Cellulite is a multi-factual condition present in 80-90% of post-pubertal women. It is estimated 38 million women have cellulite, however, men can also get cellulite.
Cellulite is completely different from generalized obesity. Obesity is characterized by the adipocytes (cells that store fat ), undergoing hypertrophy, while cellulite is characterized by stable adipocytes.
Cellulite is caused by the herniation of subcutaneous fat through the dermo-hypodermal junction of the skin. There are collagen fibers that connect the skin to the underlying structures. The collagen septa shorten and retract which causes the depressions that are pathognomonic of this problem. Septa are springy bands that connect skin to the muscle underneath. These bands are often surrounded by fat cells and can stiffen over time pulling the skin down. This pulling creates the classic puckering seen in cellulite. The collagen septa are located at right angles to the skin and when shortened pull straight down in women.
MRI and anatomical studies have demonstrated that adipose cell chambers in women are larger in height and width when compared to men. This may allow adipose cells to protrude into the overlying skin. Men have different anatomic variations of the septa and are situated diagonally to the skin so they are less inclined to pull straight down when shortened or thickened. A biopsy study of cellulite reported that there was an uneven thickness of the septa across samples and the septa were fibrosclerotic. The authors concluded that fat protrusion into the dermis was a secondary event and the result of progressive tension placed on the septa creating dimples and depressions characteristic of cellulite. The exact cause of cellulite is not known.
Factors known to contribute to the development of cellulite include:
- Sex- Female greater than male, may be hormonally driven by estrogen
- Genetics- Then to occur through families
- Lifestyle- More prevalent in a sedentary lifestyle
Many consider cellulite a result of vascular inflammation affecting the fatty tissues and the interstitial area where the septa are located.
Cellulite classification
Stage 1- Edematous Cellulite- characterized by the accumulation of fluid in the area.
Stage 2- Fibrous Cellulite- classic “orange peel” appearance.
Stage3- Sclerotic Cellulite- Characterized by hard and irregular contour due to macro-nodules. This can be painful to touch.
TREATMENTS (Clinical protocols targeting the release of the septa are the current , most beneficial treatments of cellulite.)
- Topical Agents
- Radiofrequency Devices
- Laser/Light Devices
- Massage
- Acoustic Wave Therapy
- Subcision
- Injectable Biologics
- Fillers
Topical Agents
Topical agents combined with massage have been used for years in the treatment of cellulite. The main challenge for these therapies is insufficient concentrations of the active ingredients to reach target tissues. Aminophylline, theophylline and caffeine thought to improve lipolysis (the breakdown of fat). Retinoids thought to increase dermal thickness, increasing angiogenesis and increasing new connective tissue by increasing the fibroblasts. Topical therapy may reduce skin laxity but not found to be significantly effective on cellulite
Radiofrequency Devices
Radiofrequency devices deliver a flow of energy to the subcutaneous tissues. This elevates the tissue temperature and remodeling is triggered.
Some newer RF devices have incorporated other energies into their design such as infrared light, vacuum suction and pulsed electromagnetic energy fields. These devices have shown promise in the treatment of cellulite
Laser and Light
Laser and light devices emit energy into the dermis and by heating this tissue they can stimulate collagen remodeling and can increase the microcirculation. This overall improves the skin appearance. This does not substantially disrupt the septa or cause much adipolysis. However, newer deeper penetrating devices activates wound repair and resulted in increased fibroblast activity and collagen synthesis.
Side firing lasers are being used placed in the subdermal tissues ,severing the septa and through the increase in temperature ,initiates thermal damage and stimulating increasing collagen production and adipocyte damage.
Acoustic Wave Therapy
Acoustic wave therapy is where pressure waves are transmitted into the subcutaneous tissues to promote lipolysis, improve blood flow and stimulate collagen production. This procedure does not require general anesthesia but multiple sessions are necessary.
Subcision
Subcision is a procedure where after anesthesia a needle is inserted and the fibrous cords are released using a fanning technique. Recently, newer benefits have been developed giving precise control of the treatment depth and a vacuum assist devise has been added. The main drawbacks have been edema, discomfort , pain and brusing. The vacuum assist has shown greater improvement than manual subcision.
Injectable Treatments
Collagenase Clostridium histolyticum.
Collagenase enzymes are isolated from the fermentation of Clostridium histolyticum. When injected, the collagenase hydrolyzes collagen. In cellulite, this procedure would dissolve the fibrinous septa pulling the skin down.
