3 experts take a look at the latest treatments
By Colette Bouchez
WebMD Weight Loss Clinic - Feature
Reviewed By Cynthia Dennison Haines, MD
Perhaps nothing is cuter than a pair of dimples accentuating your smile. But it's not so cute when dimples turn up on your thighs, buttocks, tummy, and upper arms.
The problem is cellulite, fatty deposits of dimpled skin that can appear on even the most fabulously thin body.
"That's because cellulite is not a fat problem, it's a skin problem. It has nothing to do with what you weigh, or how much weight you lose," says Hollywood dermatologist Howard Murad, MD, author of The Cellulite Solution.
The fat that causes cellulite is not the same as the fat that takes us from a size 10 to a 14, experts say. That fat lies far below the skin, closer to our bones, and it is what the body burns as fuel for energy.
Cellulite, on the other hand, is made up of fat cells that reside within the skin. They can't be burned as fuel, says Murad, so dieting, exercise, even liposuction won't help.
Cellulite is a decidedly womanly problem, primarily targeting females over 35. Although doctors aren't sure why, many say hormones and anatomy are key.
"The best evidence for increased incidence in women is that it's related to hormonal changes, but also the anatomy of what's called 'septa' -- fibrous bands of tissue that surround fat cells in the skin to help keep them in place," says Bruce Katz, MD, medical director of Juva Skin and Laser Center in New York, and clinical professor of dermatology at the Mt. Sinai School of Medicine.
In men, Katz says, the septa run in a diagonal pattern, while in women, their pattern is vertical.
When we are young, this doesn't matter, since both designs work equally well in keeping cellulite anchored within the deeper layers of skin. As we age, however, the normally elastic septa can become hard and rigid. When they do, they bear down on the buoyant cellulite cells, which begin pushing up through the spaces of the hardened septa pattern.
"When the septa run vertically, it results in a 'mattress tufting' effect,'" Katz tells WebMD. "The fat cells push up in between and create those dimples we know as cellulite."
Got Cellulite? Blame Mom!
Along with the pattern of the septa, it matters how many of these fibrous bands you have. Since septa are genetic, cellulite is, too -- passed down from mother to daughter like an ugly pair of heirloom earrings nobody really wants.
"Cellulite is hereditary, so much so that the indications of who will get it, and to what degree, are present almost from birth," says dermatologist Amy Newburger, MD, director of Dermatology Consultants of Westchester in Scarsdale, N.Y. In fact, Newburger tells WebMD, skin biopsies taken from infants are highly predictive of whether cellulite will develop later in life, based on the number of septa bands found in the skin.
To further complicate matters, doctors say, the circulatory system that feeds our skin cells and lymph vessels can become damaged over time, allowing cellulite to become more apparent.
The Cellulite Solutions: What May Help
For generations, doctors have said cellulite was here to stay -- a lumpy, bumpy rite of passage to womanhood that we just had to learn to live with.
But in the last 20 years several treatment options have emerged. While the science is still shaky, with few studies to attest to the effects, some experts report significant results -- at least anecdotally.
To help you get a handle on what's available, our three experts discussed the possibilities.
Option 1: Creams and Lotions
Arguably the easiest and least-costly approach is lotions and creams that purport to stimulate cell circulation, melt fat, and move fluid and toxins out. Many doctors are not convinced they help. But Newburger says there are creams and lotions that have some effect -- those whose key ingredient is methylxanthines (one form of which is caffeine).
"Caffeine creams work great to pull fluids out of the spaces between cells and induce lipolysis -- fat burning in the layer just below the skin's surface," says Newburger.
In a study published in the journal Dermatologic Surgery in 1999, researchers found that methylxanthine creams reduced fat cells in skin, with visible results in about eight weeks. The higher the concentration of methylxanthine, the better the cream worked.
Newburger says a good delivery system to drive the creams into the cells, like liposome technology, is also important.
Among the hottest-selling caffeine cellulite creams are Neutrogena's Anti-Cellulite Treatment (about $18.49 for 5 ounces) and CelluSculpt Anti-Cellulite Slimming Treatment by Avon (about $16 for 6.7 ounces).
Option 2: The Cellulite Diet
While dieting to lose weight may not help, a diet that "feeds" skin just might, according to Murad -- whose book details such a diet. He says foods rich in nutrients such as lecithin, essential fatty acids, amino acids, and antioxidants reduce cellular inflammation, reduce fluids, and increase circulation deep in skin cells. All this, he says, works to strengthen cell membranes and keep cellulite from migrating to the surface.
"The idea is to encourage collagen production to build the middle layer of connective tissue -- and improve the circulation," Murad tells WebMD.
The foods he recommends include eggs, soy, cauliflower, and peanut butter (for lecithin); flaxseed, olive and canola oils, ground flax, and raw nuts (for essential fatty acids); berries, pomegranates, goji berries (a type of berry found in Central Asia), and citrus fruits like oranges and grapefruits (for antioxidants, polyphenols, and amino acids).
Murad says that diet alone can help. But if you're not a conscientious eater, he suggests high-potency supplements, plus an herbal skin serum that he says helps burn fat cells.
