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Cellulite - What Is It And What Treatments Work Best?

Cellulite - All women know what this is, right? But there is a great deal of disagreement and some controversy within the medical community about what it is and whether it is a real thing, a true diagnosis! The WebMD website says that "his name makes it sound like a medical condition"! Well, this "non-medical" condition has serious consequences and affects about 80-90% of adult women! Hundreds of millions of dollars are spent each year on treatment. If all those who do not meet the requirements of cellulite are the real condition to be respected and noticed by our physicians then something is very wrong! However, there are many "scary" names used for what we commonly call cellulite including adiposis edematosa, dermopanniculosis deformans, status protrusions, and gynoid lipodystrophy. Common names for cellulite include orange peel syndrome, cottage cheese skin, layered mattress leather and cushioned leather seats.

Various "causes" have been implicated (including genetics) but we are still uncertain. Cellulite is rarely seen in men - is it related to hormone status? Why cellulite dominates the stomach, buttocks and thighs - why this area? No one knows but it suggests a hormonal mechanism that is being transmitted; remind of the stretch marks (striae atrophica) and their distribution area - very similar! Cellulite also appears to occur during the active period of hormones in the lives of women - adolescence, pregnancy, and menopause.

Most of us, doctors and patients alike, would recognize cellulite to be an exposed, fragmented, irregular skin surface that affects large areas. Dimples may be cute in the face, but not in your thighs! The thighs, especially the outer thighs, seem to be the most affected areas. At the microscopic level we know that something that happens to skin architecture causes it to look uneven, clumsy and unattractive. There appears to be a pseudoherniation (which stands out without the actual bulging) of the superficial subcutaneous fat poking almost through the tight fibrous connective tissue (which supposedly acts as a retaining wall for fat) under the skin. We look at the total volume of all these bulges as a whole bloated, corrugated surface. It's very reminiscent of the way the pillow material cushions between the seat cushion buttons!

Doctors who study this defective phenomenon also admit that depending on its severity, the body's position can also affect the appearance of cellulite. In 1978, the Nurnburger-Muller Scale was published:

The Nurnburger-Muller Scale (1978) for Cellulite Classification:

0 - no visible visibility

1 - Exfoliate only visible on pinch / squeeze

2 - Worst seen on stand alone (not when lying down)

3 - dimpling is always present / visible (either standing or lying down)

There are many "options" available for treating cellulite today. A recent Google search on "treatment for cellulite" revealed 1.4 million hits! But do any of them really work? Dr. Molly Wanner (Harvard dermatologist) says "there is no cure for cellulite". Dermatologist Michael McGuire of UCLA agrees (NY Times article, 2009).

Weight loss and strength training must help, but not always the answer! Cellulite is not always associated with overweight or obesity. Weight or excess weight - you can still have cellulite. Many slim women in great shape are bothered by cellulite.

Nutrition changes and supplements reported to help fight cellulite include the use of gingko biloba, sweet clover, grape bioflavonoids, bladderwrack extract, evening primrose oil, fish oil, omega 3's & 6's, soy lecithin, green tea, milk thistle, and niacin. The goal is to: increase metabolism, improve circulation, increase cellular nutrition, and increase metabolism / fat breakdown. So called anti-cellulite diets are designed to reduce inflammation, improve circulation, and increase fat metabolism. It is very difficult to prove or disprove any of these claims or to determine whether the intended effects actually occurred.

Anti-cellulite cream usually contains a form of methylxanthine (theophylline, aminophylline, caffeine) known to lower blood flow, reduce tissue fluid and improve fat metabolism - but can they pass through the skin? Does the concentration reach the level at which it works? Are they old enough to influence any real change? Very unacceptable evidence of this cream and its efficacy. Reducing tissue fluid has a temporary effect on reducing cellulite appearance. As you will see throughout this article, any technique for temporarily reducing tissue fluid will "work"!

Retin-A / retinols show some benefits by improving the overall quality of the skin that comes with better skin tone and smoother work. There is some evidence that combining Retin-A with some creams containing methylxanthine may produce better synergistic effects than either one to reduce cellulite appearance.

Tanning does not help to minimize the appearance of cellulite. But sunlight or from a salon booth works through UV damage to the skin! This leads to more obvious weaknesses (skin aging, longer-term skin irritation, skin cancer risk) than any potential benefit. Artificial tanning or spraying techniques are a safer alternative!

Herbs, seaweeds and other body types "wrap" works by reducing tissue fluid (that is, they work, but only temporarily).

