Cellulite: What Is It? How Can You Treat It?

Spring is here. You can finally stop salting your icy sidewalk and start focusing on summer issues, like cellulite.

What is cellulite?

It’s the dimpling and nodularity that occurs in women on the thighs, pelvis and abdomen. Cellulite is the result of fat pouching out of holes in the connective tissue on the skin. It occurs in 98% of girls and women post puberty. That’s right. Essentially all females have cellulite. It is a normal characteristic of sexually mature women.

Here’s what cellulite is not:

  • Cellulite is not fat. It is the appearance of the superficial fat held loosely beneath the skin. The fat is held more tightly in men which is why we do not develop cellulite.
  • Obesity doesn’t cause cellulite. Look around and you will see that skinny women have cellulite (in real life anyway).
  • Cellulite is not an accumulation of toxins or fluids; it is normal fat.

How Can You Get Rid of Cellulite?

The best treatments for cellulite have at most shown mild improvements in the appearance. Unfortunately, in almost all cases, the improvements are not maintained over time. This is because it is hard to change the loose connective fibers under the skin, which are the primary cause.

  • Weight loss can improve cellulite, but not always. Losing weight can make the skin sag, and weight loss has been shown to actually worsen the appearance of cellulite in some women.
  • Endermologie is a kneading system (like my grandmother would knead the pizza dough). Although there is some evidence it can reduce thigh circumference, how long the effects last is questionable.
  • Liposuction removes fat through suction. It is not a good treatment for cellulite because the fat is too superficial. Liposuction combined with a laser to treat cellulite sounds interesting, but has not been shown to work better than ordinary liposuction.
  • Subcision, which targets the connective tissue bands by snipping them, is a great idea, but in practice has not been shown to be very effective. There is some concern that snipping the connective fibers might actually make the fat looser, worsening the problem.
  • Mesotherapy is the injection of medications under the skin to dissolve the fat. Although it has worked for some, the results are unpredictable and can cause adverse side effects such as bruising or pain.
  • Radiofrequency treatments like TriActive or VelaSmooth generate heat under the skin damaging the fat and connective tissue, hopefully smoothing the cellulite. Improvements have been reported, but no long term efficacy has been demonstrated.
  • Herbal creams have been studied and had no effect on cellulite. It is unlikely that any topical treatment can penetrate far enough down and be potent enough to have any effect.
  • Diet has no effect on cellulite.
  • It is possible that regular exercise can improve the circulation of cellulite areas, improving the appearance, but no studies have shown that it has a significant impact. Work out because it is good for you, but stop looking at your behind in the gym mirror.
  • There are some upcoming technologies that are promising. I’ll post about them later.

What Should You Do About Cellulite?

Because it is a normal occurence in women, it’s reasonable to simply tell yourself: “Hey, this is normal!” and stop killing yourself trying to eliminate it. Many women have been pleased with any of the above treatments, but they’re all expensive and likely all temporary. If it is worth spending $500 to have a 50% improvement in your cellulite, then make an appointment with your dermatologist or plastic surgeon to discuss your options.

Keep in mind that your friends or partner might not notice that your cellulite is 50% better (what does 50% better cellulite look like anyway?). If you’re worried that you might be featured in a magazine, don’t fret. You will receive the only known cure for cellulite: Photoshop.

Do you have cellulite? Have you tried to eliminate it? How successful was it?

Photo: Tassoman

Does The Sun Cause Melanoma?

Yes. Isn’t the answer obvious? Doesn’t everyone know that the sun causes melanoma? Not so fast.

There are many people who think we dermatologists are needlessly frightening everyone. They argue that the sun is good for you because it boosts your vitamin D levels and that dermatologists are subsidized by the sunscreen industry. They argue that melanoma can occur in places that are not sun exposed (like the bottom of your feet), that sunscreens have never been proven to prevent melanoma, and that people who get sun every day, like farmers, are actually less likely to get melanoma. They’re right.

So, then does the sun cause melanoma? Yes. Melanoma is a potentially deadly skin cancer. Like other cancers (breast, lung, colon), there are many risk factors. Think of melanoma as a destination — the hell of skin cancer. There are many roads to that destination even though the final resting place is the same.

People who have light skin or a family history of melanoma have a much shorter route to arrive at melanoma. It takes less time and less environmental factors for them to get melanoma. People who have very dark skin have a very long road to melanoma; it is unlikely that they will arrive there in their lifetime. Older people are much more likely to develop melanoma than younger people (they have been travelling the road for much longer). Sun exposure, especially sun burns, pushes you farther down that road.

Brilliant research from people like Dr. Michael Stratton in the United Kingdom has shown that most of the mutations found in melanoma tumors are unquestionably the work of ultraviolet radiation damage to the DNA. We also know that people who use tanning beds before the age of 30 are 75% more likely to develop melanoma that those who do not.

The sun does have health benefits, but unfortunately it also is the main driver pushing us down the road to melanoma. Each person has to think about how far along the road to melanoma he or she is starting at to determine how careful to be with the sun.

Everyday in dermatology we see people who unexpectantly find themselves in a place they did not think possible — they have melanoma. Many don’t understand how they got there; it has been a long road. Stop and think about where you are along that journey. What are your risk factors of melanoma? It is never too late to stop and turn around.

Photo: Eduardo Amorim

Red Spots

Lots of women have been Going Red lately. “Go Red” is a campaign to raise awareness of heart disease in women. Some women I see are often going red for a different reason: they’re covered in little red spots called cherry angiomas.

Cherry angiomas are tiny lumps of overgrown blood vessels in the skin. Their name derives from their often bright or deep red color. Like a cherry. Get it?

In your thirties and forties you might have a few. By the time you’re 80, you’ll probably have many (hence their other, more unfortunate name: senile angiomas). They cluster on the chest and back and can number in the hundreds. Although they grow on men and women equally, women are more likely to see a physician to have them checked.

Cherry angiomas are harmless, but many people hate the way they look. Fortunately, they’re easy to treat. Each little red spot represents a tiny, tangled knot of blood vessels. Treatments destroy the tiny vessels, making the red spot disappear. Treatments include:

Liquid nitrogen: A blast of icy cold air freezes the vessels. Often a blister develops the next day and can leave a lightened spot.

Electrocautery: A zap of electricity burns the vessels. It can sometimes leave a tiny scar.

Laser: The blood in the vessels absorbs a blast of light energy, exploding the tiny vessels and removing the spot. The ruptured vessel can cause a bruise that lasts for weeks.

All three methods are effective at removing the red spots, although each hurts a little and each usually requires multiple treatments. The more destructive the treatment, the more likely it is to work the first time, but the more likely it is to leave a scar.

It can be difficult to determine if a red spot on your skin is a harmless cherry angioma or if it is a skin cancer. If you have spots that are changing, bleeding, or multiplying quickly, or if you have any concerns, then you should see a physician.

Photo: Bensonkua (flickr)