Subcribe to E-News
A Range of Products That Promise to Treat Cellulite
Navin M. Geria
VP-R&D
SpaDermaceuticals
As the population ages, demand for anti-cellulite products remains high. Sales of these products rose from $58.8 million in 2002 to $93.1 million in 2007.1 Surgical options, non-invasive devices, injectables and topical creams are all cellulite treatments but most lack proof of efficacy. My previous column (August, p. 45) reviewed cellulite and aging. This column reviews cellulite treatments.
Mitchell P. Goldman, medical director, La Jolla Spa MD and Dermatology/ Cosmetic Laser Associates of La Jolla, CA has created treatments that combine skin creams with bio-occlusive shorts that aid in penetration. While they are not as effective as machines, published studies have shown that patients can achieve 20% to 35% improvement using the creams. There are over 200 products currently on the market for treating cellulite, even though the role of topical treatments is highly questionable. Still, these treatments proliferate despite a lack of data substantiating efficacy.
Regular exercise increases circulation and promotes detoxification by increasing perspiration. Exercise tightens, tones tissues and helps maintain a healthy weight to prevent certain diseases. Water does not reduce the appearance of cellulite, but it fully hydrates and plumps the skin and provides health benefits. Some medical authorities suggest that those with cellulite do not drink enough water. Some doctors advocate stopping the consumption of nicotine and caffeine since they constrict blood vessels. But this finding is not supported in any research.
It is difficult to eliminate cellulite because fatty tissue is poorly vascularized. Treatments work by stimulating the basal cells of the skin to produce more collagen. Although there is no proven cure for cellulite, a recent study published in the Journal of Dermatologic Surgery revealed that certain cellulite creams reduced fat cells in the skin in a few weeks. These creams are best applied after a hot bath/shower or vigorous exercise when the skin is still moist and warm. They work as long as they are used regularly. It is important that effective creams should be used in conjunction with diet and exercise or medical treatment. Creams only temporarily help ripples look smoother. Losing weight won’t eliminate cellulite, but could make cellulite less obvious. A variety of creams are thought to stimulate lipolysis. Strictly speaking, lipolysis is defined as fat cell shrinkage as opposed to fat cell loss. Topical creams are proposed to function through lipolysis of fat by changing the structure of the dermis and connective tissue or improving circulation. Two topical compounds most studied are methylxanthines and retinoids.2
Typical claims for such products sound very scientific; e.g., “improve circulation,” “reduce the appearance of cellulite” or “stimulate the release of fat.” Some marketers embellish their claims based on poorly designed clinical studies.
It’s a Wrap!
Some dermatologists recommend wraps for those who want a quick fix because they are relatively inexpensive ($60-250). Seaweed and sea mud wraps generally help detoxify and purify the skin. The consumer wears bioceramic-coated neoprene shorts for an hour. The shorts contain a clay-like substance, which is layered into the neoprene, to help retain body heat and open the pores of the skin, allowing the body to absorb more of the cream’s active ingredient.
Herbal and cellulite wraps increase circulation, promote detoxification and compact skin tissues. Some herbal wraps are specifically designed to help break down bodily toxins. The wraps squeeze out excess fluids for an immediate tightening effect. Alas, it is only a short term solution and any inches lost quickly return. Therefore it is important to continue exfoliating and smoothing treatments between wraps.
Attempts to smooth fat have long been a staple of cellulite treatment. But a technique called Endermologie created a sensation in 1998 when it was approved by the FDA as the first therapy to reduce the appearance of cellulite. During treatment, patients wear a special body stocking and lie down while an aesthetician uses a hand-held roller that draws up skin folds and rolls the skin to break up the pockets of cellulite and increase circulation. At the same time another device suctions the skin. This somewhat uncomfortable procedure swells the skin to make cellulite go away temporarily. Endermologie typically involves two treatments a week for 10 weeks, followed by regular maintenance treatments. Each treatment costs about $100. This non-invasive deep tissue treatment smoothes and tightens the skin. Its results are temporary and maintenance is required. Many studies are underway to determine the effectiveness of this treatment. This and other mechanical treatments are designed to promote circulation, flush toxins and aid in tightening surrounding tissues.
A Controversial Treatment
Mesotherapy is a most intriguing, yet controversial, cellulite treatment. Potentially risky, mesotherapy involves injecting small amounts of drugs or natural substances into the mesoderm, the layer of fat and connective tissue under the skin. The idea is to break up and metabolize fat. The ingredients vary according to the practitioner—a variance that makes the treatment unacceptable for many. Some doctors have urged caution, noting there is no substantiated clinical evidence that mesotherapy is safe and effective. The ingredients used are FDA-approved, although mesotherapy itself is not.
Mesotherapy was developed in France 50 years ago. Today, doctors use it to treat cellulite as well as promote weight loss and alleviate migraines and chronic pain. It is very popular in Europe and South America.
Mesotherapy, or any micro-injection treatment, relies on fat-dissolving ingredients. The meso-active substances stimulate the metabolism of fat cells and accelerate elimination.
