June 25, 2009
CELLULITE — the dimpled, uneven skin that mars the backsides and thighs of women everywhere — is a scourge to bikini-wearers and a squelcher of lights-on romps in bed. No wonder the search for a solution has women shelling out millions.
But rumors of a cure are greatly exaggerated. “At this point, there is no outstanding treatment for cellulite,” said Dr. Molly Wanner, an instructor in dermatology at Harvard Medical School and an author of an evidence-based review of existing treatments in 2008. A lasting remedy would have to address the interplay between skin, fat, connective tissue and underlying muscle.
In other words, curing cellulite requires nothing short of changing the structure of skin.
Still, treatments abound, from contour-refining lotions and liposuction to massage machines with lasers and light sources. And there’s no shortage of takers. The market for cellulite-reduction devices in the United States was more than $47 million in 2008, said Amy Krohn, a spokeswoman for the Millennium Research Group. It is projected to grow to $62 million by 2013.
But no treatment has emerged as the gold standard. “Most studies show a 25 to 50 percent improvement after multiple treatments,” Dr. Wanner said. “Some patients have even less improvement, and the effects may go away over time so patients may require additional treatments.”
The Deck May Be Stacked Against You
CELLULITE is a telltale sign that life is a crapshoot. Most women get cellulite after puberty. But men usually don’t, not even if they’ve got the girth to qualify for “The Biggest Loser.”
That’s because the connective tissue bands under men’s skin are crisscrossed like a net, keeping their fat more evenly restrained. By contrast, women’s tissue bands are organized in vertical columns, so fat may bulge irregularly.
“At a normal weight your fat cells fall nicely into valleys of connective tissue,” said Dr. Michael D. Jensen, a clinical professor of medicine at the Mayo Clinic, who has studied fat for 25 years. “When you get too many fat cells or too big of fat cells now they push up on the roof.” Or, your skin.
What’s more, women don’t have as thick a roof as men, all the better to show dimples. And thanks to estrogen, women have more fatty reserves.
It doesn’t stop there. As we age, the connective tissue strands between our skin and muscle, which used to stretch to accommodate weight fluctuations, become inflexible. “Some of the bands tighten down and you get pockmarks with bulges next to them,” said Dr. Brian M. Kinney, an assistant professor of plastic surgery at the Keck School of Medicine at University of Southern California. Voilà, cottage cheese.
Nor do all women start with the same give in their connective tissue. One explanation for a slender woman with cellulite is thin skin and unusually tight connective tissue. By contrast, the neighbor we love to hate can gain 15 pounds but is blessed with stretchable bands that accommodate a fat uptick. No orange-peel bottom for her. Grrr.
I’ll Try Anything, Even if It’s Temporary
LET’S say — fingers crossed — the rain lets up by the Fourth of July and you’re headed to the beach with your man of the moment. A lot of doctors say anti-cellulite creams are nothing but a Band-Aid remedy. But hey, that’s all that you want, and now.
An anti-cellulite cream can offer a “temporary benefit simply because of swelling, but you have to keep using it,” said Dr. Michael F. McGuire, a clinical associate professor at the David Geffen School of Medicine at the University of California, Los Angeles. (Most creams mildly irritate skin, causing a little swelling which camouflages dimpling for a bit.)
That reapplication is a “benefit” for the makers of creams, he added, especially given that “realistically there is no cure for cellulite.”
Still, that hasn’t stopped the rollout of products. In 2008, 40 percent more anti-cellulite creams were introduced than the previous year, said Taya Tomasello, a senior beauty analyst at Mintel, a market research firm. And liposuction — one seemingly logical treatment — won’t necessarily help. “I would categorically say it’s contraindicated for cellulite,” Dr. Dover said. He suggested that women who get liposuction for cellulite will get “dimples where the fat was.”
Liposuction falls short, Dr. Kinney said, because it “will remove the fat,” but doesn’t address inflexible connective tissue or too-thin skin.
Get in the Fight, or Lay Down Your Arms?
EVERY summer a flurry of magazine stories suggest that cellulite is a battle women can win. Women think if they diet masterfully and exercise diligently, they will have a backside as smooth as a cheerleader’s. But just because you stair climb to whittle your backside doesn’t mean you’ll lose weight there.
“Not all areas of the body respond to diet and exercise, and it’s not entirely reproducible which ones do,” Dr. Kinney said.
SmoothShapes is one machine recently promoted in Shape and InStyle magazines as a worthy weapon. This device combines massaging rollers with a laser and a light source that is meant to smooth skin and influence circulation. Another in-office machine garnering attention is VelaSmooth, which uses infrared light, radiofrequency and mechanical massage.
At the very least, massaging an afflicted area may induce swelling, in turn temporarily improving the skin’s appearance. But no treatment at the doctor’s office addresses multiple factors in one go: thickening skin, restructuring connective tissue and melting fat, for instance.
“Some people have misrepresented the truth to suggest that there’s a lot you can do,” said Dr. Jeffrey Dover, a director of SkinCare Physicians, a dermatology practice in Chestnut Hill, Mass. But he finds today’s repertory so inadequate, he doesn’t treat cellulite and won’t, he said, until a treatment has “reproducible results” with a “long-term benefit.”
On a Scale of 1 to 5, Ugh!
SO many women have cellulite that some doctors think of it as a secondary sex characteristic.
As sure as a woman will grow breasts after puberty, she will get dimples and lumps on her skin.
But the severity of cellulite has long been in the eye of the beholder. Even for some doctors. A cellulite severity scale, published this May in the Journal of the European Academy of Dermatology and Venereology, attempts to offer more objective criteria to gauge changes after treatments.
The scale has five measures, including the number of dents, their depth, skin laxity and what the lumps and dents resemble most. According to the scale, cellulite that resembles an orange peel is a milder case than dimples as lumpy-looking as cottage cheese. The worst of the worst is when your behind looks like a quilted mattress.
Who said our aesthetic lot in life is fair?
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