The orange peel effect – cellulite explained

By Kim Bell

Cellulite is the appearance of uneven, lumpy skin, most commonly on the hips, thighs and buttocks, explains Dr Rakesh Newaj, a Johannesburg- based dermatologist. It is caused by the fibrous connective tissue cords that pull the skin to the underlying muscle, and the deposits of fats in between these cords.

To add insult to injury, one of the main causes of cellulite is being a woman. And if you suffer from cellulite, you can thank your grandmother and mother – it’s genetic. If they had it, there is no escape.

Dr Riekie Smit, chairperson of the Aesthetic Medicine Congress of South Africa and president of the Aesthetic and Anti-aging Medicine Society of South Africa, explains that the causes of cellulite are multifactorial. There are four main components: decreased microcirculation with resulting fluid retention in the area, causing the bumpy, swollen appearance; decreased lymphatic circulation with a build-up of toxins; poor connective tissue (the collagen may be of bad quality or depleted), giving rise to a general appearance of flabbiness; and fat cells that then bulge in microsegments, giving that orange-peel effect.

The cycle of cellulite
Beauty house Clarins and Inserm in Toulouse, an internationally recognised research institute, recently completed research into the formation of cellulite. They have identified the role of progenitor cells – those cells essential for the renewal of adipose tissue and, unfortunately, equally responsible for its expansion.

Our bodies are covered in fatty tissue, which is naturally larger in volume on the hips and thighs. Ever heard of the term “child-bearing hips”? Well, this is exactly the case, as this acts as a fat reserve to help ensure healthy future pregnancies.

Adipocytes, the cells that store these fats, are grouped together in lobules, vertically arranged pockets separated by rigid, fibrous walls. When there is an excess storage of fats, the volume of these adipocytes and lobules increases, the walls then pull on the skin, while the lobules push on it, creating that spongy, orange-peel effect.

Adipocytes are not only cells found in adipose or fatty tissue. Researchers have discovered undifferentiated cells that are capable of multiplying and are predisposed to differentiating into preadipocytes, which in turn can become adipocytes. As adipocyte cells are unable to multiply, progenitor cells ensure the renewal of adipose tissue, which is your body’s energy reserve.
But these cells also can cause uncontrolled expansion when the adipocytes store more fats than they release. Known as hypertrophy, the adipocyte can increase its volume by up to 100 times this way! Hypertrophied adipocytes are no longer able to store additional fats; when the lipid supply is greater than its release, new adipocytes are then necessary to store the excess fats.

Progenitor cells multiply and differentiate into the preadipocytes, then adipocytes capable of storing fats. The circle of cellulite has begun. The hypertrophy of the adipocytes reduces the diffusion of oxygen in adipose tissue. This phenomenon of hypoxia also encourages the proliferation of progenitor cells. The circle is complete.
“We have found a way to slow down the activities of progenitor cells and prevent the hypertrophy of adipocytes,” says Jody Hyam, group communications executive for Clarins South Africa.

Factors leading to cellulite
• Inactivity • Genetics • Hormonal imbalances • Smoking • Excess alcohol• Stress • Weight fluctuations

Lotions and positions
Smit says cellulite creams work. “You may not see results overnight, but it will maintain results and prevent further deterioration.” She adds that the ingredients you should be looking for include caffeine, theophylline, horse chestnut, centella asiatica, L-carnitine, fucus vesiculosus and artichoke extract. Other ingredients to look out for include aquatic mint, celosia extract, geranium, xanthoxyline and phloridzine. “The list grows yearly with some great innovations,” says Smit. “Don’t be lazy with your daily application of cellulite creams.”

Protect against cellulite
There is no way to prevent cellulite from developing, says Newaj. However, good eating habits and exercise can keep the skin and muscles well-toned, which in turn will decrease the appearance of cellulite. “Eliminating risk factors such as smoking, and having a diet low in fats and carbohydrates, may be helpful,” he adds.
Smit comments that, ideally, you need to start prevention early. “Make sure your hormones and blood tests are checked for thyroid, insulin or hormonal imbalances such as excess oestrogen or decreased testosterone. (Yes, women need this!)”
She adds that you need to keep your activity level high throughout your life, combining both cardio and weight training, and recommends that you use cellulite creams every day and night. “Dry body brushing is excellent to detoxify and stimulate microcirculation,” she says.
And, importantly, keep your stress levels down. Smit recommends incorporating relaxation techniques such as yoga, or making time for “moments of contemplation”.

Treatment options
There are many options available for the treatment of cellulite. These include the use of radiofrequency devices, pneumatic massage, heat therapy, endermologie, electrical stimulation, ultrasound and liposuction.
“Although traditional liposuction may worsen the look of cellulite, laser-assisted liposuction can help to destroy the fat cells while tightening the skin, thereby improving cellulite,” says Newaj.

That loving touch
Newaj explains that vigorous massage may help, by improving blood flow, removing toxins and reducing excess fluid in the cellulite-prone areas. “Lipomassage, also called endermologie, makes use of a machine to massage the skin with rollers. This provides an improvement to the cellulite, but it is usually short-lived,” he says.
“Massage most certainly works,” adds Smit. “Especially lymphatic drainage massage. It may be painful the first few sessions, but this will pass.” She believes home massaging can also be beneficial. “This can be done with some of the devices on the market, or dry body brushing.”

Self-Conscious?
Cellulite can affect your social life, career and even your sex life. “Many women are too shy to get undressed in front of their husbands, and quickly demand the lights to be switched off,” says Smit.
She adds that more than 70% of women over the age of 18 are affected by cellulite. “It is also common in men, but not as common. It is unappealing, and people often associate the appearance with inactivity, an unhealthy lifestyle and aging.”
The most important thing to remember, says Smit, is that cellulite is a chronic condition, just like high blood pressure and high cholesterol. “It worsens if you do not treat it and it comes back when you stop treating it. So there is no once-off solution. It is a lifelong investment in healthy eating, exercise, cellulite creams and cellulite treatments. Even the most successful treatments need maintenance. Cellulite always comes back!”
Newaj adds: “The fact is that eight out of 10 women will have some cellulite, thus it can be considered being normal.”

Food for thought
Smit advises that your diet is important when it comes to cellulite control. “This is the difficult part, as it is easier to have a cellulite treatment done than to stick to healthy eating.” However, she adds, the results are worth the effort.

Cellulite aggravators:
• Instant coffee (rather choose filter coffee or coffee with beans, as these are more natural);
• Fizzy or artificially sweetened drinks; • Sugar; • Wheat; • Preservatives;
• Refined foods; and • Excess alcohol.

Cellulite reducers:
• Grapefruit and other citrus fruits; • Spices, such as turmeric, ginger, cinnamon and cayenne pepper; • Water (especially spring and sparkling); • Greens; • Leeks; • A variety of colour: red foods (tomatoes, red peppers, chillies, berries); orange (citrus, papino, orange vegetables); green and yellow; • Salmon and trout; and • Proteins to maintain muscle mass, but rather opt for fish, organic meat or chicken where possible, and skip the marinades.

Supplements that help:
• CLA; • L-carnitine; • Alpha lipoic acid; • Magnesium; • Melatonin; • Horse chestnut; • A good multivitamin; • 7-keto-DHEA; and • Mango pip extract