Cellulite affects approximately 85 to 98 percent of post‐pubertal females of all races and skin types. It is often referred to as "orange peel" or dimpling skin, appearing in women primarily as they age on the thighs, buttocks, lower abdomen and arms. Since its discovery, there has been lots of purported treatments of what was originally described as a disease. Cellulite is not a disease, and the cause is determined to relate to several physiological factors including skin architecture, altered connective tissue, vascular and inflammatory factors, and diet as related to exercise. The cause of cellulite is understood to be related to connective tissue deterioration, which is one of the primary reasons it is more prevalent in women due to the physiology of the connective tissue and subsequent structural changes. Furthermore, fat cells in women are structured like chambers, while in men they are matrix oriented (criss-cross).
To better understand what cellulite is a review of skin microanatomy is needed. We have the outermost layer (epidermis), followed by the dermis (corium) which houses the hair follicles, sweat glands, blood vessels, nerve receptors and connective tissue. Below this layer are two subcutaneous layers. In females, the first layer contains vertical chambers where cellulite may exist; cellulite is essentially the hermiating fat tissue in this layer which causes the bumpy or "orange peel" external appearance. This can be combined with weakening of the connective tissue in the dermis which occurs with age, diet, exercise or physiology. As previously mentioned, men have different structural tissue and a thicker epidermis and dermis tissue layers in the affected areas. This however can vary if men have a deficiency in male hormones which can result in the appearance of cellulite.
Addressing Treatment Options
To effectively address treatment, one must impact the connective tissue, supporting collagen tissue, and elastin. These range from surgical options, injectables, topical, lasers and massage devices with infrared, diet and exercise. Clinical trials are hard to measure since there is no control of diet, exercise or combinations that people undergo while using a topical, thermo, laser, or massage technique in conjunction with other interventions.
Peptides such as Dermaxyl™ and Matrixyl®, which protect and support collagen and elastin, are clinically proven to be essential at the lowest level. Topical products stand-alone, or in conjunction with massage to break down the fat, and diet or exercise will likely enhance results. The key is to start with a topical treatment that contains effectively proven ingredients. New scientifically proven ingredients include:
- Lanachrys® – a natural lipolysis that has shown a 73 percent efficacy in fatty acid elimination.
- Bupleurum extract – breaks down fat and glaucine (a supporting active ingredient) preventing further formation of fat cells.
- Coenzyme A – helps release fat cells, converting to energy and combines with ingredients that protect and support collagen growth, tightens skin, and increases cellular structure or bulk of the structural cells.
When combined with vitamins A, E and the antioxidant and diuretic power of green tea, these new ingredients help the body flush out toxins and fat deposits. Moreover, it is important to note that clients battling cellulite would benefit from avoiding too much caffeine.
Some topical cellulite creams use retinoids. Similar in chemical structure to vitamin A, retinoids are a well-known anti-aging ingredient in many facial creams. Like vitamin A, retinoids have been found to increase the denseness of the epidermis in facial skin when applied for years. The hypothesis of retinoid treatment in cellulite-site areas is to promote dermis thickness. Some research suggests modest improvements in cellulite appearance with retinoid creams over a treatment period of six months, yet others show no improvement. It is imperative that the active ingredients get permeated into the lower layers, otherwise efficacy is minimal.
If a client is not looking for a topical application to treat their cellulite then a medical aesthetic approach would be beneficial. However, some such treatments reach beyond an aesthetician's scope of practice and clients looking for these types of treatments should be referred to the appropriate medical professional. Such treatments are:
- Liposuction – an invasive treatment designed to surgically withdrawal excess fat from local areas under the skin by means of a small incision and vacuum suctioning; has received mixed reviews.
- Subcision – also called as subcutaneous incisionless surgery, it is a minor surgical procedure performed with the aid of a needle for treating depressed scars, wrinkles and dimpling. This surgery can alter the structure of the tissue and often results in bruising and alters pigmentation.
- Fat reduction injection – considered a revolutionary, non-invasive cosmetic surgery. Treatment involves a series of simple injections into the area of unwanted fat.
As an aesthetic professional, massage is a great method to remove fluid in the dermis. However, it is important to note that this modality only offers a short-term solution unless it is used regularly with a topical that contains key active ingredients proven to help treat cellulite. Keep in mind, however, that when treating cellulite with topical products they must be absorbed into the dermis to reach the targeted fat tissue. Other methods for cellulite treatment are being currently tested; radiofrequency and lasers are among the technologies gaining momentum due to their ability to tighten the structural integrity at the affected areas, and strengthen thickness of the subcutaneous tissue.
In summary, clients must be educated on topical treatments and available expectations, in combination with diet, exercise and resistance training. This is imperative considering the collation between the factors in reducing cellulite and strengthening muscles that are weak or flaccid to reduce some of the underlying body fat. Therefore if the muscles in the hips, thighs and buttocks are weak and flaccid it will contribute to the "uneven" view of the skin surface. Therefore, educate clients on the importance of a combined approach. The new frontier of treating cellulite appears to be both innovative topical and medical aesthetic procedures.