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Key Points
- Similarities between localized fat, cellulite help explain why cellulite is more resistant to weight loss and surgical interventions
- A combination treatment approach is required to address multiple factors that contribute to its appearance
- Age-related skin changes are consistent with a worsening appearance of cellulite
Understanding of the pathophysiology of cellulite may help to guide the development of interventions for improving its appearance. At the 28th annual scientific meeting of the American Academy of Cosmetic Surgery, speakers discussed associations between cellulite, other subcutaneous fat and aging.
Comparisons between localized fat and cellulite show there are some similarities between these tissues as well as differences that can help explain why cellulite is more resistant to weight loss and available surgical interventions for fat reduction. However, more research is needed because there are many unanswered questions, says Misbah Khan, M.D., assistant clinical professor of dermatology, Weill Cornell Medical Center, New York.
THEORIES DEFINED According to one theory, whereas localized fat is composed of white adipose tissue, cellulite may actually originate from brown adipose tissue. Both types of fat have a role as energy storage, but brown adipose tissue is storage of excess lipids as chemical energy that is released as heat when needed for maintaining body temperature, while white adipose tissue converts its lipid store to provide energy/nourishment during times of starvation.
"The fact that cellulite fat remains intact even after extensive exercise and weight loss might be consistent with the theory that cellulite fat could be a type of brown fat, physiologically and chemically," Dr. Khan says. "Brown fat serves as stores for excess energy and converts it to 'heat' in suboptimal temperature exposures, rather than converting it to caloric energy." More extensive research is needed to compare cellulite and localized fat on a molecular level, but limited evidence indicates there are differences between them in cellular receptor types (alpha- and beta-adrenergic receptors). Beta-adrenergic receptors are vastly distributed in subcutaneous fat of lower abdomen, but they are scantily present in cellulite prone sites, such as the gluteofemoral area, Dr. Khan explains.
"Injectable fat-dissolving techniques such as mesotherapy are based on use of FDA (Food and Drug Administration)-approved chemicals that mainly target beta-adrenergic receptors. Differences in distribution of these receptors may explain why mesotherapy might not be as effective in dissolving cellulite fat as it is for abdominal fat," she says.
Hopefully, ongoing research will lead to the development of targeted treatments for cellulite, but for now, a combination approach is needed that addresses the multiple factors that contribute to its appearance, according to Dr. Khan.
"Cellulite is the herniation of subcutaneous fat within fibrous connective tissue that manifests as a topographic abnormality because of thin, flaccid skin. Effective treatment requires release of the septae, selective and careful removal of excess fat, and tightening of the skin," she says.
Dr. Khan's current approach in the treatment of cellulite combines power-assisted liposuction with microcannulas, use of the new proprietary Nd:YAG laser (Cellulaze, Cynosure) to melt the septae, and compression stockings post-procedure for six to eight weeks to achieve adequate skin tightening and to avoid fluid accumulation.
