Dimple dimple little star, how I wonder what you are?
It’s on the mouth of most…or better it is on the buttocks of many.
To be precise, about 85% of women suffer from cellulite and yet it is a great taboo, the big shame.
“Suffer from cellulite”, I think I never chose a better combination of words. Cellulite is not only a beauty problem, it is a condition that can have emotional and social repercussions.
And if this sounds exaggerated, check how many think of it as the “despicable thing”.
Let’s try to understand what is cellulite, what options we have and what we can do about it.
Whether treatments work or not, keep in mind that you are not alone!
What is cellulite and what causes it?
Medically, it is known as gynoid lipodystrophy or dermopanniculosis. Some consider it a disease due to the fact that severe stages can present:
Painful nodules and increased local temperature, which are suggestive of an inflammatory reaction occurring in the dermis and in the underlying subcutaneous adipose tissue.
Some others consider it just a normal condition that has been marketed as disease.
Cellulite is described as:
A complex problem involving the microcirculatory system and lymphatics, the extracellular matrix and the presence of excess subcutaneous fat that bulges into the dermis…Differences in the fibrous septae architecture that compartmentalize the adipose tissue have recently been reported in women with cellulite compared with men.
In other words the fat cells present in the hypodermis, or the subcutaneous adipose tissue (SAT), grow in volume and become “compressed” by collagen walls (septae) that separate different chambers in the adipose tissue. Fat cells then push upwards into the connective tissue (dermis) and create the infamous bumps.
Why this happens has not been determined with absolute confidence, however rather than a single cause there are many triggers, a multi-cause.
Tendency to cellulite has been attributed to specific genes. People with these genes have higher chance to develop cellulite.
Hormones, especially oestrogen’s have a big part in skin and they stimulate lipogenesis (the formation of fat). In fact, that is one of the reasons why cellulite is mostly a condition for women rather than men.
It is reported that fibroblasts activated by oestrogen increase Glycosaminoglycan (GAG) that leads to water retention. In this way blood vessels are compressed, leading to tissue hypoxia (when tissues are deprived of oxygen) and intercellular oedema (swelling).
Lifestayl is a very important factor in cellulite formation and it is often disregarded. No treatment will be effective if bad habits are not changed.
A non balanced diet with excessive consumption of carbohydrates and poor in fibers leads to the “hypertrophy of fat tissues” (increase in fat cells volume).
A sedentary lifestyle, smoking and wearing tight clothes decrease blood flow and venous return, contributing to the formation of cellulite.
The most evidence-based way of improving blood circulation is physical exercise. A study showed that blood flow in the fat tissue is higher near contracting muscles than resting ones.
A flavonoids-rich diet (blackberries etc) can also improve blood circulation. Researchers showed that a 45 days consumption of chokeberry juice resulted in considerable reduction of oedema.
Connective tissue structure
The structure of the connective tissue differs from men and women.
Women have a higher percentage of vertical septae (the walls that separate different chamber-like structures in the fat tissue), while men have a mostly horizontal ones.
Vertical septae favour the vertical expansion of fat cells towards the dermis, while horizontal septa favour the expansion of fat cells internally to the fat tissue and laterally.
Cellulite is associated with micro-circulation problems and venous insufficiency: when the superficial blood and lymph circulation is impaired, this can result in swelling between cells in the connective tissue.
Circulation problems have been theorised as possible cause of cellulite but this hypothesis has never been proven. Yet, often cellulite and poor micro-circulation are related.
Cellulite is classified according to the Nürnberger-Mülle scale.
No dimpling when the subject is standing and lying. The pinch test reveals “folds and furrows”, but there is no orange peel-like appearance.
In this stage, blood and lymph vessels supply the fat tissue with nutrients and remove toxins. Fat cells (adipocytes) have regular size.
No dimpling while the subject is standing or lying, but the pinch test reveals the orange peel-like appearance.
The blood vessels are more fragile, their walls cannot retain fluids and leak plasma in between cells, causing swelling. The lymphatic system is not able to completely remove fluids.
Adipocytes become bigger and clump together, hindering blood flow.
Orange peel-effect appears spontaneously when standing and not lying down.
Fat cells form micro-nodules and dermis and epidermis (first 2 layers of skin) become thinner, allowing cellulite to become visible.
Orange peel-effect is visible both standing and lying down.
Micro-nodules come together to form larger sized macro-nodules and are surrounded by stiff collagen and fibers.
Nerves might be compressed by the macro-nodules leading to painful spots.
The first stages are believed to be reversible to a certain extent while the more severe stages are considered resilient to treatment.
In general, there is no cure for cellulite, however many treatments have been developed that give somewhat short or long term effects, but no permanent solution.
What are the available treatments?
The most used ingredients in topical cosmetics are xanthines, retinoids, and plant extracts.
The new trend is to apply anti-cellulite cosmetics and use neoprene shorts overnight to provide occlusion. In topical cosmetic the most important factors are the concentration of active ingredients and how they are delivered and reach where needed.
