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Introduction What
Is Cellulite? *I find the first definition to be a little sexist because it can happen in men. It isn't exactly "lumpy fat", it is lumpy skin caused by irregularities of the fat which in turn is caused by constricted connective tissue. But I guess one could say it is lumpy fat. cel*lu*li*tis Cellulite is a non-medical term to describe when superficial fatty deposits are pressed up against or are constricted by the bands of connective tissue which run from the muscle fascia, through this fat and reconnect to the undermost area of the skin. Cellulite can look even worse when fat cells enlarge with weight gain and bulge out of the network of connective tissue. It may also either worsen or develop in those who never had cellulite before from the formation of scar tissue after liposuction. However, excess deep layer fat and having had liposuction need not be an issue for cellulite to appear -- many skinny people have it as well. Most
women and some men have cellulite and it is estimated that 90% of the female
population have or will have cellulite after puberty. It is not
something which only plagues the obese or overweight -- it can affects any
of us and has no prejudice. So, throw everything out the window that
you've heard about cellulite and listen up. Your skinny little cousin
may have it, your average-weighted friend who just had lipo may have it,
that overweight lady at the deli may have it, that muscular, cardio-freak
woman at the gym probably doesn't have it but who needs her anyway? Pinch your thigh slightly with your index and thumb and if you begin to see dents and bumps -- that is cellulite. However, many of us don't even have to pinch our thighs to see it *raising hand over here*. For many of us we can just stand there, innocently, and tear up at the sight of our dimpled backsides in the mirror. IMPORTANT! Liposuction does not usually improve the appearance of cellulite and in some cases can make the appearance of cellulite worse or "cause" cellulite in patients who did not have it prior to their liposuction. Or aggressive fat removal and scar tissue may cause the lumps and bumps -- and not the septae. Although the cannula can snap the septae and cause skin sag. Don't
Confuse "Normal" Fat With Cellulite?? Myth. These fibrous tissue bands snake through our superficial fat as it reaches up vertically from your muscle fascia to the underside of your dermis and causes mayhem. Lack of circulation, movement, and heredity may play a big roll in how the connective tissue "acts". Ever notice that your cellulite and dense fatty areas are painful upon pressure, I do. You can't squeeze it like the looser fatty areas under your navel. It's not as pliable; it is more stiff. Well that is because of the compact nature of your fat cells in that area due to fat distribution and also the small, but firm compartments made by this connective tissue. This hardening of the connective tissue is called sclerosis. Endermologie can help but it will only be temporary and very expensive for what you get. Also, the fat cells in areas which you seem to gain first and lose last are going to be enlarged more (non-areolar tissue) thus more tightly packed in a smaller area since that is where the majority of your fat mass per area is "held". My problems areas are my saddle bags so when I squeeze this area gently it hurts, my partner's is in his flanks and spare tire. This area is more stiff, tightly packed in there and he has more discomfort in this area if I were to squeeze it than on his arm or thigh. However he doesn't have cellulite, you don't have to have "cellulite" to have dense fatty areas which cause discomfort to squeeze. Same thing with the back of my arms, I can pinch more than an inch but when I do it stings like the dickens! My partner, who doesn't have much fat accumulation on the backs of his arms however, does not feel pain if I do this to him. So, I pinch him really hard when he's not looking and say, "Now you know what it feels like!" Just kidding, I don't do that -- often. The point is, the more enlarged and crowded your fat cells and/or the more they are constricted by your fibrous septae, the more stiff it is going to be. Unfortunately for us and more fortunately for men, their connective tissue seems to "hold up" better and hold their fat "in". This was once thought to be due to the more honeycomb nature of their connective tissue as opposed to our intermittent fibrous septae. However, this is unsubstantiated thus far and now we women are left again to wonder at why we have it. Well
What Causes It & How Do I Get Rid Of It?? Although some
physicians and aestheticians believe it to be circulation and connective tissue
issues, health-healers believe that "toxins" are a good part of why
cellulite appears. Some believe it is too much water which has
"pooled" underneath the skin. Some even believe icellulite is
caused from not
drinking enough water but that fact throws your whole body out of whack, not
cause cellulite, so
don't buy it. And still others believe it is a factor of all of these,
heredity, lack of exercise, connective tissue disorders, and even perhaps from
the sun reflecting off of Venus or a weather balloon which causes the shadows
and dips which mercilessly plant themselves on our thighs. Hmmmph!
