cellulite wars

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Cell ulite Wa rs!

SCAMS & REMEDIES

FEBRUARY 2014 F ITNESSRX

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By Jennifer T. Haley, MD, FAAD

Cell ulite Wa rs!

SCAMS & REMEDIES

The dreaded “C” word— Cellulite. After all, dimples are only cute on the cheeks of little children and celebrities like Brad Pitt and Mario Lopez.

If you have cellulite, you are not alone. Cellulite affects more than 85 percent of all women to some degree. It is char-acterized by alterations to the skin sur-face, presenting as dimpled or puckered skin, primarily involving the thighs and buttocks. For a long time, doctors thought that cellulite was normal and they didn’t research causes and treat-ments. With the advances in technology and more women demanding treatment, significant research has gone into better understanding and treating cellulite in the last decade.

CELLULITE CAUSES

Understanding how to best treat cel-lulite starts with understanding its causes. After all, you need to know your

enemy before you can figure out how to defeat him. Doctors currently believe that cellulite is caused by a combination of coexisting factors. There is no con-sensus on what exactly causes cellulite, but these are the current ideas.

The architecture of the con-nective tissue. In women, bands of connective tissue are oriented longitudi-nally, from the muscle to the skin. These bands separate fat into channels. As the fat layer enlarges, these bands pull the skin down towards the muscle and squeeze the fat, pushing it up toward the skin surface and creating an uneven appearance of the skin. Men have more of a crisscrossing pattern of the con-nective tissue in these areas, which holds down this superficial fat layer, pre-venting it from projecting towards the skin surface.

Think about a pillow being pushed very hard into a soccer net. The pillow is the fat, and the net is the connective tissue cords connecting the skin to the muscle.

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Also, if the overlying skin is thin, these superficial fatty pro-jections will be more noticeable.

Hormones. Hormonal changes (especially estrogen) in women that occur after puberty promote fat deposition in the hips and thighs and make the elimination of fat particles deposited in these areas difficult. Remember, we once lived in a world where famine was common and nature wanted to ensure we would have enough stores to support a pregnan-cy. Our bodies are created to store fat for survival.

Disturbance of the lymph and blood circula-tion. Anything that reduces blood flow to these areas causes fluid buildup (edema). Swelling increases the volume of fat, thus making the protrusions more obvious. External toxins including alcohol, tobacco and caffeine inhibit move-ment of fluid from these cellulite prone areas. Smoking also weakens the formation of collagen, which allows for easier protrusion of fat towards the surface.

Dietary habits. High-sugar and high-refined carbohy-drate diets tend to make cellulite worse, possibly through tissue edema.

Genetics. Blame it on your parents. If your mom has more than your friend’s mom, you are likely to have more cellulite than your friend.

Chronic inflammation. More and more research every year exposes the harmful effects of inflammation on the body. Inflammation causes the production of matrix metalloproteinases, which will break up the collagen in the skin. Have you ever run into a friend who had been through a stressful time? You can see it on her face— weathered, unhealthy, dull skin. This is the result of stress and inflam-mation on the skin. The visible appearance of cellulite has as much to do with the health of the skin as it has to do with fat. If you have thick, healthy skin overlying the layers of fat, cellulite will be less obvious. Unhealthy, thin skin = more cel-lulite exposed.

Sedentary Lifestyle. Weak, flabby muscles don’t sup-port the overlying tissues and results in more skin irregularity.

So, you can stop reading now and just chalk it up to being a woman or blame it on your parents, or read on to find the honest answers to what you can do to minimize the “C” word from taking over your life. While many treatments claim to be able to improve the appearance of cellulite, I am going to sort out the effectiveness of these treatments based on real science. With so many products and proce-dures available, it is overwhelming to try and figure out what really works.

A study in the International Journal of Cosmetic Science showed that changes in dietary habits without weight

loss improved the appearance of cellulite.

