Cellulite

{{About|subcutaneous fat|the subcutaneous infection|Cellulitis|the plastic|Celluloid}} {{Infobox medical condition (new) | name = Cellulite | synonyms = Adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, gynoid lipodystrophy, orange peel syndrome | image = Dimpled appearance of cellulite.jpg | caption = The dimpled appearance of cellulite | pronounce = | field = Plastic surgery | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }}

'''Cellulite''' ({{IPAc-en|ˈ|s|ɛ|l|j|ə|l|aɪ|t|audio=LL-Q1860 (eng)-Flame, not lame-cellulite.wav}}) or '''gynoid lipodystrophy''' ('''GLD''') is the herniation of subcutaneous fat within fibrous connective tissue that manifests as skin dimpling and nodularity, often on the pelvic region (specifically the buttocks), lower limbs, and abdomen.<ref name =Rossi>{{cite journal |doi=10.1046/j.1468-3083.2000.00016.x |pmid=11204512 |title=Cellulite: A review |journal=Journal of the European Academy of Dermatology and Venereology |volume=14 |issue=4 |pages=251–62 |year=2000 |last1=Rossi |first1=Ana Beatris R |last2=Vergnanini |first2=Andre Luiz |s2cid=18504078 |url=https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1468-3083.2000.00016.x|url-access=subscription }}</ref><ref>{{cite book |last1=Pinna |first1=K. |year=2007 |title=Nutrition and diet therapy |location=Belmont, CA |publisher=Wadsworth |page=178}}</ref> Cellulite occurs in most postpubescent females.<ref name="pmid16020201">{{cite journal |doi=10.1080/14764170410003057 |pmid=16020201 |title=Cellulite: A review of its physiology and treatment |journal=Journal of Cosmetic and Laser Therapy |volume=6 |issue=4 |pages=181–5 |year=2004 |last1=Avram |first1=Mathew M |citeseerx=10.1.1.506.7997 |s2cid=20205700 }}</ref> A review gives a prevalence of 85–98% of women of European descent,<ref name="pmid_25518090">{{Cite journal | pmid = 25518090| year = 2014| last1 = Janda| first1 = K| title = Cellulite - causes, prevention, treatment| journal = Annales Academiae Medicae Stetinensis| volume = 60| issue = 1| pages = 29–38| last2 = Tomikowska| first2 = A | url=https://www.researchgate.net/publication/269772040}}</ref> but it is considerably less common in women of East Asian descent.<ref name="Young 2021" /><ref name="Rao et al 2005 pp. 93–102" /> It is believed to be physiological rather than pathological. It can result from a complex combination of factors, including diet, sedentary lifestyle, hormonal balance, or heredity, among others.

==Causes== The causes of cellulite include changes in metabolism, physiology, diet and exercise habits, obesity, alteration of connective tissue structure, hormonal factors, genetic factors, the microcirculatory system, the extracellular matrix, and subtle inflammatory alterations.<ref name="Rossi" /><ref name="pmid16020201" /><ref name="pmid18489272">{{cite journal |doi=10.1111/j.1467-2494.2006.00316.x |pmid=18489272 |title=Cellulite: Nature and aetiopathogenesis |journal=International Journal of Cosmetic Science |volume=28 |issue=3 |pages=157–67 |year=2006 |last1=Terranova |first1=F. |last2=Berardesca |first2=E. |last3=Maibach |first3=H. |s2cid=15618447 |doi-access=free }}</ref>

===Hormonal factors=== Hormones play a dominant role in the formation of cellulite. Estrogen is thought to be an important hormone in the development of cellulite, and it has been proposed that an imbalance of estrogen relative to progesterone may be associated with cellulite. However, there has been no reliable clinical evidence to support the claim that estrogen levels are linked to cellulite, and many women with elevated estrogen levels do not get cellulite.<ref>{{cite book |last1=Bissoon |first1=Lionel |title=The Cellulite Cure |date=October 2006 |publisher=Meso Press |isbn=978-0-9764821-0-9 |page=74 |url=https://books.google.com/books?id=QsEMh00t5N8C&dq=%22cellulite&pg=PA74 |language=en}}</ref> Other hormones—including insulin, the catecholamines adrenaline, cortisol and noradrenaline, thyroid hormones, and prolactin—are believed to participate in the development of cellulite.<ref name="Rossi" />

