All Puckered Out: What Really Works (and Doesn't) to Get Rid of Cellulite
Why Your Butt Is Bumpy
Cellulite is sneaky. Even the experts don't agree on the reason it suddenly appears. Some derms say that cellulite is due to poor circulation in the skin covering your behind, your thighs and the back of your upper arms. They believe that the capillaries and blood vessels that bring nutrients to the skin there begin to deteriorate and leak lymphatic fluid into your fat cells, which get engorged. These fat cells cluster together, poofed up with liquid, and move toward the surface of the skin, causing the despised lumps and bumps.
To make matters more blobby, the health of the skin itself deteriorates in this scenario, says FITNESS advisory board member Howard Murad, MD, a dermatologist in Los Angeles and the author of The Cellulite Solution, who is a proponent of the circulation theory. That, combined with declining amounts of collagen -- a protein that gives skin its structure -- as we age, causes our skin to slacken and become weaker, making any engorged fat cells even more visible.
The trouble is, there's not much reliable scientific data behind this rationale, says Molly Wanner, MD, an instructor in dermatology at Harvard Medical School. Yet it's the basis for many popular treatments, including endermologie, in which your fat is vigorously squished and rolled in a machine that supposedly increases circulation and removes stored fat. Numerous treatments, at $100 a pop, are recommended. Ka-ching!
"There is a lot of fiction and marketing out there," says Neil Sadick, MD, a clinical professor of dermatology at Weill Cornell Medical College in New York City, who has conducted much of the available research on cellulite and its causes. He and a number of doctors discount poor circulation as a cause and instead point to what MRI and biopsy studies show: that cellulite is a structural problem in the layer of skin called the dermis, which lies under the epidermis, or the skin that we see. Below the dermis is a layer of fat -- held in place by a collagen barrier called the subcutaneous dermal junction -- as well as the tissue, or septae, which are wrapped around the fat cells.
In men, those septa threads are crisscrossed, a bit like mesh, helping to hold the fat down where it belongs. In women, however, the septae wrap around small groups of fat cells in a more vertical fashion. This means that the clusters of squeezed-together fat cells can more easily migrate up into the dermis, creating the lumps you see in cellulite. Gain weight and you've got bigger fat cells, all straining to be free. Think of a quilted ski jacket with the septae as the stitching that makes the squares. The less stuffing you have in each square, the flatter your square is. If you stuff double or triple the amount of down in the squares, the stitching becomes strained and each square looks more distinct. That's basically what's going on in your butt. Okay, my butt. "When fat accumulates between these septae, the fat layer expands, which in turn expands the pockets, and your skin gets that quilted-mattress appearance," explains Patricia Farris, MD, a dermatologist in New Orleans.
Adding to all the fun, waning levels of collagen cause the subcutaneous dermal junction -- the layer that is supposed to hold the fat where it belongs -- to weaken. "That means the fat cells are even more likely to wiggle free," Dr. Sadick says.
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