Dermal Fillers
Newer dermal fillers such as calcium hydroxyapatite and poly-1-lactic microspheres. These fillers have been used to treat scars and can be applied to smoothen the cellulite induced skin irregularities
Other Treatments
- Carboxytherapy
During this procedure, carbon dioxide gas is placed under the skin. Early studies show that women see less cellulite in the treated areas
- Endermologie
This device uses a vacuum like tool to lift up the skin while giving a massage to the tissues. This is a FDA approved device. The results are mixed so far but the side effects of the procedure are minimal
- Ionithermic cellulite reduction
During this procedure, the area will be covered in clay or algae then electrodes are placed and the area will be wrapped in plastic. An electric current is then passed into the area. Results are mixed in the literature
- Mesotherapy
This procedure uses dehydration medications
- Ultrasound
No evidence that this alone can reduce cellulite
- Cryolipolysis and Liposuction
Both of the above work well for removing fat but cellulite may persist after
Platelet- Rich Plasma
Platelet Rich Plasma is an autologous blood derived concentrate that has been shown to participate. In homeostasis, angiogenesis , inflammation and tissue repair and regeneration. Platelets are a source of thousands of bioactive factors that are responsible for tissue repair and healing. Growth factors released from platelets stimulate the differentiation of the bodies own stem cells involved in all aspects of the healing and rebuilding process. Platelet Rich Plasma provides the ability to administer super-physiologic doses of platelets to an effected area for repair and regeneration,
Platelet Rich Fibrin is the second generation of PRP derived from the PRP that provides a slower rate of degradation rate and therefore prolonged release of growth factors to the surrounding tissues.
Discussion
The etiology of cellulite is still not completely understood and proven in a single comprehensive study. Treatments focused on dissolving or removing fat alone do not provide long term benefit in the resolution of cellulite. Therefore, it is felt cellulite is not a primary fat related problem. The presence of visible cellulite is associated with biopsy proven changes in the dermis, adipose tissue and septa when compared to normal tissue. Treatments that focus on all three aspects of cellulite have been proven to provide long term success in these cases.
With the above noted, Platelet Rich Plasma/Platelet Rich Fibrin should be added to the treatments of cellulite for tissue repair and regeneration in partner with other modalities.
Studies
- Is Skin Microneedling a Good Alternative Method of Various Skin Defects Removal Dermatol Ther 2018 Nov;31(6):e 12714 PMID 30246914
The whole procedure evokes various reactions which can be divided into 3 major phases; inflammation, proliferation and remodeling. used in a variety of skin defects including cellulite.
In order to accelerate postsurgical regeneration and to enhance effects, microneedling is combined with the application of Platelet rich plasma among others. High effectiveness and limited side effects
- Treatment of Dimpling From Cellulite Plast Reconstr Surg Glob Open 2018 May;6(5):e 1771 PMID 29922557
Background- Cellulite can be seen on the skin in widespread alterations of the skin surface and dimpling. The purpose of this study was to assess the effectiveness of subcision to treat dimpling from cellulite
Results- Subcision has been shown to be effective and safe…
The author stated,” It creates a hematoma that in turn boosts the formation of new connective tissue”.
- Platelet-Rich-Plasma in Aesthetics Indian Dermatol Online J 2021 Nov;12(supp 1) :S41-S54 PMID 34976880
Purpose- The use of PRP as a treatment modality for skin rejuvenation has been increasing rapidly over the past decade. Platelets become the logical choice for replacement and renewal of cells, tissues, or organs due to low invasiveness/high healing, easy availability and abundance of growth factors. PRP is considered to be a growth factor cocktail, which promotes wound healing, angiogenesis and tissue remodeling. This was a comprehensive literature review.
Conclusion- PRP has been shown to be effective in combination therapy with ablative services like fractional laser
Author- Although there are 14,067 articles concerning Platelet Rich Plasma presently on the PUBMED site, there are currently no double- blind studies available concerning PRP solely for cellulite. However, the use of PRP with other ablative modalities for repair, revitalization and rejuvenation of tissues post ablative therapy has shown enhanced benefit. Platelet Rich Plasma is being used world wide for this problematic condition that is readily seen with a web search.
Juventix Regenerative Medical provides a FDA approved Platelet Rich Plasma Kit that is safe, easy to use and cost effective. It supplies super -physiologic concentrations of platelets taken from the same source.
Juventix Regenerative Medical has a patent pending LED – Activator that enhances the release of growth factors and cytokines from the platelets without the use of Calcium Chloride or Thrombin.
Juventix Regenerative Medical has a Bio-Incubator that transforms PRP into an injectable flowable Platelet Rich Fibrin for use in a wide variety of clinical applications. PRF is the second generation of platelet rich products and still is an autologous derived product with no antigenicity.
Juventix Regenerative Medical has a wide variety of products and services for most regenerative purposes.
RESTORE, REVIVE, REGENERATE- JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
