Introduction

What affects 95% of all women (over puberty) and 10% of all men? Cellulite.
 
Nonsurgical treatment options available today for significantly reducing if not completely treating cellulite are reviewed here for the layman and physician alike.

 

Disclaimer

Nonsurgical yes. But at the same time, not you – should be guiding his care. Do not try to simulate any of this care with any Brookstone gadgets from your local mall.
 
Yes, you should consider it. In a team wise approach with a physician you can trust.
 
Having said that, the physician you team up with should be able to accept a strong working partnership with you that allows both you and him to guide your care.
 
What I offer here is humble opinion for educational purposes only. However, in this generalized summary of the current medical literature, patient satisfaction in study after study is 92% or more in the modalities applauded below.

 

Discussion

First, before the famous F’s, the history and physical exam by the physician. These are the things your doctor should be assessing before you dive into therapy. This distinguishes a good doctor from a mill. They are assessing, they are considering, they are generating a plan. It’s all done with you. You are completely involved if your aesthetic physician is a good doc. And plenty of them are, and plenty of them aren’t.
 
History. Was there trauma before, especially in the teenage years. That can lead to sclerotic tissue. It can also lead to skin sagging.
 
Physical exam. He or she must feel your thighs, arms, areas where cellulite can occur. Are there scars under there. That can lead to fibrous tissue. That can lead to skin sagging. Exam is done without the patient generating any muscle tension in the region being assessed. Just relax. The physician palpates the region.
 
[There is a nice clinical correlation here. How do you distinguish fibrous bands from blood flow restricted areas from skin laxity. Here is a generally accepted examination technique. With the patient refraining from any muscle tension, the physician gently pulls up on the skin. If the clinician gently pulls up and the dimpling disappears, it is overly flexible skin or skin laxity.]
 
And here’s your pneumonic, right up front. “The three F’s“ – Fat, Fiber, Fitness. Or fit’nass, like my more vulgar Beverly Hills counterparts like to say. Because it’s all about the derrière “in the end”? (sorry I couldn’t resist). But I’ll save that for… The end. Okay, okay… Enough. I’m a get myself in trouble.
 
  1. Fat. For the fat component… There’s always liposuction. That has complications. Not just the classic fat embolus concern, but other surgical complications. Edema? Yeah. And it hurts more. And it’s more expensive. And the results aren’t always that great, not that even, there can be dimpling, there’s wound care, and there is a variability in the surgical teams you have across the land. Do it, For sure. But, in addition to the well researched plastic surgeon you choose, have a metabolic physician specialist involved postop to generate a plan for mobilizing the edema, treating underlying insulin resistance if there is any, generating motivational plans and modalities to make sure you continue with the great time, pain, and financial investment you have made in your temple.
 
But surgical liposuction is only a first possible step.. Many people are skipping it entirely today, or using other therapies in combination with it to produce spectacular results.
 
So, what has taken off for the past 10 years in the world of body sculpting are various nonsurgical modalities that produce lipolysis, death of the fat cells. These range from injecting chemicals into fatty areas that destroy fat (needles); to completely noninvasive nonsurgical options like laser, heat, and cold therapy.
 
And the brand new kid on the block, electromagnetic (EM), high impulse, therapy that not only kills fat cells, but also increases muscle cells in size AND NUMBER. Very exciting. Olympic athletes train 30% of their muscle most the time. This fat killing, first ever muscle augmenting nonsurgical body sculpting modality works out muscle 100%! Crazy. But it’s new. And that in my mind is about the only thing working against it. Let’s see what the next year or two shows for EM…
 
So. Non-surgical, fat killing modalities. Too good to be true? No. And clearly cheaper. Arguably safer, no doubt. And nicely effective. And you don’t have to miss any work. No downtime at all really. You don’t even have to stop working out, which will help one of the “F’s” below.
 
  1. Fiber. There are these nasty, tenacious fibers that occur around dimpling areas of fat from some prior trauma and what not that must be broken up. Unfortunately, often require surgery, or at least needling techniques that take some time and training to master. Probably little if any ways of getting around that.
 
The fibrous component of cellulite is what causes the dimpling. So I asked the ladies… It’s very very important!
 
