Cellulite is one of those topics that dermatologists find frustrating.  We are very solution driven, and up until now, there haven’t been many effective long term solutions for cellulite.  All the creams and gadgets out there claiming to help with cellulite are more hype than reality, and the in-office procedures that actually work have been, for the most part, somewhat invasive to the point that most patients are turned off by the process.

So, you can imagine, I was pretty pumped to learn about a new FDA approved injectable treatment for cellulite… yes, an injection, similar to Botox and Dysport, injections I do all day long… that can be done in the office and dramatically improve the appearance of cellulite.

Caveat: Whenever things are new, they tend to be hyped up and marketing tends to focus on all the good without doing justice to the bad.  We also tend to learn about the downside of procedures long after they launch… sometimes it takes a full year or more to really assess the real life efficacy and safety of a new treatment.

That being said, this is pretty exciting! Let’s break it down together.

First, some groundwork. What is cellulite? 

There’s a major misconception out there that cellulite is caused by diet or lack of exercise.  That’s totally not the case- stop blaming yourself for your cellulite!

Cellulite is caused by the outpouching of fat lobules under the skin.  So we have a layer of fat under the skin, and there are bands of collagen called septae that attach the skin to the underlying layer of fascia.  So imagine a sort of sandwich—the skin on top, the fascia on the bottom.  These fibrous septae run up and down and tether the two together.  Where the septae tug on the skin, that’s where you see a dimple. In between the dimples are bulges of fat pooching up (protrusions of fat). So you’re left with an uneven surface.  There are some shadows and some bulges.  That’s cellulite. These fibrous septae are oriented differently in women as compared to men, so almost ALL women get cellulite whereas lass than 10% of men get it. About 9 out of 10 women have cellulite, and it affects women of all races and ethnicities and all shapes and sizes. Yes, you can be thin, muscular, in great shape and still have cellulite!

Why do we care?

Cellulite can have a major impact on self-esteem and confidence. And no surprise here: we blame ourselves!  Studies show that the majority of women are convinced it’s THEIR FAULT they have cellulite!

What can we do about it and what is Qwo? 

Yes, there are topical treatments and devices that can temporarily improve the treatment of cellulite.  Any time you boost circulation to the area, or any topical ingredients that stimulate blood flow or help to thicken the dermal layer of the skin can make the area look better.  The thing is that most creams and lotions on the market, and most at home devices, only give you a temporary improvement.  If they do create lasting changes, those results are very subtle.

So what’s Qwo?  It’s the first FDA approved injectable for cellulite. It just got FDA approval for moderate to severe cellulite in the buttocks of adult women. Will we end up using it off label for the thighs or the arms?  Maybe!  It’s still super early so that remains to be seen.

Qwo uses an enzyme called collagenase that targets types 1 and 3 collagen, so it basically eats away at or dissolves those fibrous collagen bands tethering the skin down.  I think it’s so interesting how we are trying to fight these types of collagen degrading enzymes in the skin, face and neck, but when it comes to cellulite, we want them to chew away at the collagen.  You can see the collagen band dissolving in the images below:

The trials to evaluate Qwo are the largest cellulite studies every conducted with 845 participants, and I REALLY love that about a third of the participants have skin of color.  So many procedures are only studies on white skin, and that’s not ok.  Darker skin types have different reactions- especially things like hyperpigmentation- that need to be carefully studied so we, dermatologists, can counsel those patients appropriately about the possible risks and side effects.

So what are the risks?

So far we’re seeing mainly tenderness, bruising, some discoloration which I’m SURE will be more common in skin of color, and of course swelling. This is probably a treatment you’re not going to want to do during the summer because a bruise in the buttock or thigh area can last up to 3 weeks and bruising seems to be pretty common. The protocol involved about 3 rounds of injections, spaced 3-4 weeks apart.

Cost?  Big question mark!  We shall see when it becomes commercially available—the thought is probably Spring 2021.

The studies are still ongoing to assess how long the results will last and to assess long term safety.

So what’s my take home?

I am very excited by the photos and clinical results I’ve seen thus far. It seems to be very effective even for severe cellulite. Here are some images the company shared with me:

I like that it’s an injectable.  I consider myself an expert injector, and I feel right at home with a syringe in my hand.  I can’t imagine incorporating this into my practice will be a challenge whatsoever from a skill and technique standpoint.

I like that it’s getting to the underlying root of the problem- the septae.  It has the potential to truly deliver long term results- we’re talking years if not permanent.

I’m worried about the cost—I suspect this will be pretty pricey, especially since there isn’t a competitor on the market yet in this space. Hopefully other companies will come out with competitive molecules, but until then, these guys are going to corner the market and that always leads to high prices.