They need to learn about anatomy and stop trying to sell you treatments and
products that do not work.
Key:
An Endermologie™ session take about 30 to 45 minutes and has been described as feeling like a rigorous massage, Some patients who are new to Endermologie™ may experience discomfort as the initial dense fatty areas and septae are loosened. However, the machines do have several settings which can be adjusted to fit your comfort level. Some patients may even fall asleep. You are "required" to drink a normal to substantial amount of water during the course of your treatments. This allows your body to "flush toxins" (more than likely akin to lymphatic drainage massage) and reportedly promotes hydration which is essential for skin health. Endermologie™ also reduces body measurements and many patients report having lost several inches in their treatment area. Changes can usually be seen within 4 to 5 treatments however many patients report significant results after 8 to 10 and even up to 12 sessions. During the FDA clinicals (trials, studies, etc.), patients were required to have 2 treatments a week for a period of 10 weeks. Many of these patients, of course, saw improvement within the first 2-3 weeks. However, packages are usually bought in sets of 8 to 10. Some patients may need more, some less -- it truly is individual. Individual treatment sessions are more pricey (from $75. to $200.US) in the long run than packages bought in advance. Packages are usually the best economically but paying that much up front for a procedure you are skeptical of is a hard choice to make. There are other machines which are available and are similar but NOT the exact same as the Endermologie™ machine such as ESC's Silhouette SilkLight® Subdermal Tissue Massage System. ESC claims to have improved upon Endermologie™'s original design. Just remember that with all things comes maintenance and Endermologie™ results are NOT permanent. Patients must return for treatments between once a month or once every few months, or for as needed to keep the smooth appearance of their skin. So expect this to be a lifelong thing if cellulite is an issue not easily "beat" by diet and exercise. Does It Work? It doesn't work for everyone, but yes, it does work for a lot of patients. There are a great many people who don't believe it works and even porcine model (pig) studies which concluded that Endermologie™ did scarcely anything in some studies. I, too, was even skeptical at first until a few people I know had really great results -- without lipo beforehand or after -- and well, I am a believer. Unfortunately, since it is not permanent many of us are not going to spend the money for the initial aggressive treatment phase and then maintain the result with costly maintenance treatments. I sure as heck won't. I know people who have gotten it and kept going and quite frankly they look TOO skinny now. I know, I know - you're saying "THERE IS NO SUCH THING!!!" Trust me, there is. However these women were obsessive with cardio and diet 24-7. I highly attribute their mass reduction to the cardio and diet. Bottom line, if you can afford it, go for it as it may improve the appearance of cellulite. Just expect to keep shelling out cash to maintain it.
Superficial liposuction is controversial due to skin irregularities being unpredictable in many patients post-operatively. The results can be quite tragic in the wrong hands or in cases which a proper surgeon was used. The fact is that superficial liposuction and subdermal rasping, scoring or even laser can cause severe damage to the underlying area, causes excessive scar tissue formation and irregular angiogenesis. Some surgeons are big believers in it and it's true that some of these surgeons have excellent results. BUT, not all surgeons know what they are doing when it comes to superficial liposuction. Some surgeons use superficial fat liposuction to market "ab etching". Ab etching is a procedure where certain areas of fat are removed, mainly in areas where the separate lateral bands of fascia section off the rectus abdominus muscle. This creates a more pronounced "six pack" effect. Superficial liposuction is not only a procedure reserved specifically for abs, but is used in facial areas, submental (under chin) liposuction, the waist area, the flat area of the glutes and any other area that specific contouring is desired. I know a few surgeons who are capable of giving spectacular results with the abdominal etching procedure - but remember, not all are capable. The superficial fat layer is more dense is surrounded by many essential nerves and blood vessel and irregularities are a probability. Many surgeons choose not to offer their patients superficial liposuction however, many still do. Please be VERY careful in your surgeon-choice and be sure all aspects of this procedure and its inherent risks are discussed at the consultation. Target Cell Liposuction is a newer, and unconventional technique where just the areas which bulge are liposuction with a fine cannula. Since it is impossible to verify which cell or collection of cells are responsible for the bulging area without a larger incision -- this procedure is performed blindly and more by feel -- like other liposuction procedures. Some surgeons claim that it does, indeed, work -- others are skeptical classifying it as anything different than basic liposuction which targets fatty areas.
