Most women and some men worldwide complain of the problem of cellulite or what is called ‘orange peel' skin, which is based on forming fatty accumulations in the outer appearance of the skin. hese comprise superficial cells and toxins that collect and sit under the top skin layer, which the body has failed to get rid of. That means these cells in the skin layers have become deformed into becoming cellulite. They are divided up by connective tissue that makes the collagen harden, creating unattractive appearance to the skin. According to specialists, cellulite is mainly induced in women as a result of pregnancy and delivery, while in men it is due to a fat person reducing his weight then becoming fat and then trying to lose weight once again. This is additional to too little movement and activity, hypertension drugs and diuretics, drinking too much coffee, tea and smoking. "All these factors contribute in forming cellulite in woman in the areas of the buttocks, thighs and hips," states Dr Iman el-Sayyed, physiotherapy and obesity consultant, Qasr el-Aini school of medicine. Stages of cellulite Dr el-Sayyed pointed out that the development of cellulite is divided into three stages; the first one may come in the form of ripples under the skin surface in certain areas. They begin several years before cellulite becomes the sitting position and needs several years to be noticed. While the second stage cellulite is revealed when the skin is hit with rippling while the patient is standing up, and the third stage is the advanced one; in which such ripples markedly appear when the patient is standing up position, she added. Dr el-Sayyed noted that often at such times these areas are painful and if the patient has cellulite on their legs, he or she may notice the pain even more after standing or sitting for extended periods of time. Concerning the treatment techniques, Dr el-Sayyed remarked that before starting to deal with these problems, if the patient was fat, they should loss part of this weight and then start the treatment that is based on using radio frequency (RF), which contributes to broken fatty cells beneath the skin. Furthermore, RF also helps to tighten the skin through stimulating the collagen in new cells that are reproduced and the technique reportedly has no adverse side effects. An alternative treatment is cold laser, which is very effective in breaking down fatty cells, as well as mesotherapy that has satisfactory results in removing cellulite, she added. Mesotherapy in collaboration with caffeine and artichoke substances affect the fatty cells through moulding them so as to allow blood influx easily, says Dr el-Sayyed, noting that green coffee also contributes effectively to removing cellulite. According to Dr el-Sayyed, green coffee has become a tool to reduce weight, according to Dr Mehmet Oz, US Turkish cardiothoracic surgeon, who has carried out much research and getting successful results using green coffee in losing weight. She noted green coffee has become available in the form of effervescent and other tablets. These are available in Egypt but at high prices. She regretted that the Egyptian Ministry of Health does not recognised these new techniques, whether mesotherapy or other treatment, despite US Food and Drug Administration (FDA) approval. The preventive approach requires the consumption of grapes, peaches, pineapple and pear, which are highly effective in fighting cellulite, in addition to reducing diuretic drugs and keeping active and taking part in sports.