Very frequently, women (and men) make requests
to doctors to prescribe a medication or treatment
that will smooth out the contours of the body - eliminate
cellulite. It presents a problem for the doctors who
are not dermatologists, plastic surgeons or obesity
experts because they are somewhat removed from the
latest concepts regarding adipose tissue distribution
and problems. Medical literature is fairly thin on
this subject while the lay literature describes numerous
questionable treatments that promise to rid the body
of irregular appearing fat deposits. It is apparent
that this topic - cellulite - has not been studied
by medical science very much. It is perhaps time to
look at what evidence does exist is on this subject.
What is cellulite?
Dimpling of the skin of the buttocks and thighs, especially
in women, is known as cellulite. Many people have
heard stories about the existence of two types of
fat - brown and white - in which the brown is the
type in cellulite, but medical studies have failed
to confirm that there are any different types of adipose
tissue. One study, Rosenbaum M, Prieto V, Hellmer
J, Boschmann M, Krueger J, Leibel RL, Ship AG :An
exploratory investigation of the morphology and biochemistry
of cellulite. Plast Reconstr Surg 1998 Jun;101(7):1934-9
looked at both the anatomical structure of cellulite
as well as its physiologic function.
Ultrasound examination of the thigh showed a diffuse
pattern of extrusion of underlying fat (adipose) tissue
into the reticular dermis in individuals with cellulite,
but not not in unaffected, individuals. Studies also
demonstrated that women had a generalized pattern
of irregular and discontinuous connective tissue immediately
below the skin (dermis), but this same layer of connective
tissue was smooth and continuous in men. They also
found no significant differences in they way the fat
tissue looked under the microscope, how it responded
to fat deposition and resorption, or even regional
blood flow between affected and unaffected sites within
individuals. They did find there were structural characteristics
of connective tissue below the skin that predispose
women to develop the irregular extrusion of adipose
tissue into the dermis, which characterizes cellulite.
In other words, cellulite represents areas of a "break
in the fence" where fat cells come into the skin
area and the dimpling represents where the support
structure of the skin (the original "fence")
is still intact.
What causes cellulite deposits?
In spite of the above paper, most scientists really
do not know what causes cellulite. They have studied
fat metabolism and deposition and had many and varied
findings. Most areas of fat deposits are the result
of two factors
the number of fat cells - adipocytes
the amount of fat inside the adipocytes
Current evidence suggests that the original number
of fat cells in any area of the body is controlled
by one's original genetic make up. There are no factors
or substances that increase the number of cells in
a body region but rather they do not multiply unless
the other fat cells get filled to capacity.
Occasionally there are reports that cellulite fat
has more proteoglycans that lead to more water retention
or that there are more or less receptors for various
physiologic hormones or proteins, but it does not
appear that these are the causative factors. Cellulite
fat will respond to calorie restriction just as any
other fat cell, but it is the stored fat that goes
away; the cell is still present and can refill if
calorie excess resumes. That is why most treatments
of cellulite are directed at removal of the cells
surgically.
Are women more likely to have problems with
cellulite or are they just more concerned about it?
Yes, women are more predisposed to cellulite than
men. The Rosenbaum study found that women have a much
more irregular, discontinuous supporting skin matrix
than men do so there is more opportunity for fat cells
to extrude into the dermis area. To some extent this
must be hormonally controlled through estrogens because
most men are not as prone as women to cellulite but
men who are given estrogens as treatment for medical
problems are known to develop new areas of cellulite.
Fat distribution is different also in women and men.
Women have more fat deposits under the skin but tend
not to accumulate it inside the abdominal cavity;
men seem to have less room for fat over their muscles
and under the skin but they will accumulate much more
excess fat inside the abdominal cavity. Regionally,
women have a tendency for more fat deposition in the
buttocks and thighs (gluteal/femoral areas) but that
tendency only starts after a women's ovaries become
hormonally active.
Are there any medical treatments known to
actually get rid of cellulite?
The medical literature does not support evidence that
I could find of any topical creams or ingested medicines
or substances that get rid of cellulite unless those
treatments result in significant loss of total body
fat. In those cases, the dimpling from cellulite becomes
less apparent but does not actually go away. This
observation must be tempered by the realization that
medical science does not seem to have studied this
subject very rigorously, thus the room for many "claims
of cure" that cannot be refuted as well as they
should be.
Can cellulite be treated surgically?
Most physician-based treatments are surgical. Either
fat cells are removed by various excision or suction
techniques or/and the cells are redeposited in areas
of dimpling so the contour looks more even. None of
the surgical treatments are directed at fixing the
underlying cause but merely fixing the result. Cellulite
areas will recur as long as there is any excess fat
deposition over the natural metabolic rate.
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