Cellulite

what causes it?

Cellulite (orange-peel or cottage-cheese skin) is a condition in which the skin has a dimpled, lumpy appearance.

The exact cause of cellulite has not been identified but it involves fibrous connective cords that tether the skin to the underlying muscle, with intervening fat. As fat cells accumulate, fat deposits push through the long, tough cords of connective tissue pulling down the skin, creating an uneven dimpled surface.

While cellulite affects both men and women, it is more common in females, due to the differing distributions of fat, muscle, and connective tissue. In fact, most women develop some cellulite after puberty and 80 to 90% of women will probably experience cellulite. In women, the fat cells and connective tissue in this layer are arranged vertically and it is easier for fat to protrude into the layer of skin giving the appearance of cellulite. Furthermore, women's fat is typically distributed in the thighs, hips and buttocks — common areas for cellulite. In men, the tissue has a robust criss-cross structure and it is harder for fat to protrude. This may explain why men are less likely to have cellulite than women.

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Men-Vs-Women-fat-cells

Risk factors

Many factors may influence cellulite development

  • Genetics: Genetic factors linked to metabolic speed, subcutaneous fat distribution, ethnicity, and blood circulation may affect cellulite development
  • Age: Aged skin is less elastic, thinner and saggier, with a higher risk of cellulite
  • Hormones: Estrogen, noradrenaline, thyroid and pancreatic endocrine hormones and prolactin are part of the cellulite production process.
    • One theory is that as ladies’ estrogen level decreases, blood flow, oxygenation and collagen production in the connective tissue under the skin also decreases. Fat cells also enlarge as estrogen levels fall. The fat deposits under the skin become more visible and protrude through weakening connective tissue producing cellulite.
  • Diet and lifestyle
    • an inactive lifestyle
    • pregnancy
    • an unhealthy diet with too much fat, carbohydrates, salt and too little fibre
    • smoking
    • underwear with tight elastic that limits blood flow

Evidence-Based Treatments

to treat cellulite safely and effectively

Encurve Non Contact Radiofrequency

enCurve is a non-contact field radiofrequency (RF) system that generates a constantly oscillating electromagnetic field at a specialised frequency of 27.12 MHz. The high-frequency oscillating field generates heat concentrated mostly in the fatty tissue, but also heats the overlying skin.

This heating causes the fat cells to go into natural and gentle programmed cell death, known as apoptosis, that allows the body to excrete the lipids contained. The heat also stimulates collagen production and improves microcirculation. The dual effect of the heating combines to reduce the appearance of cellulite.

Extracorporeal Shockwave Therapy

Extracorporeal Shockwave Therapy uses a hand-held device to transmit focused shockwave energy deep into the tissues, this improves cellulite by:

  • disruption of either the fat, or the septae or both
  • reduction of lymphedema
  • influencing mesenchymal stem cells
cellulite shockwave
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Fractional Microneedle Radiofrequency

Fractional microneedle radiofrequency used insulated microneedles to spare the upper part of the skin and deliver radiofrequency energy precisely up to 4mm deep in the skin, to break up fat cells, increase collagen production and improve microcirculation, diminishing the appearance of cellulite.

Subdermal laser

A tiny probe inserted under the skin is used to conduct laser energy, breaking up the fibrous tissue and increasing collagen production. This reduces the appearance of the cellulite.

subdermal laser
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Subcision & Filler

In subdermal incision (subcision), surgical tools inserted under the skin via small needle punctures are used to release the connective tissue bands. Filler is then interposed to prevent the two layers from sticking back together during the healing process.

1Aesthetics's View

dr wan's perspective

Cellulite plagues many ladies who find it unsightly especially when they wear shorts or swimwear. Consciously or unconsciously, this causes them to avoid such clothing out of embarrassment.

Larger areas of shallow cellulite

Dr Wan would recommend a combination of non-invasive treatments using enCurve, shockwave therapy and topical retinoids as they have a synergistic effect. Topical retinoids support collagen synthesis, enCurve both reduces subcutaneous fat and thickens the overlying skin, while shockwave therapy reduces edema and improves local microcirculation

Worse dimpling or refractory to non-invasive therapy

Dr Wan uses fractional microneedle radiofrequency or subdermal laser to treat these. Fractional microneedle radiofrequency can penetrate up to 4mm deep to reduce subcutaneous fat and tighten the overlying skin. Subdermal laser inserted under the skin can produce direct tightening to the deep tissue plane and reduction of the underlying fibrous septae.

Deeper focal depressions

Dr Wan mainly uses subcision and filler for these to directly release the tethering. Results can be seen quickly and are generally long-lasting. Filler is used to prevent the cut fibres from sticking back together, reducing recurrence.

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