| Staying Healthy - Friday, January 30, 2009
Got cellulite?
Danville doctors address this common problem for women
by Sonia Badreshia-Bansal and Vivek Bansal
Commonly known as "cottage cheese thighs," the unsightly, lumpy and dimpled skin on the thighs and buttocks known as cellulite is what women try to hide. It is caused by fiber adhesions that bind down the skin against swollen fat cells, similar to a quilt blanket. It can resemble the surface of an orange peel or cottage cheese and look like skin irregularities such as puckering and dimpling.
How do I know if I have cellulite?
You may or may not want to know! Most women can see the dimpling very readily. You can easily do a self evaluation by using the "squeeze test." It is best performed in a dimly lighted room holding a flashlight held about six inches away. Gently squeeze the skin on your upper thigh and the lighting will accentuate shadows that represent skin dimpling and irregularities. This is cellulite.
Why must this happen to women?
Hormones, especially estrogens, influence the formation of cellulite. It is normally seen in women after puberty to maximize fat deposits to ensure enough calories are available during pregnancy and lactation. This storage is also essential for nutrition, energy, support, protection and insulation. Cellulite is often localized to the thighs and buttocks, likely due to decreased circulation and lymphatic drainage.
Are there other causes?
Cellulite is most common in females with a family history. Because the cause is hormonal, it can be made worse during pregnancy, nursing, menstruation and estrogen therapy from oral contraceptive use and hormone replacement. All ethnicities are affected. Finally, being overweight causes greater fat deposit storage, which can enhance the appearance of cellulite on the skin surface.
Help! What do I do?
She says...
If you're not ready for surgery, Board Certified Dermatologist Dr. Sonia Badreshia-Bansal suggests conservative measures, including lifestyle changes, topical treatment, systemic management and/or physical modalities. Unfortunately, there is no cure for cellulite. Adopting a healthy lifestyle combining a well-rounded diet, regular exercise and avoidance of hormone can reduce the appearance of cellulite.
Topical therapies can include herbal therapy including ginkgo, ginger, green tea and caffeine to improve vascular and lymphatic circulation, red grapes to be used as an antioxidant, and caffeine to destroy fat cells. However, evidence supporting efficacy is not available. Vitamin C, retinoic acid, and related Vitamin A derivatives can stimulate collagen synthesis. Retinoic acid also stimulates circulation and decreases the size of fat cells.
Systemic therapy includes an emerging approach utilizing mesotherapy, the injection of pharmacologic agents and vitamins into deeper layers of the skin by directly destroying fat cells. However, reports show that untrained non-physicians are performing this procedure, which can lead to severe complications. The safety and efficacy of this therapy is also controversial.
Physical therapies include Endermologie, an FDA-approved procedure developed in France that uses a rhythmic suction massage device to increase blood and lymphatic flow; it requires several sessions with subjective and temporary results. Lasers are available, including the FDA-approved devices Triactive, which mimic Endermologie with more emphasis on circulation, and Velasmooth, with emphasis on heat production to increase blood flow and destroy fat cells.
He says...
For more severe cases, which are often difficult to treat, Board Certified Plastic Surgeon Dr. Vivek Bansal recommends other options. The simple surgical procedure called subcision helps moderate-to-severe cellulite by using local anesthesia and a catheter to break up the fibrous adhesions responsible for the skin puckering.
Another very effective treatment is the most advanced medical technology, which is a minimally invasive procedure called laser liposuction. This procedure is increasingly popular for body sculpting in targeted areas, which uses heat energy to remove local fat deposits while achieving skin tightening, resulting in a smoother and firmer aesthetic body contour with minimal downtime and discomfort.
The verdict...
Dr. Sonia Badreshia-Bansal and Dr. Vivek Bansal agree that a combination of treatments that targets different aspects of cellulite formation will offer the best results along with a balanced diet and regular exercise. This emerging topic will likely lead to greater understanding and proven efficacy of evolving treatments in the future.
--Dr. Sonia Badreshia-Bansal, a Danville dermatologist, is medical director of Elite MD Inc., Advanced Dermatology, Laser and Plastic Surgery Institute; her husband Dr. Vivek Bansal is a plastic surgeon.
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