## What is cellulite? In medical terminology, cellulite is an acute purulent inflammation of the subcutaneous fatty tissue. But in everyday life this is called non-inflammatory structural changes of subcutaneous fat tissue, which appear as tubercles and dimples on the skin and are a purely cosmetic defect. ## Why does it occur? Cellulite is present in 85-90 % of women and only 10 % of men. Women suffer from it much more often because of the influence of estrogen and peculiarities of the structure of subcutaneous fat. Estrogen activates the enzymes responsible for fat deposition and promotes an increase in the size of the fat cells. Subcutaneous fatty tissue is predominantly composed of collagen fibers of connective tissue, which are fibrous septa that form a cellular structure. When the fibrous septa connecting the skin to the muscular fascia create tension, dimples appear on the surface of the skin. In men, these fibers are more interwoven than in women and resemble mesh, through which fat is more difficult to penetrate. Women's connective tissue, on the other hand, is not as dense and there is more space between the fibers. In addition to the main causes of "orange peel", there are factors ===that exacerbate the problem: - Slowing of metabolic processes, deterioration of blood circulation and lymph flow. - Lack of sleep, which slows down many metabolic processes, including the elimination of fluid from the body. - Wearing tight clothes and high heels, which leads to mechanical compression of blood vessels, violation of lymph flow and fluid retention in the body. - Stress, which often causes overeating and, as a consequence, weight gain. - Smoking and alcohol, as smoking leads to spasms of peripheral vessels and alcohol abuse impairs kidney function and makes it difficult to excrete fluid. - Low physical activity, poor diet and inadequate water consumption also have a serious influence on the formation of cellulite. ## Overweight = cellulite? Cellulite affects women of all body types, and losing weight doesn't always help the problem. If a person is overweight and has an "overweight" BMI, losing weight may have a positive effect on skin quality, but if they have normal weight, the cellulite probably won't improve. ## Will fitness help? Athletic women have cellulite, too! Exercise can have a positive effect on the appearance of your skin, but it's not a cure-all. Muscle-building exercises such as squats, lunges, and barbell exercises can help to increase skin turgor and reduce cellulite on the thighs and buttocks. Thanks to strength training the body will look firmer and tighter and the external appearance of cellulite will be reduced — but it is unlikely to disappear to the end. ## What about treatments and creams? Even professional procedures do not produce a miraculous effect. LPG, pressotherapy, ultrasonic cavitation, RF treatment, mesotherapy and other widely advertised methods of struggle will improve the appearance, but will not actually get rid of cellulite. Moreover, it is not worth waiting for the massage and creams to achieve the desired result. The massage improves blood circulation and disperses lymph, but it is not possible to squeeze the fat out of the fat cells with your hands. Creams containing large amounts of caffeine, algae and collagen tighten the upper layer of the skin, but their effect wears off after a few hours. ## Is there a solution? Medicine is always evolving, and on July 6, 2020 the FDA approved QWO™, an injectable treatment for moderate to severe cellulite in the buttocks area, manufactured by Endo Aesthetics. When injected into problem areas, it breaks down the fibrotic partitions that pull the surface of the skin tight and contribute to the formation of "dimples". The treatment course consists of 3 procedures (up to 12 injections per buttock) in 21-day intervals. The end result is promised within a week of the completion of the full course. QWO injection side effects include bruising (84 % of patients), pain (48 %), itching, thickening, redness, and swelling. Generally, side effects disappear within three weeks. Contraindications include hypersensitivity to collagenase and other components of the remedy and skin diseases in the buttocks in the acute stage. Not enough time has passed yet to confidently call the drug a panacea, but its appearance certainly gives some hope. While you may be undecided on trying a cellulite treatment, let us remind you that cellulite is a normal phenomenon. It is inevitable for most women and does not harm health, so don’t worry too much about it!