In independent -- and unpublished -- studies a combination of the diet, supplements, serum, and some professional exfoliation treatment was shown to lead to a 78% increase in firmer skin, and a 47% reduction in stretch marks in 12 weeks. Results first became apparent in eight weeks, according to the research.
The cost of the Murad Cellulite Serum, book, and vitamins for one month is $210. Newburger says Murad's dietary approach makes sense, but adds that any eating plan that increases our intake of fruits and vegetables and cuts down on junk food is bound to help our skin look better.
"A healthy diet will also help reduce fluid retention, and that immediately improves the appearance of cellulite," says Newburger.
Option 3: Light Devices
The idea here: Use light energy to melt cellulite while mechanically massaging the skin to increase circulation and encourage drainage of lymph vessels. To this end, the FDA recently approved two devices. The first, called TriActive, relies on laser light.
Katz, who tested the device, says: "It works by first cooling the skin so the laser can penetrate deep without harming the top layer, then a combination of suction and laser beams treat the cellulite."
He says the device works because it increases circulation on a cellular level, removing fluids and putting pressure on fat cells, while the suction aspect loosens the septa bands to diminish the dimpling effect.
In a study presented by Kathryn Frew, MD, at the 2004 annual meeting of the European Academy of Dermatology, the TriActive laser removed cellulite in 83% of patients. So far, a three-month follow-up has shown that the results last. TriActive is a nonmedical device, and is available in both doctor's offices and skin care centers.
A second light device, approved by the FDA in June, is VelaSmooth. It uses a combination of radio frequency energy and infrared light to heat up and then release cellulite from cells. At the same time, it rolls over skin in a massaging motion, using suction to soften and release septa bands. Because it emits a high level of energy, VelaSmooth is classified as a medical device, with treatments available only through a doctor.
Either way, gorgeous thighs don't come cheap or fast. TriActive is sold in a package of 16 twice-weekly, 40-minute treatments for about $1,200. VelaSmooth can run as high as $2,000 for 10 treatments, with results lasting at least six months.
Option 4: High-Tech Massage
The procedure is known as endermologie -- a deep mechanical massage that combines cylindrical rollers and suction to affect the skin's connective tissue, stimulate blood flow and lymphatic drainage, and trigger what the developers say is the body's natural system for eliminating fat from cells.
While experts say the procedure has a visible impact on cellulite, Newburger says it's only temporary. "You're not changing anything except how you are going to look for the next couple of days -- and at 150 to 300 bucks a pop, temporary can be pretty costly," says Newburger.
Endermologie experts say that 14 to 20 of the 45-minute treatments will give results that last from several months to several years. However, they recommend twice-monthly maintenance, at a cost of $300 to $500 a month.
Option 5: Mesotherapy
Among the most controversial cellulite treatments is mesotherapy. Developed in France in the 1950s, it combines a mixture of off-label, FDA-approved medicines (that is, medicines approved for other purposes) with herbs and vitamins. The goal is to break up fat cells and dissolve rigid septa bands.
The medication "cocktail" (which can vary widely among practitioners) is administered in a series of rapid injections over a 30- to 60-minute session. Practitioners say that it usually takes 10 sessions for optimal results.
While a reported 5,000 U.S. doctors now offer mesotherapy for cellulite (since it uses pre-approved medicines; the treatment doesn't require FDA approval), a recent report published in the journal Plastic and Reconstructive Surgery cautions physicians not to experiment with this treatment until more is known. The report also questions the safety of the drugs when used in the injected cocktails, and questions their power to dissolve cellulite. Also of concern is what happens to the fat that melts -- and whether it may end up in the liver.
In an accompanying editorial, Rod J. Rohrich, MD, a plastic surgeon at the University of Texas Southwestern Medical Center at Dallas writes: "It is mind boggling to think that a physician would inject patients -- or that patients would allow [it] -- with unknown, unproven substances based on hearsay and unsubstantiated clinical findings."
However, some practitioners, such as mesotherapy pioneer Lionel Bissoon, DO, report great success with the treatment, declaring that in the right medical hands, it is safe, effective, and has a 90% success rate.
The cost for mesotherapy in the United States runs between $800 and $1,500 for six to 10 sessions. Results are said to be long-lasting.
Published July 2005.
SOURCES: Dermatologic Surgery, 1999; vol 25: pp 445-62. Plastic and Reconstructive Surgery, April 15, 2005. Murad study conducted by Clinical Research Laboratories, Piscataway, N.J., Allendale Investigational Review Board, Robert J. Staab, Ph.D. Frew, K., presentation, annual meeting European Academy of Dermatology, November, 2004, Florence, Italy. Howard Murad, MD, associate clinical professor of dermatology, University of California-Los Angeles; and author, The Cellulite Solution. Bruce Katz, MD, medical director, Juva Skin and Laser Center, New York; clinical professor of dermatology, Mt. Sinai School of Medicine, New York. Amy Newburger, MD, director, Dermatology Consultants of Westchester, Scarsdale, N.Y.
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