Mesotherapy



TREATMENTSBased on what we think causes cellulite (this may

change, as everything does), current treatments aim at reducing the superficial fatty layer where cellulite exists, stimulating vascular flow and drainage, increasing the thickness and elasticity of the skin (so that these fatty pro-trusions appear smoother), and breaking up the cords that separate the fatty compartments that lead to dimpling.

So what is out there, what is safe, and what is worth the money? Here’s an overview of the current treatments for cellulite, and each is rated for cost, safety and effective-ness.

Vigorous massage Theoretically, massage removes excess fluid and toxins

by improving lymphatic drainage. The goal with treatment is to improve collagen and circulation. Some studies show that initially the improvements are short term and just related to the removal of excess fluid and loosening the connective bands through friction. However, prolonged, repeated treatments may improve the appearance of cellu-lite on a longer term basis.

Mechanical stretching of the skin and underlying layers may stimulate collagen synthesis, increase the thickness of the skin, and inhibit fat deposition. As a less expensive alternative, you can also try to use a body brush every day to boost your circulation and help flush away toxins.

LPG Endermologie® is a machine-assisted mas-

sage in which a system of rollers and a suction device are used. This technique can improve circulation, body contour and skin texture. It works to massage cellulite buildup so that the fat is redistributed into the bloodstream and car-ried out the body. Frequent treatments are needed to maintain the results.

Cost: $Safety: Effectiveness:

Topical Anti-Cellulite Creams

The number and vari-ety of cellulite creams on the market is dizzying and generates over $12 million in department stores annually. Before we begin to discuss the ingredients in these creams and how they may work, understand that if any cream worked perfectly, there would only be one cream— no one would have cellulite, and all sales would banish, as everyone would be cured!

Despite the existence of a great number of anti-cellulite products, the reduction of fat deposits achieved through continuous use of these products depends on a number of factors. A product’s efficacy depends on the availability of the active ingredient at the action sites, the concentration of the ingredient in the formulation, and the physiological properties of each active ingredient. Applying something on your skin doesn’t necessarily mean it will get to where it needs to be in the skin or do what it may have done in the lab. The ingredient must reach the site of action and at the right concentration for its effects to be realized. Even the best topical formulations include skin enhancers that increase penetration through the skin and facilitate the delivery of the active ingredients to the action site.

Cellulite creams often contain many of these active ingredients: retinol, methylxanthines (caffeine, aminophyl-line, theophylline), green tea extract, algae extract, blad-derwrack, butcher’s broom, ginkgo biloba, artichoke, com-mon ivy, horse chestnut extract, sweet clover, centella asi-atica (gotu kola), red grapes, yohimbe, papaya and pineap-ple. All these topical anti-cellulite preparations theoreti-cally work by either increasing the circulation to reduce fluid retention, reducing fat storage while promoting fat breakdown, restoring the normal structure of the skin, or preventing toxin buildup. Many studies showing improve-ment with various creams had subjects apply the cream under a heavy duty garment daily to help promote pene-tration of the cream through skin.

It is very difficult to prove that a cream does or doesn’t work. The use of topical creams involves a massaging action. Therefore, the direct physical stimulus of rubbing a cream may alone contribute to an improvement in the condition over time for the same reasons deep mechanical massage works in stimulating collagen and decreasing fat

KEY:

$ LOW

$ $ MODERATE

$ $ $ HIGH

LOW LOW RISK

MODERATE RISK HIGH RISK

NOT VERY EFFECTIVE

SSOMEWHAT EFFECTIVE

MOST EFFECTIVE

Endermologie ››

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One study showed that acceleration training alone

reduced cellulite by 26 percent.

activity locally. When the skin is healthier, cellulite will always appear less obvious.

Most available creams show a partial and temporary effect in improving cellulite and, of course, none have been shown to lead to its complete disappearance. Studies that have shown any benefit in improving the appearance of cellulite looked at creams containing caf-feine and retinol. Caffeine is thought to work locally as a diuretic by removing excess water in the skin, making skin appear tighter, smoother and more firmed, which tempo-rarily gives the illusion of a reduction in cellulite. Look for concentrations of about 5 percent.

