Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Can You Get Rid of Cellulite? October 27, 2010

Is there any comfort in the fact that anyone can get cellulite?    Thin people get cellulite, rich people get cellulite, beautiful people get cellulite.  About 85% of women over the age of 18 have some degree of cellulite on their upper legs, buttocks, and abdomens.  It can affect you regardless of ethnicity, age, race, weight, and lifestyle choices because cellulite is mostly a genetic disorder.   This lumpy appearance on our thighs, some call it the cottage cheese look, is caused by fat cells bulging upwards – a function of the structure of how the fat and skin fit together.  Our epidermis, the top layer of our skin, has fibrous anchors that go down to the fat layer of our skin, and it is these connections that cause the dimpling appearance of cellulite.  While losing weight may help improve the appearance of cellulite on some people there are many other factors involved in the formation of cellulite that make it a huge challenge to treat.  Of course that doesn’t mean that Americans aren’t willing to try – by 2012 it is estimated that Americans will spend more than $215 on anti-cellulite treatments.

 

Myths About Cellulite

There are so many ideas out there about what causes cellulite and how to treat it.  In a piece on her website Paula Begoun debunks a number of  the biggest cellulite myths:

Drinking water helps: If water could change skin structure and reduce fat I assure you no one would have cellulite, or would be overweight for that matter. Drinking water probably is beneficial (although there is really no research showing how much is healthy versus unhealthy) but there is no research showing water consumption will impact fat anywhere on your body, let alone the dimples on your thighs.

Arguments for high water intake are generally based on the assumption that because our bodies consist mostly of wa-ter (50-70% of body weight, about forty-two liters) and our blood, muscles, brain, and bones are made up mainly of wa-ter (85%, 80%, 75%, and 25%, respectively), we therefore need at least eight 8-ounce glasses of water each day. But assumptions aren’t science and this one is a non-sequitur; it is similar to arguing that since our cars run on gasoline, they always need a full tank to run efficiently. (Source: American Journal of Physiology—Regulatory, Integrative, and Comparative Physiology, November 2002, pages 993-1004)

Water retention causes cellulite: It’s ironic that low water intake is considered a possible cause of cellulite, and the polar opposite—retaining too much water—is thought to be a factor as well. There is lots of speculation of how water retention can affect cellulite but there is no actual research supporting this notion. Further, fat cells actually contain only about 10% water, so claiming to eliminate excess water won’t make a difference and any measurable result would be transient at best. It is true that water retention can make you look bloated and feel like you’ve gained weight, but water itself doesn’t impact fat or the appearance of cellulite. (Source: Journal of Strength and Conditioning Research, November 2003, pages 817-821)Eating a specialized diet can help: A healthy diet that encourages weight loss may help your entire body look better. How-ever, because weight in and of itself is not a cause of cellulite, dieting won’t change the skin structure of your thighs, which causes the dimpled contours to show. For some people cellulite is made worse by the accumulation of extra fat. In those cases, weight reduction may decrease the total area and depth of cellulite. (Source: Clinical Dermatology, July-August 2004, pages 303-309)

Exercise can help: Exercise helps almost every system in the human body, but it won’t necessarily impact the appearance of cellulite. Exercise doesn’t improve skin structure and it can’t affect localized areas of fat. In other words, you can’t spot reduce fat accumulation in a specific area. (Source: British Journal of Plastic Surgery, April 2004, pages 222-227)

Detoxifying the body reduces the appearance of cellulite: Detoxifying the body for consumers has taken on the meaning of purging it of pollutants or any other problem substances in the environment or in the foods we eat. In terms of the way this concept has been mass marketed, there is little research showing credible efficacy as to whether or not detoxification of the body is even possible. However, “detoxifying” the body as it is used in the scientific community describes the process of reducing cellular damage primarily by antioxidants or enzymes that prevent certain abnormal or undesirable cell func-tions from taking place. There is no doubt this is helpful for the body. Whether or not this reduces cellulite is completely unknown because skin structure and fat accumulation are not caused by toxins in the environment. Furthermore, there are no studies showing toxins of any kind prevent fat from being broken down. (Sources: Journal of Endotoxin Research, April 2005, pages 69-84 and Journal of Biochemistry and Molecular Biology, May 2003, pages 258-264)

 

 

Treatment Options

 

Cellulite treatment options fall into two main categories:  topical products and machines.  I’ll also mention mesotherapy which are injections.

