"Cellulite", still no proven permanent cure

August 6, 2003 - Most women, to varying degrees, are plagued with cellulite, a condition that gives the skin a dimpled appearance and usually is most prevalent in the thigh, hip and buttock areas. Patients consulting with board-certified plastic surgeons for body contouring frequently ask what can be done to reduce the appearance of cellulite. Currently, there is no ideal treatment.

"Cellulite is caused by bands of fibrous tissue that connect the muscle to the skin," says Peter Fodor, MD, President-Elect of the American Society for Aesthetic Plastic Surgery (ASAPS). "If these bands are tight and the fat between the muscle and the skin is compressed, there will be dimpling." Almost all women (and some men) have cellulite, stemming from genetic predisposition, hormonal changes and weight gain.

Various treatments have emerged over time that claim to "treat" cellulite. ASAPS, the leading society of plastic surgeons who specialize in aesthetic (cosmetic) surgery, offers this information summarizing the current available information:

• Liposuction: Lipoplasty, commonly known as liposuction, does not reduce cellulite; however, some surgeons have reported performing a technique of cellulite lysing (breaking up) using a liposuction cannula (hollow tube powered by gas or electricity) that features a smooth, round-tipped tunneling rod inserted in a hollow casing with a sharp, V-pronged cutting edge. The tunneling rod assures passage under the skin to the area to be broken up, while the curette fork (loop shaped surgical instrument) extends at the tip to sever only the dimple-causing connective tissue system.
• Fat Injections: Autologous fat harvested from donor sites in the abdomen and flank areas may fill in depressions. However, the results of fat injections often are not permanent.
• Lower Body Lift: This procedure evolved from one called "Cellulite Lift." The technique was designed to replace the thigh/buttock lift, a procedure that works well for some patients but may produce scars that are visible when wearing a bathing suit. The lower body lift requires an incision around the entire circumference of the abdominal area, so that excess skin can be removed and the entire flank, thigh and buttocks areas can be lifted. The incision can usually be placed discreetly within standard or high-cut bikini lines. The result of the procedure is tightening of the back, flank and abdominal tissues, and reduction in the appearance of cellulite in the lifted areas. The lower body lift is a major surgical procedure that requires a lengthy recovery and leaves an extensive, though well-positioned, scar. For this reason, it requires especially careful patient selection and, as with all cosmetic surgery, the patient's full informed consent.
• Endermologie: Mechanical roller massage therapy has been proposed as a treatment for cellulite and as an adjunct to liposuction. Treatments may produce temporary improvement in the appearance of cellulite, but long-term results of this noninvasive therapy have not been established, either clinically or scientifically. According to a 2001 study published in Aesthetic Surgery Journal, ASAPS' peer-reviewed publication, Endermologie in and of itself has not been found to be beneficial for producing long-term and lasting clinical results.
• Mesotherapy: Small amounts of homeopathic medicine are injected immediately beneath the surface of the skin to break down the cellulite and to improve circulation and lymphatic and venous drainage. Currently, there are no peer-reviewed articles or scientific studies to back up claims that mesotherapy improves the appearance of cellulite.
• Herbal and dietary supplements: Some makers of herbal and dietary supplements claim to cure what they say are the internal causes of cellulite, such as poor circulation, slow metabolism, and bloating. Since supplements are not regulated by the US Food and Drug Administration (FDA) unless they are marketed as a cure for a disease or a medical condition, some companies market supplements with claims that are unsubstantiated by scientific studies. Until reliable data is provided concerning any herbal or dietary supplement, consumers should be skeptical of claims and should also be aware that many such supplements carry risks.
• Creams and lotions: "Miracle" creams and lotions are frequently marketed with claims of diminishing the unsightly dimpling of cellulite. These topical "cures" contain a variety of active ingredients including, but not limited, to: caffeine, green tea, plant extracts, retinol, aminophylline (an asthma drug), and the antioxidant DMAE. While creams may mask cellulite temporarily by hydrating and swelling the skin, there is no science to back up their long-term efficacy.

Conclusion: Although some treatments may provide temporary improvement in the dimpled appearance of cellulite, to date there is no proven, permanent "cure" for cellulite.

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