Cellulite is an ill-defined condition commonly known as skin alteration affecting dermal and sub dermal planes. This is also commonly called Gynoid lipodystrophy as it predominantly affects woman of all age.
It is a condition that has many controversies with regards to its assessment and treatment. Clinical assessment of the patient starts with history of the problem. Particular question important to ask is weight gain and previous treatment. Any medications that have affect on weight gain. There are general medical conditions that also have negative influence on development of cellulite.
On clinical examination of the patient it is often found that it particularly affects thighs and buttocks of woman. It can give an appearance of skin mattress in extreme cases, usually it is asymptomatic and considered to be the anatomic expression of the underlying problem of fat and subcutaneous tissue. It gives clinical appearance of dimpling on skin on static or with some limb maneuvers.
There are also anatomical variations between woman and men fatty tissue specially fibrous septa architecture that divides fatty tissue into compartments.
It is hard to explain what are the exact clinical reasons behind the appearance of this condition though some physiological changes are worth mentioning with relates to this ubiquitous condition.
- Protrusion of fatty tissue into the dermal layer
- Dermal thickness variability and its relation to some forms of cellulite
- Variation in sub dermal fatty layer
- Nature of adipocyte found in the area differ from elsewhere in the body
Physical examination of the most effected area is far most a reliable method for the diagnosis; it includes measurement of gluteal fold, thighs and above or below this area. However there are other useful techniques explained in the literature that are helpful in establishing a diagnosis. An ultrasound probe to assess the body mass index (BMI) and thigh circumference measurement is explained in literature with great success.
High frequency μ-Scan ultrasound device with mechanical probe is a useful device that can be utilized to evaluate the Epidermis and Dermis thickness, dermal echogenicity, all of which can be effected with the anti cellulite treatment. Treatment of cellulite varies from using simple creams to use of extensive liposuction technique. Treatment depends on understanding the complex pathophysiology of the condition, which is poorly understood.
Patients often get benefit when they have weight loss as the severity of cellulite decreases however in obese people the dimpling doesn't change significantly. Histological examination reveals that there is retraction of fat protrusions into the dermis.
There are several treatments mention in publish series that are based on complex anatomy and physiology of the cellulite prone areas, which includes using of aminophylline creams, xanthines, Endomerolgy, ultrasound, laser or radiofrequency assisted liposuction. This is based on reducing the lipogenicity or removing of fat cells.
Massage seems to decreases the tissue edema and has some effect on cellular level by stimulating fibroblast activities.
External ultrasound, external radio frequency and external laser devices also shown to have beneficial effect by increasing the thermogenecity and improving the micro circulation with some new collagen synthesis.
Unfortunately all of the above mentioned modalities have limited prove of efficacy contrary to the huge advertisement.
Recenty it has been shown that VASER(3rd generation ultrasound) can be helpful in treating cellulite significantly particularly because of its ability to work well with superficial fatty tissue which seems to be the main pathophysiology of the problem.
Cellulite assessment and treatment is still controversial because of the lack of significant evidence that supports its physiology and way of treatment. Treatment can vary from using simple cream to extensive liposuction techniques. This wide variation of treatment modality is available due to lack of significant evidence available in unified standardization of treatment. Selecting the treatment regimen can be based on physician choice and based on his/her experience of treating cellulite.
Further large size study may be helpful in the future to establish some protocol of management for this illusive condition.
By Dr. Hasan Ali,
Plastic, Reconstructive and Esthetic Surgeon
American Academy of Cosmetic Surgery Hospital
Dubai Healthcare City,
United Arab Emirates