Cellulite

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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What is cellulite?

The term cellulite refers to the dimpled appearance of the skin that some people have on their hips, thighs, and buttocks. Cellulite is much more common in women than in men because of differences in the way fat, muscle, and connective tissue are distributed in men's and women's skin. The lumpiness of cellulite is caused by fat deposits that push and distort the connective tissues beneath skin, leading to the characteristic changes in appearance of the skin. Cellulite has been medically referred to as edematous fibrosclerotic panniculopathy (EFP).

Cellulite is not related to the condition known as cellulitis, which is a spreading bacterial infection or inflammation of the skin and tissues beneath.

What causes cellulite?

The dimpled appearance of cellulite can be considered to be a normal variant -- one way that many perfectly normal human beings look. Heredity, skin thickness, gender, the amount and distribution of body fat, and age can all influence the extent to which cellulite is present or visible. Cellulite is thought to occur due to shrinkage or shortening of the fibrous tissue cords that anchor the skin. While cellulite is more common in women than men, men can also be affected. Cellulite occurs in people of all races living all around the globe. Although female hormones may play a role in contributing to this pattern of fat distribution, cellulite is not treatable by hormone therapy.

What are risk factors for cellulite?

Cellulite is more common in women than in men. Having a family history of cellulite is another risk factor. Pregnancy and an inactive lifestyle may increase the risk of developing cellulite.

What are cellulite symptoms and signs?

Cellulite causes dimpling of the skin and a lumpy appearance to the flesh. Cellulite can cause an "orange peel" appearance to the skin. It is most commonly located in the hips, buttocks, and abdomen. Sometimes it occurs in the breasts, upper arms, or belly. With mild cellulite, the dimpling is not apparent unless the skin is pinched.

How do doctors diagnose and assess cellulite?

Cellulite is typically considered to be a cosmetic problem. The characteristic appearance of cellulite is sufficient to confirm that the condition is present. There are no diagnostic tests for cellulite.

What specialists treat cellulite?

Since cellulite is considered to be a cosmetic problem, aesthetic physicians, including plastic surgeons and some dermatologists, may offer some treatments for cellulite.

Quick GuideCellulite Facts and Treatment Options

Cellulite Facts and Treatment Options
Learn about ways to get rid of cellulite.

How do I get rid of the cellulite on my thighs?

Cellulite is caused by irregular patterns of connective tissue beneath the skin, and as the adipose (fatty) tissue, which forms in compartments of little honeycombs, pushes into the skin, it causes the dimpling of cellulite. It has been shown that people who have cellulite have different patterns of connective tissue than people who don't, and men tend to have this pattern much less than women. Cellulite is not directly a function of excess weight, but a genetic difference in the way adipose tissue and connective tissue form. In fact, cellulite affects people whether they are overweight or not. Biochemically, cellulite does not behave any differently than other fat, and there is no health risk from cellulite (some evidence even suggests that lower extremity fat is protective against chronic diseases like diabetes and heart disease).

What are the supposed treatments for cellulite?

Many people dislike the appearance of cellulite and prefer to have skin as smooth as they possibly can. Therefore, much has been written about cellulite, and many treatments have been promoted, ranging from dietary changes to cellulite creams and mechanical treatments. Some of these therapies include