Materials injected into cellulite during mesotherapy include aminophillin and isopropanol to break up fat cells, collagenase and hyaluronidase to dissolve the connective fibers, anti-inflammatory medicines to control pain and swelling, and agents such as melilotus, an extract of sweet clover that dilates the blood and lymph vessels to increase circulation. To reduce pain, doctors sometimes add lidocaine.
Many cellulite treatments promise great results, but any improvement is often only temporary, according to experts. |
The patient remains conscious, but a topical numbing cream is used to mitigate the pain. The doctor inserts the needle to a depth of less than a third of an inch, several dozen times. Afterward, the patient may see some bruising at the injection site. Side effects may include sores and scarring. The price range for a session is $800-$1,500. Six to 10 sessions are typically recommended. The treatment often produces bruising, swelling and itching which lasts from a few hours to several days. A modest improvement is visible.
Localized fat deposits typically are the targets of liposuction. But this $5000 technique of extracting fat by vacuuming it from under the skin is not an effective cellulite treatment. In fact, liposuction may worsen the appearance of the skin by eliminating the cushion of fat that resides just under the skin. The result is additional dimpling.
Heat Treatments
Several cellulite treatments depend on heat. One is a hand-held probe that delivers electro-magnetic radio waves to heat underlying fat tissue. The procedure reportedly reduces the appearance of dimpled fat and even slightly shrinks thighs, hips and belly. Published data are limited, but some physicians say the treatments produce a noticeable, though temporary effect on many patients.3
The Accent System is a new device that uses radio-frequency energy to heat underlying tissue at different depths, causing skin to contract and tighten. The procedure is medically supervised and is non-invasive. It is also expensive—$3,000 for six treatments.
The Thermage method is the most promising for long-term cellulite reduction. The device transmits radio frequency heat, which penetrates more deeply than lasers without burning, to zap collagen bundles and dissolve them. The procedure is painful and can take more than two hours to treat a single area. Therefore, doctors often administer pain medication. Thermage causes temporary redness and swelling of the skin or mild bruising.
The body replaces damaged cells with new connective tissue. Treatments are expensive (about $4,000), but produce noticeable results after only one session. Moreover, results last six months or longer compared to other options that require more visits.
TriActive is a painless, non-medical laser. It combines a low-energy laser to enhance blood circulation with mechanical massage to stimulate and tighten tissue. It works best if patients initially undergo 10 to 12 treatments weekly with monthly maintenance treatment thereafter. The cost is $80-150 for a 30-minute treatment. It is a non-invasive machine that helps loosen the septa and improve the circulation. It combines skin suction with a cool diode laser and was approved by the FDA last year.
Other treatments include:
Ultrasound—The Ultrashape is a non-FDA approved device that has been recently shown to reduce fat.
Carboxy Therapy—Carbon dioxide is injected into the subcutaneous tissue. This treatment affects fat cells and circulation.
VelaSmooth—A well-accepted device by doctors but it has limitations. It combines infrared light and radio frequency with rollers that manipulate tissue. This sends heat into the tissue more deeply than existing treatments to help break down fat within cells and shrink the cells. Due to the device’s high energy level, treatments must be performed or supervised by a doctor, according to 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. Skin improvements usually last about six months. Monthly treatments are needed to maintain the benefits. Most people do not find the treatments painful. The cost is $200 per treatment. It uses radio frequency waves to break up fat and infra red heat to improve circulation. The makers of this device say it eliminates the appearance of cellulite, improves blood flow and softens fat. It is non-invasive and helps loosen the septa and improve circulation. FDA cleared the device in 2005 for the temporary reduction in the appearance of cellulite.
According to Dr. Tina Alster of the Washington Institute of Dermatologic Laser surgery in Washington D.C., and a professor at Georgetown University, School of Medicine, VelaSmooth is an improvement over Endermologie. Patients also need monthly follow-ups to maintain the results. Noninvasive skin treatment devices are classified in Table I.
Conclusions
The causes of cellulite are poorly understood, but it is safe to conclude that collagen breakdown may play a role. There are many treatments, with minimal benefits.
While the FDA has approved massage and combined laser/massage therapies, note that these costly and time-consuming treatments are approved only for the temporary decrease in the appearance of cellulite and require ongoing treatments to maintain any improvements.
The most effective way to treat cellulite is through diet and exercise. This way you can impact the fat that makes its way through the net of fibrous tissue that makes up the skin to cause several small granular swellings or domes. To effectively reduce cellulite remember to watch your diet, eat fresh and natural foods, drink plenty of water to avoid dehydration, limit the consumption of caffeine and alcohol, avoid high fat foods, get plenty of fiber, stop smoking, avoid unnecessary medications and get plenty of exercise to keep the body as taunt and smooth as possible.
References:
1. Euromonitor International.
2. Evidence based assessment of cellulite treatments, M. Wanner, M. Avaram MD, J. Drugs in Dermatology, April 2008, Vol. 7, Issue 4 (table).
3. L. Johannes, Aches and Claims, Wall Street Journal, June 10, 2008.
