Cellulite describes the herniation of fat within fibrous bands. Cellulite is not a defect with the fat itself, but rather the connective tissue within the fat, resulting in unsightly skin dimpling. Cellulite often occurs in the buttock and limbs and less frequently the abdomen, and is found more often in women than men.
Before and After Photos
In fact, cellulite is very common. It is most often found in postpubescent women at a rate of over 80%. Because it is so ubiquitous, it is best to view this condition as a normal physiological change in the body that becomes more prevalent with age and weight gain. However, weight and age are not the sole players in the development of cellulite. Genetics and hormones are often more decisive culprits. Diet and exercise also play roles but to what effect is largely debatable.
Probably more influential are the hormones circulating in the body. Many are suspected to influence the development of cellulite, including estrogen, insulin, thyroid hormones, prolactin and adrenaline and noradrenaline. But perhaps the strongest determinant of whether one develops cellulite (and to what degree) or not, can be traced to mom and dad.
Genes related to angiotensin converting enzyme (ACE) and hypoxia-inducible factor 1A (HIF1a) largely contribute to the development of the fibrous bands responsible for the displeasing dimpling seen in cellulite. Of note, adrenaline and noradrenaline are catecholamines released during times of stress and thus it can be argued that a stressful lifestyle may exacerbate the condition. In addition, while there is no unequivocal evidence linking estrogen to the condition of creation of cellulite, it is interesting to observe that it is rarely seen in men. And, it is more common in men with androgen deficient conditions as found in Klinefelter’s syndrome, hypogonadism, and in men receiving estrogen therapy in the treatment of prostate cancer.
So, now that we know some of the causes and what it is how do we get rid of it? Unfortunately, no particular diet or exercise regimen will likely eliminate cellulite altogether. Weight loss at a reasonable rate may help the condition as well as a low-inflammatory diet, but to what degree is not clear. And of course, age is the enemy of all things beautiful.
To date no pills, potions, or lotions have found to be effective tools against the cellulite tyrant. Lasers and radiofrequency (RF) devices that tout cellulite reduction can be costly largely ineffective as they only address fat—not the fibrous bands responsible for the dimpling. And, RF devices have been known to cause fat loss which may exacerbate cellulite or reduce the plumpness of the buttock. Often, this is the last thing women (and men) want.
What has been found to be clinically effective in improving cellulite is injections of the collagenase enzyme produced by the bacterium Clostridium histolyticum. Interestingly, this is the second protein made by the Clostridium species that has found its way into bottles for beauty. The first, of course, is Botulinum toxin created by the bacteria Clostridium botulinum manufactured as Botox®. QWO®, Xiaflex® and Xiapex® are the product names utilizing Clostridium histolticum’s collagenase to degrade these pesty fibrous bands that cause the dimpling found in cellulite. And they do so without affecting the fat cells, which is in direct contrast to the imprecise blitzkrieg that RF delivers to tissue. That is, these products are specific to the culprit and minimizes collateral tissue damage.
The Food and Drug Administration (FDA) approved Xiaflex ® for the treatment of a condition called Dupuytren’s contracture. This disease caused deformities of the hands. A similar disease process, Peyronie’s disease, causes deformities of the penis, and in 2013 Xiaflex ® was approved to treat it. QWO® has now been FDA approved for the treatment of cellulite in the buttock and thigh.
The Food and Drug Administration (FDA) approved Xiaflex ® for the treatment of a condition called Dupuytren’s contracture. This disease caused deformities of the hands. A similar disease process, Peyronie’s disease, causes deformities of the penis, and in 2013 Xiaflex ® was approved to treat it. QWO ® has now been FDA approved for the treatment of cellulite in the buttock and thigh.
Each injection session takes less then fifteen minutes and is performed with very small needles. Bruising is expected after each session, and results should be visible within weeks to a few months.
Of note, QWO® treats cellulite, not skin laxity. Thus it is essential that patients are evaluated in person to assess whether or not dimpling is a result of skin elasticity or cellulite bands. This “tug test” takes just a few seconds, and in skilled hands, a physician can determine if QWO® is indicated.