The Secret About Cellulite Is No Secret At All

That dimpled skin on the thighs, hips and buttocks that looks like bubble wrap is the result of uneven distribution of body fat. It’s not serious, but it does little for self-image.  That can be debilitating… mentally, at least. One can always refrain from wearing shorts or a bathing suit, but that would change quality of life for many of us. What happens is that the collagen that holds us together, that connects fat to the skin, may break down, stretch, or pull tight, allowing the fat cells to bulge outward. From that come the ripples.

It’s In The Genes Genes can play a part in having cellulite or not. Lousy diet, s-l-o-w metabolism, fad dieting, hormones and insufficient hydration play a role, too. Lots of money goes down the drain to get rid of cellulite, mostly an exercise in futility. Sorry. Liposuction, about as drastic a measure as any, doesn’t work, and will probably make things worse. With a little luck, all those creams, wraps, exercise and massages may offer temporary relief at best (Khan, 2010, Parts 1 & 2).

Looking for clues to cellulite treatment is not a top priority for medical researchers because cellulite is considered a fact of life and not a condition. One of the first of those clues, as pointed out by Spanish dermatologists, is that cellulite is a physiological phenomenon characteristic of women more than men (Do we need scientists to make that observation?) and is multi-causal (same comment) (de la Casa, 2012).

To make it seem more like a condition worthy of attention, we have devised names for cellulite—adiposis edematosa, status protrusis cutis, gynoid lipodystrophy, and dermopanniculosis deformans. Such elevated semantic achievement aroused the interest of a group of Brazilian doctors who looked at cellulite from a new angle and decided to expose their patients to four hours a day of manual and mechanical lymph drainage and cervical stimulation using the “Godoy and Godoy technique.” This modality was originally used in the treatment of lymphedema, a swelling that results from obstruction of lymph nodes and consequent accumulation of lymphatic fluids (Godoy, 2004, 2012). These researchers found the technique efficacious in cellulite treatment, with a reduction in gluteal perimeter measurements by as much as ten centimeters and an average of nearly 5.0 cm (Ibid). Practically antipodal to this finding was the comparative failure of long-pulsed laser treatment using a Nd:YAG solid state laser. This employs neodymium and yttrium aluminum garnet in the projecting beam, sounding like a tool in a Bond movie, apparently intended to create heat and to evaporate the water that inhabits fat cells, thereby shrinking them. The rate of improvement was minor in less than half the population (Truitt, 2012). Since fat cells don’t go away but merely shrink, what happens when they become re-hydrated? If blessed by the good fortune fairy, you might experience positive effects for a few months. If you have the money, you can do it again (Peterson, 2011). Mechanical massage, somewhat akin to the Godoy system, might save a few bucks (Bayrakci, 2010).

Prevention Before Intervention The tips postulated to avoid cellulite in the first place parallel the adage about an ounce of prevention being more valuable than a pound of cure. The National Institute of Health suggests a diet rich in fruits, vegetables and fiber, including substantial hydration.  Regular exercise and the avoidance of yo-yo dieting are encouraged. Oh, yeah… no smoking. (NIH, 2012) http://www.nlm.nih.gov/medlineplus/ency/article/002033.htm

Mesotherapy is a cosmetic procedure used for several purposes, cellulite elimination among them. This entails multiple injections of pharmaceutical or homeopathic medicines or extracts into subcutaneous fat. Although fat cells are the target, with lipolysis the goal, surrounding cells also are affected, often leading to unwanted complications. The list of substances that can be used in these injections is surprisingly long, accompanied by a list of successes that is not surprisingly short, most of which resulting in inflamed granulated nodules associated with lipid deposits, called eleoma (Ramos-e-Silva, 2012). Because the disruption of neighboring tissue is a real issue, mesotherapy, though medically benign, might not be your cup of tea (Rotunda, 2005).

Topical treatments for cellulite work on the assumption that microcirculation can be improved, that lipogenesis can be interrupted, and that lipolysis can be promoted.  All this is supposed to happen while the normal architecture of the skin and underlying tissue is restructured during free radical removal. To the dismay of the consumer more than the researchers, none of this occurs with predictability or regular efficacy (Hexsel, 2011). However, one avenue of study sought to find a way to thicken the skin by stimulating production of keratinocytes, the cells that make more than ninety percent of the skin you see when you look at a person. In this French study supported by Johnson & Johnson, a combination product made of caffeine, carnitine, forskolin (from the coleus plant), and a chelating chemical called tetrahydroxypropyl ethylenediamine was found to reduce circumferential measurements after only four weeks of a twice-a-day application.  “Orange peel” and cellulite were significantly decreased (Bertin, 2011). If this stuff is available, it’s got to be $$$$.

Extracorporeal shockwave therapy is advertised on the radio to treat plantar fasciitis and tennis elbow.  What used to take a half hour under local anesthetic is now complete in less than ten minutes without it. This procedure introduces inflammation to the targeted tissue, producing re-routed blood flow to the area that intends to promote healing. Skin remains undamaged while collagen and elastin formation is enhanced, thereby improving the scaffolding within subcutaneous fat (Kuhn, 2008) (Knobloch, 2010) (Angehm, 2007).  It seems to work.

