liposuction cosmetic surgery institute
Liposuction: New Hope For A New Figure Through The Art Of Body Contouring
By Dr. Leon Forrester Tcheupdjian, M.D.
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Chapter XX

Cellulite: The Facts

Almost without exception, the women who come to The Liposuction Institute for an initial consultation about liposuction ask about cellulite. Some may not be quite sure what the term means; they may not be certain whether or not they have cellulite, but they want to know whether liposuction can help rid their bodies of this undesirable condition.

1. Patient showing an accumulation of fine cellulite.

2. Patient with a different type of cellulite called "coarse".

That depends, I tell them. In my judgment, based on a thorough review of the medical literature and my personal experience with thousands of cases on which I have performed liposuction, the surgery can often be of considerable benefit to those who suffer from cellulite. Although liposuction cannot get rid of cellulite totally, there is frequently a marked improvement in the condition after surgery.

Cellulite primarily affects women. The problem is limited almost exclusively to the female sex, for reasons that will be apparent when we discuss causes of the condition.

Cellulite is attracting considerable attention in the medical world. In fact, the American Academy of Cosmetic Surgery considers the problem so important that it has given time and attention at its 1987 international meeting to a discussion of the latest information on this vexing condition.

Cellulite is a particular form of fat found under the skin. It has a specific and characteristic composition unlike other fat. Cellulite is made up, we believe, of fat cells, blood cells, lymphatic tissue, connective tissue, collagen, elastin, and other tissues which seem to be arranged together in certain ways.

1. This patient exhibits fat and skin cell changes known as cellulite.

I have categorized cellulite into three main forms. Lipodystrophy-a large, fatty accumulation-occurs in concentrated areas where cellulite is packed together. Such areas could include saddlebags, pot bellies, and Athunder thighs. Liposuction can be of considerable benefit in these cases, because the fat cells are removed permanently during the operation.

Peau d'orange-the Askin of an orange deformity as the French term it-is a form of cellulite that causes many irregularities and dimplings of the skin. The indentations are relatively coarse and each of them may be as large as a dime.

Grains de ris-Agrains of rice is the translation of the French term-is another form of cellulite in which the irregularities and dimplings are smaller ... roughly, the size of a small grain of rice.

The skin has a finer appearance than it does in the peau d'orange form of cellulite.

All three conditions, or course, are most distressing to women concerned about their appearance.

Although cellulite often occurs in overweight persons, not everyone who is overweight will develop cellulite. Dieting does not help cellulite. The pounds may come off, but the cellulite doesn't. Changing your eating habits is no solution for cellulite sufferers, either. There is no magical anti-cellulitediet.

Nor does exercise cure cellulite. Exercise can do many things, including toning up and defining muscles, but if you are troubled by cellulite, you can exercise for hours and still have the problem. Many women who are active in various sports, including running and jogging, still have cellulite, no matter how much time and energy they spend in athletics.

Many researchers, myself included, are still studying the causes of this troublesome problem. From what we currently know, I believe cellulite is partially related to the body's production of estrogen, one of the hormones produced by a woman's ovaries. It seems as if there are special estrogen-sensitive receptors in certain body areas, such as saddlebags, buttocks, Alove handles (in women, the iliac crest below the waist), and thighs ... in fact, in many of the body areas where refractory fat bulges occur. Other places peculiarly sensitive include the back of a woman's upper arms, fat pads in the chin or neck, the lower abdomen underneath the navel, and the fat pads of the upper back.

In women who seem to be prone to develop cellulite, the condition often first shows up at the time of puberty or shortly thereafter, just at the time the ovarian hormonal cycle is playing a significant role in body changes. Women who take birth control pills are frequently troubled with cellulite activity. Cellulite formation and deposits seem also to be more severe after pregnancy, and just before menopause.

Another hormone which seems to be connected with cellulite is the follicle stimulating hormone (FSH), produced by the pituitary gland.

Knowing more about the causes of cellulite, and its relationship to other physical conditions will be helpful to most patients, in dealing with this problem.

At The Liposuction Institute, we see women with three forms of cellulite. Some are unfortunate enough to have all three...others have more of one form than another, especially in certain body parts.

1. This patient's problem is the type called hard cell cellulite.

2. The patient shows the condition of soft cellulite.

Hard cellulite is concentrated, firm, and dense. Women who are active often suffer from this condition. If you touch the cellulite area, it feels hard and resilient. Often, a woman who has this problem will also have varicose veins, or "spider" veins on her thighs or legs.

At The Liposuction institute, we have found that women with this type of cellulite usually developed the condition at puberty. About 15 percent of our patients with cellulite fall into this category. Usually, they are not overweight.

Soft, flaccid cellulite is another form of the problem. Women affected in this manner are usually sedentary and do not exercise much. They have a propensity towards "spider" veins.

A woman with flaccid cellulite often has a hormonal imbalance. Cellulite first became a problem for her after pregnancy, or just before her menopause. At The Liposuction Institute, we estimate that 30 percent of our patients with cellulite developed it after pregnancy. An additional 25 percent of cellulite patients first had problems with the condition in the five to ten years before menopause.

Many of the patients with soft, flaccid cellulite are slightly overweight.

The third form is edematous (swollen) cellulite. Patients with this problem are often women whose metabolism is not in balance. Whenever they try to lose weight, it becomes extremely difficult. They can go on a 1200 calorie diet but tend to "plateau" after only a slight weight loss. In order for them to drop more pounds, they must reduce their diet still further, to 1000 calories, or even less. Such a diet plan, of course, is not basically healthy and should never be attempted without the strict medical supervision of a physician, preferably one with substantial experience in problems of weight loss and gain. In my experience, women of this type seem to lose lean tissue from their chests and faces, while retaining the unwanted cellulite. Diuretics do not help them much, either, and sometimes and sometimes cause loss of essential minerals like potassium.