The device is held over treatment areas for 12 minutes and then small incisions are used to drain the fluid and fat cells. It is reported that 10 Cosmetic Plastic Surgeons were chosen for a study regarding lo level laser-assisted liposuction.
This surgery can be performed under IV sedation with local anesthetic or under an oral sedative with local anesthesia. However, I received a call from a representative at their company that no sedation or sedative is necessary. Are
You a Candidate For Cellulite Removal? First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery. Good Skin Elasticity is definitely a plus. Communication is crucial in reaching one's goals. You must be able to voice your desires to your surgeon if he/she is to understand what your expectations are. Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved. You must be mentally and emotionally stable to undergo an cosmetic procedure. No surgeon would agree to work on a mentally unstable person. At least he should not. Surgery is not getting a cavity filled. This is an operation which requires patience and stability in dealing with the healing period. There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue. Please consider this before committing to a procedure. What
to Expect at Your Consultation You will also discuss the available anesthesia that will be used for your procedure. Some surgical cellulite removal procedures are performed under Light Sleep Sedation and local anesthetic. Discuss this matter beforehand. However, if you do go under General, you make sure that the anesthesiologist is certified. Please read the All About Anesthesia Page - the risks regarding "going under" are a whole different ball game entirely. I personally prefer Light Sleep with procedures as the risks are lowered when General is excluded. Do realize though that thousands of patients safely go under General anesthesia every day. You will also discuss the complications and risks of this procedure. If the surgeon does not discuss with you the risks of your surgery including anesthesia, you should be very wary. You will discuss where the surgery will be performed as well as after care and post-operative visits. He or she should discuss with you all of the aspects of surgery, including bruising and pain management. You will also discuss fees, medication costs and any hidden costs that may arise. Insurance does not cover cellulite treatments. Preparing
For Surgical Methods It is quite possible that you will have "preliminary blood work performed. This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count (CBC, complete blood count) which ultimately alerts one to disease or disorders beforehand. So many things to do... so little time. Surgery will be here before you know it so visit the Preparing For Surgery page and relax. This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day. How
Some Surgical Cellulite Removal Procedures Are Performed Once you are on the operating room table, you will then be given your choice or your surgeon's preference in anesthesia as discussed prior to your surgery date. If you had been given an oral sedative or valium prior you will have less anxiety. They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular doorway for anesthesia, antibiotics, and other medications. If you haven't been given a sedative, it is more stressful for some patients. If you feel that you may experience anxiety inquire beforehand regarding an oral sedative. Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time. It's the initial placement of the IV that may sting a bit. Some people get their IV placed in the crook of the elbow, some the hand -- it all depends upon your veins though. So if your veins are not very prominent this can be a problem. You are then brought to the O.R. if you aren't on the table yet. After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein. This is called a catheter. The catheter is taped to your skin so it is not accidentally knocked or pulled out and is ready to be used as a sort of entryway for anything the surgical team deems necessary for your body. This is usually done before you get into the actual O.R., by a nurse, and you have a saline bag hooked up to you. The medications will usually be given with a drip system with this saline. As said before, the saline will keep you hydrated both during and post-operatively. If you have chosen an IV Liquid Sedative, they will insert a hypodermic into your tube that you are attached to or they attach the bag of anesthetic with a drip system to add a few drops every few seconds and when they spring open the stopper and it starts heading towards your body. The the effects of the anesthesia are felt soon after injection or opening the stopper -- a few seconds in fact. It may feel similar to a sensation of heat entering your arm or hand at the catheter site. It then feels as though it is creeping up your arm -- then it jumps from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized. The anesthesiologist or surgeon will then