Cellulite appears as a result of "the herniation of the normal fat that exists under the skin -in the hypodermis-, between the connective tissue fibers, which are somewhat weaker in the typical areas where those characteristic 'holes' are seen: thighs, hips and abdomen, "explains Dr. Cristina de Las Heras De Gracia, specialist in Aesthetic Medicine of International Dermatological Clinic (Madrid).
Although its presence on our skin can make us visually uncomfortable, what should really interest us is what it could say about our health, as this specialist points out. "Cellulite should not be considered only as an inaestheticism (bodily characteristic that does not 'conform' to the 'established' aesthetic canons), but should be managed as a chronic disorder of the subcutaneous tissue, called edemato-fibro-sclerotic pathology in allusion to the metabolic and dystrophic alterations of the parenchyma of adipose tissue and the interstitial matrix with a clear circulatory compromise that occur."
Popularly known as 'orange peel', cellulite does not have to be, as it might seem, related to excess weight and can emerge even in the driest anatomies. In fact, it is estimated that it affects 90% of women, in its different degrees, and even men can also suffer from it (although to a lesser extent). "Cellulite affects women more than men for a reason of distribution of body fat and a hormonal cause, since, in them, the subcutaneous tissue is lax (to be prepared to stretch in pregnancy) while, in them, it is compact and retains fat better without showing it. In addition, the high concentrations of estrogen in the blood that women have alter the functioning of blood vessels, which become fragile and porous, which favors the accumulation of fluids and toxins, causing fat cells to become inflamed, lose their dimension and consequently produce cellulite, "explains Dr. Cristina Chacón, expert in aesthetic medicine and CEO of the CCH Privé center in Madrid.
CAUSES OF CELLULITE
Although the exact causes of cellulite are still unknown, what is known is that there are some factors that can favor its appearance, such as hormonal changes that occur during pregnancy, puberty, menstrual periods, menopause or the use of oral contraceptives; genetic predisposition (estimated to be hereditary in up to 50% of cases); or the presence of pathologies, such as obesity or diabetes, that affect lymphatic drainage.
In this sense, Manuela Auñón, coordinator of the Department of Aesthetics of Palasiet Thalasso Clínica (Benicassim, Castellón), emphasizes that "today's studies maintain that cellulite is linked, above all, to hormonal changes. Therefore, it appears, in most cases, after puberty and decreases with menopause. It is known that, in this 'hormonal storm', those fluctuations in estrogen levels that women experience during the different stages of our lives play a fundamental role, favoring fluid retention and fat accumulation. "
The lifestyle, the way we eat, rest, move or manage our emotions, influences much more than we think. Leading a sedentary life, wearing very tight clothes on a regular basis, following an unbalanced diet – abusing fats and carbohydrates – and even suffering from high levels of stress, are some of its triggers. "When suffering episodes of stress and anxiety, more cortisol is released, a hormone that causes more fat to be stored and more fluids to be retained," says Dr. Cristina Chacón.
His 'favorite foods', as we know, are "sugars and carbohydrates of rapid absorption are not consumed or transformed into energy, since they are stored, within the adipocytes, cell responsible for storing fat," adds Manuela Auñón.
Why do even the thinnest women have it? "Because our body is designed to procreate and, therefore, stores 'reserves' of fat. In addition, the fatty tissue acts as cushioning to thermoregulate our body and, in case of fall, protect our bones so that they do not break. In short, our body is much more perfect than we think and is designed to 'self-regulate', depending on the structural variations of women," says Auñón.
STEPS TO BEAT CELLULITE
To defeat the 'enemy', it is said, one must know him. With cellulite the same thing happens, to combat it, the first thing we must do is, according to Manuela Auñón, know what we are facing. "There are several stages and we can find: soft cellulite; hard or compact cellulite and edematous cellulite. That is why it is so important to put yourself in the hands of a good professional who carries out a correct diagnosis about your type and its degree to, based on that information, recommend the most appropriate treatments in each case. "
How to recognize the type we have? Here are some clues. The compacta, usually present in young women in areas such as buttocks and thighs, is not visible to the naked eye, although, normally, it produces pain when touched. The soft, the most common and widespread from the age of 35, is easily appreciated and is accompanied by flaccidity and fluid retention. Finally, edematous can appear at any age and is characterized by a padded touch, a marked swelling in the legs, related to poor circulation and malfunction of the lymphatic system.
