Is it a disease? In the old days, cellulite was thought to be a no inflammatory complex tissue reaction to traumatic, topical or infectious stimuli. This explains the many names given before such as gynoid, lipodystrophy, etc. Nowadays, cellulite is viewed, not as a disease, but as an anatomical expression of the normal fat structures at the affected areas. Is it related to obesity? Cellulite is not related to obesity.

In fact, weight loss does not significantly alter the appearance of cellulite. This relates to the anatomy of the fatty tissue which includes two layers separated by a membrane: the Areolar fatty layer (superficial) and the Lamellar fatty layer (deep).Mainly, Cellulite is related to changes in the superficial layer while obesity is related to changes in the deeper layer. Predisposing and aggravating factors: Cellulite affects exclusively women. It is rarely seen in men. Further more, whites develop cellulite much more than Asians or blacks.

Other factors seem to aggravate or uncover a predisposed individual. These include hormones (oestrogen, pregnancy status, and lactation), diet (excess fat, carbohydrates or salt), and sedentary life style (tight clothes, alcohol, emotional disturbances and medications) (antihistamines) How does cellulite form? In cellulite, there is a regional accumulation of fat within the superficial fat layer. This stretches the superficial fat lobules vertically upwards, leading to partitioning of connective tissue strands which are the thick fibers that attach the skin to the underlying fat. Later, fat lobules will protrude leading to the formation of the papillae adipose, collections of fat cells under the skin.

Upon external compression (such as in pinch test), they will bulge causing the overlying skin to protrude forming the mattress phenomenon (skin surface will appear like a mattress). Further on, collections of fat cells will slowly enlarge to form micro and macro nodules, leading to the bumpy appearance of the skin. Other theories suggest that fluid retention in the fatty tissue leads to localized edema contributing to the formation of cellulite. How can I know whether I have cellulite? The clinical picture of cellulite varies from incipient cellulite (status protrusus cutis) to full blown cellulite (dermopaniculosis deforman). In fact, cellulite encompasses a whole spectrum of clinical presentations and is classified into four grades:

Grade one : No changes over skin surface, and no complaints (changes on skin biopsy only)
• Grade two : Orange peel appearance upon pinching the skin (pinch test) or muscle contraction (reflects dermal edema);patient complains of pallor , decreased elasticity and temperature
• Grade three : Same findings as above present at rest. Patient will also have a padded appearance and tiny granulations under the skin
• Grade four |: Same as grade three but with more palpable , visible and painful nodules with an obvious wavy appearance of the skin.

Treatment of cellulite: Up till now, there is no single 100% effective treatment for cellulite. This explains the many treatment modalities available and the continuous quest to find a solution for this condition. Basically, taking care to avoid the aggravating factors is helpful in cellulite.

One should monitor diet, exercise regularly and use non-hormonal contraceptives. Avoiding stress and anxiety is of considerable value. Pharmacologic agents: These include a variety of topical medications (ex: creams) or oral pills that are given to improve cellulite.

Some acting on the fat cells to decrease their size: These include methylxanthines (ex: caffeine) which is found in coffee, Green tea, Cocoa and Mate. When applied over the skin, Caffeine penetrates the skin easily and is therefore useful for the treatment of cellulite. Other drugs act on the microcirculation to improve venous return and decrease the edema in the skin. These include ginkgo biloba extracts. Centella extracts improve the underlying skin attachments. It is usually taken as pills.

Interventional: It is worth noting that liposuction is not an effective treatment for cellulite. Mesotherapy, which involves injecting multiple vitamins (and other compounds) directly into the skin, is currently used as a treatment. However, its efficacy is still unknown.

The most widely used treatment is liponic sculpturing, which includes LPG and its cousin Silhouette. LPG (invented by Louis Paul Guitay) was initially used to treat trauma and burn scars. Physicians quickly noticed its ability to reduce the appearance of cellulite. LPG is a non-surgical technique which does not break the skin.

It involves the use of a motorized device with two adjustable rollers and controlled suction, which creates a symmetrical skin-fold. The skin gently folds and unfolds under the continuous action of the rollers allowing for smooth and regulated deep tissue mobilization. This gradually improves the skin texture, improves the skin’s appearance and removes the dimples. Multiple sessions are usually needed (around 14). The results last about one year but regular exercise reduces cellulite reappearance. Another way to reduce cellulite is Proslimelt: An innovative low frequency ultrasonic device that dissolves the fat cells using sound waves without any surgery.

It is very useful for localized areas of increased fat as well as for cellulite. Note worthy is to mention the importance of regular exercise, healthy food intake, and avoiding tight clothes. Article written by Mohamad Kashmar,M.D., copyrighted
Khashayar toodehfallah oct 7th at 10:50 am
thanks for the comment (: you have a strong body of work as well
Khashayar toodehfallah oct 7th at 10:50 am
thanks for the comment (: you have a strong body of work as well