July 4, 2000 -- It's bikini season. Thousands are surging to the beaches, cottage-cheese thighs gleaming in the sun. There's only one word for that dimply skin, and it's cellulite -- an ages-old, international scourge. From the French Riviera to the Caribbean to the Mississippi River Basin, sun-loving girls just want to have fun -- and cellulite can dampen the mood.
Doctors say that cellulite takes shape like an "overstuffed chair" -- when connective tissues underneath the skin become stuffed with fat, toxins or fluid, dimpling occurs. Others say that it's age-related; when the bands that form connective tissue begin to shorten, they pull at the skin.
Cellulite plagues women more than men, simply because of estrogen and thin skin. Estrogen drives the fluid buildup in fatty tissue. Men have thicker skin -- literally -- so their superficial fat does not show so easily. And genetics are a driving force. If Mom had a bad case of cellulite, chances are her daughter will, too. Fat women are just as prone as thin women. Even young girls can get bad cases of cellulite.
The bottom line: over time, those small, stuffed pockets will harden and grow -- and become more difficult to erase. Ads for miracle creams, special extracts, and herbal drinks promise that legs will "rapidly improve in appearance" -- at least in badly lit, black-and-white photographs. Some doctors and their patients swear by liposuction, a fat-removal technique that has been fine-tuned over the last few years.
Will researchers ever find that cellulite gene? Until they do, what are the best options?
In the heart of Tennessee, baby pigs are getting daily massages -- deep-muscle Swedish massages -- to help researchers better understand one cellulite treatment called endermology. Developed in Europe, endermology has won the FDA's blessing as a treatment that "temporarily decreases the appearance of cellulite."
Bruce Shack, MD, chair of plastic surgery at Vanderbilt University School of Medicine in Nashville, is in charge of the piglet research program. Endermology works to smooth out those dimples and ripples via a vacuum-like device, explains Shack. Equipped with rollers, it both sucks and massages the skin. While used extensively in Europe, endermology has only been available in the U.S. for the past three years.
In their initial study, Shack gave treatments to 10 young pigs, whose skin is similar to human skin. Some were treated daily for four weeks, some for 10 weeks, some for 20 weeks. Researchers found a "surprising, and very dramatic increase in subcutaneous collagen," a substance in the body that helps skin keep its youthful appearance. They also found that the 'strings' attached at the muscle level were looser and had lost their indentation, creating a smooth surface.
However, he admits, "It probably doesn't last forever. We've likened it to a callus. If you work with your hands [you get] thickened skin. If you stop, the calluses go away."
In glitzy Los Angeles, Peter Fodor, MD, associate professor of plastic surgery at UCLA, keeps three endermology machines running constantly in his private practice. "We have hundreds of patients coming through here," he tells WebMD.
Endermology generally shows its results after a series of 14 treatments, he says. Some go for yet another series before switching to a maintenance program. To keep the effect long-term, you need to have one treatment every other week.
"Patients compare it to a relaxing massage, and the cost itself is not different from a massage," Fodor adds. "Some patients try it, thinking that if nothing else they get a relaxing massage. But what our technicians tell me, which I almost cannot believe, almost unheard of, is [that patients have] close to a 100% satisfaction rate. ... Patients lose inches, not weight. They are redistributing things."
"But I don't want to build it up as something incredible, because quite honestly ... it does not replace liposuction. Liposuction removes fat," says Fodor. In fact, studies he has conducted show that when endermology is performed immediately after liposuction surgery, bruising and swelling from the surgery disappear faster.
"Endermology is a fancy roller massage," James McKay, MD, tells WebMD. "It's really expensive, and the reason people look good is that the rollers compress or roll ... fluid out of body tissues. It's a short-term fix, not curing the basic problem. But a lot of people like it; you see various package prices advertised." McKay is associate professor of plastic surgery at Emory University School of Medicine in Atlanta.
Charges for these procedures vary among doctors; endermology treatments range from $50 to $100 per treatment. Liposuction ranges from $2,000 to $6,000.
From the sunny Florida beaches, Leslie Baumann, MD, director of cosmetic dermatology at the University of Miami, gives WebMD a more global perspective. "In France, women don't drink carbonated beverages so they won't get cellulite, but I've never seen studies on that. It's an old wives' tale."
Also in Europe, women get injections of caffeine, but that's not been published, Baumann adds. "Some of my patients from Europe have told me about it, that it worked for their friends."
Creams are the way to go, says Baumann. "Creams that contain caffeine and aminophylline help dehydrate the fat cells, so they have a temporary benefit, but it only lasts about 24 hours. It just temporarily shrinks up the fat cells." She adds that the change is subtle.
As for endermology, "there really are no good studies on that," she tells WebMD. "Most studies have been done by the company and I've been able to find nothing that's an unbiased study. A lot of people report liking it, but I personally don't believe that it works."
Unfortunately, the best thing, she says, is diet and exercise. "It does help get rid of cellulite. Fat cells shrink in size ... and it does help prevent cellulite. Part of the problem is decreased muscle tone allows the fat to protrude. But with increased muscle tone, you can hide it a little bit."
Donald Robertson, MD, tells WebMD that "diet can play a part in modifying cellulite, as does regular exercise. One thing that can be most effective is drinking water. ... Water is one of the body's ways of helping body to [break down] fat." Robertson is medical director of the Southwest Bariatric Nutrition Center in Scottsdale, Ariz.
Cellasene is an herbal drink touted as the world's first cellulite reduction product, designed to "increase blood circulation, reduce fluid buildup, stimulate metabolism, and reduce localized fats," says its marketing materials. Robertson says that only two small studies (both done by Cellasene's manufacturer) show significant decreases in measurements of hip, thigh, and ankle. "The problem is, there is no long-term study to see if it comes back."
The drink contains a laundry list of herbs, including evening primrose oil, sweet clover, ginkgo biloba, grape seed, and fish oil. "I don't think it can hurt anybody ... although there may be some problems with ginkgo biloba," Robertson tells WebMD.
"People have tried [creams], enzymes, electrical stimulation, massage. None of them work," McKay says. "We're not out to sell smoke and mirrors. I think right now the only reasonable treatment is liposuction, focusing on the superficial layer of fat as well as the deep fat pockets. We call it body contouring. And weight loss helps, but nobody wants to hear that."