Eliminating it completely is a very complicated objective, although it can be significantly improved by following a care routine, among which some dietary and sports guidelines stand out, as well as anti-cellulite treatments focused on treating localized fat proposed by CCH Privé:
1. Follow a healthy diet. It is recommended to opt for green and leafy vegetables, avoid alcohol, carbonated drinks and processed or ultra-processed foods, as well as drink plenty of water, around two liters a day, to keep the skin elastic and healthy. "To combat this condition, we must limit salt intake, as it can cause fluid retention and, consequently, contribute to cellulite. In addition, it is recommended to consume foods such as artichokes, leeks, onions, asparagus, green salads, celery, chard, radishes, infusions of green and red tea or fruits such as watermelon, pineapple or orange, "says Dr. Chacón.
2. Perform specific exercises. Sport is one of the main allies in the fight against cellulite and, therefore, it is advisable to follow a training routine that focuses on treating the affected area, as in the case of squats, an exercise that, according to the expert, "strengthens the muscle and, where there is muscle, cellulite cannot settle". In addition, aerobic routines, such as running, jumping rope or cycling, can help combat overweight and, therefore, cellulite, as well as practicing yoga, a discipline with which different parts of the body are stimulated and that allows to reduce stress levels (and, therefore, cortisol).
3. Shower with cold water. It is advisable to finish the daily shower with cold water on the areas to improve, as this will activate circulation and tone the skin. Subsequently, you should apply anti-cellulite lotions and massage the affected areas, in order to improve the drainage of toxins from the skin.
4. Avoid tight clothing. Tight clothing obstructs circulation and promotes fluid retention. Therefore, whenever possible, it is advisable to wear loose clothing, preferably cotton, avoiding synthetic fibers and lycra.
5. Opt for localized aesthetic treatments." Among the techniques recommended to combat cellulite, infiltrated treatments with mesotherapy technique with draining, lipolytic or skin tightening effect stand out, as well as treatments with collagen inducers that improve the appearance of orange peel through the patient's self-production of collagen, smoothing the typical dimples. The result of these treatments will be progressive and it is advisable to combine it with machine treatments, such as LPG, cavitation and vacuum therapy, "concludes Dr. Chacón.
COSMETICS
The question is: to what extent are all these anti-cellulite creamsthat 'promise' to erase the 'orange peel' from our thighs effective? The harsh reality is that there are few studies – carried out on a small part of the cosmetics available – not all – and with a small number of patients – that prove their real effectiveness.
Dr. Mercedes Sáenz de Santa María, from Clínica Dermatológica Internacional, explains why we should not believe the 'magic' that advertising promises us: "By definition, creams do not penetrate beyond the epidermis, the most superficial layer of our skin. When we talk about excess fat, cellulite, flaccidity, etc., we refer to alterations in which the adipose panicle, fibrous septa, dermis and all adjacent deep structures intervene. If the cream is not able to penetrate at that level, it is not possible for it to improve these conditions."
The only truly effective thing in these cases," he continues, "is the constancy that can give you to have a specific product for it, that you apply it daily and that when doing so you do it with a vigorous circular and ascending massage. This movement hydrates the epidermis, improves its appearance and the massage drains and discharges fluids, stimulating circulation in these tissues."
Conclusion? Its continued use can partly improve the texture of the skin and contribute to diminish the appearance of orange peel but, in general, the improvement is discreet and transient (which is also not superfluous).
