Saturday, May 14, 2005
Science marches on, but cellulite remains.
By MICHAEL PRECKER
KNIGHT RIDDER NEWSPAPERS
DALLAS -- Her weight normal and her body fit, Shanan Brown was satisfied with how she looked in her first three decades.
Then she had two children, and cellulite moved in.
"All of a sudden it was 'Oh my God, this is a big difference,'" said Brown, a pharmaceutical saleswoman who lives in Plano, Texas. "How the heck am I going to get rid of this?"
She worked out and tried to eat right, but her thighs refused to shed the overstuffed, dimpled look that bedevils most women at some time in their lives.
"I'd always felt confident wearing shorts and swimsuits," said Brown, who's 34. "Suddenly I was covering myself up all I could. It was just a whole new self, and I didn't like it."
Those feelings propel millions of women into an expensive and frustrating war against cellulite, despite one overriding fact:
"First and foremost, there's no cure for cellulite," said Dr. Jeffrey Kenkel, a plastic surgeon who is an associate professor at the University of Texas Southwestern Medical Center at Dallas. "There are a million treatments, but none are effective long-term."
That doesn't mean there's nothing to be done. There are lots of options, lots of pitfalls and lots of things to consider -- and high season is approaching.
"My patients are starting to say, 'It's getting warm out. I'd like to look better on the beach this summer,"' Kenkel said.
Sustained effort
The most effective strategy -- diet and exercise -- involves sustained effort and lifestyle changes.
"But a lot of people want a simple solution," Kenkel said. "Unfortunately, they may find somebody who will take their money and do something that may not work."
First let's define the problem. Dr. Stephen Barrett, who publishes Quackwatch and other newsletters that track bogus health claims, said the term "cellulite" dates from the early '70s, when European salons gave an old fat a new name.
"People have been getting ripped off ever since," he said.
Cellulite refers to fat that bulges under the skin. When skin and the fibers connecting the skin to layers of fat underneath weaken, fat cells can rise to the surface. That creates a lumpy look often indelicately compared to cottage cheese.
"It's definitely nondiscriminating," said Leah Blevins. She's an aesthetician at the Plano, Texas, Aesthetics Center, which offers cosmetic laser and skin care services. "We see ladies that are size 2 and ladies that are size 20 who have it."
Dr. Jim Gilmore, a Dallas plastic surgeon who is president-elect of the American Academy of Cosmetic Surgeons, said the causes probably include genetics and hormones as well as excess weight.
Most women, but very few men, have at least some cellulite.
"Testosterone causes more thickening of the skin," Gilmore said. "Estrogen makes the skin smooth but thin" -- and more prone to dimpling.
From expensive creams to high-tech machines, cellulite treatments usually have a qualifier: They claim to "reduce the appearance" of cellulite. That means even if something seems to help, once you stop treatments, the cellulite is coming back.
Paula Begoun, author of "Don't Go to the Cosmetics Counter Without Me," who also writes newsletters critiquing cosmetic company claims, is dubious of any compound that claims to treat cellulite.
"They're not regulated by anybody," she said. "They're just tossing things in that they think sound good to the consumer, and it's not backed up by any research."
Ingredients such as caffeine and Retin-A may make skin appear firmer, she said, but won't change what's underneath. "What you definitely cannot do is dissolve fat from the outside in," Begoun said.
New methods
Can technology provide the answer? Endermologie, a process that combines suction with rollers aimed at breaking up fat and stimulating blood flow, has been popular for a decade. It's embraced by some as a temporary aid, but derided by others as an expensive massage.
Newer techniques are using lasers and sound waves with the same goal. Blevins at the Plano Aesthetics Center said some of her clients are benefiting from a new device called VelaSmooth, which uses radio frequencies, infrared light and suction.
"It's exciting technology, but it's not a silver bullet," Blevins said. "It's one component. But we take a holistic approach. We also want people to increase their activity and improve their diet."
Dr. Howard Murad, a Los Angeles dermatologist, believes diet holds the key. His new book, "The Cellulite Solution" (St. Martin's Press, $24.95), advocates foods that he said will keep cells hydrated and skin smooth.
"This is a skin problem, not a fat problem," Murad said. "The question is, how do we repair cells and connective tissues so they retain more water and remain healthy?"
Kenkel said some patients with cellulite ask about liposuction, which he said has been shown not to work.
"Sometimes it can make it worse," he said.
Gilmore said he has had some success by combining "very delicate liposuction" with a procedure to release scar tissue under the skin to produce a smooth surface.
It's one of many new procedures being refined and tested. On one hand, that makes it harder for people to sort through all the options.
On the other, the options may be getting better.
"It's like your cellphone," Blevins said. "Every couple of months the technology gets better."
Gilmore said he is cautious, but more hopeful than before.
"This is a perplexing problem, but we have some things on the horizon to fix it," Gilmore said. "We may be getting closer."