Caution Cellulite: Bumpy Road Ahead

Cellulite is a complicated and controversial topic with no agreement among researchers as to exactly what it is physiologically or which treatments, if any, can have a positive effect. The only two things about cellulite everyone agrees on are what it looks like and that if you have it, you hate it and you want to get rid of it. Regrettably, most of us (women that is) have it to one degree or another. According to statistics, and this is really shocking, cellulite shows up on the thighs of more than 85% of females past the age of eighteen regardless of ancestry, although it is somewhat more common for Caucasian and Asian women. To make matters worse, for women, cellulite represents stored, hard to metabolize fat that is interdependent on estrogen. And any amount of fat (and we all need some in our bodies) can show up as cellulite on women's thighs. (Source: Cosmetics & Toiletries magazine, October 2004, page 49)

As the anti-cellulite product and treatment market increases, research regarding efficacy remains at a bare minimum and is often obscured by self-serving studies from those who peddle these cures. Sadly, the lure of these supposed remedies is hard to fend off because fighting cellulite is an uphill battle. For lots of women the mere hope or illusion that something may work is a powerful temptation, and that weakness is something the cosmetics industry counts on and exploits to the max. (Source: Journal of Cosmetic Science, November 2005, pages 379-393)

Myth Busting
Let's start by straightening out some popular myths about cellulite:

Men don't get cellulite: To some extent that's true. Physiologically, women are far more prone to accumulating fat on the thighs and hips while men gain weight in the abdominal area. Plus, for women, the connective tissue beneath the skin has more stretch and is vulnerable to disruption, which is the perfect environment for developing cellulite. Some men do get cellulite—just statistically not as much as women. (Source: Journal of Cosmetic Science, March-April 2005, pages 105-120)

Drinking water helps: Drinking water probably is beneficial (although there is really no research showing how much is healthy versus unhealthy), but there is no research showing that water consumption impacts fat anywhere on your body, let alone the dimples on your thighs. (Source: American Journal of Physiology—Regulatory, Integrative, and Comparative Physiology, November 2002, pages 993-1004)

Water retention causes cellulite: It's ironic that low water intake is considered a possible cause of cellulite, and the polar opposite "retaining too much water" is thought to be a factor as well. There is lots of speculation of how water retention can affect cellulite but there is no actual research supporting this notion. Further, fat cells actually contain only about 10% water, so claiming to eliminate excess water won't make a difference. And any measurable result would be transient at best as the water lost would soon be replaced. (Source: Journal of Strength and Conditioning Research. November 2003, pages 817-821)

Eating a specialized diet can help: A healthy diet that encourages weight loss may help your entire body look better. However, because weight in and of itself is not a cause of cellulite, dieting won't change the skin structure of your thighs. For some, cellulite is made worse by the accumulation of extra fat. In those cases, weight reduction may decrease the total area and depth of cellulite. (Source: Clinical Dermatology, July-August 2004, pages 303-309)

Cellulite is different from fat on the rest of the body: Theories abound about how cellulite differs from regular body fat. However, few studies show how cellulite clumps differently than other fat on your body. But overall, most researchers feel cellulite is just fat, plain and simple. Besides, even if cellulite is different in how it congregates, what you can and can't do about fat on any part of the body remains the same. (Source: http://www.quackwatch.org/01QuackeryRelatedTopics/cellulite.html)

Exercise can help: Exercise helps almost every system in the human body, but it won't necessarily impact the appearance of cellulite. Exercise doesn't improve skin structure and it can't affect localized areas of fat. In other words, you can't spot reduce fat accumulation in a specific area. (Source: British Journal of Plastic Surgery, April 2004, pages 222-227)

Detoxifying the body reduces the appearance of cellulite: Detoxifying the body in popular culture has taken on the meaning of purging it of pollutants or any other problem substances within the environment or in the foods we eat. In terms of the way this concept has been mass marketed, there is little research showing credible efficacy as to whether or not detoxification of the body is even possible. However, "detoxifying" the body as it is used in the scientific community describes the process of reducing cellular damage. Antioxidants, enzymes, and proteins can prevent certain abnormal or undesirable cell functions from taking place. There is no doubt this is helpful for the body. Whether or not this reduces cellulite is completely unknown because skin structure and fat accumulation are not caused by toxins in the environment or the food we eat. Furthermore, there are no studies showing toxins of any kind prevent fat from being broken down. (Sources: Journal of Endotoxin Research, April 2005, pages 69-84 and Journal of Biochemistry and Molecular Biology, May 2003, pages 258-264)