===Genetic factors=== There is a genetic element in individual susceptibility to cellulite.<ref name="Rossi" /> Researchers have traced the genetic component of cellulite to particular polymorphisms in the angiotensin converting enzyme (ACE) and hypoxia-inducible factor 1A (HIF1a) genes.<ref name="doi 10.1111/j.1468-3083.2009.03556.x" /> Evidence for the heredity of cellulite is supported by studies showing that both the presence and degree of cellulite is similar between females within the same family.<ref name="Rao et al 2005 pp. 93–102">{{cite journal | last1=Rao | first1=Jaggi | last2=Gold | first2=Michael H | last3=Goldman | first3=Mitchel P | title=A two-center, double-blinded, randomized trial testing the tolerability and efficacy of a novel therapeutic agent for cellulite reduction | journal=Journal of Cosmetic Dermatology | publisher=Wiley | volume=4 | issue=2 | year=2005 | issn=1473-2130 | doi=10.1111/j.1473-2165.2005.40208.x | pages=96 | pmid=17166206 | s2cid=10123904 |quote= "heredity: empirically, it has been found that the degree and presence of cellulite, as with body habitus, is often similar between females within the same family; race: Caucasian women are more likely to develop cellulite than Asian or African American women;9}}</ref>

===Predisposing factors=== Several factors have been shown to affect the development of cellulite. Sex, ethnicity, biotype, distribution of subcutaneous fat, and predisposition to lymphatic and circulatory insufficiency have all been shown to contribute to cellulite.<ref name="Rossi" /> It is considerably less common in women of East Asian descent than in white women.<ref name="Young 2021">{{cite journal |last1=Young |first1=V Leroy |last2=DiBernardo |first2=Barry E |title=Comparison of Cellulite Severity Scales and Imaging Methods |journal=Aesthetic Surgery Journal |date=18 May 2021 |volume=41 |issue=6 |pages=NP521–NP537 |doi=10.1093/asj/sjaa226 |pmid=32785706 |pmc=8129470 }}</ref>

===Lifestyle=== A high-stress lifestyle causes an increase in the level of catecholamines, which have also been associated with the development of cellulite.<ref name="Rossi" /> Inactivity can cause vascular stasis, forming cellulite.<ref name="Young 2021" /> Excessive carbohydrate consumption may also be related to cellulite in some instances.<ref name="Young 2021" />