Side effects: we need to really asses how severe the swelling, bruising and tenderness are, and how often it leads to hyperpigmentation – and how long it takes for those dark spots to lighten up.  My patients with skin of color who suffer from hyperpigmentation after a bug bite or scratch or pimple sometimes find the stain left over for months is worse than what caused it in the first place.

Stay tuned! I promise to update you guys on this as new info comes out.  For now, stick with self-tanners and cellulite creams and a cute skirt or flattering shorts!  And, please stop blaming yourself if you have cellulite.  WE ALL DO.  You’re in good company.

Check out my video with more info right here!

Dr. Whitney

During my Bowe Glow Boot Camp, my dear friend, David Kirsch, shared fitness and healthy cooking tips each week. David and I have known each other for years and every time I have the opportunity to see him or speak to him, I adore him even more. He’s not only an incredibly inspiring and talented trainer — to celebrities including J. Lo, Liv Tyler, and Heidi Klum – but he’s also a natural teacher. He has connected with so many people during quarantine through virtual platforms like HoneyComb.Fit and through his Instagram page – providing free workouts and tips to keep us all motivated, healthy, and moving. One of the most beautiful things about David is his role as a Mapa to his absolutely beautiful twins, Francesca and Emilia.

I am so honored to share this interview with you:

WB: In many homes, it’s a constant battle right now between screen time and staying physical.  How do you get your girls off their screens and convince them to be active? 

DK: So, full disclosure, there is still the occasional battle over screen time with Emilia and Francesca.  That said, my girls have grown up watching me exercise – both in the gym, at home and on vacation.  They have been organically exposed to the importance of moving your body a little every day.

WB: Do you think that people will return to gyms and working out with personal trainers in facilities in the same way they did pre-Covid?  What do you think people miss most about those in person workout experiences as compared with the remote training people have been doing from home? 

DK: I don’t think that things will completely go back to pre – Covid ways.  I think there is and will be genuine concern and monitoring of the number of bodies in the gym at any given time.  I think the thing that people miss the most about going to the gym is the social aspect and the overall general positive energy.  I have worked ‘overtime’ to try to create the energy, intimacy and vibe through my Zoom training sessions.

WB:  What’s your plan to return to training people in person?  Will you and your clients wear masks during the session?  Any tips for using a mask during times when people are really exerting themselves? 

DK: I think for the immediate future and for some time after, we will be masked and be socially distant and maintain a high level of personal hygiene.  I think masks are going to be extremely important, especially when people are exerting themselves – exhaling hard, and, at times, ‘spraying some saliva.’

WB: Do you have a go-to breakfast that Emilia and Francesca love and that you also feel good about giving them in the morning? We loved your frittata recipe and would love more of your insight! 

DK: Francesca and Emilia’s favorite go-to breakfast is avocado toast!!  My girls don’t like eggs, so my frittata doesn’t work for them.  I am a huge believer in healthy, substantial breakfasts.  Some of my favorites: frittata with whatever is in the fridge; avocado toast with hard boiled eggs, and Kite Hill unsweetened vanilla almond milk Greek yogurt with some seeds and fresh almond butter.  My girls are quite comfortable and competent in the kitchen, so I let them create at will.

WB: Do you have a mantra that keeps you motivated? Do you share a mantra with Emilia and Francesca?

DK: “It is better to conquer yourself than to win a thousand battles” — Buddha

WB:  What does your own personal workout schedule usually look like in a week? 

DK: My workouts have been shortened and are more frequent now.  I have turned my living room into a home gym with some hand weights, kettle bells, a strength band and a medicine ball.  All that said, my favorite purchase was a pull-up bar that I need to pass every time I leave my bedroom.  I workout via Zoom with a friend of mine no less than 5 days a week for at least 30 – 45 minutes.  Additionally, we ‘push’ each other to do at least 100, but most days, 200 pull-ups.  Last, in addition to my personal workouts, I often workout along with my clients.

WB: What type of activities do the girls like to do to stay active?

DK: Emilia loves to dance and she’s got those TikTok moves down (unofficially, as I won’t let her have an account).  Francesca loves doing Live workouts and has gotten quite good at it!  They both love to swim, play tennis and softball.

WB: What’s the one tip you would give families right now who are struggling to stay active? 

DK: It just takes a few minutes to get off of the sofa, put down the devices and MOVE your body!  It could be a walk, bike ride, or a swim in the pool.  Do it as a family, 5 – 10 minutes a day and build up from there.  You’ll have better energy, have a more positive outlook, be less stressed and look and feel healthier.

WB: Tell us more about Honeycomb and these amazing free workouts?

DK: HoneyComb.Fit was born out of the idea of creating a fully comprehensive health, wellness and lifestyle destination. We realized the best way to disseminate this philosophy was through social media. Mark Messier is one of the founding partners. Stacey Griffith, Tracy Carlinsky, and I have been offering exclusive, free workouts for almost four weeks now and the feedback has been good, as the buzz and our following is steadily growing.  After over thirty years in the fitness industry, I have truly enjoyed the opportunity to reach out to so many people around the world that wouldn’t otherwise have a chance to train with me.  I am so proud to be part of the HoneyComb family!!  In the next coming weeks, we will be inviting guest trainers with a variety of different exercise disciplines to join the team and share their expertise.

