction from the waist. Caruso MK1, Pekarovic S, Raum WJ, Greenway F.

Retinol -Products that contain retinol can help increase collagen in the skin. Thicker skin can help reduce the visibility of cellulite.

Before using a skin cream consider doing a patch test first to ensure you not allergic to the cream.

Mesotherapy can help reduce fat pockets and this may help improve the appearance of small areas of cellulite. This procedure is not expected to help large areas of cellulite. Mesotherapy side effects include swelling, infection, and irregular contours.

Supplements that market cellulite reduction.

There is no evidence that supplements can help reduce cellulite.

Dry brushing

There are no long-term studies that show that dry brushing can help reduce cellulite.

Dry brushing can help stimulate the lymphatic system, increase circulation and exfoliate the skin

According to the Cleveland Clinic, “There is absolutely no evidence in the literature to confirm that dry brushing aids in digestion or the appearance of cellulite. It’s likely that what people interpret as cellulite reduction is really just a temporary “plumping up of the skin” from increased blood circulation. The claim that it actually reduces cellulite isn’t supported by any scientific evidence.”

Massage

Massage and other spa treatments may have a temporary effect on the dimpling appearance of skin. But they do not remove cellulite, any short-lived effect is probably due to the removal of excess fluid.

Endermologie uses a suction device with rollers to pull and squeeze the cellulite areas. Usually, 10 treatments are needed, and results vary. There may be an improvement but results are expected to be temporary. Cellulite is expected to return once maintenance treatments are stopped.

Ultrasound

There is little evidence that ultrasound alone can help cellulite.

Z-wave

According to the manufacturer’s website,

“The high energy radial shockwaves scientifically proved to have a large impact on collagen structure and the skin connective tissue, improving blood circulation.
It stimulates collagen formation, while the skin becomes more elastic and its firmness is visible after only a few treatments.”

Z-wave works through sound waves that can help build up collagen.

This treatment may be combined with other treatments such as fat reduction to offer better results.

Cryolipolysis®

Treatments such as Coolsculpt freezes fat, some of the fat will liquefy. Fat pockets might shrink but cellulite will still be present.

Ionithermie 

Ionothermie uses galvanic stimulation which sends small currents to the skin, it is used to tone muscles.  Algae and clay are usually placed on the skin.

A pub med search failed to reveal and evidence of using this technique.

Skin irritation can occur from clay.

People with metal plates or implants in the area should not have this treatment.

Radiofrequency uses heat to melt and treat cellulite.

Vela Shape laser treatments

According to the manufacturer’s website, “VelaShape uses vacuum technology to manipulate your skin while infrared light (IR) and bi-polar radio frequency (RF) energies will gently heat fat cells and surrounding tissue. Over the course of your treatments, you will notice a reduction in both circumference and in the appearance of cellulite in the treated areas.”

Velashape typically requires 10 to 15 sessions to significantly improve appearance, and require monthly maintenance treatments.

Dr. Mahira Tanovic, a plastic surgeon in Lake Success New Yorks states,

“Cellulite is hard to treat as you know.
The best results I see are from Vela Shape, patients usually need 6-8 treatments. Treatments are delivered every week and after that, one treatment monthly for maintenance.
As you know, results depend on skin quality and severity of the cellulite.”

Procedures that require needles or small incisions

Cellulaze

According to the Manufactures website

  • A couple of tiny incisions are made under local anesthesia.
  • The Cellulaze laser fiber is threaded through a very small tube (or cannula) and inserted through the incision site
  • Your physician will use the SideLaze3D™ Cellulaze laser fiber to:
    • Level out bumps of fat
    • Treat dimples by releasing the fibrous bands that pull down on the skin
    • Stimulate collagen production to increase your skin’s depth and elasticity for a smoother look
  • The liquefied fat is gently pressed out
  • The entire procedure should take about 1–1.5 hours

Recovery from Cellulaze

  • You may have some bruising, discomfort and leaking from incision sites.
  • Your doctor may recommend a compression garment.
  • You can resume normal activities after a day or two, you may be asked not to participate in strenous activites to allow better healing.
  • Your results will continue to improve for the next three to twelve months.”

Results of Cellulaze

“93% of patients surveyed were satisfied or very satisfied with their results one-year post-procedure”

“Cellulaze was shown to increase skin thickness by 25%, and skin elasticity by 29% even after 1 year”

Cellfina™

Dr. Kevin Tehrani, a plastic surgeon in Great Neck, New York states, “Cellulite is difficult to treat. That’s why there are many modalities available. In my experience, the best modalities to Cellulite permanently are a combination of either Cellulaze or Cellfina followed by SmoothShape or VelaShape postoperatively.”

Liposuction is a procedure that can reduce fat.

The American Academy of Dermatology warns that liposuction may actually worsen the appearance of cellulite by creating more depressions in the skin.

 Meta-analysis comparing the different types of devices

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