 

Topical Products

In my opinion, topical creams that claim to treat cellulite are pretty much a big waste of your money.  I’m certainly not alone in my opinion.  Ellen Marmur, MD in her book Simple Skin Beauty, page 213 writes:

As with most topicals, any visible results wash off or fade away fast.  Again, if any one of these really worked, it would be the hottest product on the market.  …  My advice:  save your money, let the cellulite battle go, and buy yourself a beautiful pair of shoes.  That will have a much better payoff.

Furthermore, Paula Begoun states:

As far as skin-care products for the body are concerned, the litany of options is mesmerizing. Yet there is almost no uniformity between formulas. It would appear, if the claims are to be believed, a wide variety of unrelated plant extracts can deflate or break down fat and/or restructure skin. Looking at the research, however, most articles suggest there is little hope that anything rubbed on the skin can change fat deposits or radically improve the appearance of cellulite.

The hope that botanicals have the answer is odd because not one study points to what concentration of an ingredient needs to be in a formulation, what physiochemical characteristics particular to each active ingredient need to be present, or whether or not these ingredients retain any standardized properties between batches. (Sources: Dermatologic Surgery, July 2005, pages 866-872 and The European Journal of Dermatology, December 2000, pages 596–603)

So as tempting as it is to think that you can solve your cellulite problem with a cream – skip it.   At best these creams and lotions very temporarily reduce the appearance of cellulite.   But there is one thing to keep in mind – a fake tan will make your cellulite less noticeable.  So thinking to invest in a good self-tanner is actually a viable option in order to disguise your cellulite temporarily.  (For a very thorough breakdown of both ingredients and products that claim to treat cellulite see Paula Begoun’s article)

 

What about in office treatments?

 

First let me talk about mesotherapy which I would advise against.  During a mesotherapy treatment caffeine, enzymes, anti-inflammatories, alphahydroxy acids, vitamins, or the drugs phosphatydalcholine and deoxycholate  are injected into the areas of cellulite and fatty deposits.  It is said that these injections help to break up fat cells (fat cells burst and die) and reduce cellulite.  Complications can include ulcers, scarring, deformities, skin infections, and tissue damage.  Mesotherapy is widely practiced in Europe, but highly controversial in the United States.  Currently the FDA has started cracking down on medical spas that offer this treatment, but it has taken the FDA time to look into the practice since it falls outside of FDA regulations.  The American Society of Aesthetic Plastic Surgery along with the Aesthetic Surgery Education and Research Foundation is conducting a FDA approved study on the safety and efficacy of mesotherapy.  There is a hope that in the future there will be both a FDA approved formula for injection and a standardization of procedures, safety, and protocols.   As I already stated, I would stay away from mesotherapy.  Once the FDA reaches its conclusions about this procedure it might be time to reconsider, but overall I think it will never be a good option for treating cellulite.

 

Machines

 

Perhaps you have heard of Endermologie or VelaSmooth for treating cellulite.  Endermologie uses rollers and suction to massage areas with cellulite, and while the device is FDA approved for cellulite treatment that does not prove that it actually works as claims.  At best these treatments are expensive and offer a temporary improvement in the appearance of cellulite.  So try Endermologie at your own risk, a risk mostly to your bank account.  Velasmooth combines infrared light, radio-frequency, and mechanical suction in an attempt to reduce the appearance of cellulite by heating the fat and liquefying it or reducing its size.  As with Endermologie a series of treatments is needed in order to see results with Velasmooth, and once again, treatments do not come cheap.  Results, as always, are mixed.    Personally I would save my money when it comes to both of these treatments.  While there are few risks to your health with these treatments, they also don’t really work.  The only place you will see a real difference is in your bank account.  Save your money!

There are even more procedures out there that claim to address cellulite including cellulite subscissions that uses a needle to sever the anchors under the skin so that the skin looks smoother.  While this might make theoretical sense, it works successfully on acne scars, safety studies are few and far between and the surgery is expensive.