Massage the inside tissue in theory it would increase local blood flow, eliminate toxins, and reduce tissue fluid. The only one of these three that has proven (albeit temporarily) effectiveness is the "fluid reduction" claim! Massage as part of any treatment method will result in at least temporary improvement in cellulite as it causes a temporary decrease in tissue fluid and temporary "redistribution / shifting" of subcutaneous fat as well.

The Endermology device using a special vacuum / roller massage technique. This doesn't help - but like many treatments - it's temporary. Short-term, temporary treatments such as Endermology seem to be effective because they reduce the tissue fluid in the area, and / or affect the "redistribution" of temporary fats. As you will see, this strategy is the basis for many cellulite treatment options.

The Silhouette The device is essentially the same as Endermology technology, using the principles of mass-reducing tissue fluid and fat transfer / redistribution to temporarily reduce cellulite.

Mesotherapy very controversial for the effectiveness or consistency of fat removal only. Many needles and injections are involved. The injected chemical cocktail is intended to encourage "melting" fat not really for cellulite treatment. And more aberrations in the texture of the skin surface can result in mesotherapy because the smells aren't necessarily uniform or even - more cellulite! Other reported problems include infections, rash, and allergic reactions.

Radiofrequency (RF) is one of the few non-invasive machines and techniques available today. RF works by creating heat. This heat can melt fat and "shrink wraps" loose skin to various degrees. Does it make sense that this should have the benefit of cellulite - or is it? The results have not been resolved so far and therefore the RF has not been approved or cleared by the FDA for anti-cellulite treatment.

Vanquish uses RF to heat and kill fat cells in a manner similar to HIFU (see below). The skin can be very warm / hot (like intense sunlight exposure). A series of 6 - 8 treatment sessions, each lasting approximately 45 minutes, is required. The total cost is approximately $ 3000 - $ 4000.

Pellevé using RF and massage for (as expected) "temporary improvements" of cellulite.

Infrared / red light as non-invasive low level laser therapy (LLLT) seems to work - but (as all research shows), it must be the right wavelength of light to work.

Laser diode based systems rely on a series of most effective treatments, like most treatments. However, diode lasers can be a major component of non-invasive LLLT systems and will be useful if the correct wavelengths are used.

Smooth shape uses a vacuum massage coupled with 650nm light and 915nm laser. The massage effect is temporary. Low-level laser therapy (LLLT) has more basis for long-term efficacy but no research supported / peer reviewed data published on light or laser wavelengths.

The TriActive The machine uses the form of LLLT plus vacuum massage.

Liposuction It is a good option to resign through the removal of a troublesome local fat deposit, but it is a bad choice for treating cellulite itself. Liposuction can never make any cellulite better and can actually make cellulite worse!

SmartLipo Laser lipolysis technology (melting fat) is a minimally invasive (non-invasive) procedure. Theory: Laser melts fat, tightens the skin, causing overall smoothness. In practice - good enough to get rid of stubborn fat, rarely helps cellulite.

Cellulaze is from the same company (Cynosure) that manufactures SmartLipo machines. Cellulaze is also promoted as a "minimal invasive" procedure - but this is a surgical procedure! Thin laser cables are inserted under the skin through slices to dilute the subcutaneous fat and gossip the fibrous strips that nourish the skin. It works - kind of - but it's not great. All risks of surgical procedures - recovery / downtime, infections, scars - must be considered.

Subcisi is a very old-fashioned method developed to try to "release" and fasten the lower, depressed, scar attached to the actual surgical cut on the scar tissue stranded under the skin. This technique is sometimes recommended in one form or another to treat cellulite. In fact, Cellulaze depends on this strategy. The effectiveness of subcutaneous techniques for treating cellulite has never been clearly established.

Collagenases is a true connective tissue that dissolves the enzyme used or injected under the skin, aimed at relaxing tight, fibrous pathways as a way to potentially ease paralysis. There are many ongoing studies, but this is still an experiment.

HIFU means High Intensity Focus Ultrasound. This is a non-invasive, non-surgical way to target fat storage for liquids. Focused ultrasound produces great heat under the skin, killing and melting fat cells as a possible alternative to liposuction - but it really hurts! CoolSculpt uses fat freezing technology instead of heat to kill fat cells. Technology also has no positive effect on cellulite. For all we know, the effect of ultrasound or freezing on cellulite may be similar to that often seen for liposuction - not good!

The Verjú Green Laser is a really invasive, painless, elegant technology that actually works! Please see our article, "Verjú Green Laser: Fat Reduction and Cellulite Reduction" to learn more about this new anti-cellulite technology!


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