Cellulite - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Cellulite is formed when the pockets of fat juts out toward the skin surface, giving it a dimpling or orange peel appearance.[1] Cellulite is usually located on the buttocks, hips, thighs and abdomen. It occurs most commonly in women, and can be seen in over 90% of women, but is rarely seen in men.[2]

Treatment Philosophy

Cellulite is a bothersome condition to most, but can be minimized with basic lifestyle changes. Weight loss and maintaining a balanced diet will help to decrease cellulite, while avoiding long periods of sitting or standing will minimize cellulite. If cellulite is persistent and lifestyle modifications have not proven effective, there are numerous procedures that can be used to decrease its appearance. These procedures either decrease the fat in the area or manipulate the area so that the fat lays flat instead of bunching up creating dimples.

Symptoms

Generally, cellulite gives an appearance of dimpling in the skin. More specifically, cellulite can be divided into 3 main grades, each with its own distinct appearance.[3]

Grade 1 (mild):

  • Smooth skin without any dimpling when standing up or lying down
  • Mattress-like look when pinching the skin

Grade 2 (moderate):

  • Mattress-like look when standing, but disappears when lying down

Grade 3 (severe):

  • Skin dimpling when standing and lying down
  • Skin dimpling is worse when pinching the skin

Causes

Normally, our body has fiber networks that hold pockets of fat in place and prevent them from outpouching towards the skin. Cellulite occurs when the fat pockets are pushed outward to form “skin dimpling”. The actual cause of cellulite is not well understood, however several factors may be linked to cellulite formation:[1,4]

  1. Abnormal water metabolism in the body causes the tissue under the skin to swell and pushes fat pockets outward toward the skin.
  2. Abnormal fluid flow in the veins and lymphatic vessels under the skin. This partially weakens the fibers that normally hold fat pockets in place.
  3. The way we stand and move our body may cause tension on the tissue beneath the skin and may weaken the fiber network holding fat pockets together.

Credit: "firmer skin with a lotion" (CC BY 2.0) by sketchr

 

Risk Factors

Your body

  • Age: cellulite is more common in older and menopaused women. This may be because women have lower estrogen levels after menopause, which can weaken the fibers holding the fat pockets in place.[5,6]
  • Gender: cellulite is more common in females
  • Ethnicity: cellulite is more common in Caucasian than Asian women
  • Weight: cellulite is more prominent in overweight people
  • Pregnancy: pregnancy hormones can increase water in the body and worsen cellulite
  • Hormones: insulin can increase the amount of fat in the body and may worsen cellulite

Lifestyle[4]

 

  • Positions: Long periods of sitting or standing can worsen cellulite
  • Diet: eating too many carbohydrates may worsen cellulite

Treatments

Cellulite generally causes no discomfort, therefore is not harmful to one’s health. However, it may cause embarrassment, therefore treatments are directed at improving the appearance. Treatments can be both through topical application directly on the skin and through the use of procedures. The majority of the topical treatments aim to improve the strength and elasticity of the fiber network holding the fat lobules together. The procedural (surgery and using devices) methods mainly aim to destroy the fat cells underneath the skin. It is important to keep in mind that most of the currently available treatments do not have very strong evidence in long term benefit.

Products & Medications

  • Topical retinol: similar to topical retinoids {insert link to topical retinoids}. When used for over 6 months, it may improve cellulite, likely by increasing the strength and elasticity of the fibers that hold the fat lobules together.[7]

Procedures and surgery

  • Fat massage: devices massage fat in the affected areas to make the fat layers thinner and may improve the appearance of cellulite.[8]
  • Carboxy therapy: injecting carbon dioxide gas into the fat tissue to dissolve fat has been shown to improve the appearance of cellulite.[9]
  • Cryolipolysis: a devices cools the skin surface to freeze and destroy the fat cells in order to improve cellulite.[10]
  • Liposuction: surgical suction of fat cells may be useful in removing large areas of deeply located fat to help improve the appearance of cellulite.[11]
  • Subcision: a needle is used to cut fibrous bands between the fat lobules. This may correct surface depressions on the cellulite areas.[12]
  • Mesotherapy: injecting chemicals such as phosphatidylcholine or deoxycholate into the fat underneath the skin dissolves the fat tissue.[13]
  • Radiofrequency devices: use electric energy to heat up and dissolve small areas of fat deposition and may improve cellulite.[14]
  • Ultrasound devices: ultrasound energy applied on top of the skin (noninvasive) is used to destroy fat cells and may improve cellulite.[14]
  • Lasers: various lasers have been studied to treat cellulite with varying success.[15] They can be used alone or in combination with other treatments methods.

