Say Goodbye to Cellulite…….. We may have found the answer.

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In my many years of practising medical aesthetics and consulting beauty, one of the most cause of distress for many people is the appearance of cellulite. Even I, myself feel distressed at the appearance of some unsightly uneven orange peel or cottage cheese look, especially when I’ve been slacking on my exercise and taking too much sugar. Yes, I admit, I am vain. It is the disease of Dorian Gray, and as the years are starting to catch up with me, my inquisitive mind is forever looking for a solution.

So before we talk about how to handle cellulite, we have to understand what cellulite really is.

According to Wikipedia :

“Cellulite (also known as adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, gynoid lipodystrophy, and orange peel syndrome) is the herniation of subcutaneous fat within fibrous connective tissue that manifests topographically as skin dimpling and nodularity, often on the pelvic region (specifically the buttocks), lower limbs, and abdomen.[1][2] Cellulite is a secondary sex characteristic[3] occurring in most postpubescent females.”

Basically, the uneven lumpiness you see on your thighs, or calves or arms are cellulite. It is most often seen in female than males because of the difference of fat distribution and amount. Other names for it would be orange peel, or cottage cheese appearance of fats.


So what causes cellulite?

There are many factors that causes cellulite mainly hormonal change, age, genetics, diet and lifestyle.

  1. Hormones – Sexual hormones play a very important role in cellulite formation namely oestrogen and progesterone which explains why cellulite is more commonly seen in women. Throughout the different cycles of the woman’s life, the relative low oestrogen compared to progesterone play a big role in how fat is stored and the appearance of skin. Relative high progesterone create stagnant microcirculation and more water accumulation inside fat cells thus giving the more lumpier look. Inside the fat cells, two processes are always interchanging i.e. the storage of fat (lipogenesis) and the destruction of fact (lipolysis). Hormones and neurotransmitters that help with lipolysis are oestrogen, testosterone,thyroid stimulating hormone (TSH), ACTH, adrenaline & noradrenaline, growth hormone, leptine, antidiuretic hormone (ADH) and glucagon. Meanwhile, the hormone that helps with lipogenesis is insulin. Over production of fat cells leads to more cellulite.
  2. Age – The older you get, the more the hormone balance will be disturbed and as women reach menopause, the sexual hormones start to decline rapidly. For men, testosterone levels go down with age that leads to higher risk of cellulite. Other hormones like growth hormone, and TSH also starts to decline. Also, with ageing, the skin loses more of its elasticity and collagen leading to more chances of skin dimpling and cellulite appearance.
  3. Genetics – Genetics does play a role as to where and when you will start getting cellulite. This is based on the fat distribution of the body that is determined by genes and gender. Some people accumulate more on thighs, others on the tummy area, and some even on the arms. However, genes only play 10% role so there are still things you can do about it.
  4. Diet – More and more literature on diet in relation to cellulite is coming out. We all know that a good diet is important to keep the hormones and body in balance. Studies have shown the correlation of sugar to cellulite, and this can be explained by the rise in insulin levels when we consume sugar (especially refined sugar) that is involved in lipogensis. Higher consumption of salt contributes to cell swelling and water retention in the cells, and poor hydration also causes poor microcirculation that leads to worsening of the appearance. As for fats consumption, in the past we use to believe consuming fat causes fat but nowadays, we understand better that consumption of saturated and unsaturated fats are important for sexual hormone production and that it is the trans fats (or chemically modified fats in fast food, processed food) that is a worst culprit. (Read more on fats here)
  5. Lifestyle – Lifestyle plays an important role in cellulite. Smoking has shown an association with increase appearance of cellulite. Lack of sleep, no exercise and sedentary lifestyle is also another common factor. Wearing too tight restrictive clothes also causes cellulite in the long run.

