Written by Ioannis Nikitidis, Medical Doctor, Dietitian and Nutritionist
Cellulite was firstly reported in the French literature 150 years ago; however, it was elegantly portrayed by the artists of the 1600s. Since its occurrence is nearly universal in post-pubertal females, it is considered as a female secondary sex characteristic. Cellulite is defined as a metabolic disorder of subcutaneous tissue that provokes an alteration in the female body shape. It presents as a modification of skin topography evident by skin dimpling and nodularity that occurs mainly in females on lower limbs, the pelvic region and abdomen. It is caused by the herniation of subcutaneous fat within fibrous connective tissue, leading to a padded or orange peel–like appearance. Since there is no mortality or morbidity associated with this condition, it is not considered as a “pathologic” condition, but it is a cause of embarrassment to even young and fit women. (1)
The prevalence of cellulite among post-pubertal women is between 80 and 90%. However, the digitally altered photos in the media deceive the public about the true frequency of this condition which is currently one of the major cosmetic concerns for women. (2)
Causal factors of cellulite
Beyond genetics, there are numerous factors leading to the development of cellulite:
- Gender differences: cellulite affects women exclusively and only very little percentage of men get cellulite.
- Pregnancy, which is associated with an increase in certain female hormones, such as prolactin and non-female hormones like insulin, and increased overall fluid volume—promote cellulite by lipogenesis and fluid retention.
- Ethnicity—white skin women tend to get cellulite more than Asian women.
- Lifestyle— Obesity and high-carbohydrate consumption provokes hyperinsulinemia and promotes lipogenesis, leading to an increase in total body fat content, thereby enhancing cellulite.
- Sedentary lifestyle is characterized by prolonged periods of sitting or standing and may impede normal blood flow, leading to more stasis and causing alterations in the microcirculation of cellulite prone areas. (1)
How cellulite is formed
Several structural and architectural differences characterize cellulite compared to normal fat: Skin dimpling in cellulite and dermal stretch marks. Additionally, women with cellulite have a higher percentage of thinner, perpendicularly oriented hypodermal septae than unaffected women. Moreover, cellulite occurs by gender-related differences in connective tissue that are clinically more evident with weight gain. (1)
Furthermore, there are metabolic and biochemical differences between cellulite and “normal” fat: The human hormones that acutely affect lipolysis in human adipocytes are catecholamines (epinephrine and norepinephrine, which are lipolytic) and insulin. Catecholamine-induced lipolytic responsiveness is greatest in visceral fat than in abdominal subcutaneous tissue and is least responsive in cellulite-prone areas. (1)
Current cellulite treatments and their effectiveness
There are plenty of treatment modalities for cellulite ranging from topical creams to invasive procedures, including laser-assisted lipolysis and liposuction. (3)
Here is a list of the most common cellulite treatments used during the last decades:
- Weight loss
- Topical phosphotidylcholine and LED
- Laser-assisted lipolysis
- Topical herbs and retinol
- Carboxy therapy
According to a 2011 study there is little clinical evidence of an improvement in cellulite, and none have been shown to lead to its resolution. (4) Despite the considerable commercial interest in developing effective strategies aimed at reducing cellulite, most of treatment attempts to date have been conducted in an empirical manner and without the application of rigorous scientific methodology. (5) Recently (2015), researchers analyzed 67 studies regarding the efﬁcacy of various cellulite treatments. They reported that most of these studies have important methodological ﬂaws; some do not use cellulite severity as an endpoint or do not provide sufﬁcient statistical analyses. Among the 67 studies analyzed in this review, only 19 were placebo-controlled studies with randomization. Additionally, researchers didn’t manage to identify clear evidence of good efﬁcacy in any of the evaluated cellulite treatments, even with the most researched topics. (2)
The only device that showed clear superiority over control was the acoustic wave therapy (AWT). Acoustic shock wave therapies use radial or focused waves to treat diseases of the musculoskeletal system, including pain syndromes and muscle aches. AWT has since been introduced as a treatment option for cellulite. It is supposed that AWT may improve local blood circulation. Additionally, shock waves should further increase cell proliferation of collagen and elastin ﬁbers to improve skin elasticity and to revitalize the dermis. AWT may also promote lymph transport and thus effect on lymphedema which is a pathway often associated with cellulite. (2)
Another device that showed congruent improvements in ﬁve studies was the minimally invasive pulsed 1440 nm Nd: YAG laser. It has a side-ﬁring ﬁber and temperature-sensing cannula that is placed sub-dermally. The use of this device seems to signiﬁcantly improve the clinical appearance of cellulite, decrease the number of dimples, dimple depth and smoothen the contour of the skin. However, consistent reproducibility of these results is still pending. (2)
To sum up, cellulite concerns most of the women after adulthood. Media and fashion models create an ideal standard of body image that is not close to the average woman, increasing the demand for better appearance and without cellulite. Despite the market promises, very limited therapeutic options are available that can alter the causal factors responsible for cellulite and their result is not permanent. Some evidence indicates that acoustic wave therapy (AWT) and the 1440 nm minimally invasive laser treatment could have a potential beneﬁt on cellulite, but further research is needed to confirm current suggestions.
Can cellulite be treated, cured? A scientific approach
~ Written by Ioannis Nikitidis, Medical Doctor, Dietitian and Nutritionist