September 18, 2021

What is cellulite? 

Cellulite is the term used to refer to the dimpling of the skin on the buttocks and thighs that occurs when fat underneath the skin push through the loose connective tissue in the skin. It results in the ‘lumpy bumpy’ appearance of the skin.

Why do some people have more than others? Does everyone have some amount of cellulite?

It is common- estimates show that well over 80-90% of women have it! This appearance can look worse when bloated or with extra fluid in our soft tissue. 

Does perimenopause and/or menopause impact the occurrence, presence, impact of existing cellulite? 

The lower estrogen levels that come with 
menopause is one of the most important factors that contribute to the development of cellulite. Lower estrogen leads to changes in circulation and a decrease in the production of collagen and elastic fibers.  With poor circulation comes excess fluid build up in the soft tissue. With less collagen the connective tissue in the skin that holds the adipose or fat, the fat slips through and looks lumpy bumpy on the surface.  Think of the collagen as containing the fat or holding it in. Less elasticity gives the skin a tissue paper like wrinkling not the surface to worse the appearance.

If cellulite only starts to appear after 45/50, is there anything different to note about it? 

No real difference technically other than one factor.  The thinning of the skin as we age does not help the appearance of cellulite.  Pre-menopausal treatment tends to be more effective for this reason.

Does diet/exercise affect cellulite?

Massaging the areas can improve the appearance of cellulite. This may be somewhat possible by reducing the excess fluid in the soft tissue by massaging it out. However, this cannot get rid of the actual fat or improve the strength connective tissue fibers that have loosened to result in the actual cellulite.

 Is there any effective "treatment" for it?

The only way to do this is to either treat the fat (noninvasive radio frequency fat removal or liposuction) or tighten the adhesions through subcision. 

The thing I remind patients seeking cosmetic options for cellulite is that most every woman has it! Media photos of celebrities may remove it from photos but many of these women likely have it as well. 

There are three targets for anti cellulite treatments: the circulation, the fat itself, and the connective tissue.

Circulation is the focus of most topical therapies and massage.

Essentially the hope is that a topical such as caffeine, antioxidants or tannins are focused on trying to reduce inflammation in the skin to make the fat less noticeable.  Massage helps return excess fluid build up from the soft tissue back to the lymphatics to make the fat less noticeable.
The fat can be targeted with liposuction directly or through radio frequency or cold lipolysis.  The basis for the effectiveness of these treatments is if there is less fat itself, there will be less irregularities to the appearance of the skin.  Liposuction will reduce the volume of fat that your connective tissue needs to ‘hold back’ but alone does not always strengthen the connective tissue that needs to hold the fat in.  It does improve the overall appearance of the area however.

The connective tissue is targeted via radio frequency devices tightening the skin and improving collagen and elastic production or by subcision.

Subcision is performed by taking a cannula or NoKor needle under the surface of the skin and breaking apart of some of the prior connective tissue adhesions and stimulating collagen production under the surface. I describe this to patients as almost like “banging out a dent in a car from underneath the surface.” Commonly used for acne scars as well. Studies show as high as an 80% satisfaction with subcision alone.

The newest treatment for cellulite is an injectable called Qwo.  Qwo uses collagenases to break down the connective tissue that creates the dimpled appearance to cellulite.  The fat can then redistribute and appear smoother.  

Tags cellulite qwo

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