As far as I am concerned, retinol should be applied to all areas of the skin daily— whether or not there is the presence of cellulite. Retinoids (retinol, tretinoin) have been proven time and time again to reverse sun damage, reverse skin aging, and thicken the healthy layers of the skin when used consistently for six months or longer. Thicker skin helps make cellulite less noticeable. Look for concentrations of 0.3 percent. Higher concentrations may be more irritating to the skin and you should avoid retinol if you are pregnant.

Cellulite creams could be considered an adjunctive therapy to diet, exercise and weight loss, but you will be sorely disappointed if you expect any cream to be a solu-tion. Skin is designed to keep things out, so even ingredi-ents proven in the lab to work on reducing fat pockets often don’t get to where they need to in order to com-plete that job. Also remember that most of these creams are botanical (just like poison ivy is botanical) and may contain hundreds of ingredients, many of which may cause allergic reactions.

My recommendation is that if you are going to use an anti-cellulite cream, don’t break the bank and think of it as a high-end moisturizer that you vigorously massage into the area when applying. A great and inexpensive idea is to body brush your skin, shower, and then immediately apply a great moisturizer.

Cost: $Risk:

Effectiveness:

Weight Loss Weight loss actually has a variable effect on the

appearance of cellulite. One could imagine that if there is less fat, there is less dimpling of the skin (less tension of the pillow protruding against the soccer net). As the fat globules retract with weight loss, the skin doesn’t appear as dimpled. This holds true in women with healthy skin. But, if the skin is not healthy, skin looseness can result in rapid weight loss, making dimpling even worse! It is best to keep a steady weight and avoid drastic fluctuations in your weight. One thing for sure— weight gain WILL make cellulite worse.

Cost: $Risk:

Effectiveness:

LiposuctionCellulite is a superficial fat just below the skin. While

liposuction can diminish fat deposits deep in the deep fat, its effect on the superficial fat layer as seen in cellulite is often disappointing. Moreover, traditional liposuction may actually worsen the appearance of cellulite by creating more depressions in the skin. The Nd:YAG (1064 nm) laser, SmartLipo™ and other laser-assisted liposuction devices target selected areas of fat for destruction in addition to simultaneously tightening the skin. This technology is also less invasive compared to conventional liposuction. Still, all liposuction is better at removing fat and should not be used primarily for cellulite reduction.

Cost: $ $ $Risk:

Effectiveness:

Medical DevicesDevices using radiofrequency, laser and light-based

energies— alone or in combination— are available for improving cellulite. Just remember— as with creams, if one laser worked perfectly for everyone, there wouldn’t be so many! Cellulite has many complex causes and that is why there are a multitude of treatment choices!

Tri-Active LaserDermology™ for cellulite treatment combines mechanical massage, laser stimulation and localized cooling. VelaSmooth™ and VelaShape™ combine bi-polar radiofrequency, infrared light energy, pulse vacu-um and mechanical massage, showing smoothing of the skin surface and reduction of the thigh circumference. VelaShape™ has slightly more power and comes equipped with a smaller handpiece to treat smaller areas (face, arms). While VelaSmooth™ takes 15 treatments, VelaShape™ reportedly only takes six treatments. Other devices that use radiofrequency include Venus Freeze® , Thermage®, and Accent XL® . Acoustic Wave Therapy® system uses high-intensity sound waves. SmoothShapes®

uses laser and light energy with contoured rollers (mas-sage) and vacuum suction to stimulate collagen, tighten skin, improve circulation and reduce edema.

Lasers and radiofrequency theoretically work by apply-ing heat. The heat is supposed to firm and thicken the skin and possibly melt some of the bulging fat underneath while stimulating skin tightening to smooth out the bulg-es. Acoustic waves are high-pressure waves that aim to break up the cords that pull down on the skin.