 

 

Bottom Line

 

I’ll reiterate what Dr. Marmur wrote:

Save your money, let the cellulite battle go, and buy yourself a beautiful pair of shoes.  That will have a much better payoff.

And if you really, really want to try something to reduce the appearance of your cellulite before wearing a bathing suit or short skirt I’ll mention it again – use a self-tanner to temporarily disguise the appearance of cellulite.  Above all – don’t believe the hype or anything for that matter when it comes to cellulite treatments.

 

Sources and Further Reading

 

 

Another Reason to Love Tim Gunn: He Helps Those with Psoriasis October 11, 2010

I’m a huge Project Runway fan.  I realized that I’ve actually seen every episode of every season except for the very first episode of the first season of the show.  I think this season of the show has turned out to be one of the best, and my favorite contestant is definitely Mondo (who I really hope wins it all).  Anyhow, any fan of Project Runway must have an opinion about Tim Gunn who functions as a mentor to the fashion designers on the show.  Personally I think Tim Gunn is great.  I even read his new book which was interesting to say the least (I mean how many people describe themselves as “asexual”?  If you like Tim Gunn read this book; you can read it in a day or two.  Gunn definitely has some mother issues to work out, but I do appreciate his honesty and integrity.)

But back to skincare issues.  I read a Skin Inc. online article about how Tim Gunn and Dr. Susan C. Taylor (who wrote the book Rx for Brown Skin) are helping people with psoriasis ( Tim Gunn Hosts Online Style Resource for Clients with Psoriasis).  Amgen and Pfizer have launched an online resource center called Address Your Psoriasis! for people suffering from psoriasis with an emphasis on style:  making good fabric choices and finding clothes that are comfortable and breathable.  By teaming up with Tim Gunn and making these tips available online the creators of the website hope to help psoriasis sufferers look good and feel confident about their appearance.

Why is looking good such an issue for psoriasis sufferers?  Let me explain (I’ll quote from the website):

 

Psoriasis is a noncontagious chronic disease in which the immune system causes the skin cells to grow at an accelerated rate. 

Approximately 7.5 million American adults suffer from psoriasis. Although there are several types of psoriasis, approximately 80 percent of patients have plaque psoriasis.

Psoriasis is commonly diagnosed in early adulthood. Certain people may be genetically predisposed to develop psoriasis. A “trigger” often seems to cause symptoms to appear. These triggers may include emotional stress, injury to the skin, some types of infection, or reaction to certain drugs.

While there are several types of psoriasis, the most common form is plaque psoriasis. Approximately 80 percent of patients suffer from plaque psoriasis, which is characterized by skin lesions that appear as patches of thick, red, or inflamed skin covered with silvery scales. Instead of being shed, skin cells pile up, causing painful and itchy patches, which are also referred to as plaques.

While the exact cause of plaque psoriasis is unknown, we know that it is a disease involving the immune system. Certain cells in the immune system become overactive and release proteins called cytokines. Overproduction of these cytokines plays a large role in causing inflammation that leads to development of often painful and sometimes debilitating skin plaques.

In addition to the skin symptoms, plaque psoriasis can also negatively impact people’s lives in other ways. It can:

  • Interfere with basic functions, such as sleeping, using hands, and walking, as well as sitting or standing for long periods of time.
  • Impact a person’s job performance, with many patients reporting missed time from work due to their condition.
  • Cause people to feel helpless, embarrassed, angry, frustrated, and/or self-conscious. This distress may lead to feelings of social isolation.

 

The better you look, the better you feel, right?  I’ve always believed that was true.  Since psoriasis can affect self-esteem so severely I was very happy to see these free online tips that can really help anyone with the condition feel much better about their appearance.   And now I have even more reasons to love Tim Gunn.

