Cellulite might sound like a sexy name for a high-tech fabric, but it is not. When called by its actual name, edematous fibrosclerotic panniculopathy, it definitely does not sound so sexy! While cellulite poses no significant health risk, it can cause a significant amount of cosmetic embarrassment. While cellulite affects up to 90% of the female population, its prevalence indicates that it is a physiologic, rather than pathologic, process.1
The term cellulite was first used in the 1920s to market the services of beauty spas and was first seen in English-language periodicals such as Vogue in 1968.2 A myriad of treatments have been developed to treat cellulite, though most have limited success. Today’s slim-fit, revealing clothing make surface irregularities associated with cellulite harder to hide, driving the desire in consumers for effective treatments.
What It Is
Cellulite is caused by the herniation of subcutaneous fat within vertical fibrous connective tissue bands that manifests topographically as skin dimpling and nodularity. It is most commonly found in the pelvic region (specifically the buttocks), lower limbs, and abdomen,and cellulite occurs in most post-pubescent women.3 There are several factors that can enhance the appearance of cellulite: poor diet, yo-yo weight loss, slow metabolism, lack of physical activity, reduction in estrogen levels causing reduction in the production of good collagen, dehydration, excess total body fat, thin skin, and lighter colored skin.4 These factors affect one or more of the following: volume of fat, strength of fibrous connective tissue, or thickness of skin.
Current Treatment Options
While many treatment modalities have been developed in recent years, not many have had much success. Researchers have been able to show some reproducible success in the treatment of the condition with multimodality therapies. While there is no “cure” for cellulite, these treatments have the potential to improve the appearance of cellulite and patient satisfaction.
Weight loss. Any patient who is overweight and presents with complaints of cellulite will need to recognize that one thing they can do at home is create a lifestyle that aids in gentle, consistent weight loss. Reducing excessive subcutaneous fat reduces the stress on the fibrous compartments in the superficial skin and results in less obvious cobblestone appearance. This is in stark contrast to yo-yo dieting, which causes cellulite to worsen by repeatedly stretching and shortening collagen fibers in the skin to the point of failure. Reduction in tensile strength of these fibers increases their laxity, causing visual malformation of the skin’s surface.5
Topical creams. The cosmeceutical market is filled with creams that promise the impossible: a cure for cellulite. Most simply never live up to those claims.6 There are a few topical ingredients, however, that have been shown to have an effect. One such ingredient is 0.3% retinol. Vitamin A-derivative retinoids such as retinol are known to help increase the thickness and strength of the skin. Research has shown that using topical 0.3% retinol for at least 6 months can help improve the appearance of cellulite.7
Another ingredient shown to be effective for treating cellulite is topical caffeine. Caffeine is added to antiaging skin care creams because of its ability to “tighten” skin as a vasoconstrictor that reduces intracellular edema and a promoter of lipolysis. This, in turn, shrinks the fluid-filled fat cells and causes a tightening effect in the superficial skin, resulting in smoother looking skin.8,9 Caffeine is also a known antioxidant, and its use promotes the reduction of free radicals in the skin and can augment the protective effects of sunscreen against UV photoaging.10 Caffeinated creams must be used daily to maintain the effects.
Aminophylline/theophylline creams function in a way similar to caffeine. In one study that compared patients using a topical preparation containing aminophylline vs placebo, results showed a significant reduction in the appearance of cellulite.8
Tissue massage. Over the last 20 years, there has been exploration of the idea that massage (soft tissue massage, manual lymphatic drainage, connective tissue manipulation, and vacuum massage [eg, Endermologie]) can improve the appearance of cellulite. While the exact mechanism by which massage helps is unknown, it has been shown to help skin by draining excess lymphatic fluid, redistributing and reducing fat cell mass, and improving microcirculation in the skin.11-13 While this may sound great, these studies11-13 showed the appearance of cellulite returned within 3 months after cessation of treatment protocols. Additionally, the risks of deeper massage techniques include skin injury, bruising, hematoma, and hemosiderin deposition. Though not a cure, massage may be a valuable adjunct for patients, especially in terms of at-home management.
Subcision modalities. Subcision is known to help improve the appearance of indented scars by cutting and releasing fibrous connections to the skin’s surface using specialized cutting needles or forked liposuction cannulas. It is also an excellent technique to reduce the appearance of cellulite in more limited or focal areas.14
Vacuum subcision is one particular technical variant of this approach. One vacuum subcision device (Cellfina) has shown excellent results; with this device, larger indentations can be suctioned into the device and cut at two different depths to provide significant and complete tissue release. Patient satisfaction is extremely high with this treatment, with a low incidence of significant side effects and results maintained for at least 3 years.15,16