Tackling Cellulite & Stretch Marks


The term “cellulite” refers to unsightly, puckered or dimpled skin on the backs and sides of the thighs and buttocks. The appearance has been likened to that of cottage cheese or to a “peau d’orange” (an orange peel). Cellulite is largely seen in women, and current estimates suggest that more than 85 percent of women suffer from it. For this reason, it can perhaps be more aptly viewed as a normal female developmental characteristic.

The exact causes of cellulite are still unknown. Under the microscope we find fat deposits and tissue swelling within the subcutaneous (fat layer) of the skin bound between tight, horizontal fibrous tissue bands. The upward swelling of the fatty tissue is responsible for the puckered appearance and the downward pull of the fibers for the pitted look of the overlying skin.

Contrary to popular misconception, cellulite is not a matter of being excessively overweight, since it can be found in individuals of all body shapes and sizes. However, being overweight may worsen the appearance. A predisposition for the development of cellulite does run in families, and it is also more common in caucasians. While it manifests as early as adolescence, the condition clearly worsens with advancing age as the overlying skin thins.

At present, there is unfortunately no cure for cellulite. Many therapies have been proposed for dealing with it, but rigorous scientific substantiation is lacking for any of them. These include the use of topical agents to decrease tissue swelling and promote lymphatic drainage; massage therapy (manual or mechanical), to break up fatty deposits and fibrous bands; and even liposuction or liposculpture, to remove excess fat and disrupt fibrous tissue. The benefits of any of these tend to be temporary, and maintenance treatment is generally required. More recently, laser and focused ultrasound therapies to promote fat breakdown, resorption, and recontouring have been introduced, but these, too, await further intensive investigation to validate their long-term efficacy.

In my experience, deep dermaspacing, a minimally-invasive office procedure, followed by the injection of a volumizing agent, such as Radiesse, have proven quite helpful for individuals who have multiple, discrete areas of pronounced puckering. Since it stimulates natural collagen production, dermaspacing alone may be helpful for raising up a site the way it does when treating depressed chicken pox or acne scars. I have found, however, that the supplemental use of a volumizing agent, such as Radiesse, is essential for achieving optimal results. .

The procedure is simple. First, approximately ten of the most prominent or deepest dimples and craters are outlined with a surgical marker on each side of the thighs and buttocks.. Next, a small amount of local anesthetic containing epinephrine (for constricting blood vessels and diminishing bruising) is instilled directly underneath each of the spots. A needle-like cutting instrument, or trochar, is then inserted immediately below the dimple and fanned about in all directions to break up the tight fibrous connections encircling the fat bundles and to create a small pocket into which newly synthesized collagen will be deposited.

Finally, the volumizer is injected directly into the newly created pocket. This serves to directly plump up the overlying skin. It also enhances native collagen synthesis. And lastly, it acts a spacer material to prevent the pocket from closing before there is sufficient natural collagen produced to fill it up and raise the pucker above.

Each site requires just a couple a minutes to treat, and the entire procedure may take only twenty to thirty minutes.

Bruising, slight swelling, and discomfort are common and may last for several days. Since the resulting wounds all lie entirely below the skin surface, they are allowed to heal by themselves and require no special wound care. Cosmetic improvement is usually seen in about two to four weeks, the time it takes for new collagen to be laid down. The procedure may need to be repeated one or more times to achieve maximal correction. Fees typically range from $1500-$3000.

Stretch Marks

Stretch marks, or striae distensae, are another common cosmetically-troubling problem for which ideal treatment is still unavailable. Like the American flag, stretch marks come in red, white and blue. Early on, they may be reddish and slightly elevated, later, dusky purple or bluish, and finally, ivory-colored or whitish flattened bands with a wrinkly, crinkly surface. Typically, they appear on the breasts, abdomen, thighs and arms and commonly appear after the skin is excessively stretched as a result of adolescent growth spurt, pregnancy, weight gain and weight lifting. They are estimated to affect seventy percent of adult women and forty percent of young men.

Although much remains to be learned about what causes them, current wisdom suggests that stretch marks result from an overproduction of adrenal glucocorticoid, which accompanies each of the above circumstances. They can also appear following prolonged use of high potency glucocorticoid creams and ointments. Whichever the case, the high level of steroids interferes with the production of collagen and elastin fibers, resulting in a loss of dermal support that leads to tearing when the skin is stretched.

The term stretch marks is actually a misnomer. Although stretching may determine where striae may appear and even in which the direction they run, it does not cause them. In fact, no matter how much you stretch or overstretch, they will not appear unless glucocorticoid steroid levels are increased.

To be effective, treatments must be geared to the particular phase of stretch mark development. Early on, during the reddish-purple phase, therapy must be directed to dealing with dilation of blood vessels and damage to collagen in the dermis. Later, during the white crinkly "mature stretch mark" phase, the approach must address thinning of the epidermis (the topmost layer of the skin) and the inflammation and remodeling of collagen theat leads to the loss of pigment cells or obscuring of normal skin pigmentation.

Unfortunately, we currently do not have any gold standard method for entirely eliminating stretch marks. We do, however, have a number of very effective techniques for improving them. In general, the earlier the mark is treated, the greater the anticipated improvement. Certain lasers and intensed pulsed light therapies (IPL) have proven useful for diminishing the vascular dilation of the early phase and for promoting the production of healthy collagen. Light-emitting diodes (LEDs) in the ultraviolet range have stimulated pigment production. Each of these methods usually requires anywhere from six to ten or more treatments.

I have found that all all stages, daily topical application of high potency retinoids (vitamin A derivatives), such as Avage, along with alpha hydroxy acids, such as Amlactin, has been helpful for promoting new collagen and elastic fiber production and stimulating the turnover of epidermal cells. Here, too, the earlier treatment is begun, the better.

I have also found that a series of microdermabrasion treatments can be helpful for smoothing the surface of stretch marks. In selected cases, I add dermaspacing for breaking up distorted collagen bands and stimulating new collagen production.

Article by
New York Dermatologic Surgeon