Fibrous bands from some long ago forgotten injury that must be dealt with… Versus skin laxity… Which should be dealt with differently. Versus some important blood vessel you don’t want to damage! The world of the plastic surgeon! Gentle retraction on the skin by the hand of a trained surgeon produces difference effects, allowing them to distinguish between these important different things. Hence on to the right kind of surgery – – If you’re so inclined, and if you’re even a candidate according to the plastic surgeon’s experience.
 
But wait! There IS a non-surgical modality doctors can use to break up fibrous bands in dimpling cellulite. Shockwave therapy (SWT) provided by acoustic ultrasound machines can indeed break up some banding underneath the tissue of the skin if done aggressively enough. So, no needles. No surgery. And you can get rid of those fibrous bands over time — with a little persistence. And ultrasound SWT.
 
And another nice advantage to shockwave, ultrasound, acoustic therapy like this is that it increases new blood vessels in that area! Bonus! So, whatever fat has been destroyed by the non-invasive fat killing modalities mentioned above can have a faster, smoother exit from the subcutaneous tissue because of new increased vasculature. Rather than just wait for the body to rid the fat that has been killed by one of the nonsurgical modalities above by it’s regular pokey, slow rate (something the body doesn’t ever seem to want to do; am I right ladies?), ultrasound therapy increases vascularity in whatever tissue it is aimed at so the fat loss is faster. Faster fat elimination. That always sounds good.
 
  1. Fitness. The doctor does his part with the other two “F’s”. Here’s where the patient has to do her part. Here, I have to sell the cellulite patient on eating better than they ever have done before, exercising, non-impact of course (biking, not motorbiking —swimming, yeah you have to get wet, or kayaking, just kidding, but an option). Okay, okay, I’ll be nice. Anyway… I’m not sure why, if it’s the increased teamwork the genuinely interested physician fosters with his or her fat conscious patient, or maybe it’s increased investment they have finally made to their temple… But, bit by bit, the body sculpting patient tends to start doing the right thing! Really going to that gym they joined months ago, genuinely eating less because they are actually following calorie counts finally…
 
That’s right. The only way to genuinely eat less is to do calorie counts. I’ve spent time with people who swear they don’t eat much at all. They have no clue. To eat less, or less enough to make a difference anyway, you must do your calorie counts! Then… Stick to what you discover for 1 to 3 months, make a change downwards 10% if you are not losing weight. Etc. Easy.
 
The main other, easy carry away pearl is the four grades of cellulite:
 
  • 0. No dimpling even with pressure applied
  • 1. Dimpling only when pressure applied
  • 2. Dimpling visible standing but not lying down
  • 3. Dimpling visible even when lying
 
They are important because scientific studies prove that most patients can improve by one grade.
 
Most patients have only grade one cellulite.
 
You put these two facts together, you can conclude that, even if you cannot discontinue gravity, aging, and the formation of cellulite, you CAN keep cellulite at 0 or 1 if you do a few things. That is, you can always stay a step ahead and at 0 or 1 cellulite by maintenance programs of eating light and exercising if you first eliminate or reduce it using Cryo and Shockwave therapies.

 

Conclusion

So there are some kind of template that will definitely require surgery. But having said that, all of this is elective aesthetics anyway. And having said that, even if you want to alleviate those types of surgical dumpling, the surgeon may not find your candidate for it based on your presentation, based on his or her experience. The elective world must remain a safe world, a tolerable world, both medically and financially.
 
Fortunately, most kinds of cellulite are fully amenable to nonsurgical, noninvasive body contouring techniques. And partnering pairs of these modalities is clearly showing to be key if not synergistic. I’ve definitely seen combination therapy as a recurrent principal of noninvasive body sculpting care in general.
 
So, now it’s time to do your Internet search for the body sculpting modality of your choice! Aesthetics are important! And if you don’t think so, think about self-esteem. And don’t forget about eating less and exercising more. And please do all your care, even weight loss, with a team oriented, experienced doctor trained to keep scientific evidence on your side, geared towards putting you first at all times.
 
 
Stay well,
David Allingham, MD, MS

 

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