What is Cellulite?

As normal, I was handling the boredom of the grocery store line by catching up on my celebrity news and gossip from the tactful magazine covers (sarcasm). I recognized one of my favorite tactics to get us to pick up the magazine...exposing celebrities' cellulite, but blocking their face. Whether it is to feel more normal or empathize with these celebrities, we open the magazine to quench an insatiable urge to see which celebrities fall into the cellulite 'Hall of Shame'.

Products, advertising and scams feed off of our disgust and intrigue with cellulite. To protect ourselves, we must better understand cellulite and attempts at its treatment.

What is Cellulite?

Aesthetically, cellulite is the unappealing, 'orange-peel' or 'cottage cheese' dimpled appearance of the skin. The word 'cellulite' is thought to have emerged in French medical literature over 150 years ago, but usage has become more popular in America since the 1960s.

Cellulite is common, affecting up to 98% of all post-pubertal women.¹ Cellulite is not specific to overweight men or women, and most commonly appears in the gluteal-femoral region (buttocks-hips-thighs). And, yes, even celebrities get it.

Physiologically, cellulite is an interactions of excess fat under the skin (i.e. subcutaneous fat) and fibrous strands, called septae (or septa).

Take a look at the following diagram: 

The septae are the vertical strands of stiff fibrous tissue, and act like wires holding the skin to the muscle. Without septae, our skin would just slide around, without anything holding it in place.

Because the skin is soft and malleable, when fat builds up in some level of excess, it pushes up from the underside of the skin, creating a bulge. Where the skin is held in place at septae locations, a dimple is created.

We have now created the appearance of cellulite, and anyone can experience it. For instance, some people just have really short septae, so it takes very little fat to create the appearance of cellulite (feel free to use that one if you want).

Common Treatments

Common cellulite treatments target 1 of the 4 parts that we just discussed:

1. Skin
2. Fat
3. Septae
4. Muscle

Skin

Skin is the main target for most cellulite creams. Remember, skin is soft and malleable, so when fat pushes up from underneath, it bulges. If we can stiffen the skin, the excess fat is not strong enough to create the bulge. There are numerous ways that cellulite creams may accomplish this stiffening, such as simply making the skin tighter or limiting the amount of fluid in the skin (e.g. retinoids, aminophylline, herbals). As a result, the 'appearance' of cellulite may be improved, but there is no effect on the underlying fat.

Fat

Though the manufactuers may make magical claims, creams or products applied to the skin do not impact the fat that sits under the skin. Cellulite reduction techniques that target the fat are commonly more mechanical in nature...sucking, pinching, rolling or massaging.

Sucking commonly comes in the form of liposuction or lipoplasty (shown to left), which is a very invasive technique requiring a surgical procedure to suck out subcutaneous fat from under the skin. A straw like needle, called a canula, is inserted through the skin into the subcutaneous fat layer. The canula is attached to a vacuum device, which sucks out the fat that the surgeon has destructively broken apart by the pushing and pulling motion of the canula through the fat layer.

Liposuction is expensive, painful, can lead to extensive scar tissue build up, worse appearance of the skin, increased dimpling of the skin, infection and even death. Due to these risks and potential for poor cosmetic outcome, liposuction is not recommended for treatment of cellulite.¹

Vigourous massaging, rolling or pinching has long been a popular technique to unsuccessfully combat cellulite. Dr. Lawton, one of my favorite pioneers of fitness product scams, was promoting his guaranteed Fat Reducer in the early 1900s (it was just a rubber toilet plunger). Like the products or techniques claim today, which have no scientific support of their effectiveness, the Fat Reducer claimed,

"by a gentle manipulation the Reducer breaks down and disintegrates fatty tissue which becomes waste matter and is carried out of the system through the organs of elimination, thereby the blood circulation is improved."

Techniques have advanced since the early 1900s to very expensive, machine-assisted massage systems (e.g. Endermologie), but the claims still remain the same as Dr. Lawton's guaranteed Fat Reducer.

Septae

The most common procedure to deal with septae is called 'Subcision'. It is also a very invasive procedure, using a 16 to 18-gauge needle to pierce the subcutaneous fat layer and shear the septae in half. Subcision treatments claim that by severing, cutting or burning away the septae, the structure that causes the dimples is removed. These procedures are expensive, painful, potentially dangerous, and of course, remove the important septae that we are supposed to have.

Muscle

There is common thought that if we work the underlying muscle, then the fat resting on top of that muscle will miracously melt away. Despite many popular claims for produces and exercise programs, this fallacy of 'spot loss' or 'spot reduction' has already been BUSTED (read here).

Conclusions

Cellulite is extremely common, and is not a disease or health condition. Two scientific reviews have shown that there are no truly effective treatments for cellulite.^1,2 However, because of our perpetual disgust with fat and cellulite is so prevelant, companies will continue to create or recycle ideas to combat cellulite. We must be cautious, despite the hope that they may instill in us. 

If excess fat is the main culprit, then consistent physical activity and healthy eating is the only long-term, safe method for controlling cellulite. Remember, cellulite, by itself, is not a disease or sign of poor health. Even healthy fit men and women have it.

I once had a very fit woman in short running shorts come to me for help in getting rid of her cellulite. I glanced at her legs, and asked, "what cellulite?" She proceeded to turn, and forcefully squeeze all of her fat into one small area on her hip, thus making cellulite appear. She looked up at me and said, "see?"

If she had understood what cellulite was, she would have known that there was nothing wrong with her. She was not too fat or unhealthy, she was simply packing subcutaneous fat into one small area, forcing bulges to appear around all her short and sturdy septae. She was creating a concern that was not even there!

By understanding what cellulite is, we can make informed decisions on the claims of products, treatments and even our own body image concerns.

References

¹Avram, M.M. (2004). Cellulite: A review of its physiology and treatment. Journal of Cosmetic and Laser Therapy, 6, 181-185.

²Rawlings, A.V. Cellulite and its treatment. International Journal of Cosmetic Science, 28, 175-190.