 

Rosacea: Causes, Triggers, and Treatment Options October 7, 2010

Rosacea poses a vexing problem for estheticians and physicians.  It is a fairly common skin condition since it affects around 16 million people a year yet a poll found that 78% of Americans have no knowledge of this condition and do not know how to recognize or treat it.  Perhaps what is most frustrating about rosacea is that there is both no known cause* or cure (though there is ongoing research to determine the cause of this disorder).  Correct diagnosis can be difficult since there is no test for rosacea and symptoms can sometimes mimic those of acne or other skin problems and diseases.  Be sure that you trust the source of your rosacea diagnosis.  I should point out here that we estheticians cannot legally diagnosis health problems and rosacea is classified as a skin disorder.  So while an esthetician may be sure you have rosacea because of her experience be sure to get a physician’s opinion as well.  Plus as you will read below there are treatment options for rosacea that can only be dispensed by physician.

 

What is Rosacea?

 

Rosacea is a genetic inflammatory skin disorder that usually affects the face but can also affect other parts of the body as well such as areas as the chest and ears.  It is particularly common in people with fair skin and light-colored eyes.  Normally the symptoms of rosacea appear after the age of 30, and rosacea is more commonly found in women than men.  But interestingly rosacea is usually worse in men than in women.  Rosacea shows a range of symptoms from mild to severe (see the illustration below).

According to The National Rosacea Society:

 

Rosacea (pronounced “roh-ZAY-sha”) is a chronic and potentially life-disruptive disorder primarily of the facial skin, often characterized by flare-ups and remissions. Many have observed that it typically begins any time after age 30 as a redness on the cheeks, nose, chin or forehead that may come and go. In some cases, rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness tends to become ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue. This is the condition, called rhinophyma (pronounced “rhi-no-FY-muh”), that gave the late comedian W.C. Fields his trademark bulbous nose. In many rosacea patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

 

 

Sun exposure and other rosacea triggers, more on triggers in a moment, cause blood vessels near the surface of the skin to dilate.  As this occurs the complexion appears red.  This causes the body to send inflammatory cells to the area of the dilated blood vessels and even triggers the growth of more blood vessels in the area.  The body tries to stop this process by creating more veins so that the inflammatory cells can fix the problem but all this does is create more of a problem. 

 

Rosacea Triggers

 

If you have been diagnosed with rosacea you need to take the time to figure out your triggers.  Managing your triggers will help keep your symptoms under control as much as possible.  UV (aka sun) exposure is one of the biggest rosacea triggers.  Using sunscreen and staying out of the sun (wearing a hat as well) are key to controlling rosacea.  Heat, stress, hormones, hot tubs, fragrance, allergies, spicy food, alcohol, exercise, and topical products can all trigger rosacea flare-up or make symptoms worse.

 

Rosacea Treatment Options

 

 First and foremost use your sunscreen everyday if you have rosacea.  Do not forget to reapply throughout the day even if the only time you are “outdoors” is when you are only driving to and from work.  Figure out your personal rosacea triggers and avoid them.  Use gentle skincare products (recommendations below) that contain anti-inflammatory ingredients.

A doctor can prescribe Metrogel (metronidazole) which is a powerful anti-inflammatory.  Some doctors prefer to prescribe Finacea which is azaleic acid, another strong anti-inflammatory ingredient.  Lotions and creams with sulfur, yet another anti-inflammatory ingredient, may also be prescribed.  If those steps are not enough than oral antibiotics such as Oracea may be prescribed.  Hydrocortisone is only sporadically prescribed today to patients, but a low dose of a beta-blocker like propranolol may be prescribed to prevent vasodilation and redness.

In terms of in-office treatments for rosacea IPL (intense pulse light) and laser treatments are available.  IPL is a very effective way to get rid of extra blood vessels and to calm redness.  In the case of severe rosacea a doctor may opt to treat with a laser such as the Vbeam instead of using IPL.

Rosacea patients need to be patient since it usually takes 12 to 16 weeks to see improvement when treating rosacea.  Additionally, as with acne you must be diligent and persistent in treating rosacea since, as of yet, there is no cure for this disorder.

 

Products:

  • Obagi Medical, which is a great physician dispensed skincare line, as set of products for rosacea:  Rosaclear
  • I have also seen that Avene has a rosacea line though I don’t know anything about it specifically.

 

Sources and Further Reading 

 

*  There is a theory that rosacea is caused by microscopic skin mites but as with all theories about the causes of rosacea this has not been conclusively proved.

 

 
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