Although cellulite is not pathological and is present to some degree in most women, some women are affected by it more than others and experience other lower body related issues in conjunction with worsening cellulite such as tired, achy, puffy legs, tenderness in areas affected by cellulite and water retention (edema). Many of these women have gone through life changes such as pregnancy or menopause, have been affected by stressful lifestyles, or have a genetic predisposition to these issues. This is why I have decided to research and start providing custom cellulite massage treatments in addition to lymphatic drainage in Vancouver. This type of protocol is well known in parts of the world such as Eastern Europe and South America and has been used by therapists there for decades.
I am pleased to be the first massage therapist offering cellulite massage in Vancouver in order to help patients address these complaints in a safe, non-invasive manner.
I was privately trained in European anti-cellulite treatment by Ontario RMT Dmitri Basmanov. Dmitri is a veteran of the massage therapy profession and has developed and practiced this safe and non-invasive massage therapy treatment for over 25 years using techniques within the RMT scope of practice. My treatment also combines other cellulite specific massage techniques as proposed by Ross Turchaninov, MD, Kulreet Chaudhary, MD, and LMTs Susan Brown, Mercedes Jordan and Boris Prilutsky.
What is Cellulite?
Cellulite, also known as genoid lypodystrohy, is a metabolic condition of the fat and connective tissue layers seen in various degrees in most women and some men. It can affect all body types since cellulite does not refer to fat, but to the “mattress” or dimpled, nodular and uneven appearance of the surface of the skin.
Cellulite is not pathological, however the presence of cellulite, especially grades 3 and 4, indicates degenerative processes affecting tissue health, such as fibrosis, inflammation, decreased microcirculation and skin laxity. Although it does not represent a significant health hazard, cellulite may impact the psychosocial health of an individual [1] and become an issue of importance for them. Grade 3 or 4 cellulite may also be accompanied by pain in the affected areas. Also, cellulite may constitute an aggravating factor for increases in the perimeter of the legs and abdomen of patients with lipedema [2]. Stimulation of the lymphatic system is indicated as part of the treatment plan [2]. These reasons have led scientists to invest a lot of time and effort to completely understand all the factors surrounding cellulite in order to provide effective treatments, however there is still a lot of misinformation surrounding cellulite in the general public.
What Causes Cellulite?
Cellulite is hormonally and genetically influenced and in women it tends to appear (or worsen) during adolescence, pregnancy and menopause [3], or in the presence of factors such as hormonal birth control, prolonged sitting and a stressful lifestyle. Cellulite is mostly visible in the thighs, abdomen, buttocks and above the knees and is quite commonly seen in otherwise healthy women – it affects approximately 85% of the post-pubertal female population across all races [4]. Interestingly, cellulite rarely affects men, however, if it occurs, it may be indicative of a lack of male hormones [4].
In order to comprehend the mechanism of cellulite development, some knowledge of a basic anatomy of the skin is required. The superficial layer of the skin is called the epidermis. Beneath the epidermis lays the dermis, where most of the sweat glands, blood vessels and hair follicles are located. Beneath the dermis is a layer of subcutaneous fat. The small protrusions of subcutaneous fat that grow into the dermis represent the basic mechanism of cellulite development. There is a hypothesis that the loss of skin elasticity allows the subcutaneous fat to protrude into the dermis, directly causing the appearance of cellulite [5]. This would mean that degenerative tissue changes affecting the dermis are a factor in cellulite development. The alterations in the architecture of elastic fibers and the loss of collagen fibers in women increase the risk of cellulite.
As women advance in age, the decrease in estrogen negatively impacts blood vessels. This causes inflammation, decreased circulation and lymph drainage, proliferation of fibrous tissue, tissue degeneration and the protrusion of fat through layers of the skin, worsening the level of cellulite. In advanced cases, due to decreased microcirculation and lymphatic stagnation, the areas affected by cellulite can be cooler and feel more tender than the surrounding tissues.
Types and Grading of Cellulite
Cellulite is not a simple issue as there are several types of cellulite that differ in morphology and the mechanism of development [6]: soft, hard and edematous [7].These different types of cellulite present different challenges to treatment and can benefit from individualized approaches. The severity and progression of cellulite is graded using the Nürnberger and Müller scale or the Cellulite Severity Scale.