Nutrition and diet

  • Diet: low carbohydrate intake can lower insulin resistance and may help slow down the worsening of cellulite.[1]

Lifestyle changes

  • Weight loss: for those obese helpful to slow down the worsening of cellulite.
  • Position: limit long periods of sitting or standing in order take pressure off areas at risk of cellulite formation such as the buttocks and thighs.
  1. de la Casa Almeida M, Suarez Serrano C, Rebollo Roldan J, et al. Cellulite's aetiology: a review. J Eur Acad Dermatol Venereol. 2013; 27(3):273-278; PMID: 22758934 Link to research.
  2. Rossi AB, Vergnanini AL. Cellulite: a review. J Eur Acad Dermatol Venereol. 2000; 14(4):251-262; PMID: 11204512 Link to research.
  3. Muller G, Nurnberger F. [Anatomic principles of the so-called "cellulitis"]. Arch Dermatol Forsch. 1972; 244:171-172; PMID: 4648682 Link to research.
  4. Khan MH, Victor F, Rao B, et al. Treatment of cellulite: Part I. Pathophysiology. J Am Acad Dermatol. 2010; 62(3):361-370; quiz 371-362; PMID: 20159304 Link to research.
  5. Leszko M. Cellulite in menopause. Prz Menopauzalny. 2014; 13(5):298-304; PMID: 26327870 Link to research.
  6. Nurnberger F, Muller G. So-called cellulite: an invented disease. J Dermatol Surg Oncol. 1978; 4(3):221-229; PMID: 632386 Link to research.
  7. Pierard-Franchimont C, Pierard GE, Henry F, et al. A randomized, placebo-controlled trial of topical retinol in the treatment of cellulite. Am J Clin Dermatol. 2000; 1(6):369-374; PMID: 11702613 Link to research.
  8. Bayrakci Tunay V, Akbayrak T, Bakar Y, et al. Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite. J Eur Acad Dermatol Venereol. 2010; 24(2):138-142; PMID: 19627407 Link to research.
  9. Lee GS. Carbon dioxide therapy in the treatment of cellulite: an audit of clinical practice. Aesthetic Plast Surg. 2010; 34(2):239-243; PMID: 20111965 Link to research.
  10. Carruthers J, Stevens WG, Carruthers A, et al. Cryolipolysis and skin tightening. Dermatol Surg. 2014; 40 Suppl 12:S184-189; PMID: 25417573 Link to research.
  11. Sadick NS. Overview of ultrasound-assisted liposuction, and body contouring with cellulite reduction. Semin Cutan Med Surg. 2009; 28(4):250-256; PMID: 20123424 Link to research.
  12. Hexsel DM, Mazzuco R. Subcision: a treatment for cellulite. Int J Dermatol. 2000; 39(7):539-544; PMID: 10940122 Link to research.
  13. Rotunda AM, Kolodney MS. Mesotherapy and phosphatidylcholine injections: historical clarification and review. Dermatol Surg. 2006; 32(4):465-480; PMID: 16681654 Link to research.
  14. Peterson JD, Goldman MP. Laser, light, and energy devices for cellulite and lipodystrophy. Clin Plast Surg. 2011; 38(3):463-474, vii; PMID: 21824543 Link to research.
  15. Zerini I, Sisti A, Cuomo R, et al. Cellulite treatment: a comprehensive literature review. J Cosmet Dermatol. 2015; 14(3):224-240; PMID: 26147372 Link to research.