The bottom line (no pun intended) is that a woman has more fat cells than a man. That is to address nourishing a fetus from her own energy reserves. Since lots of fat is contained in the gluteal fold to begin with, it makes sense that is where it’ll end up.  Exercise is the best way to keep it where it started. Keep the fat cells small through a righteous diet. Drink plenty of fluids. Start with the most conservative measures if money is burning a hole.

Angehrn F, Kuhn C, Voss A. Can cellulite be treated with low-energy extracorporeal shock wave therapy? Clin Interv Aging. 2007;2(4):623-30.

Bayrakci Tunay V, Akbayrak T, Bakar Y, Kayihan H, Ergun N. 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 Feb;24(2):138-42. Epub 2009 Jul 13.

Bertin C, Nkengne A, Da Cunha A, Issachar N, Rossi A. Clinical evidence for the activity of tetrahydroxypropyl ethylenediamine (THPE), a new anti-aging active cosmetic. J Drugs Dermatol. 2011 Oct;10(10):1102-5.

José Maria Pereira de Godoy, Maria de Fátima Guerreiro Godoy Manual lymph drainage: a new concept J Vasc Br 2004;3(1):77-80

de Godoy JM, Groggia MY, Ferro Laks L, Guerreiro de Godoy Mde F. Intensive treatment of cellulite based on physiopathological principles. Dermatol Res Pract. 2012;2012:834280. Epub 2012 May 14.

de la Casa Almeida M, Suarez Serrano C, Rebollo Roldán J, Jiménez Rejano JJ. Cellulite's aetiology: a review. J Eur Acad Dermatol Venereol. 2012 Jul 3.

Hexsel D, Soirefmann M. Cosmeceuticals for cellulite. Semin Cutan Med Surg. 2011 Sep;30(3):167-70

Khan MH, Victor F, Rao B, Sadick NS. Treatment of cellulite: Part I. Pathophysiology. J Am Acad Dermatol. 2010 Mar;62(3):361-70; quiz 371-2.

Knobloch K, Joest B, Vogt PM. Cellulite and extracorporeal Shockwave therapy (CelluShock-2009)--a randomized trial. BMC Womens Health. 2010 Oct 26;10:29.

Kuhn C, Angehrn F, Sonnabend O, Voss A. Impact of extracorporeal shock waves on the human skin with cellulite: a case study of an unique instance. Clin Interv Aging. 2008;3(1):201-10.

National Institutes of Health--Department of Health and Human Services MedlinePlus: Cellulite. 27 September 2012 http://www.nlm.nih.gov/medlineplus/ency/article/002033.htm

Ono S, Hyakusoku H. Complications after self-injection of hyaluronic acid and phosphatidylcholine for aesthetic purposes. Aesthet Surg J. 2010 May-Jun;30(3):442-5.

Peterson JD, Goldman MP. Laser, light, and energy devices for cellulite and lipodystrophy. Clin Plast Surg. 2011 Jul;38(3):463-74, vii.

Proebstle TM. .

Ramos-e-Silva M, Pereira AL, Ramos-e-Silva S, Piñeiro-Maceira J. Oleoma: rare complication of mesotherapy for cellulite. Int J Dermatol. 2012 Feb;51(2):162-7.

Rotunda AM, Avram MM, Avram AS. Cellulite: Is there a role for injectables? J Cosmet Laser Ther. 2005 Dec;7(3-4):147-54.

Roure R, Oddos T, Rossi A, Vial F, Bertin C. Evaluation of the efficacy of a topical cosmetic slimming product combining tetrahydroxypropyl ethylenediamine, caffeine, carnitine, forskolin and retinol, In vitro, ex vivo and in vivo studies. Int J Cosmet Sci. 2011 Dec;33(6):519-26. doi: 10.1111/j.1468-2494.2011.00665.x. Epub 2011 May 13.

Sadick NS, Mulholland RS. A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating. J Cosmet Laser Ther. 2004 Dec;6(4):187-90.

Sasaki GH, Oberg K, Tucker B, Gaston M. The effectiveness and safety of topical PhotoActif phosphatidylcholine-based anti-cellulite gel and LED (red and near-infrared) light on Grade II-III thigh cellulite: a randomized, double-blinded study. J Cosmet Laser Ther. 2007 Jun;9(2):87-96.

Truitt A, Elkeeb L, Ortiz A, Saedi N, Echague A, Kelly KM. Evaluation of a long pulsed 1064-nm Nd:YAG laser for improvement in appearance of cellulite. J Cosmet Laser Ther. 2012 Jun;14(3):139-44.

Wassef C, Rao BK. The science of cellulite treatment and its long-term effectiveness.

J Cosmet Laser Ther. 2012 Apr;14(2):50-8.