== Treatments == Cellulite can be resistant to a variety of treatments.<ref>{{cite journal |doi=10.1016/j.det.2013.09.005 |pmid=24267421 |title=A Modern Approach to the Treatment of Cellulite |journal=Dermatologic Clinics |volume=32 |issue=1 |pages=51–9 |year=2014 |last1=Rossi |first1=Anthony M. |last2=Katz |first2=Bruce E. }}</ref> Aside from "topical" products (creams, ointments) and injectables (collagenase), treatments for cellulite include non-invasive therapy such as mechanical suction or mechanical massage. Energy-based devices include radio frequency with deep penetration of the skin, ultrasound,<ref name="pmid29846343">{{cite journal|vauthors=Juhász M, Korta D, Mesinkovska NA| title=A Review of the Use of Ultrasound for Skin Tightening, Body Contouring, and Cellulite Reduction in Dermatology. | journal=Dermatol Surg | year= 2018 | volume= 44 | issue= 7 | pages= 949–963 | pmid=29846343 | doi=10.1097/DSS.0000000000001551 | s2cid=44101405 }}</ref> cryotherapy chambers,<ref>{{cite journal | last1=Ingargiola | first1=Michael J. | last2=Motakef | first2=Saba | last3=Chung | first3=Michael T. | last4=Vasconez | first4=Henry C. | last5=Sasaki | first5=Gordon H. | title=Cryolipolysis for Fat Reduction and Body Contouring | journal=Plastic and Reconstructive Surgery | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=135 | issue=6 | year=2015 | issn=0032-1052 | doi=10.1097/prs.0000000000001236 | pages=1581–1590| pmid=26017594 | pmc=4444424 }}</ref> laser and pulsed-light devices.<ref name=":0" /><ref name="pmid28123311" /> Combinations of mechanical treatments and energy-based procedures are widely used.<ref name=":0">{{cite journal |doi=10.1111/j.1610-0387.2012.07950.x |pmid=22726640 |title=Cellulite – an overview of non-invasive therapy with energy-based systems |journal= Journal der Deutschen Dermatologischen Gesellschaft|volume=10 |issue=8 |pages=553–8 |year=2012 |last1=Gold |first1=Michael H. |s2cid=21099081 |doi-access=free }}</ref> Ionithermie, a form of electrotherapy using electrical muscle stimulation, has been described as ineffective.<ref name=":02">{{Cite web |last=Feldman |first=Melissa |date=2018-03-09 |title=Ionithermie Cellulite Treatment Reviews: Does It Work? |url=https://www.consumerhealthdigest.com/cellulite-cream-reviews/ionithermie-cellulite-treatment.html |access-date=2023-12-24 |website=Consumer Health Digest |language=en-US}}</ref><ref>{{Cite journal |last=Coleman |first=Kyle M. |last2=Coleman |first2=William P. |last3=Benchetrit |first3=Arie |date=December 2009 |title=Non-Invasive, External Ultrasonic Lipolysis |url=http://dx.doi.org/10.1016/j.sder.2009.10.004 |journal=Seminars in Cutaneous Medicine and Surgery |volume=28 |issue=4 |pages=263–267 |doi=10.1016/j.sder.2009.10.004 |issn=1085-5629|url-access=subscription }}</ref> More invasive 'subcision' techniques utilize a needle-sized microscalpel to cut through the causative fibrous bands of connective tissue. Subcision procedures (manual, vacuum-assisted, or laser-assisted) are performed in specialist clinics with patients given local anaesthetic.<ref name="pmid28123311">{{cite journal|vauthors=Friedmann DP, Vick GL, Mishra V| title=Cellulite: a review with a focus on subcision. | journal=Clin Cosmet Investig Dermatol | year= 2017 | volume= 10 | pages= 17–23 | pmid=28123311 | doi=10.2147/CCID.S95830 | pmc=5234561 | doi-access=free }}</ref>

== Epidemiology == In European populations, cellulite is thought to occur in 80–90% of post-adolescent females.<ref name="doi 10.1111/j.1468-3083.2009.03556.x">{{cite journal |doi=10.1111/j.1468-3083.2009.03556.x |pmid=20059631 |title=A multilocus candidate approach identifies ACE and HIF1A as susceptibility genes for cellulite |journal=Journal of the European Academy of Dermatology and Venereology |volume=24 |issue=8 |pages=930–5 |year=2010 |last1=Emanuele |first1=E |last2=Bertona |first2=M |last3=Geroldi |first3=D |s2cid=26214159 }}</ref><ref name="pmid18459514">{{cite journal |pmid=18459514 |year=2008 |last1=Wanner |first1=M |title=An evidence-based assessment of treatments for cellulite |url=https://jddonline.com/articles/dermatology/S1545961608P0341X |journal= Journal of Drugs in Dermatology |volume=7 |issue=4 |pages=341–5 |last2=Avram |first2=M }}{{free access}}</ref> Its existence as a real disorder has been challenged,<ref name="pmid632386">{{cite journal |doi=10.1111/j.1524-4725.1978.tb00416.x |pmid=632386 |title=So-Called Cellulite: An Invented Disease |journal=The Journal of Dermatologic Surgery and Oncology |volume=4 |issue=3 |pages=221–9 |year=1978 |last1=Nürnberger |first1=F. |last2=Müller |first2=G. }}</ref> and the prevailing medical opinion is that it is merely the "normal condition of many women".<ref>{{MedlinePlusEncyclopedia|002033|Cellulite}}</ref> It is rarely seen in males.<ref name="Rossi" />