Liposonix® is a high-intensity focused ultrasound devise that is FDA cleared for waist circumference reduc-tion. It has no proven effect in cellulite reduction.

Cellulaze™ is a laser that is inserted under the skin and used to break up the cords that are pulling down on the skin while simultaneously cooking pockets of fat and



reducing bulges. This device reportedly melts fat under the skin, breaks up the fibrous bands under the skin, and stimu-lates collagen production by applying heat to the underside of the skin. Peak results are achieved about six months after the surgery (it takes 3-6 months for new collagen to form) and it may take three to four weeks to recover. For the roughly $7,000 price tag, improvement is about 65 per-cent and lasts up to two years. This is probably the most effective treatment that is currently in the marketplace.

Numerous devices have been introduced for the treat-ment of cellulite but are not guaranteed to work in every-one, as so many factors are involved in the formation of cellulite that one device cannot completely and permanent-ly address. Even using the best technologies that are cur-rently available and spending upwards of $5,000 for multi-ple treatments, people may see an improvement of about 25 percent, which will diminish over time. Clinical studies with all of these devices have shown variable improvement in the appearance of cellulite and skin irregularity.

Cost: $ $ $Risk:

Effectiveness:

Body Wraps Body wraps may smell and feel good. They may even tem-

porarily tighten skin or reduce inches through dehydration of the localized tissues. But there is no evidence that body wraps have any lasting effect and once you are rehydrated, those inches will return in a day or two.

Cost: $Risk:

Effectiveness:

Mesotherapy™ (Lipodissolve®)This involves a series of injections into small pockets of

cellulite. The injections contain a variable solution that sup-posedly breaks down fat and flushes it away. This procedure is more common in Europe than the United States, as there hasn’t been good evidence that it works, it isn’t FDA approved, and it may cause very serious infections and uneven skin contours.

Cost:$ $ $Risk:

Effectiveness:

SubcisionThis is a method in which a needle is inserted into the

dermis and breaks up the connective tissue cords. No con-sistent improvement has been shown.

Cost: $ $Risk:

Effectiveness:

TanningMany people erroneously think that if they are tan, their

cellulite will appear less obvious. While darker skin tends to make cellulite less noticeable, tanning will backfire in the long run by causing permanent damage to your skin and underlying blood vessels. When the tan fades, cellulite will look even worse, as the UV rays make the skin thinner and less resilient. Ultraviolet rays permanently damage the elas-tic fibers and collagen in the skin, making cellulite more obvious. I recommend a self-tanner as a safer alternative— especially one with added moisturizer and SPF!

Cost $Risk:

Effectiveness:

DietMost treatments can help improve the appearance of cel-

lulite only while you use them. But unless you commit to a healthy diet and challenging exercise plan, the effects of most of these treatments just won’t last, no matter how much you spend.

Readers of FitnessRx are savvy enough to know there are no shortcuts. We know that the results of training are 80 percent diet and so is the health of your skin, and minimiz-ing the appearance of cellulite is partially determined by your genetics. As a dermatologist, I see many patients with diabetes, and I can always tell if they are cheating by the appearance of their skin. With diabetes, circulating sugars damage all the proteins and structures of the organs— and the skin is your largest organ. There is no way around it— processed and refined carbohydrates will ALWAYS result in the appearance of unhealthy skin. And, as we have dis-cussed, 50 percent of the appearance of cellulite is a skin issue. Thin skin shows every single irregularity in the super-ficial fatty layer.

An anti-cellulite diet focuses on removing excess fat and toxins, eating more fruits, vegetables and lean protein. Don’t be afraid of healthy fats in your diet from oily fish, flaxseed, nuts and avocado. Drinking plenty of water will help flush out toxins from the body. Make your plate a col-orful rainbow and avoid anything processed in a package. Excessive salt, sugar, alcohol and caffeine will cause expan-sion of the fat cells, retention of fluid, and increased toxin accumulation. It is best to eat five or six small meals to keep your metabolism working efficiently and also avoiding your body entering “storage mode,” which occurs after eating large meals. This means more fat deposition.