TREATMENTS
The demand for body treatments skyrockets every year at this time, but the reality is that only some work and others only become long, tedious and expensive sessions of techniques that do not achieve what is expected, as warned from the Spanish Society of Aesthetic Medicine. "The market is saturated with exclusive treatments that offer miracles," explains Dr. Cerrud.
How do you know what works and what doesn't? Where to go or who to deal with? "If there are needles involved or appliances that use a high power (inherent to the medical professional), the one who performs the treatment must be a doctor and do it in a clinic or medical center. If it does not meet these premises and it is a purely aesthetic treatment, the one who carries out the procedure can be a beautician, aesthetic assistant, nurse or nursing assistant, with the own accreditation of aesthetics and, in that case, it can be carried out in a beauty center or spa, "clarifies this specialist.
What procedures can we trust? "You always have to be wary of a market that offers such a variety of supposedly different products and procedures to treat the same condition. Body treatments, sometimes, are expensive, long, uncomfortable and annoying, but many maintain the illusion of improvement in which every human being needs to believe. Some work halfway and not all over the world. Actually, the younger you are, the more noticeable they are and the longer they last."
Here are their recommendations on injectables:
Mesotherapy." After almost 20 years of using L-Carnitine, artichoke, silicon and various homeopathic substances, I do not consider intradermal injections to treat cellulite and localized fat to be the most effective to treat cellulite. The effects are discreet and are only constant if combined with body appliances. On the other hand, mesotherapy focused solely on treating cellulite based on Alidya has great draining power and great results when combined with shock waves (ultrasound)".
Intralipotherapy. "It is the treatment to destroy localized fat on a small scale. It is not indicated for large volumes or to lose weight. These are lipolytic infiltrations (what actually breaks is the adipocyte) of a substance present in our body capable of dissolving those love handles that resist diet and sport. This occurs in both men and women, although in the female case it is distributed more in the abdomen, hips, holsters and bra area, while in men it is more common in the lower abdomen and flanks. It is painless and, as a side effect, there may be mild discomfort such as stiffness and some possible bruising and inflammation at the point of infiltration that disappear in two or three days. "
And also in appliances:
Ultrasounds." They have a wide variety of applications, especially when it comes to eliminating or reducing localized fat, as well as numerous studies that support them. They affect the adipocyte and fibrosis, which makes them excellent allies against cellulite. They are a form of mechanical energy that produces vibratory waves of different frequencies that propagate through the air, producing deep heat practically imperceptible to the patient and, in addition, improve lymphatic drainage. Within the ultrasounds we distinguish:
Shock waves." They are ultrasound, but pulsed, unlike the previous ones, which are continuous. In this way the mechanical effect of sound waves is used and "shocks" occur. They generate a mechanical effect on the adipocyte and fibrotic bands that are part of the pathophysiology of cellulite, dissolving part of the adipocyte and improving the tissue, with more intensity than the ultrasounds previously named".
HIFU." They are also ultrasound, but they focus all the energy on a specific point, generating deep and intense heat at the level of the muscle fascia, which in turn generates retraction and improves flaccidity. It is a safe treatment and with a good diagnosis can provide results in a few sessions."
Radio frequency. "It doesn't matter the type: unipolar, bipolar or tripolar; The effect is the same: it heats the dermis to generate a controlled inflammatory reaction that leads to the production of collagen. It is used to treat sagging. It seeks an increase in temperature, controlled inflammation and, finally, stimulation of collagen and, therefore, tension. With realistic and adequate expectations, it's a good procedure."
Lymphatic drainage or pressotherapy. "Combining it with draining mesotherapy and shock waves is excellent for treating cellulite. Of course, by itself it only helps to relieve the tension of the loaded legs"
Conclusion? "At the body level you can improve almost everything, but always knowing what to expect, sticking to a strict diagnosis and adjusting expectations, but we should know that grade 4 cellulite (which is already pure fibrosis with irreducible nodules) or large accumulations of localized fat is impossible to treat without a scalpel. For all that, as a last resort, there is always plastic and reconstructive surgery."
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