Patients often present to dermatologists with complaints of cellulite, trying to treat the issue medically. This demand, in turn, has led to increased treatment options. The global cellulite treatment market is projected to reach $5.7 billion by 2031.1 With the variety of treatments available, including complementary and alternative therapies that may not be safe or effective, it is important to understand how these products work to better guide your patients.
Q: What is cellulite?
Cellulite is the altered topography (eg, dimpling, filling, orange-colored) of the skin on the backside of the thighs, arms, buttocks, and abdomen that is created by the stretching of the skin due to fibrous bands or septa that connect the skin to the underlying muscle. Interestingly, despite its rather high prevalence, there is little published epidemiological data. Although cellulite is considered to be multifactorial in nature, as subcutaneous fat accumulates (usually during puberty), the fat stretches the diaphragms creating superficial dimples. Methods to improve the appearance of cellulite include reducing subcutaneous fat, reducing extracellular fluid, and improving microcirculation/lymphatic drainage.
Q: How is treatment effectiveness documented?
Documenting the effectiveness of cellulite treatment is indeed challenging from an aesthetic point of view, because only the appearance of cellulite can be treated. Improvement is usually noted through the circumference of the thighs. However, the reduction of the thigh circumference does not involve any structural change and does not concern specific mechanisms of action, allowing the product to remain in the cosmetic field. Additionally, thigh circumference is a very subjective measurement and is prone to variation between individuals based on where the tape measure is placed on the thigh and how tight the tape is pulled.
Q: Why is caffeine included in anti-cellulite cosmetic products?
Many topical cellulite products contain caffeine, an alkaloid found in the leaves and beans of the coffee tree. It is a methylxanthine-inhibiting phosphodiesterase, which converts cyclic adenosine monophosphate (cAMP) to adenosine monophosphate (AMP) and provides β-adrenergic stimulation. Caffeine is thought to mobilize triglycerides, converting lipids into free fatty acids and glycerol that can be removed by the lymphatic system. The challenge is whether topical caffeine can accomplish this task.
Q: Why are herbal extracts included in anti-cellulite creams?
Many cellulite creams contain a botanical cocktail of ingredients such as ginkgo extract (Ginkgo biloba), mallow (Malva sylvestris) extract, seaweed (Follicular cystitis) extract, onion (Centella asiatica) extract, etc. These anti-inflammatory agents may reduce inflammation caused by reduced lymphatic drainage. Botanicals are widely used in cosmetics because they are not classified as drugs.
Q: Does retinol play a role in reducing cellulite?
Because retinoid receptors are present in the skin and retinoids can improve skin thickness, retinol (a synthetic form of vitamin A) is a common ingredient in cellulite reduction products. Manufacturers use an over-the-counter retinoid and oral vitamin form consumed in red, orange and yellow fruits and vegetables, with the idea that it improves skin firmness. In theory, improved skin firmness should mean the skin is less likely to dimple and deform, thus minimizing the appearance of cellulite.
Q: Will eating licorice reduce cellulite?
Glycyrrhetinic acid, the active metabolite of licorice, is found in skin care products with a variety of indications, including skin whitening, antiaging, and cellulite improvement. Glycyrrhetinic acid is thought to regulate the availability of cortisol, which is involved in fat deposition. Much of this data comes from oral consumption of glycyrrhetinic acid, however the creams are topical. It is important to note that licorice candy may not contain the same licorice extract. So, eating large amounts of licorice candy is not likely to improve the appearance of cellulite. Additionally, consuming large amounts of black licorice can be unhealthy for patients.
Q: Can local changes in blood flow improve the appearance of cellulite?
It has been suggested that increased skin adhesion via extracellular fluid contributes to cellulite. With this in mind, natural treatments for cellulite often include hand massage or kneading devices that attempt to push the extracellular fluid back into the lymphatic and venous systems for removal. Likewise, there are botanicals (eg, barley, ivy, mushrooms, sweet clover) that are labeled as phlebotonics. These vasoconstrictors are considered an option because they improve peripheral microcirculation thereby reducing edema.
Concluding Thoughts
Although cellulite is not considered harmful to the patient’s health, individuals may seek treatment to minimize it and improve their appearance. Familiarity with the options will better prepare you for your patients’ questions.
Report
1. Prathmesh B, Onkar S. Cellulite Treatment Market by Procedure Type (Non-Invasive, Minimally Invasive, Local), By Cellulite Type (Soft Cellulite, Hard Cellulite, Edema), By End-User (Hospitals, Clinics & Aesthetic Centers, Others) : global opportunity analysis and industry forecast, 2021-2031. Allied Market Research. October 2022. Accessed February 7, 2023. https://www.alliedmarketresearch.com/cellulite-treatment-market-A10923https://www.alliedmarketresearch.com/cellulite-treatment-market-A10923
Zoe Diana Draelos, MD, is a consultant professor of dermatology at Duke University School of Medicine in Durham, North Carolina, and chief medical editor of Dermatology Times®.
