Cellulite is a dermatologic condition that predominantly affects postpubertal females.1–3 It is characterized by topographic changes of the skin, especially in areas of greater fat storage, mainly the thighs, buttocks, and hips. Clinically, the topographic changes manifest as dimpling, denting, or nodulation, leading to an uneven surface of the skin. The dimpling gives the skin the appearance of “mattress-like,” “cottage cheese,” or “orange peel,” which is the characteristic clinical appearance of cellulite. Medically, cellulite is referred by various terms, including gynoid lipodystrophy, nodular liposclerosis, edematofibrosclerotic panniculopathy, adiposis edematosa, dermopanniculosis deformans, and status protrusus cutisreflecting some of the perceived pathophysiology (functional and/ or biological changes) of this condition.
There are numerous treatments for cellulite, from non-invasive to minimally invasive modalities. However, the treatment of cellulite remains a challenge, partly because it is a complex disorder with an enigmatic etiopathogenesis and partly because of the limited efficacy of available treatments.
Females of all races/ethnicities are affected, although Caucasian females are more susceptible than Asian or African American females. There is no particular age of onset for cellulite. It can occur at any age post-puberty, although it mostly appears between the ages of 20 and 30. Males are rarely affected by cellulite. In about 2% of males, cellulite may develop due to androgen deficiency secondary to castration, hypogonadism, Klinefelter's syndrome, or estrogen or antiandrogen therapy for prostate cancer.
Because gender is a primary influencer of the biomechanical forces at the subdermal junction, the female sex hormone estrogen likely plays a pivotal role in the development of cellulite. In addition, high-estrogen states, such as pregnancy, nursing, chronic oral contraceptive use, or hormone replacement therapy in post-menopausal females, appear to exacerbate or worsen the progression of cellulite.
A number of other factors may also contribute to the development or worsen the severity of cellulite. Aging negatively impacts the dermis and the fat lobules. Aging reduces the collagen and elastin content of the dermis, atrophying the dermis. Fat herniation can increase at the subdermal junction through an atrophied dermis. With aging, there is also hypertrophy of fat lobules. Enlarged fat lobules may cause further imbalances of the biomechanical forces within the subcutaneous layer. Advancing age, thus, increases the risk of cellulite development. Indeed, elderly females with a high BMI have the greatest risk of developing or worsening of cellulite. Age, however, is unlikely to be a primary contributor because aging of the dermis occurs in both genders.
Treatment:
Caffeine and retinol are the most studied ingredients in oral formulations. Caffeine acts by inhibiting phosphodiesterase, thereby inducing lipolysis. It also stimulates cutaneous microcirculation and is an antioxidant. Retinoids act by increasing dermal thickness, increasing angiogenesis, synthesizing new connective tissue components, and increasing the number of active fibroblasts.
A plethora of oral supplements are utilised to improve skin appearance. Supplements containing extracts of Vitis vinifera, Ginkgo biloba, Centella asiatica, Melilotus officinalis, Fucus vesiculosus, fish oil, and borage oil are thought to be useful in cellulite treatment because of their antioxidant effects. Aronia juice may help reduce cellulite, as it is believed to enhance cellular metabolism, increase collagen and elastin synthesis, reduce edema and bowel inflammation, and improve microcirculation.
Massage is one of the oldest methods to treat cellulite that works by stimulating lymphatic drainage, thereby addressing the underlying impaired microcirculation and drainage deficiencies associated with cellulite. Massage can be performed manually or mechanically with the help of devices. Manual massage is rarely performed in clinical practice.
Non-invasive, energy-based devices utilizing RF, light and lasers, and acoustic waves have been extensively studied for the treatment of localized adiposity and/or skin laxity, 2 factors that may contribute to cellulite appearance.
Radio Frequency (RF) devices deliver thermal energy via electrode(s) to the target area. Thermal energy is produced from the resistance to the flow of an electrical current through the dermis and subcutaneous tissue; this resistance is referred to as bioimpedance. The heat generated elevates the tissue temperature at the target area, stimulating collagen denaturation, re-modelling, and neocollagenesis, which cumulatively lead to skin tightening.
RF devices are available in various iterations: the first-generation devices include unipolar, monopolar, or bipolar devices and the newer generation devices include multipolar, multi-generator, or temperature-controlled devices. The depth of penetration of the thermic energy differs between the devices, with the multipolar devices having the greatest depth of penetration followed by monopolar and then unipolar devices. Bipolar devices have the least depth of penetration. In temperature-controlled devices, where superficial skin layers are cooled at the same time, RF can penetrate to the deeper fat tissue and stimulate lipolysis, resulting in circumference reduction. Some of the RF devices also integrate other technologies, such as infrared light, vacuum suction, and pulsed-electromagnetic fields
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RF devices, particularly the newer generation devices, have been shown to be effective in reducing the appearance of cellulite in clinical studies.
Similar to RF devices, light and laser devices work by emitting thermal energy into the target area. The extent to which the emitted energy penetrates the target tissue (dermis or subcutaneous tissue) is dependent on the wavelength. The heat generated stimulates collagen re-modelling and increases microcirculation, potentially improving cellulite appearance. There is some evidence of benefit for lasers but the need for multiple sessions and the lack of durability of results are limitations.
Acoustic wave therapy is widely used to treat musculoskeletal injuries, as it helps improve cutaneous microcirculation, neocollagenesis, and lymphatic drainage. Because of these effects, acoustic waves are also used as a treatment for cellulite to help restructure the skin and improve its topography. Usually 6 to 8 treatment sessions are needed to see a visible reduction. Data on the durability of results beyond 1 year is lacking.
This is just part of the article on cellulite and I will copy more about the subject. This is not my own work. If you wish to read the full article now, then it is here:
Gabriel A, Chan V, Caldarella M, Wayne T, O'Rorke E. Cellulite: Current Understanding and Treatment. Aesthet Surg J Open Forum. 2023 Jun 21;5:ojad050. doi: 10.1093/asjof/ojad050. PMID: 37424836; PMCID: PMC10324940.
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