Improving the Appearance of Cellulite
Cellulite……that bumpy, dimpled skin on the hips, thighs and abdomen causing an irregular, lumpy, “orange peel” surface. Its unsightly appearance drains confidence and creates warm weather shut-ins who avoid the beach, pool and other summertime outdoor activities. Cellulite affects women (>90%) disproportionally and most post-adolescent women will develop some degree of involved skin. Cellulite isn’t a “disease,” but the irregular, knobby skin is always detested by those who have it.The extent to which cellulite affects the overlying skin can be a significant predictor of response to LLL treatment. The Nurnberger-Muller Cellulite Classification Scale is a useful tool to document the stage of cellulite progression.
Nurnberger-Mὓller Cellulite Classification
Stage 0 – No skin dimpling when standing, lying down or with pinching of the skin
Stage 1 – Dimpling seen only with skin pinching or with muscular contraction
Stage 2 – Dimpling seen when standing but not when lying down
Stage 3 – Dimpling seen both when standing and lying down
The goal of all cellulite treatment is to achieve a 1-2 Stage improvement in appearance. Earlier treatment of Stage 1 or 2 cellulite more often results in significant improvement with one treatment series than advanced State 3 progression, which may require 2-3 courses of therapy.*
How does cellulite develop?
Cellulite is visible at the skin surface, but it’s not a true skin abnormality. The real problem is underneath. To understand how cellulite develops, we first have to understand the anatomy of the fatty tissue underlying your skin.
Most know that a layer of fat tissue lies between the skin and the underlying muscles. However, this fat tissue actually has two compartments – superficial and deep. Separating these two layers is a very thin but surprisingly sturdy membranous structure called Scarpa’s fascia. The composition and structure of the superficial and deep compartments in men and women differ significantly. This difference explains both the genesis of cellulite and its predilection for mature women.
How is subcutaneous anatomy related to cellulite formation?
Abdominal, hip and/or thigh skin is held in place by bands of sturdy fibrous collagen and flexible elastic bands (elastin). Collagen holds the skin in place and elastin provides flexibility and elasticity. Fat is deposited in both subcutaneous compartments into bundles, called lobules, which are separated by these collagen bands. In the superficial compartment these bands are tightly attached to the skin and to Scarpa’s fascia. In women these bands run vertically so the fat lobules between adjacent collagen bands have a direct path upward toward the skin. In men these same bands are arranged in a crisscross pattern effectively blocking most upward migration of fat lobules toward the overlying skin. As a result, cellulite is common in women and rare in men. In the deep compartment the collagen bands are less numerous, more loosely organized and run from Scarpa’s fascia down to the deeper muscle surface.
In women superficial compartment fat lobules grow in size as age-related decreases in estrogen levels increase fat deposition and fluid accumulation. As they expand, these lobules migrate upwards toward the skin. At the same time, both collagen and elastin fibers weaken and become more lax and their ability to hold the growing fat lobules in place lessens. A bumpy, irregular skin surface is the result, with areas of stronger collagen and elastin fibers interspersed between areas of weaker fibers unable to contain the enlarging, upward migrating fat lobules.
Cellulite Q & A’s
How does cellulite develop?
Cellulite is visible at the skin surface, but it’s not a true skin abnormality. The real problem is underneath. To understand how cellulite develops, we first have to understand the anatomy of the fatty tissue underlying your skin.
Most know that a layer of fat tissue lies between the skin and the underlying muscles. However, this fat tissue actually has two compartments – superficial and deep. Separating these two layers is a very thin but surprisingly sturdy membranous structure called Scarpa’s fascia. The composition and structure of the superficial and deep compartments in men and women differ significantly. This difference explains both the genesis of cellulite and its predilection for mature women.
How is subcutaneous anatomy related to cellulite formation?
Abdominal, hip and/or thigh skin is held in place by bands of sturdy fibrous collagen and flexible elastic bands (elastin). Collagen holds the skin in place and elastin provides flexibility and elasticity. Fat is deposited in both subcutaneous compartments into bundles, called lobules, which are separated by these collagen bands. In the superficial compartment these bands are tightly attached to the skin and to Scarpa’s fascia. In women these bands run vertically so the fat lobules between adjacent collagen bands have a direct path upward toward the skin. In men these same bands are arranged in a crisscross pattern effectively blocking most upward migration of fat lobules toward the overlying skin. As a result, cellulite is common in women and rare in men. In the deep compartment the collagen bands are less numerous, more loosely organized and run from Scarpa’s fascia down to the deeper muscle surface.
In women superficial compartment fat lobules grow in size as age-related decreases in estrogen levels increase fat deposition and fluid accumulation. As they expand, these lobules migrate upwards toward the skin. At the same time, both collagen and elastin fibers weaken and become more lax and their ability to hold the growing fat lobules in place lessens. A bumpy, irregular skin surface is the result, with areas of stronger collagen and elastin fibers interspersed between areas of weaker fibers unable to contain the enlarging, upward migrating fat lobules.
Artist: Lauren Smith - St. Petersburg, FL
Why is cellulite so common in women?
Most cellulite develops in females and its prevalence increases with age. It’s likely that a number of factors are involved, but fluctuating estrogen levels, increasing age and the anatomy of the superficial subcutaneous layer (see illustration) are almost certainly significant factors. Supporting the critical importance of hormonal influence on cellulite development is the observation that men with low testosterone levels or who are taking estrogen to treat prostate cancer are also more prone to develop cellulite. It has also been proposed that fluctuating estrogen levels reduce blood flow to superficial compartment collagen and elastin fibers, accelerating the weakening process.
Can cellulite be prevented?
Not at the present. And since it’s not a disease, “cure” is not an issue. Many treatments, both invasive and noninvasive, have been used, most with little success, but the EMERALD LASER has shown considerable promise and is the only noninvasive device to be granted FDA approval for “improvement in the appearance of cellulite.”
Can EMERALD LASER help with cellulite?
In addition to its ability to reduce superficial compartment fat tissue, the 532 nm wavelength of the low level EMERALD LASER is the optimum wavelength for absorption by collagen. The LASER energy is thought to “awaken” tired and sagging collagen and even elastin fibers and stimulate new collagen and elastin formation which tightens and firms the loose skin overlying areas of cellulite. A decrease in fat combined with rejuvenated collagen and elastin fibers can often smooth the skin surface and improve the appearance of the cellulite. Connective tissue regeneration takes time, so a noticeable improvement in cellulite typically takes several weeks longer than for body contouring and treated patients can see continuing improvement up to six months after treatment.
Will treatment completely eradicate my cellulite?
Usually not. We hope to achieve a 1-2 stage improvement in appearance on the Nurnberger-Muller scale, either of which will be a quite noticeable change. Occasionally a patient will show dramatic resolution, but complete disappearance of cellulite is uncommon. Patients are always prone to recurrence. Recurrence rates are minimized by regular walking exercise, a low carbohydrate diet, avoidance of weight gain and attention to good hydration. Recurrence of some extent is the rule, not the exception, but the good news is that recurrences of cellulite can also respond to LLL EMERALD LASER treatment!
Why does treatment for cellulite take longer than for body contouring?
From the prior discussion you can understand that cellulite is not just the accumulation of excess fat. It is a mixed disorder related to fat and fluid accumulation, changes in blood supply and hormone induced alterations in connective tissue – principally collagen and elastin. Optimum improvement in cellulite appearance requires removal of some of the superficial fatty tissue but also requires remodeling and regeneration of collagen bundles, which occurs over a period of weeks to months.
