Roll models

An array of over-the-counter products, including skin creams and herbal remedies, claim to make cellulite disappear from women’s thighs, hips and buttocks. But most of those concoctions fall short of delivering on their promise of erasing the dimpled skin that many women consider unsightly.

Several new treatments that actually are in the offing appear to be effective at smoothing the skin. One uses heat and massage; another utilizes a low-energy laser and a massage device. Still another, used for years in Europe and now becoming popular in the United States, is a controversial injection-based therapy.

However, none of these new therapies is the cure that women – about 80 percent of whom have some cellulite – have been hoping for. The products offer noticeable, yet modest, improvement in appearance.

The newest device, called VelaSmooth, uses heat and massage to smooth the skin. It is expected to be approved this year by the Food and Drug Administration.

“Management for cellulite would be truly revolutionary,” says Dr. Rod J. Rohrich, professor and chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center at Dallas.

A real breakthrough in cellulite treatment will likely come from some type of prescription drug rather than devices that essentially beat or heat cellulite into submission, he says.

Still, some of the new treatments can significantly change the appearance of the fat deposits, say doctors familiar with the therapies. Results vary from person to person, however, and periodic follow-up treatments are needed to maintain the benefits.

For some women, return visits are a small price to pay.

Andrea Carter, 33, underwent treatments with VelaSmooth in February after realizing that simply being fit wouldn’t make her cellulite disappear.

“I exercise four times a week,” the La Quinta, Calif., advertising account executive said. “But the dimpling just doesn’t go away.”

The treatments greatly reduced the appearance of cellulite, she says, with the results holding up thus far.

Treating cellulite is difficult because the condition is natural. Society has made it a problem because people don’t like how it looks, Rohrich says.

Experts don’t understand precisely how and why cellulite forms, but they generally describe it as the clumping and enlargement of ordinary fat cells surrounding the fibrous tissue that connects the skin and deeper layers of tissue. Cellulite is linked to hormonal changes, genetics and dietary factors.

“It has to do with estrogen-induced skin changes,” Rohrich said. “It’s natural. Everybody has cellulite.”

The appearance of cellulite is more common in women, however, because of differences in the distribution of fat, muscle and connective tissue.

Even liposuction does not cure cellulite, Rohrich said. It removes fat and can shrink thigh circumference, but it does not change skin composition.

Here are the pros and cons of the most promising treatments.

Heat and massage

The VelaSmooth device – which is approved for use in Europe and Canada and has been used in clinical trials in the United States – is the first treatment to generate some enthusiasm among doctors. But it has limitations.

The device combines two sources of energy – infrared light and radio frequency – with rollers that manipulate the tissue. This combination sends heat into the tissue more deeply than existing treatments to help break down fat within cells and shrink the cells.

Because of the energy level of the device, the treatments must be performed or supervised by a doctor.

“You also have the mechanical action of the rollers that kneads the skin. It kind of massages it and facilitates penetration of the heat,” says Dr. Mary Lee Amerian, a Los Angeles dermatologist who has participated in the clinical trials of VelaSmooth.

Patients typically undergo 45-minute treatments twice a week for about six weeks. Any improvement from the initial series of treatments tends to last about six months, Amerian said.

Monthly treatments are needed to maintain the benefits. Most people do not find the treatments painful, she says.

One controlled clinical trial of 20 patients showed that all had some improvement in the appearance of cellulite, and 75 percent had a reduction in the circumference of the treated thigh, with an average reduction of 2.5 centimeters.

VelaSmooth, which costs about $200 per treatment, is an improvement over massage-only techniques, says Dr. Tina S. Alster, founding director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C.

“I think it’s the best thing out there right now for cellulite,” says Alster, who conducted a study on the device for the manufacturer, Syneron Medical Ltd.

“Does it melt cellulite away? No. But as far as an easy treatment that is effective, it’s the most effective thing I can find.”

Laser and massage

TriActive, approved last year, is a nonmedical laser device – meaning people other than medical doctors, such as aestheticians, can use it.

It combines a low-energy laser to enhance blood circulation with mechanical massage to stimulate and tighten tissue.

One physician-supervised study of the device showed that the treatment improved the appearance of cellulite in 83 percent of patients, compared with 17 percent of patients who received a massage-only therapy.

Another study, of 16 women, presented last year at the American Academy of Cosmetic Surgery annual meeting, found a 21 percent improvement in the appearance of cellulite, although the results usually disappeared within four weeks.

TriActive works best if patients undergo an initial 10 to 12 treatments, weekly or semiweekly, with monthly maintenance treatments thereafter. The painless 30-minute treatments cost $80 to $150.

Massage

Attempts to force the fat into smoothness have long been a staple of cellulite treatment. But a technique called Endermologie created a sensation in 1998 when it was approved by the Food and Drug Administration as the first therapy to reduce the appearance of cellulite.

Patients don a special body stocking and lie prone while a technician uses a hand-held device with rollers that draw up skin folds and roll the skin to break up pockets of cellulite and increase circulation. It can be uncomfortable.

“It swells the skin to make cellulite go away temporarily,” Rohrich says.

Endermologie, which costs about $100 per treatment, typically involves two treatments a week for 10 weeks, followed by regular maintenance treatments.

Upgraded technology, including more effective rollers, became available a couple of years ago, making the procedure more comfortable and efficient, according to the manufacturer, LPG One Inc.

Mesotherapy

One of the most intriguing treatments for cellulite is a drug treatment known as mesotherapy.

Many leaders in dermatology and plastic surgery are wary of it because of the dearth of U.S. studies and because it’s potentially risky.

Mesotherapy is the term for a variety of treatments that involve injecting small amounts of drugs or natural substances into the mesoderm, the layer of fat and connective tissue under the skin. It was developed in France half a century ago and is popular in Europe and South America.

The technique, which must be administered by a doctor, recently gained a toehold in the United States for treating cellulite. But the therapy can also be used for pain, psoriasis and weight loss, depending on the substances injected, says Lionel Bissoon, a New York-based osteopath who has championed mesotherapy in the United States.

For body contouring, doctors inject a combination of substances aimed at breaking up and metabolizing fat. The ingredients can vary according to practitioner, which critics say is one of the treatment’s more unsettling aspects.

Bissoon says he uses phosphatidylcholine, a naturally occurring phospholipid that plays a role in the digestion of dietary fat; aminophylline, an asthma medication that Bissoon says helps break down fat; as well as some other substances and homeopathic ingredients.

“If you treat cellulite, you need to break down fat and increase circulation,” he says. “Each medication is specific to the condition.”

The mainstream medical community, however, remains wary of mesotherapy.

In an article published last month in the journal Plastic and Reconstructive Surgery, doctors noted that there are few English-language studies attesting to its safety and effectiveness, patients could suffer from allergic reactions or toxicity, and just how the injected substances work to reduce cellulite is unknown.

The article and accompanying editorial advise consumers to avoid mesotherapy until more is known about it.

Patients undergoing mesotherapy, which typically entails 10 to 15 initial treatments and an annual follow-up treatment at $500 each, should ask what is in the syringe and should avoid reusable injection devices, or “guns,” that may not be sterile, Bissoon advises.

Ultimately, although new treatments may improve the appearance of cellulite, women still have to do their part.

All treatments will produce better results, experts say, if consumers also diet, exercise and drink plenty of water.