WB: What is one thing you’ve learned about yourself as a trainer during quarantine? 

DK: The most important thing I’ve learned about myself during quarantine is that I have discovered my love and passion for online training.  I was born to teach and I have conquered my initial trepidation of “talking” to my iPhone, and thoroughly enjoy the relatively new medium.

WB: What is one thing you’ve learned about yourself as a parent during quarantine?

DK: The one thing I have learned about myself as a parent during quarantine – in spite of the moments, and there are some, I love, appreciate and am grateful for the time I have gotten to spend with Emilia and Francesca.  Real quality time of laughing, loving, cooking together, exercising together, and just quality quiet time.  I have honed the art of patience, and realize that I am not always the perfect Mapa.  By the way, the art of good parenting is not about perfection, but striving to do your best, and remembering to say “I’m sorry, and daddy loves you always and forever” when I have those moments and ‘lose my xxxxx.’

And now you can see why I love David so much!! Be sure to check out his insta page because you will become as hooked on his workouts – and family workouts- as we are!

Today I’m proud to present my interview with one of the most in-demand dermatologists in the country, Dr. Whitney Bowe, M.D. As a top dermatologist, Dr. Bowe specializes in skin rejuvenation, laser dermatology, and the link between nutrition and skincare. Her work has earned the attention of top media outlets, netting her invitations to lend her expertise on programs like Good Morning America, The Rachael Ray Show, The Doctors, and Dr. Oz, and publications like The Wall Street Journal, The New York Times, ALLURE, and INSTYLE. Welcome, Dr. Bowe!

Our bodies are designed to be active. Exercise improves every one of our systems, including metabolism, body tone and strength, and our bone density. Working out lowers your stress levels, brightens your mood, and increases your energy throughout the day. At night, having worked out helps you get a better night’s sleep.

Meanwhile, most of us spend the majority of our days sitting! Do you sit for most of the day at work – four to six hours at a time with barely any walking breaks? (And if you don’t know, find an app to track yourself—you’d be surprised!)

Why is all of this sitting so bad for you?

Prolonged sitting compromises metabolic health and increases the risk of premature death—regardless of how old you are, how much you weigh, or even the amount of other physical activity you get in a day! Contrary to popular belief, an hour-long session on an exercise machine first thing in the morning or after work will not necessarily undo all the damage of sitting the rest of the day (in front of the computer, commuting, watching TV).

Basically, when you’re inactive, your circulation slows down and your body uses less of your blood sugar. And the longer you’re immobile, the more of an impact that metabolic slow-down will have on you. This is why prolonged sitting will not just negatively affect your blood sugar, but also triglycerides (blood fats), good cholesterol, resting blood pressure, and even your appetite hormone that tells you when to stop eating! Translation: Sit for too long and you won’t be able to control how much you eat! And you’ll likely gravitate to the very foods that will further push your metabolic buttons—foods high in processed fats and sugars, which will do a number on your skin.

The good news is you do not have to train for a marathon or join a CrossFit gym. The simple truth is that you just need to find something you enjoy enough that you want to do it regularly.

Here are my take home tips:

  • Get moving throughout the day. Research shows that you can get similar health benefits from doing three ten-minute bouts of exercise as you would from doing a single thirty-minute workout.
  • Surprise your body! When you get used to doing one form of exercise all the time, your body adapts to it. The more you vary your routine, the more you will see and feel your body grow stronger.
  • Stay hydrated when you work out, especially if it’s a vigorous routine that gets you sweating.

Why are you still here?? GET MOVING!! It’s a New Year and it’s the perfect time to jump start your health routine for wellness from the inside out and the outside in!

I was game when my friend Carolyn (an instructor at CoreLab) suggested the Lagree Fitness Workout which is performed on a Megaformer.

This workout is a modified version of Pilates which fatigues your muscles, but is still low impact. It helps to build your core and has a West Coast vibe.

I’ve been loving my body’s response. I used to gravitate toward high intensity workouts like extreme boot camp and kick boxing. When I started mixing in lower impact workouts like the Megaformer, I wasn’t dripping with sweat and totally worn out at the end of each workout, but I started seeing more muscle definition and I FELT stronger and more focused throughout the day.

Now, I alternate this kind of low impact workout with my higher intensity cardio workouts (spinning/running) and aim for about two Megaformer or Pilates-type workouts per week.

If you want results, my motto is surprise your body and keep mixing it up to get the best results!

@DrWhitneyBowe

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This site offers health, wellness, fitness and nutritional information for educational purposes only. The information on this website is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.

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