Cellulite Treatment

NYC dermatologist Novick, Nelson

By Nelson Lee Novick, MD

New York, New York 10028

Physician (MD, DO), Cosmetic Dermatology, Dermatologic Surgery, Dermatology

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The term “cellulite” refers to unsightly, puckered or dimpled skin on the backs and sides of the thighs and buttocks. The appearance of cellulite has been described as being similar to cottage cheese or to an orange peel ( “peau d’orange”). It is seen most commonly in women, and current estimates suggest that more than 85%  of women suffer from it. For this reason, it can perhaps be viewed as a characteristics of normal female development.

The exact causes of cellulite are still unknown. Under the microscope we find fat deposits and tissue swelling within the subcutaneous (fat layer) of the skin bound between tight, horizontal fibrous tissue bands. The upward swelling of the fatty tissue is responsible for the puckered appearance and the downward pull of the fibers for the pitted look of the overlying skin.

Contrary to popular misconception, cellulite is not a matter of being excessively overweight, since it can be found in individuals of all body shapes and sizes. However, being overweight may worsen the appearance. A predisposition for the development of cellulite does run in families, and it is also more common in Caucasians. While it manifests as early as adolescence, the condition clearly worsens with advancing age as the overlying skin thins.

At present, there is unfortunately no cure for cellulite. Many therapies have been proposed for dealing with it, but rigorous scientific substantiation is lacking for any of them. These include the use of topical agents to decrease tissue swelling and promote lymphatic drainage; massage therapy (manual or mechanical), to break up fatty deposits and fibrous bands; and even liposuction or liposculpture, to remove excess fat and disrupt fibrous tissue. The benefits of any of these tend to be temporary, and maintenance treatment is generally required. More recently, laser and focused ultrasound therapies to promote fat breakdown, resorption, and recontouring have been introduced, but these, too, await further intensive investigation to validate their long-term efficacy.

In my experience, deep subcision, a minimally-invasive office procedure, followed by the injection of a volumizing agent, such as Radiesse, have proven quite helpful for individuals who have multiple, discrete areas of pronounced puckering. Since it stimulates natural collagen production, subcision alone may be helpful for raising up a site the way it does when treating depressed chicken pox or acne scars. I have found, however, that the supplemental use of a volumizing agent, such as Radiesse, is essential for achieving optimal results.

The procedure is simple. First, approximately ten of the most prominent or deepest dimples and craters are outlined with a surgical marker on each side of the thighs and buttocks.. Next, a small amount of local anesthetic containing epinephrine (for constricting blood vessels and diminishing bruising) is instilled directly underneath each of the spots. A needle-like cutting instrument, or trochar, is then inserted immediately below the dimple and fanned about in all directions to break up the tight fibrous connections encircling the fat bundles and to create a small pocket into which newly synthesized collagen will be deposited.

Finally, the volumizer is injected directly into the newly created pocket. This serves to directly plump up the overlying skin. It also enhances native collagen synthesis. And lastly, it acts a spacer material to prevent the pocket from closing before there is sufficient natural collagen produced to fill it up and raise the pucker above.

Each site requires just a couple a minutes to treat, and the entire procedure may take only twenty to thirty minutes.

Bruising, slight swelling, and discomfort are common and may last for several days. Since the resulting wounds all lie entirely below the skin surface, they are allowed to heal by themselves and require no special wound care. Cosmetic improvement is usually seen in about two to four weeks, the time it takes for new collagen to be laid down. The procedure may need to be repeated one or more times to achieve maximal correction.