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A New Look at Cellulite, Part II

By: Peter T. Pugliese, MD
Posted: July 23, 2008, from the August 2008 issue of Skin Inc. magazine.
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There is no rational reason to use physical modalities, except perhaps well-executed lymphatic drainage. This process will provide a reduction in interstitial fluid and decrease some internal pressure, thus allowing for a better environment in which tissue repair can occur. Many estheticians are skilled in lymphatic drainage, but many are not, so make sure you have the proper skills to perform this modality. Heat sometimes helps, but only in the form of gentle heat; a skin temperature should not exceed 36°C. Walking with support hose is the best physical measure you can use.

I have explored the used of progesterone topically in the treatment of cellulite and find that the physiological effects of progesterone are multiple and diverse. Much of the research about this is very often contradictory and questionable.

The way forward

I have used this treatment in various formulations for more than two years, and the results have been very satisfactory, though they are still evolving. As more is learned of the complex nature of cellulite, its treatment will be able to be modified to more of a magic bullet approach. Before you undertake to use a method to treat cellulite, whatever it may be, make sure you fully understand the reason behind the method and what scientific data exists to support it.

Summary

Cellulite is a hormonally initiated disease driven by MMPs’ destruction of adipose connective tissue, which are derived from the menstrual cycle production. Because menses is cyclic in nature, there is no way to stop the effects of this process other than to block the action of the MMPs on the connective tissue. Cellulite is characterized by collagen dissolution and displacement of adipose tissue. Correction lies in inhibiting MMPs, reducing displaced fat and rebuilding collagen connective tissue. The role of external pressure as treatment modality is important. Therapeutic measures should not be harmful or heroic. Other than moderate hand massage associated with lymphatic drainage, no physical modalities provide a rational basis for their use in the treatment of cellulite. The concept of MMPs as etiological agents for cellulite provides a rational basis for effective treatment. (Learn more about the questions that still exist about this disease.)

REFERENCES

1. Lagouge et al, Resveratrol improves mitochondrial function and protects against metabolic disease by activating SIRT1 and PGC-1α. Cell, 127 1–14 (2006)