determine if you are sedated properly, your stats are stable and if you are ready for the surgery to begin. Alternately, some patients may choose local anesthesia and an oral sedative as spoken about in the Introduction To Anesthesia Page. You may then be scrubbed with Betadine and with some procedures, injected with a solution of Lidocaine, epinephrine and saline, or an epinephrine/bicarbonate/lidocaine mixture. The epinephrine is a vasoconstrictor. This will impede your skin's ability to bleed excessively. The lidocaine is of course for pain management. Tiny incisions will be made in the predetermined placement and special tools (as one of our surgeons described as looking like "pickle fork" in older methods, incidentally this method was said to cause nerve damage) are inserted into these incisions. The problematic septae will then be severed and removed during the procedure until a uniform smoothness is achieved. The surgical team then performs a sponge and instrument count. Sutures are usually not ever needed. You may or may not be required to wear a compression garment post-operatively. Of course there may be differences in surgical technique depending upon the preference of your surgeon. For instance, for RejuveSkin treatments please see our RejuveSkin page. If you were sedated, you are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released. This is dependent upon the individual but may take as little as 20 minutes to up to two hours. Your treatment area may feel tight and quite tender as the anesthesia wears off. You may even feel emotional or upset -- this will depend upon your body's reaction to anesthesia. You may also experience rigors or shivering. This may feel uncontrollable and is usually from the medications -- more than likely epinephrine that is used as a vasoconstrictor. The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable. You may even be fortunate to have heating lamps. Some patients feel nothing different although if you have had General you may feel a little sick -- hopefully your surgeon gave you something to lessen this. Your prescribed medication should alleviate this pain and discomfort. However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately. You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home. The
Road To Recovery For help with keloid prevention and scar flattening some surgeons suggest silicone gel sheeting such as 'The Patch' cut to size from www.BioDermis.com. For further scar fading, you may consider using silicone gels like Mederma® and Xeragel™. These usually aren't as beneficial to scars as the sheeting, as clothing or other types of friction can rub off and have lack of pressure which is beneficial in flattening. However, in conjunction with sheeting it may be beneficial. Ask your surgeon if he approves. Risks
and Complications of Cellulite Removal There are more risks with liposuction or microliposuction due to the fat and its surrounding tissues becoming necrotic (dead). If the fat becomes necrotic from lack of blood supply, the fat tends to turn orange-ish clear and drain from the incision. If the tissue becomes necrotic, that's a completely different story. You must have the tissue removed before a major infection develops, possibly causing gangrene. Even with the ultrasonic technique, patients have been known to receive actual burns from the ultrasonic technique. The fat is actually melted within the body by 'exciting' the fat molecules with high frequency radio waves and is suctioned out. There may be asymmetry, hyper-pigmentation (permanent dark spots) from the bruising. Major blood loss is a factor is some cases. As is hematoma and infection. Another risk of liposuction* is pulmonary Thromboemboli. A thromboebolus is a blood clot and this blood clot can break free and travel to the lungs resulting in pulmonary Thromboemboli. This can put a patient into adult breathing distress and subsequently into cardiac arrest or coma -- leading to the patient becoming 'brain dead' shortly thereafter or in a vegetative state from loss of oxygen to the brain. Pulmonary Thromboemboli can happen within three (3) weeks of the surgery but will most likely show symptoms of shortness of breath and fatigue within the first 72 hours. However, pulmonary Thromboemboli can occur suddenly, without warning. Most patients with P.E. collapse and begin rapid deterioration after attempting to climb a flight of stairs. Also anesthesia problems can happen, allergic reactions, respiratory arrest, prolonged or permanent numbness, permanent bruising and more. Please discuss this with your surgeon. Do
These Treatments Work? As far as surgical measures, RejuveSkin is the only one which looks promising to me, however I have not had it myself. Slightly similar attempts have been made by few surgeons to sever the septae but it is unknown how effective their particular techniques were and how considerable the negative effects were. Only time will tell, but I have hope. Related
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