There are many classifications of cellulite, usually from 0 to 3, with 0 being no cellulite and 3 being cottage cheese appearance of cellulite at rest which shows marked lymphatic involvement. Regardless of the classification, treatment is warranted when it bothers you. Some women have grade 3 cellulite and they do not notice. In any medical treatment (including medical aesthetics) we treat the pain.

Recently, I have been playing around with a lot of medical aesthetic machines and my body was literally turned into a lab field with one part belonging to one device, the other part to another device. Whilst testing out some protocols I cam across the BTL X-wave and I find that this simple machine is pretty amazing in what it can actually do. Most of the time when it comes to cellulite treatment, we focus on fat loss to reduce the appearance and thus radiofrequency and ultrasound devices came into the picture. They worked fairly well, although the results can be really temporary and requires multiple treatments and still despite inches loss, there is still some appearance of cellulite. Furthermore the cost per session will really rack up quite a bill especially if you are using the high end devices which actually work. I am very particular about technology and a lot of times, I find that beautician imitations lack the actually power and penetration of the medical grade devices that makes it not even worth while to try. But saying so, even medical grade devices used by ignorant hands, would not give you the best results.

How does it work?

It uses shock wave technology, which is basically acoustic energy i.e. from sound waves. The acoustic waves are extremely strong non-focused sound pulses that induces vibrations inside the body. However, they have been tailored to allow the waves to enter through the skin safely without damaging the structure. The use of acoustic waves in medical treatment started with muscle pain treatments where vibrations were used to ease muscle pain, and improve blood circulation to increase healing of the fibres. The vibrations also helps to reduce muscle spasms in a gentler way which is comfortable to the patient. Initial vibration treatments were low powered, but subsequently, they noticed better improvement of higher frequencies and vibrations without damaging structure. The use of q-switch lasers also shows how targeted frequencies can affect specific areas of treatment with acoustic energy causing less tissue damage than direct ablation. Contrary to ultrasound or radiofrequency treatments, there are no heat involved which makes it comfortable to heat sensitive patients. Vibrations has shown to help stimulate cell growth in various lines of the body including bone, skin, muscle and other tissues. Clinical studies using this device on patients have shown promising results. How it affects cellulite is basically through a few methods. First of all, it vibrations increase blood flow to the adipose tissue allowing fat circulation to become better thus increasing the flow of fatty acids into the circulation. Secondly, the vibrations also stimulate fibroblast action to create more collagen, thus makes the skin tighter int he long run. Mechanically, the massaging using acoustic energy helps improve the lymphatic stagnation that occurs in cellulite, thus improves flow as well, and to a certain extent also loosens up the fat cells inside the tissues so that it can be metabolised easier. A combination of all this helps to reduce the appearance of cellulite which we know is due to over expansion of fat cells, water retention, poor circulation, poor skin tone and poor lymphatics.


So how often to do this treatment and how much would it cost?

Based on the study done, you should have a minimum of 6 treatments to have a lasting results of at least 3-6 months based on a normal diet and lifestyle i.e. not splurging on the sugars and having enough sleep. You can do the treatment as frequent as three times a week, but once weekly would suffice to have a good result. Too long a gap may cause a delay in getting the results you want. I did one session on myself before and initially there was a bit of swelling after using the X-wave which was  not tender. There was improvement immediately after but was more evident after 3 days when the swelling subsided. I would say around 15-20% reduction of the appearance of my cellulite. Subsequently, I was busy so I did not have time to use the machine. But the results persisted despite a month gap. A combination of X-wave with radiofrequency and ultrasound technology would give faster and better results, although vanquish effects only came in after 3 weeks. One session of X-wave is between RM 300-RM 500 depending on how many shots they use on you. A standard treatment is 6000 shots within 8 minutes, but for thighs usually you need more. (minimum 12000). It is pretty user dependent, since there are specific massage techniques that will give better results as compared to just going through blindly. It has a really loud sound (like a machine gun) but it is not painful unless it is pressed on to the bone, which may leave you sore for a couple of days. Personally, I love it. You can view a video of it on my Instagram account @dr.marr .

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