== History == The growing interest in cellulite has historically been linked to the growth of the cosmetic industry in the West, as well as globalization. The term was first used in the 1920s by spa and beauty services to promote their services, and began appearing in English-language publications in the late 1960s, with the earliest reference in ''Vogue'' magazine, "Like a swift migrating fish, the word ''cellulite'' has suddenly crossed the Atlantic."<ref>''Vogue'' 15 Apr 1968 110/1{{primary source inline|date=April 2015}}</ref> According to Italian researcher Martina Grimaldi, cellulite has often been pathologized as a "disease" in Western European news media, and it has been shown that French magazines promoting this misinformation are often funded by pharmaceutical companies that manufacture anti-cellulite skincare products.<ref>{{cite book |last1=Hackett |first1=Paul M. W. |last2=Hayre |first2=Christopher M. |title=Handbook of Ethnography in Healthcare Research |date=2 December 2020 |publisher=Routledge |isbn=978-1-000-26398-5 |page=166 |url=https://books.google.com/books?id=twsLEAAAQBAJ&dq=industry+sales&pg=PT166 |language=en |quote= "In the text "The female body between science and guilt: The story of cellulite", Ghigi (2004) explains the role of French magazines in the construction of the concept of cellulite. It shows how two French magazines, "''Votre Beaute''" and "''Marie Claire''" have helped to show cellulite as a disease. These are two newspapers funded by pharmaceutical companies that manufacture anti-cellulite products."}}</ref> American journalist Susan Faludi notes that the Western beauty advertisements have attempted to portray cellulite as a symptom of women's social progress, that cellulite is caused by being a working, independent woman. Faludi writes that such messaging is motivated by a fear within the cosmetic industry that women's social progress might lead to declining profits in the beauty industry as a whole, noting that profits did decline in the 1970s and 1980s, the era of second-wave feminism.<ref>{{cite book |last1=Faludi |first1=Susan |title=Backlash: The Undeclared War Against American Women |date=18 November 2009 |publisher=Crown |isbn=978-0-307-42687-1 |page=213 |url=https://books.google.com/books?id=5I-qlHF3DskC&dq=cosmetic+industry&pg=PA213 |language=en}}</ref>

== References == {{Reflist}}

== Further reading == * {{cite journal |doi=10.1016/j.jaad.2009.10.042 |pmid=20159304 |title=Treatment of cellulite. Part I. Pathophysiology|journal=Journal of the American Academy of Dermatology |volume=62 |issue=3 |pages=361–70; quiz 371–2 |year=2010 |last1=Khan |first1=Misbah H. |last2=Victor |first2=Frank |last3=Rao |first3=Babar |last4=Sadick |first4=Neil S.}} * {{cite journal |doi=10.1016/j.jaad.2009.10.041 |pmid=20159305 |title=Treatment of cellulite. Part II. Advances and controversies|journal=Journal of the American Academy of Dermatology |volume=62 |issue=3 |pages=373–84; quiz 385–6 |year=2010 |last1=Khan |first1=Misbah H. |last2=Victor |first2=Frank |last3=Rao |first3=Babar |last4=Sadick |first4=Neil S.}}

== External links == * {{Commons category-inline}} {{Medical resources | DiseasesDB =  | ICD11 = {{ICD11|EF02.3}} | ICD10 =  | ICD9 =  | ICDO = | OMIM = | MedlinePlus = 002033 | eMedicineSubj = | eMedicineTopic = | MeshID = | SNOMED CT = 248306003 }}

Category:Cosmetic surgery Category:Skin Category:Tissues (biology) Category:Women's health Category:Secondary sexual characteristics