Dr. Aaron Stone explained this issue much better than I could ever hope to do...so...with thanks to him....
Cellulite is the only word we have to describe the uneven pitted surface or dimpling of the skin commonly seen on the thighs of women. I am not sure who first coined the term but doubt it was first used by cosmetics manufacturers to describe this condition. It is common in women, rarely seen in men & begins at various ages depending on body habitus, genetic makeup, etc..
The outer skin is separated from the underlying muscle by a layer of fat. The fat has little strength therefore lying parallel to the skin throughout the fat layer is a sheet of connective tissue called superficial fascia. This fascia in turn is connected via finger like septal extensions through the fat to the overlying skin & underlying muscle. This architecture helps hold the fat together. In some areas the distance between skin, superficial fascia & muscle is very small.
In men the superficial fascia is much thicker than it is in women & the septal extensions are crosshatched lying oblique to the plane of the skin. In women the septal extensions are fewer & lie perpendicular to the skin surface. If cellulite were solely due to the amount of fat present under the skin then men & women with the equal amounts of thighfa wuld show similar degrees of cellulite. This is clearly not the case. Even very obese men rarely have cellulite but cellulite can even be seen in slender women with good muscle tone who exercise regularly.
My feeling, although I can't prove it scientifically is that there are 3 possible causes for cellulite 1)edema or swelling of the skin & fat due to increased water content 2)contraction of the muscle pulling the septal extensions or shortening of these septa resulting in pitting of the overlying skin 3)descent of the skin & fat envelope that normally occurs with aging resulting in skin pitting due to the pull of septa whose length is unchanged. This is more common in women who have an inherently weaker fascial support system to hold the skin up.
Treatment of the first is straightforward - get rid of the water. The second requires surgical transection of the responsible septa. The third is most common & requires lifting of the skin & fat envelope i.e. a thigh buttock lift. There is no difference in fat metabolism in areas of cellulite vs. areas without cellulite. Thus, aminophylline & other creams have no effect. Exercise will have little or no effect because it works on the underlying muscle, not the fascial support system. Fat removal by liposuction or weight loss can diminish the severity of cellulite skin dimpling but will not ameliorate the underlying fascial structural problem that creates it.
Liposuction will have little effect. It will not cure the problem. Unless there is very severe sagging I usually do not recommend a thigh buttock lift in younger women. Endermologie whereby external suction & motorized massage are applied has been ok'd by the FDA for the temporary reduction in the appearance of cellulite. This may be due to the swelling induced by twice weekly treatments & then the requirement of maintenance treatments. There has been no evidence to date whether or not after a certain number of treatments you can stop & will have permanent reduction of cellulite. To see which category you are in you should see a qualified plastic surgeon & find out what options you have available to correct this problem.
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Aaron Stone MD
Aesthetic & Reconstructive Plastic Surgery
2080 Century Park East, Suite 1110
Los Angeles, CA 90067
(310)843-9021
FAX(310)277-6510
e-mail - astone@earthlink.net
http://www.aaronstonemd.com