All too often my patients ask me about the orange-peel textured skin, commonly known as cellulite, that appears on their upper thighs. They want to know if I can smooth it out for them? Or, they wonder, if they are stuck with it forever? There are many lavish creams and costly procedures that are heavily marketed to get rid of the unsightly puckered skin. The question remains, however, is it really possible to get rid of cellulite? In our fat-phobic society, the cellulite industry has blossomed to a billion dollars plus annually. And it is predicted to continue growing. Common questions about cellulite What is cellulite? Cellulite is common. It is harmless and it is not a medical condition. Cellulite is the term commonly used to describes the lumpy dimpled flesh that is usually found on the upper thighs, hips, and buttocks. Cellulite is not a medical condition It is harmless And, it is common That being said, the uneven appearance of skin that often makes people feel self-conscious about wearing shorts or a bathing suit. It is the main reason why they pursue remedies to “cure” it. What causes cellulite? There is no known cause of cellulite. It is a result of fat pushing against fibrous connective cords that tether the skin to the underlying muscle. This causes the surface of the skin to pucker. Cellulite formation is believed to be influenced by hormones. This is because cellulite most commonly develops after puberty. And, it may increase during pregnancy. Cellulite development may have a genetic component as genes determine skin structure, patterns of fat deposition, and body type. What are the risk factors for developing cellulite? Cellulite affects 80%-90% of women after puberty. It is more common as we age and lose skin elasticity. Cellulite is not an indication of being overweight, however, overweight and obese individuals are more predisposed. Anyone regardless of their BMI (Body Mass Index ) can have cellulite. Since extra weight can increase the occurrence of cellulite, weight loss may reduce it. Improving muscle tone with exercise may also make cellulite less noticeable. Cellulite is less noticeable in darker skin so applying a self-tanner may make the dimples on the thighs less evident. Treatments being used for cellulite There are many over-the-counter products that promise to rid of those lumps and bumps on the thighs, hips, and buttocks. However, beware, there is very little scientific evidence that proves that any of them are permanently effective. Medically proven treatment options are also available. Unfortunately, all too often, the results of these treatments are not immediate nor are they long-lasting. This can be disappointing to many patients who were expecting to return the affected areas to their pre-cellulite look. Perhaps, lowering expectations so that treated individuals anticipate only, a temporarily improved appearance, or a diminishment of the dimpled skin would yield more satisfaction with existing therapies. Over-the-counter topical creams OTC creams that contain aminophylline and caffeine are often touted as effective treatments. Caffeine-containing creams supposedly dehydrate the fat cells making the cellulite less obvious. Promotions of aminophylline-containing creams claim that they initiate the process of fat breakdown. Unfortunately, these products have been shown to cause racing of the heart. They may also interact with certain asthma medications. To date, no double-blinded control studies prove the efficacy of these types of creams. In addition, the necessity to apply creams daily to obtain and maintain results should any improvement occur is both costly and time-consuming. Spa treatments FDA-approved medical devices that may temporarily improve the appearance of cellulite by deep tissue massage while also lifting the skin with a vacuum-like device are touted at local spas to treat cellulite. Although this treatment option has few side effects, there is little evidence it is effective. Procedures used to improve the appearance of cellulite Procedures that may temporarily improve the appearance of cellulite include the following: Laser & radiofrequency Both ablative (treatment that injures the top layer of skin) and non-ablative (treatment that heats up the lower skin layers without harming the most superficial skin surface) methods are available to minimize the appearance of cellulite. One particular minimally invasive method uses a thin fiber to apply heat to destroy the underlying fibrous bands. Non-ablative treatments typically require more treatments than their ablative counterparts. These treatments, again, may temporarily reduce the appearance of cellulite. Subcision This procedure involves the insertion of a needle just below the skin which is used to break up the fibrous bands beneath the skin. Studies show a high percentage of patient satisfaction after this procedure for up to 2 years. Vacuum-assisted precise tissue release Vacuum-assisted precise tissue release is similar to subcision. This technique uses a device that cuts through the tough fibrous bands with small blades. It is followed by the use of a vacuum to pull the skin into the dimpled area. The temporary benefits may last for several years but the procedure is more costly than other cellulite treatment options and longer recovery times are often necessary. Carboxytherapy This procedure involves the insertion of carbon dioxide gas (CO2) just beneath the skin to destroy the fat. Although temporary improvement may occur, this procedure may be painful and can cause significant bruising. Other cellulite therapies Other touted cellulite therapies that require more studies to determine if they are beneficial: Liposuction Liposuction is effective in removing deeper fat but has not been shown to be effective in removing cellulite. In fact, it has even been shown to worsen the appearance of cellulite possibly by creating more depressions in the skin. Ultrasound Ultrasound is a non-invasive procedure that uses sound waves to destroy the underlying fat but there is no evidence it can reduce the appearance of cellulite. Therapies that should not be used to treat cellulite The American Academy of Dermatology recommends that the following therapies not be used for treating cellulite: Cryolipolysis Using a vacuum suction device, the skin is frozen to destroy the fat. This device has not been shown to get rid of cellulite. Mesotherapy This procedure involves a non-standardized series of injections of any number of substances into the cellulite with the hopes of smoothening the dimpled skin. Substances often used include caffeine, various enzymes, and plant extracts. Allergic reactions, inflammation, infection, and skin swelling are not uncommon side effects. Oral supplements There is no current evidence that taking oral supplements can reduce cellulite. Future treatments In July 2020, the FDA approved an injectable, Qwo (collagenase clostridium histolyticum-aaes), for the treatment of moderate to severe cellulite of the buttocks of adult women. This drug is thought to release enzymes that break up the fibrous bands resulting in smoother skin and improved appearance of cellulite. This treatment option is expected to be available in the spring of 2021. The bottom line Although it may be possible to temporarily improve the appearance of cellulite, a permanent cure has not yet been discovered. And, until there is a complete overhaul of our cultural beauty standards, there is no way to permanently triumph over dimpled skin. Source