Massage Therapy and Cellulite
Massage focused on improving connective tissue health by manipulating the fascia and enhancing local circulation and lymph drainage can help improve the dimpled appearance of cellulite. A study of 60 women with cellulite found that “mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques offer safe and effective methods for cosmetic local fat reduction or distribution from the waist-buttocks and thighs.” [8]
One goal of massage therapy is to remove the accumulated fluid in the dermis of the skin, which directly leads to the improvement of the dimpled skin appearance. Deep massage technique may even induce alterations to the connective and elastic tissue within the dermis thereby targeting the core of the problem [8]. Therapists can also use myofascial release techniques to restore the flexibility of the targeted tissue [9] (in this case, the dermis). Manual lymphatic drainage stimulates the flow within the lymphatic tissue, which is quite important due to the fact that there is some evidence that impaired lymph flow represents one of the risk factors for the development of cellulite [10].
Thus, massage focused on improving connective tissue health by affecting the fascia and stimulating local circulation and lymphatic drainage can help improve the dimpled appearance of cellulite. Cellulite massage can also help relieve other complaints often stemming from cellulite such as:
- Tired, achy, puffy legs
- Pain and tenderness in the areas affected by cellulite
- Water retention (edema)
- Digestive issues such as bloating and constipation
Cellulite massage techniques can also help post liposuction surgery by helping decrease edema, reduce sensitivity and improve contour by addressing the irregular appearance caused by scar tissue adhesions. The techniques used should be customized in order to address the tissues’ current stage of healing.
Cellulite Massage Therapy
My approach to cellulite treatment combines a individual blend of techniques based on assessment of affected areas and contributing factors such as hip alignment techniques, hot and cold stone therapy, myofascial release, stimulatory massage techniques and lymphatic drainage techniques. For cellulite treatment I use the Godoy and Godoy method of lymph drainage since this approach has been researched and proven effective for cellulite in several large studies. [11]
Please note that this is a vigorous type of massage and it can be perceived as uncomfortable, especially during the first few sessions. Communication with the therapist is essential and encouraged in order to work within your comfort level. You may also feel temporary post treatment tenderness in addressed areas and although not common, some bruising might occur. Individualized home care supporting the work done during the massage treatment will be provided based on addressing contributing factors.
The number of treatments necessary varies from person to person, however it is very important that the initial 6-10 treatments are schedules at least twice a week for the best outcome. If the inital course of treatments produces satisfactory results occasional maintenance treatments and continued home care are recommended to maintain the results. It is important to note that massage cannot get rid of cellulite or fat cells and no such claim is made. Cellulite specific massage may improve contour by lessening the “mattress” or “orange peel” aspect of cellulite along with improving other associated symptoms such as water retention and tenderness in the affected areas. Results vary based on the individual as well as ongoing contributing factors.
I will be offering cellulite massage treatments in my office in Vancouver at Broadway and Pine starting March 2019.
To learn more see my other articles related to cellulite:
References:
[1] Green JB. (2015). Therapeutic approaches to cellulite. Semi Cutan Med Surg.
[2] Godoy J.M.P, Barufi S., Godoy M. F. G. (2013). “Lipedema: Is Aesthetic Cellulite an Aggravating Factor for Limb Perimeter?”. Journal of Cutaneous and Aesthetic Surgery. 6(3):167.
[3] Lezko, M. (2014). Cellulite in menopause. Menopause Review 6, 13(5): 298–304.
[4] Avram, M. (2004). Cellulite: a review of its physiology and treatment. Journal of Cosmetic and Laser Therapy, 6, 181-185.
[5] Pierard-Franchimont, C., Pierard, G.E., Henry, F., Vroome, V., and Cauwenbergh, G. (2000). A randomized, placebo-controlled trial of topical retinol in the treatment of cellulite. American Journal of Clinical Dermatology, 1(6), 369-374
[6] Janda K, Tomikowska A. (2014). Cellulite – causes, prevention, treatment. Ann Acad Med Stetin. 60(1):29-38.
[7] Terranova F, Berardesca E, Maibach H. Cellulite: nature and aetiopathogenesis. Int J Cosmet Sci 2006;28:157-67.
[8] Bayrakci T., Akbayrak T., Bakar Y., Kayihan H., Ergun N. (2010). Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite. J Eur Acad Dermatol Venereol.138-42.
[9] Silver, F.H, Siperko, L.M., and Seehra G.P. (2003). Mechanobiology of force transduction in dermal tissue. Skin Research Technology, 9(1), 3-23.
[10] Spinaris T, DiGiovanna EL (2005). Chapter 12: Myofascial release. An Osteopathic Approach to Diagnosis and Treatment (3rd ed.). Lippincott Williams & Wilkins. pp. 80–82.
[11] Rossi, Ana Beatris R; Vergnanini, Andre Luiz (2000). “Cellulite: A review”. Journal of the European Academy of Dermatology and Venereology. 14 (4): 251–62. [12] Godoy J.M.P, Godoy A.C.P., Godoy M. F. G. (2017). “Considering the hypothesis of the pathophysiology of cellulite in its treatment”. Dermatol Reports. 9(2): 7352.