Even though caffeine may improve cellulite when applied in a cream formulation, it may worsen cellulite when ingested. Gotu kola extract is one sup-plement that has been specifically researched for its benefits in reducing cellulite orally as well as topically. It is best taken at bed, as it has relaxing properties. Please check with your doctor before starting

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any new supplements to prevent side effects and interac-tions with other medications you may be taking.

Some experts advocate intermittent fasting. We aren’t talking about going days without eating. You can shift your body from burning sugar to burning fat for fuel by restrict-ing your eating to a six- to seven-hour window— for example, skipping breakfast and eating only between the hours of 11 a.m. to 6 p.m. each day. You will not restrict your calories and will continue to focus on eating healthy protein, fat, veggies and fruits and avoiding sugars. This 16-hour fast will help shift your body into effective fat burning.

A study in the International Journal of Cosmetic Science showed that changes in dietary habits without weight loss improved the appearance of cellulite. The addition of a cream, which improved the health of the skin, reduced the appearance of cellulite even more.

Cost: $Risk:

Effectiveness:

Exercise Exercise is one of the best things you can do to reduce

the appearance of cellulite. Weight training is especially important, as the more you build your underlying supportive muscles, the tighter the skin will appear and the thinner that superficial fat layer should be, making cellulite less visible. By toning your muscles with weight training, the muscles will push out and shape your skin and make those areas tighter and smoother.

High-intensity interval training (HIIT) will boost your metabolism and naturally boost your levels of growth hor-mone, a fat-burning hormone. Acceleration training, in which you perform exercises on a vibrating platform, improves cir-culation and breaks down cellulite. The vibrations cause muscle contractions that help to flush out toxins. One study showed that acceleration training alone reduced cellulite by 26 percent.

Exercise can also help with stress reduction. Stress, once again, can be blamed for hormonal abnormalities that can worsen cellulite. Increased stress releases insulin, cortisol and adrenaline, which change the way fat cells function and are distributed throughout the body. Breathe deeply. Take care of yourself. Give yourself a break. You deserve it!

Cost: $Risk:

Effectiveness:

BOTTOM LINEThere are many cosmetic and medical treatments for cel-

lulite. However, there is little clinical evidence that cellulite can be completely removed with any of these treatments. While science has yet to determine exactly what causes cel-lulite, we know that there are many factors involved. That is why anti-cellulite treatments may modestly help to diminish the appearance of cellulite, but they will not get rid of it per-manently. Also, most studies show that even with successful treatment, cellulite often returns over a few months to a few years. This is why lifestyle behaviors are so important—

daily physical exercise, healthy diet and drinking plenty of water. While there is no cure, there is hope, and you are in control, using your power to make healthy lifestyle choices. You only get one body— treat it kindly and it will reward you.

RECOMMENDATIONS• Think hard before investing too much money, and choose

safely.• Cellulite creams are minimally effective, so if you decide

to use one, think of it as a good moisturizer to improve the health of your skin.

• Healthy skin will reduce the appearance of cellulite.• Keeping off excess pounds and strengthening your mus-

cles through consistent, regular exercise will go a long way towards maintaining your skin tone and texture.

• Expect a 25 percent improvement in the appearance of cellulite with any medical procedure or you will be disap-pointed.

• Even with successful treatment, cellulite often returns over months if healthy lifestyle behaviors are not main-tained. n

Dr. Jennifer Haley, a board-certified dermatologist with a degree in Nutrition Science from Cornell University, enjoys sharing her knowledge about skin health, nutrition and exercise. Dr. Haley has been an NPC bikini competitor, consultant to the U.S. Capitol, and currently enjoys an active lifestyle in Scottsdale, AZ and Park City, UT with her husband and three boys.

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