What Cellulite Is, Exactly
I can't tell you how many times I've cast my envious gaze on those women in yoga class who can put their ankles behind their necks or contort into a full wheel while I struggle to reach my toes. Today, though, as I twist in front of the mirror, trying to look at my own butt, I'm grateful for my inflexibility. It's as if my body is protecting me from the dimpled, puckered truth.
I am talking about cellulite, which some 80 to 90 percent of women — even Olympic beach volleyball players and supermodel yogis — have. While those oh-so-attractive lines and divots in your fatty bits are in no way harmful to your health, the dermatologists and plastic surgeons who study the condition have nonetheless staged its severity just as they have cancer. From what I can tell, my butt is between stages I and II: a bit of visible orange-peel texture when I am standing, which is more obvious when I clench or grab a chunk (sorry — TMI!). In stage III, you see more ripples on your skin, and stage IV has even more and deeper pits on a larger area of your body, like the surface of the moon in a bad sci-fi movie.
Surprisingly little is understood about cellulite. Here are seven things docs do know.
- It's more than skin-deep. In the simplest terms, cellulite is pockets of fat that have squeezed between bands of tissue, called septae, that are under your skin.
- Cellulite definitely discriminates. Women of all races get it, while virtually no men do. That's because septae are different in women than they are in men. Guys have sturdier bands in a crisscross formation that keeps fat in place more effectively. Women have flimsier vertical septae that fat can more easily push through.
- Size doesn't matter. Both thin and heavy women get cellulite. The more body fat you have, the more likely you are to also have significant dimpling. But even skinny women have some fat between their muscles and skin. That's all it takes for cellulite to happen.
- You can't diet cellulite away. Losing weight sometimes makes it better, but ironically, it can also make it worse. When you drop pounds, you also ditch flab, meaning, theoretically, that you should have less cellulite. However, your skin can become saggy after weight loss, which can make cellulite more pronounced.
- Your mom may be to blame. Cellulite runs in families. Genes help determine how you store fat and how likely that flab is to push through the septae that are supposed to contain it.
- Hormones play a role. But exactly what role isn't known. Because cellulite starts at puberty, doctors think estrogen is involved. However, that hasn't been proved.
- Treating it isn't easy. Liposuction, which has been marketed as a treatment for cellulite, often makes the condition worse. Removing fat with lipo can leave your skin even more puckered looking than it was before.
So what can you do to reduce cellulite and hopefully get rid of it? Read on for the latest info.
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.
If you read cellulite treatment claims closely, you'll notice that reputable ones tend not to say that their cream, laser or massage therapy will get rid of cellulite. The ugly truth is that because cellulite is most likely a structural problem, it's going to return like the proverbial bad penny if the structure is unchanged. "You cannot cure it," Dr. Sadick says. "But you can help make it look significantly better."
That's the good news: There are ways to temporarily minimize your lumps and bumps. At least two of those techniques — working out and dropping pounds — have other health benefits as well.
Hit the weight room. Exercise is crucial. While there is — shockingly — no specific research on how working out affects cellulite, a toning routine can tighten up the whole package. "Women need to start lifting weights two to three times a week. I'm a big proponent of this," Dr. Farris says. "Resistance exercise acts like fillers for your skin. If your muscles are more defined, your skin will look smoother." Dr. Wanner agrees: "If you lose weight and replace it with muscle, you're going to have a fat layer that's not as thick, and your cellulite is going to improve."
Scale back. Getting to a healthy weight can help reduce cellulite. Yet just ditching pounds without firming up is not always the no-brainer cellulite-reduction move you would think it is. When you lose weight, "your skin may be more lax, pulling on the septae, and cellulite may become more visible," Dr. Wanner says. The younger you are and the better your skin elasticity is, the smoother the results. For the rest of us, strength training is the number-one way to keep things as taut as possible.
Make your skin stronger. Want to do even more to de-lumpify your derriere? Topical treatments that may build collagen in the skin, like Retin-A or creams with retinol or vitamin C, couldn't hurt and may help, Dr. Sadick says.
Don't get sucked into trying lipo. A lot of doctors still suggest it, but it doesn't work and can actually make skin look more dimpled by removing too much fat, Dr. Wanner says.
The bottom line is that the same things you would do to keep your body fit and healthy are your best weapons against cellulite. In the meantime, take it from me: Self-tanner, which can help camouflage the cottage cheese, is a lumpy butt's best friend.
The Cellulite Treatment Experts Endorse
If you hate your lumps enough to spend big bucks to zap them, Cellulaze, an FDA-approved therapy, looks like a promising solution.
What it is: A laser that is inserted under the skin and shoots heat in three directions. When the laser is rotated, it liquefies fat, cuts the septae that surround fat cells to loosen puckering, and heats the skin to encourage collagen regrowth, says Bruce Katz, MD, the director of the Juva Skin & Laser Center in New York City, who was involved in Cellulaze's FDA-approval process.
What it promises: A 70 to 80 percent improvement that lasts at least a year, according to Dr. Katz, who says that in the more than three years since he began performing the procedure, no one has reported that their cellulite has come back. (People have had touch-ups, however.)
Who it's best for: Active women with mild to moderate cellulite who are not significantly overweight and who have good muscle tone.
The cost: A whopping $5,000 to $7,000 on average, depending on the size of the area being treated.
The recovery time: The outpatient procedure is done under local anesthesia. "Most of our patients go back to work the next day," Dr. Katz says. They wear a Spanx-like surgical garment for a week for the bruising and swelling.
The verdict: "I think it's a very good technology," says dermatologist Dr. Sadick, who has used it. However, he isn't ready to declare the results permanent. And like any invasive procedure, there are risks involved. Plus there is no data on the long-term effects. To find out more or for a referral to a derm who is using Cellulaze, go to Cellulaze.com.
Originally published in FITNESS magazine, July/August 2013.