  1. Methylxanthines: Methylxanthines are a group of chemicals that include aminophylline, caffeine, and theophylline. These chemicals are present in many cellulite creams and are promoted as treatments for cellulite because of their known ability to break down fat stores. However, skin creams cannot deliver the required concentration of these chemicals for the length of time required for significant fat breakdown. While studies have shown a small reduction in thigh measurements with some of these preparations, they do not promote significant loss of cellulite.
  2. Dietary supplements: Several of these products have been marketed and contain a variety of ingredients such as ginkgo biloba, sweet clover, grape-seed bioflavinoids, bladder wrack extract, oil of evening primrose, fish oil, and soy lecithin. These preparations claim to have positive effects on the body such as boosting metabolism, improving circulation, protecting against cell damage, and breaking down fats. Such claims are difficult to evaluate as is the case with similar assertions made on behalf of many supplements and alternative therapies. Concepts such as "metabolism," "circulation," or "cell damage" cannot be easily measured on an objective basis to determine whether or not any improvement has been achieved. Additionally, because these products are sold as dietary supplements and not as drugs, they are not subject to the jurisdiction of the U.S. Food and Drug Administration (FDA). They are therefore exempt from meeting the scientific standards for both safety and effectiveness that are applied to drugs. Furthermore, there are no valid clinical studies to support the use of these dietary supplements for the treatment of cellulite. Studies that have been conducted have not demonstrated any value of these supplements. Some dietary supplements that are promoted for the treatment of cellulite may also pose health risks or may interact with certain prescription drugs. For example, the formulation known as Cellasene contains iodine, which many doctors warn may be harmful for those with thyroid and other conditions.
  3. Massage treatments: Several machines have been introduced that massage the areas affected by cellulite. These machines use rolling cylinders to gather areas of skin and massage them inside a chamber. One example of massage treatments is Endermologie, which was developed in France and has been used for cellulite treatment since the mid-1990s. This technique uses an electrically powered device that suctions, pulls, and squeezes affected areas. Treatments are expensive and typically last for 30-45 minutes. Ten to 12 treatments are typically required before results are noticeable. Endermologie has been approved by the U.S. FDA for temporary reduction in the appearance of cellulite. While a temporary decrease in the appearance of cellulite may occur, the technique appears to redistribute fat rather than permanently alter its configuration under the skin. Regular maintenance treatments are required after the initial effect has been achieved or the cellulite will return.
  4. Laser, light, or radiofrequency therapy: The FDA has approved certain light-therapy devices that combine suction or massage with light therapy for the temporary reduction of the appearance of cellulite. TriActive is a treatment that combines a low-level laser treatment with suction and manipulation of the skin, while Velasmooth/Velashape is a treatment combining laser and massage therapy. Like Endermologie, both treatments require multiple treatment sessions and maintenance treatments to keep up the improved appearance. Laser/massage treatments are even more costly than massage treatments; the complete program generally costs thousands of dollars. Other systems use radiofrequency therapy in combination with massage and infrared light or radiofrequency at multiple levels simultaneously.
  5. Mesotherapy: Mesotherapy is a controversial treatment for cellulite that involves injecting drugs or other substances directly into affected tissue. Often, FDA-approved medications are used off-label (meaning that they have been approved for other conditions but not for treatment of this particular condition) in the injections. Herbs and vitamins are often used as well in the injection cocktails. Many injections over multiple (typically 10 or more) sessions are administered. Although this procedure is offered by some physicians, most experts feel that this treatment is unproven and risky.
  6. Collagenase: Collagenase is a naturally occurring enzyme in the body that breaks down collagen, a component of connective tissue (the tissues that bind our cells together). Some studies have suggested that injections with this enzyme may be beneficial in improving the appearance of cellulite, but the long-term effects of these injections are still unknown, and studies have not yet been completed to determine the extent and duration of the improvements, if any. The treatment is considered experimental and is not yet routinely available, but research and trials are under way to determine if collagenase injections may become an option for the treatment of cellulite.
  7. Cellulite diets: Special "cellulite diets" have been proposed that claim to be effective in treating cellulite. Proponents of these diets claim that the combination of foods in the diet can reduce inflammation and improve circulation in affected areas and diminish cellulite. However, no studies published in the medical literature have supported these claims. Experts have conclude that eating a healthy diet can decrease fluid retention and improve the overall health and appearance of skin, but specific diets designed to target cellulite are of no value.
  8. Wraps: Many salons offer herbal or other types of body wraps as treatments for cellulite. Like cellulite diets, their effects have not been proven or reported in controlled studies in the medical literature. While wraps may decrease fluid retention and improve the overall appearance of skin, these effects are temporary. It is also not possible to "detoxify" the body by the use of herbal or other wraps.
  9. Subcision: This technique involves cutting the fibrous cords (septae) that pull down on the lower part of the skin. Subcision is performed with the Cellfina device, manufactured by Ulthera. The U.S. FDA approved the treatment in 2015 for improvement in the appearance of cellulite on the buttocks and thighs with no loss of benefit for up to two years.
  10. Retinol cream: Applying retinol cream (the product used to combat wrinkling of the facial skin) two times per day has been shown to decrease skin dimpling after six months of use.

How about liposuction?

Liposuction is also not a recommended treatment for cellulite. This technique of extracting fat by vacuuming it from under the skin is not effective for cellulite. In fact, liposuction may worsen the appearance of the skin by sucking out the cushion of fat that resides just under the skin. The result is additional dimpling of the skin.

How to get rid of cellulite

  • Eating a healthy diet and keeping muscles toned by regular exercise are reasonable approaches to keeping the body as taut and smooth as it can be.
  • Patients should be very cautious before trying out surgical procedures, dietary supplements, or elaborate techniques of unproven value.
  • While the FDA has approved massage and combined laser/massage therapies, it is important to remember that these costly and time-consuming treatments are approved only for the temporary decrease in the appearance of cellulite and require ongoing treatments to maintain any effect.

What is the prognosis for cellulite?

Cellulite is not a medical problem and does not have adverse health consequences. Most treatments, even those that are FDA-approved, only offer a partial and temporary solution. The prognosis is related to cosmetic opinion and treatment results.

Is it possible to prevent cellulite?

It is not always possible to prevent cellulite, but maintaining a healthy weight and getting regular exercise may help diminish the appearance of cellulite. Maintaining hydration (drinking plenty of fluids) and smoking cessation may also make cellulite less noticeable.

REFERENCE:

Tuck, Miriam E. "Cord-Cutting Technique Smooths Cellulite for 3 Years." Medscape.com. Mar. 11, 2016. <https://www.medscape.com/viewarticle/860285>.

Quick GuideCellulite Facts and Treatment Options

Cellulite Facts and Treatment Options

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Reviewed on 9/6/2016
References
REFERENCE:

Tuck, Miriam E. "Cord-Cutting Technique Smooths Cellulite for 3 Years." Medscape.com. Mar. 11, 2016. <https://www.medscape.com/viewarticle/860285>.

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