What We DO Know
There are three leading theories about cellulite formation: 1. Women have unique skin structure on their thighs, which causes cellulite to easily form. 2. The connective tissue layers on the thigh are too weak or thin to maintain a smooth appearance—allowing fat contour to show through; 3. Vascular changes and possible inflammatory conditions may be to blame. (Source: Journal of Cosmetic Laser Therapy, December 2004, pages 181-185; Journal of Applied Physiology, April 2002, pages 1611-1618; and Skin Research and Technology, May 2, 2002, pages 118-124)

Most cellulite products come in the form of lotions and creams with a vast array of either exotic-sounding or lab-synthesized ingredients. Beyond topical products there are devices such as endermologie, medical treatments such as lasers and mesotherapy (a procedure involving repeated injections, which is claimed to break down fat). As far as skin-care products are concerned, the litany of options is mesmerizing. Yet there is almost no uniformity between anti-cellulite formulas. It would appear, if the claims are to be believed, a wide variety of unrelated extracts can deflate or break down fat and/or restructure skin. Looking at the research, however, most suggest there is little hope that anything rubbed on the skin can change fat deposits or radically reduce the appearance of cellulite. (Sources: Dermatologic Surgery, July 2005, pages 866-872 and The European Journal of Dermatology, December 2000, pages 596-603)

Lotions and Creams
A review of the more popular anti-cellulite products may be found in the full-length report.

A Bevy of Anti-Cellulite Ingredients
A review of the more typical ingredients contained in various anti-cellulite products may be found in the full-length report.

Mesotherapy
Mesotherapy is a procedure, which has been claimed to dissolve fat from the repeated injection (and I mean lots and lots of injections) of various substances into the fat layers of skin. Mesotherapy got its start 50 years ago in France through the work of a physician who was trying to find a cure for deafness. (Source: Dermatological Times, December 1, 2004)

Some of the substances being injected are homeopathic and some are pharmaceutical. Strangely, there isn't necessarily any consistency, and the cocktail of ingredients can vary from practitioner to practitioner, which makes this treatment very hard to evaluate. The most typically used substance is phosphatidylcholine, but it can also be combined with deoxycholate. A handful of studies have shown that this can successfully reduce fat when injected into the skin, with one study demonstrating this for the undereye area. Theoretically, the reduction of subcutaneous fat may be caused by inflammatory-mediated cell death and resorption.

However, mesotherapy isn't without risk. One study explained, "Side effects included burning, erythema, and swelling at the injection site. At follow-up averaging 9 months, 50% of patients reported persistence of benefit, 20% experienced some fading, and 30% [received no benefit at all].

Finding out if this would work for you isn't inexpensive. Mesotherapy costs $300-$500 for each treatment and about ten to fifteen sessions are recommended, so it actually ends up being more expensive than liposuction.

(Sources: Journal of Cosmetic Laser Therapy, December 2005, pages 147-154 and March 2005, pages 17-19; Morbidity and Mortality Weekly Report, November 2005, pages 1127-1130; Plastic and Reconstructive Surgery, July 2003, pages 162-70; and Aesthetic Plastic Surgery, July-August 2003, pages 315-18)

Learn more about mesotherapy in our complete report.

Endermologie
Developed in France in the 1980s, the FDA approved this high-powered, handheld massage tool in 1998. It consists of two motorized rollers with a suction device that is moved over the skin, somewhat like a mix between an old-time, wet-clothes ringer and a vacuum cleaner. (By the way, European women are confounded by cellulite, too, even though they tend not to have the weight problems Americans do. But remember, weight and cellulite are not directly related.)

While claims abound, legally those advertising endermologie treatment are only permitted to promote it for "temporarily improving the appearance of cellulite." Of course, somehow the word "temporarily" never is seen in the ads or Web sites promoting this device. Finding out if this works is time consuming and pricy. Anywhere from ten to twenty treatments are recommended plus one or two maintenance visits per month are required to preserve any results. There is no typical cost, and depending on where you go, prices can range from $75 to $200 per session.

More information on endermologie is available in the complete report.