Usually, the effects regress as soon as these treatments are stopped.
These are very common and include caffeine, aminophylline and theophylline. Their effect is to break fat, often referred to as lipolysis.
Amynophylline are however the least promising, showing almost no effect
Retinol at 0.3% has been used over a period of 6 months and was reported as effective. It is absorbed and transformed into retinoid acid. This improves the collagen and elastic fibers.
At cellular level, it has also the ability to reduce fat through cellular heat dissipation, in other words “burning” fat locally.
Anti-cellulite creams often use plant extract like Centella asiatica, butcher’s broom, horse chestnut, ivy, Ginkgo biloba, Witch hazel, white oak, green tea, lemon, kola, fennel, algae, barley, sweet clover, etc… The strength of these extracts is their molecules, like flavonoids or terpenes. Their main action is that of enhancing the peripheral circulation of blood and lymph. Some algae such as fucus vesiculosus, laminaria flexicaulis, and ascophyllum nodosum are used to improve skin texture.
In simple words, this means fat freezing. This kind of non-surgical procedure is used for localised fat. A device cools down the treated area to about 4 degrees Celsius and is kept on spot for about 45 minutes-1hour. The technique uses a combination of acoustic waves and cryolipolysis. The shock waves improve the appearance of cellulite by remodelling collagen, while the freezing of fat cells in the subcutaneous layer initiates an inflammatory response that destroys fat cells. Cryolipolysis improves also skin tightness.
TriAcrive is a technique that combines suction, massage, low-level laser light, and contact cooling.
A study reports the improvement of cellulite, skin texture and tone. The subjects with light to moderate symptoms showed the greatest improvement.
VelaSmooth and VelaShape use both infrared light (700 − 2000 nm) and radiofrequency (RF) energy. Many studies reported its effectiveness, where up to 90% of subjects, with moderate cellulite, noticed an improvement. As a side effect some patients experienced bruising. The effects regressed to an average 25% cellulite improvement after 6 months.
Another study compared TriActive to VelaSmooth. The results with the two techniques were very similar, except that subjects experienced more bruising with VelaSmooth.
Shock wave therapy (SWT)
A device produces shock waves or acoustic waves that propagate into the skin and improve collagen structure.
Several studies showed that SWT helps prevent fibrosclerosis, the hardening of fibers and that:
An amazing induction of neocollageno- and neoelastino-genesis is observed within the scaffolding fabric of dermis resulting in increased thickness of the dermis.
Fat is not reduced but collagen synthesis is promoted and becomes denser and firmer.
In general, this technique has been proved to show good temporary results.
This kind of technology, known as Cellulaze or CelluSmooth, requires only one treatment however it is invasive: a very thin fiber with aNd:YAG 1440 nm laser is inserted in the skin, breaks down fat and the septae that pull down the skin. Several studies reported that this procedure:
Produced significant improvement in cellulite with one treatment after 6 months of follow up.
Radio Frequency (RF)
RF is used to treat cellulite by heating the dermis and hypodermis.
RF thermal stimulation is believed to result in a microinflammatory process that promotes new collagen.
A study affirms that:
RF treatment on cellulite produces a decrease in lipid content of cells as well as changes in the adipocyte membrane which will lead to cell rupture and the death and extrusion of lipid content out of the cell.
Treatments like deep massage, manual and pneumatic lymph drainage are more effective in the initial stages of cellulite as they stimulate blood and lymph flow, help in removing toxins and fluids in between fat cells and delay the formation of fibrosclerosis and nodules.
Research showed that:
Deep mechanical massage enhances the presence of longitudinal collagen bands whereas distortion and disruption of adipocytes was noted.
In other words, massage helped to brake fat cells and enhance horizontal septae (collagen bands) instead of vertical ones that are related to cellulite.
Endermologie is based on the theory that devices that use massage techniques can improve cellulite.
The skin is massaged and kneaded by the device to increase lymph drainage and affect the skin architecture (collagen bands etc…)
Though Endermologie is a popular treatment, the available scientific results are controversial and feelings are mixed. Some studies report a certain degree of improvement, whereas other studies only very modest results
In a nutshell
Of the topical cosmetic solutions, retinoids are your best bet.
Among the non invasive treatments:
- Cryolipolysis is effective against localised fat, however it needs shock waves or other to be effective against cellulite.
- VelaSmooth/VelaShape results are comparable to TriActive, except that VelaSmooth can cause more bruising
- Shock waves and RF work mainly by boosting collagen production. The thickening of skin can improve cellulite appearance.
- Massages can moderately help by improving microcirculation and mildly affecting the collagen structure, this is valid also for Endermologie.
- Laser fibers procedures are costly and invasive but effective in reducing cellulite. This does not mean that all the dimples will disappear and your skin will be smooth as silk.
All the treatments depend on the ability of the technician that applies them. All have a temporary effect.
Yet, there is no cure or miracle for cellulite. You cannot eliminate it but you can improve its appearance.
My firends, after so much information it is time to say Poopaye!