International Academy of Cosmetic Dermatology

CELLULITE

Cellulite is an anatomical alteration to the cutaneous surface that confers a mattress, cottage cheese, and orange skin appearance to the affected areas. It may vary from patient to patient, regarding its severity and intensity.  Cellulite mainly occurs in women, affecting the thighs and buttocks, due to the particular anatomy of the women’s body with the subcutaneous fat layer of these areas being thicker in women than in men of the same age, height, and weight.

The characteristic depressions of cellulite are due to subcutaneous fibrous septa pulling the skin down and acting as subcutaneous bridges under the skin in the affected areas.   Cellulite often appears after puberty, usually in obese patients, but also in non-obese patients.  Generalized weight gains and localized fat deposits will worsen cellulite, making it more evident.

The treatment of cellulite is a challenge. Although several techniques and devices are promoted to remedy the situation, appropriate dietary regimens and physical exercises are still the best and most efficient measures.

  • Topical products, which may be used as adjuvant to other treatments, have limited capacity to modify the structure of the underlying fat and to penetrate the subcutaneous tissue.  They work by promoting fat destruction, stimulating the venous flow and lymphatic drainage, and smoothing the surface of the skin of the affected areas.
  • Mechanical treatments are very popular in the management of cellulite. They act as lipomodulators, through the different modalities of massage applied to the affected areas.
  • Manual massage to increase the lymphatic drainage is another popular treatment for cellulite that can be combined with topical treatment. Some devices are also designed to help the lymph drainage.
  • Endermology is performed with devices that must be carefully used, as suction of the skin can increase the laxity. Some devices use mechanical massage alone, without skin suction and are intended to redistribute the fat, making it more uniform and possible increasing the penetration of topical agents.
  • Subsicion® is a simple surgical technique, originally described is able to cut the subcutaneous septa which cause the depressions of cellulite and promote the formation of new connective tissue.  This diminishes the severe depressions of cellulite without scars in one or more sessions. The technique is also useful in treating the most frequent liposuction sequelae.
  • Laser therapy was recently developed for the treatment of cellulite. This usually combines mechanic massage with lasers and/or lights to improve the absorption of the liquids in the subcutaneous and their consequent edema and to increase the blood and lymphatic flow.
  • Radiotherapy is also used in the treatment of cellulite.

Doris Hexsel, MD
Porto Alegre, Brazil

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