Non-ablative Lasers and Light Systems
Ever since the FDA approved TriActive Laserdermology (Cynosure Inc, Chelmsford, MA) as a Class II medical device that "temporarily reduces the appearance of cellulite," lots of companies have wanted in on the action. TriActive combines a diode laser (at a wavelength of 810 nanometers) with localized cooling, suction, and mechanical massage (sort of a cross between a laser and an endermologie machine). Treatment protocol varies, but generally the process is three times a week for two weeks and then biweekly treatments for five weeks. As a Class II medical device, this laser can be sold and used without physician supervision, which means a growing number of salons and spas are advertising its success and changing the FDA classification of "temporarily reduces" to a more alluring "reduces" cellulite. (Sources: http://www.fda.gov/cdrh/pdf3/k030876.pdf; Securities and Exchange Commission Information, http://www.secinfo.com/dsvRx.z4y6.htm; and Journal of Cosmetic and Laser Therapy, June 2005, pages 81-85 and June 2004, pages 181-185)

Another device approved by the FDA is the VelaSmooth system (Syneron Inc, Richmond Hill, Ontario, Canada). It combines near infrared light at a wavelength of 700 nanometers, continuous wave radiofrequency, and mechanical suction. Twice-weekly treatments for a total of eight to ten sessions have been recommended. One of the only studies demonstrating this machine's efficacy included twenty women, and eighteen of the twenty personally thought they saw improvement. Yet the actual measurements only showed a 0.3-inch reduction in thigh circumference. Hardly sweeping results by any standard, making it clear that larger-scale studies are needed, especially before you decide to spend $1,000 or more to see if these kinds of machines can get you what you want, namely smoother thighs, not a lighter wallet. (Sources: Journal of Cosmetic and Laser Therapy, December 2004, pages 187-190; December 2004, pages 181-185; June 2005, pages 81-85)

Electrical Muscle Stimulators (EMS) and Iontophoresis Devices
According to www.quackwatch.com, "Muscle stimulators are a legitimate medical device approved for certain conditions" to relax muscle spasms, increase blood circulation, prevent blood clots, and rehabilitate muscle function after a stroke. But many health spas and figure salons claim that muscle stimulators can remove wrinkles, perform face lifts, reduce breast size, reduce a "beer belly," and remove cellulite. Iontophoresis devices are prescription devices that use direct electric current to introduce ions of soluble salts (i.e., medications) into body tissues for therapeutic or diagnostic purposes. The FDA considers promotion of muscle stimulators or iontophoresis devices for any type of body shaping or contouring to be fraudulent. (Source: http://www.fda.gov/ora/fiars/ora_import_ia8901.html)

Body Wrapping
Many salons and spas offer a cellulite/weight-loss service where the body is tightly wrapped or dressed in special garments with or without a "specialty" cream or lotion applied first. Promising to reduce inches off your body, the cost for these treatments range from $65 to $500 depending on the salon and if the clientele is elite enough to warrant the steep price. Scientific-sounding information makes this process seem legitimate, but in the long run all it is doing is temporarily compressing your skin (you could probably do this yourself with plastic wrap), which will then return to its original shape in a matter of time, how much time depends on your skin's response. Impressive results often are delivered after measuring several parts of the body and adding up small incremental changes, which in total, end up sounding far more impressive than it really is.

Infomercials, Internet sites, and some multilevel marketing companies sell at-home systems claiming to eliminate toxins and squeeze water-logged fatty tissue dry. You can't squeeze toxins out of a cell. While you may be able to squeeze water out of a cell that same pressure would concurrently injure other cells, which isn't good for your skin. Plus, the water content would return to whatever level is natural for the body fairly soon due to homeostasis. All in all, there is no research whatsoever showing body wrapping does anything positive and it will not get rid of fat or cellulite. (Source: Federal Trade Commission, www.ftc.gov/opa/2004/12/transdermal.htm)

Skin Patches
Learn more about skin patches for cellulite in our complete report.

Liposuction
Liposuction has been used to reshape and reduce the appearance of accumulated fat layers and cellulite. However, the primary function of this procedure is to remove fat in localized areas, not cellulite. In cases, where liposuction involves the removal of large quantities of stored fat, it can sometimes worsen the appearance of cellulite by creating unsupported and slackened skin, which allows any remaining fat (and some always remains) to show through.

Paula Begoun