Many of these women are extremely athletic. Yet their cellulite worsens drastically with birth control pills, pregnancy, or their premenopausal years. No matter how hard they try, their cellulite does not respond readily to physical activity or spot reducing.

Although researchers cannot be certain exactly why, they believe that women from a Mediterranean background (southern Europe and Northern Africa) seem to be more likely to develop cellulite than those of Oriental heritage. Genetic factors may also play a part in weaknesses of the circulatory system, which may contribute to cellulite formation, especially where cellulite is associated with varicose veins or spider veins. Lymphatic vessels and the lymphatic circulatory system in the region of cellulite may be not working properly, and may be a contributing factor.

Some researchers believe the autonomic nervous system and the sympathetic nervous system play a role. Many of these autonomic nerves are found in the abdomen and pelvis.

Other theories advanced as various causes of cellulite include abnormal liver functioning, allergy, and thyroid imbalance.

While the role of nutrition and diet in cellulite formation is far from clear, it is possible that certain women have physiologic problems with water, salt, and minerals. Perhaps their bodies do not metabolize and excrete them properly.

At the present time, cellulite is treated in several ways. Medical treatments available include oral medications and injections, electro-physiotherapy (including ionization and ultrasound), and local injections directly into the cellulite as in the French multi-injection method.

Laser treatment is being explored. A variety of systemic medications to correct hormonal imbalances are being studied. Sometimes hormones are combined with enzymes and injected in many sites.

Non-medical treatments for cellulite, in my opinion, have not solved the problem. These include tight wrapping in garments or bandages made from cellophane or nylon, and botanical preparations made from aloe vera and algae. Vigorous massage and acupuncture have also been tried. So have mud baths and whirlpool baths.


1. Above, the patient's legs show the bumpy, wrinkled, dimpled skin of cellulite condition.

2. The same patient after treatment shows firmer, smoother legs.

In order to understand how liposuction can help cellulite in various areas of the body, we need to consider the anatomy of cellulite itself. I have studied cellulite extensively under the microscope and have seen enlarged and dilated fat cells. The cellulite area, whether it is in hips, thighs, buttocks, or upper arms, has many more fat cells than the same area would have in a "norma" patient.

It is as if fat cells have migrated to the area and clumped together. As they enlarge, they crush and displace the fibers of collagen and elastin. Normally, these fibers are arranged vertically. in cellulite areas, though, they appear bent, fractured, or broken into small pieces. If you think of collagen and elastin fibers like steel beams in a building, holding the walls in place, it does not take too much imagination to picture them holding up the skin. When these fibers are bent and displaced by the large numbers of grossly enlarged fat cells, the skin they "hold up" is wavy and dimpled, instead of being smooth and level.

Also contributing to the unattractive appearance of cellulite are small blood vessels. Normally almost invisible in the skin, these small blood vessels are compressed by the enlarged fat cells. Consequently, the veins are squeezed.The resulting back pressure dilates the capillaries. Water and fluid ooze out of them, making the skin appear puffy and unattractive.

The matrix, or gelatin-like substance underneath the skin that holds the collagen fibers and the fat cells, is also damaged in many cases of cellulite. It seems to be weak, and holds more water and tissue fluids than normal. Consequently, the swollen, puffy appearance so characteristic of edematous cellulite adds to the problem. Liposuction can help the patient with cellulite.

As we have discussed in Chapter 8: Liposuction of the Arms, the surgery literally vacuums out the fat cells and the broken, displaced fibers from the area. Once these cells are gone, they will not return. They have vanished forever.

The skillful feathering of the surgeon, as he gently shades the cellulite area, much as an artist draws small, delicate strokes, and the tightly compressed bandaging done after surgery all help to improve the site where the cellulite has previously been. It is thought that the compression bandage helps the skin bind more tightly to itself, thus helping to eliminate a good deal of the dimpling and indentations that previously existed.

Liposuction can often relieve much of the discomfort and unsightly appearance cellulite causes. Nevertheless, it is only fair to say that this method does not work on everyone. You should discuss your condition with your own liposuction surgeon, who is the best person to evaluate your individual problems and to advise you.

Because liposuction permanently removes the grossly enlarged fat cells from the body, however, it represents a new hope for many women troubled by the condition.

Although topical preparations applied to the skin are certainly not enough to banish cellulite forever from your life, many women I have known have benefitted from certain formulas. At The Liposuction Institute, I prescribe Reverse Cellulite Formula*, which seems to help patients after surgery.

Available through Forrester Laboratories, P.O. Box 1906, Arlington Heights, IL 60006, 312-259-0101

The creams and lotions described to help the cellulite condition are available through the Forrester Laboratories, 1700 West Central Road, Arlington Heights, IL 60005.

1. Above, left, the broken veins often associated with cellulite, show clearly.

2. Below, left, Cellulite is associated with circulation derangement.

3. Above, right, the patient's legs show varicose veins, edema (swelling), and spider veins.

4. Below, the patient's buttocks marked with cellulite condition.
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Liposuction: New Hope For A New Figure Through The Art Of Body Contouring - By Dr. Leon Forrester Tcheupdjian, M.D.
ISBN 0-9621284-1-4 | Library of Congress registration #: 2-414-199
copyright © 1988-2006 Dr. Leon Forrester Tcheupdjian M.D.
Published by Dr. Leon Forrester Tcheupdjian M.D. 875 Rush Street Chicago, IL 60611

All rights reserved. No part of this book may be reproduced in any medium whatsoever, including photocopy or other electronic medium, without the express written permission of Dr. Leon Forrester Tcheupdjian M.D..