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Need to Know: the Science of Cellulite

Cottage cheese, hail damage, the mattress effect, and orange peel skin — from the French translation peau d’orange, which the doctors in France who first defined cellulite in 1922 named it. Nearly all women have it, and whatever you call it, cellulite is something many women say they dislike about their bodies. 

The appearance of cellulite worsens as we age, especially when we hit menopause — and unfortunately we may be stuck with it. Though there are a slew of treatments and creams claiming to “cure” cellulite, the world has yet to produce any that definitively work beyond short-lived results that take deep pockets to maintain. 

So we reached out to multiple dermatologists to get to the bottom of, well, our lumpy bottoms. Here’s what they said.

Cellulite 101

Some in the medical arena consider cellulite a genetic “disease” and even a mental health issue due to the depression some women suffer from seeing their dimples. Eighty to 90 percent of women develop cellulite during their lifetime (as early as in their late teens) compared to only 10 percent of men. DNA is mostly to blame, due to the different distribution of fat, muscle, and connective tissue in women — and the extra two layers of fat we have on our butts, hips, and knees, where cellulite is most common, as well as our thighs and upper arms.

“Fat and collagen deposit in different patterns in men and women,” explains NYC-based dermatologist Susan Bard. “In women, collagen bends run vertically and horizontally to the fat, leading to the dimpled appearance.” Put visually, men have a tighter collagen structure, like a crisscrossed chain-link fence, whereas women have more open square links, which let fat nodules protrude. “But it’s not a measure of how ‘fat’ you are,” adds Bard. “Even very thin women can have cellulite, while obese men do not. It’s a function of hormones and genetics.”

Estrogen is the big whammy for women when it comes to cellulite. Estrogen produces more fat, and too much estrogen makes fat cells larger. So we’re genetically predisposed to develop cellulite. And then there is menopause.

“The lower estrogen levels that come with menopause are one of the most important factors that contribute to the development of cellulite,” notes Erum Ilyas, a dermatologist in King of Prussia, Pennsylvania. “Lower estrogen leads to changes in circulation and a decrease in the production of collagen and elastic fibers containing the fat and holding it in, and less elasticity gives the skin a tissue paperlike surface.”

This results in even more lumpy fat cells showing through the fence, the extent of which is now graded on the Cellulite Severity Scale.

What Cellulite Treatments Work Best?

Treatments need to address three things: collagen, circulation, and fat. The American Academy of Dermatology (AAD) took a close look at research on the many treatments available — from topical creams to in-office procedures. Below are the approaches the research shows work best, with some treatments signifying hope to diminish the appearance longer term.

Acoustic Wave Therapy (AWT)
This is a handheld device emitting sound waves used by dermatologists to break up cellulite. According to the AAD, studies have shown that AWT can reduce cellulite appearance over several treatments.

Laser
Of the several types of laser treatments for zapping cellulite, research shows that Cellulaze is showing the best results. It’s a minimally invasive miniscule laser fiber inserted and fired under the skin to break up the tough collagen bands. Cellulaze also thickens aging skin, which helps smooth cellulite. Results can last up to a year, whereas with other laser approaches dimples reappear much sooner.

Subcision
Also minimally invasive, with this medical procedure called Cellfina dermatologists insert needles to break up collagen. Results can last two years or more, and in one study 99 percent of patients said they were satisfied.

Vacuum-Assisted Precise Tissue Release
A dermatologist uses a device with small blades like teeny hatchets to cut the culprit collagen bands, which allows tissue to move closer to the surface to fill out dimpled skin so it’s smoother. The AAD feels more research is needed, but one study showed results lasting three years.

Liposuction
Women often assume that liposuction will combat cellulite, but it’s not recommended as it only removes fat. “Liposuction is not an effective treatment for cellulite. In some cases, it can make the appearance of cellulite worse by creating dimples,” explains Dallas plastic surgeon Zachary Farris.

Massage
Extra fluid in our soft tissue makes cellulite look worse. “Massaging the areas can improve the appearance of cellulite by reducing the excess fluid in the soft tissue,” says Dr. Ilyas. “However, it cannot get rid of the actual fat or improve the strength of connective-tissue fibers that have loosened resulting in the actual cellulite.”  

Topical Creams
Creams targeted at cellulite today typically contain caffeine and can help somewhat. “Topical caffeine-containing creams can temporarily dehydrate skin, so puckering is less apparent,” says Beverly Hills dermatologist Tsippora Shainhouse. Research is also showing that creams containing 0.3 percent retinol can positively impact cellulite. But in both cases they take at least six months to see real effects and usually require daily application.

Weight Loss
You may think weight loss would be an ideal approach to reducing cellulite, but it can backfire. “For some, weight loss can help decrease the appearance of their cellulite because there’s less fat pushing through the net of collagen fibers,” says Dr. Bard. “For others, weight loss can accentuate cellulite as the skin becomes looser and can appear more rippled.” (Of course, don’t let this hold you back from pursuing weight loss for important health goals.)  

Exercise
Most agree that staying fit helps fight cellulite. More muscle, less fat! Keep doing your cardio and strength training, because replacing fat with muscle helps skin look smoother and cellulite will be less noticeable — a theory supported by the AAD. 

Photo: Republica

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