American women spend hundreds of millions of dollars each year on creams, laser treatments, massages, and body wraps, hoping to rid themselves of unsightly skin dimples, otherwise known as cellulite. According to John Kitzmiller, MD, of Rawlings, Md, 85% of all women are affected by cellulite.
To date, there is no consensus as to the direct cause of cellulite. Some physicians believe it is caused by changes in the fat cells. Others believe that toxins are responsible, and still others think it is caused by hormones. However, one plausible explanation—which also explains why very few men suffer from cellulite—is based on the composition and behavior of women’s fat cells and the connective tissue that holds them in place.
A woman’s connective tissue is very inflexible, so as she gains weight and her fat cells expand, they tend to bulge upward toward the surface of the skin, giving the classic orange-peel appearance of cellulite. Men not only have less fat on their thighs, but also their outer skin is thicker and obscures what is happening to any surplus fat under their skin.
According to plastic surgeons, being overweight does not cause cellulite. However, there is a clear association between cellulite and excess fat. A study published by the American Society of Plastic Surgeons in August reports that weight loss may decrease the severity of cellulite for some women, but it may worsen the condition for others.
In the study, 29 women who enrolled in medically supervised weight-loss programs, including low-fat meals, liquid diets, medication, and bariatric surgery, were examined. In 17 patients, the appearance of their cellulite improved; in nine patients, it worsened. The average weight loss was 30.5 pounds.
Patients who lost larger amounts of weight and lowered their percentage of thigh fat experienced the greatest improvement in cellulite. These patients had a higher starting body-mass index (BMI) and more severe cellulite, on average. Patients whose cellulite worsened started with a significantly lower BMI, lost smaller amounts of weight, and had no change in the percentage of thigh fat.
Skin elasticity after weight loss also played an important role in improving the appearance of cellulite. Cellulite worsened in patients whose skin became looser after weight loss.
“Cellulite doesn’t necessarily discriminate with weight,” says Anthony Youn, MD, of Rochester Hills, Mich. “That being said, most people notice cellulite more in people who are overweight, and this may be due to fibrous connections between the muscle fascia and the overlying skin.”
“There is no answer for completely eliminating cellulite,” Kitzmiller says. “Although the appearance of cellulite diminished for the majority of patients, weight loss did not totally eradicate the condition. The dimples appear to be permanent features that lessen in depth as the pounds come off.”
The primary function of cellulite treatments is to improve the skin’s appearance by enhancing tone, tightening, and promoting lymphatic drainage. Unfortunately, cellulite continues to develop as we age, and treatment options are not permanent.
Some noninvasive and nonsurgical treatments that Youn recommends are devices that use motorized rollers and regulated suction. One of the systems creates a symmetrical skin fold, which allows deep-tissue mobilization to occur and results in a reduction of cellulite and the loss of inches. Another system smoothes cellulite and incorporates external ultrasound to heat up the deeper fat layers. This helps the smoothening effect to be evenly distributed and more effective. Both devices have been approved by the US Food and Drug Administration.
According to David Bank, MD, director of the Center for Dermatology, Cosmetic, and Laser Surgery in Mount Kisco, NY, the bottom line is simple anatomy: Not even Hollywood stars can eliminate cellulite—they’re just great at hiding it.