If your dimpled thighs ever stopped you from wearing a short skirt or caused you to keep your cover-up on at the pool, you're not alone: 90% of women have cellulite. And the quest to get rid of cellulite has become a billion-dollar business. In the past 6 years, the market for products claiming to reduce cellulite fast has grown by more than 113% worldwide, and it shows no signs of slowing down.
Most cellulite "cures," doctors and scientists agree, have been ineffective, to put it charitably. Recent research into the structure of skin confirms that cellulite is not the result of toxic buildup or inflammation, as is often touted by marketers. Instead, cellulite is the product of anatomy, genes, and hormones.
The solution, therefore, is to alter what Mother Nature gave you—at least temporarily. There is no permanent cure, no magic cellulite-squelching cream or surgery, but there are advances: A drug delivery system is being put to a cosmetic purpose; wrinkle-reducing, skin-tightening lights and lasers are being turned from the face to the lower body; deep dimples are being filled; and in Europe, an injectable fat melter is being studied. If you want to reduce cellulite fast, here's what's new—and what works.
HIGH-TECH TOOLS
Treatments for cellulite with lasers and other devices are sometimes painful, need to be repeated periodically, and must be done by a physician. But women who want to reduce cellulite fast may want to try these pricey techniques before lower-tech options.
A caveat: Some of the technologies are FDA-approved as Class I devices—meaning, they present minimal potential for harm. But others are being used off-label—that is, not for the purpose for which they are approved. And some are still being tested and have not yet been submitted for FDA approval.
Laser Toning For cellulite that has more ripples than isolated, divotlike depressions, Beverly Hills dermatologist Harold Lancer, MD, relies on the Galaxy, a device commonly used for facial wrinkles. It directs radio frequency and laser light energy beneath the skin's surface, causing a wound response that lays down new collagen and tightens the skin. "I've treated 100 patients with the Galaxy, and the results are good," he says. He is one of a few doctors using the laser for cellulite reduction.
Cold-Laser Massage The Tri-Active laser was approved by the FDA in January 2004 and is permitted to claim that it "temporarily reduces the appearance of cellulite." This device combines suction massage to increase lymphatic drainage, which filters fluid from cells; low-intensity diode heat to stimulate collagen production and tighten skin; and a cooling head to counter any burning sensation. "It's so painless you can fall asleep while it's being done," says Mitchel Goldman, MD, an associate professor of dermatology at the University of California, San Diego.
But that may depend on how deeply you sleep. One patient reported: "The feeling ranges from that of a pleasant, light massage to an uncomfortable, deep-tissue rubdown."
VelaSmooth This handheld device combines radio frequency with infrared light (both of which, the company claims, soften and rearrange fat) and suction (to stretch out the fibrous strands that cause dimpling). Testing required for FDA approval is under way at approximately 100 doctors' offices across the US. One of the investigators, Lisa Benest, MD, a dermatologist in private practice in Burbank, CA, says, "After eight sessions, patients' measurements are an inch or two smaller, and their skin looks tighter with less rippling. We believe that fat is being melted."
Mechanical Massage Endermologie's Cellu M6 Keymodule is a handheld device that sucks up about an inch of skin between rollers and squeezes it to increase blood and lymphatic flow and stretch out the dimple-causing cords. "It hurts a little, depending on how high the dial is cranked up," says one patient. The temporary swelling that results helps disguise cellulite, reports V. Leroy Young, MD, chairman of the nonsurgical procedures committee of the American Society of Aesthetic Plastic Surgery (ASAPS). "There's a good animal study showing Endermologie produces a little collagen in deep dermis," he says.
The Cellu M6 has been cleared by the FDA for "temporary improvement in local blood circulation and...in the appearance of cellulite."
Fat-Melting Injections From the south of France to South America, where smooth thighs are a national obsession, fat-melting injections have been used on everything from thigh flab to undereye fat pads. The drug—phosphatidylcholine, an extract of lecithin from soybeans—was first intended to dissolve artery-blocking plaque, but when injected repeatedly just under the skin (a technique called mesotherapy) is said to melt subcutaneous fat.
Though the drug sounds like the answer to a cellulite-ridden woman's prayers, animal studies indicate it may cause serious side effects such as bleeding and ulcers. Phosphatidylcholine has now been banned in Brazil but is being studied in Europe. In the US, Lancer says, it is a "backroom" treatment and "not proven to be safe or effective."
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CUT-AND-FILL SOLUTIONS
Liposuction can remodel your contours, but it can't do much for skin texture. So some doctors are attempting to treat cellulite dimple by dimple.
Filling the Holes For large cellulite dents, Young says a filler can give good results, and he prefers to use the person's own fat. "It makes the most sense to try to fill with fat. The only problem is that you get spotty survival. However, the fat that is established will last for years," he says.
Sculptra, a material that is more predictable than fat and is FDA-approved to fill out the faces of those with AIDS, hasn't been studied for lifting cellulite dents, but Lancer has injected it. "By manipulating the skin I can see exactly where the [fibrous] tether is, which I inject with a pea-size amount of Sculptra," he says. "The needle detaches the tether, and the depression puffs up nicely with the filler. It smooths out the puckering."
Other physicians, including Prevention advisor Mary Lupo, MD, a clinical professor of dermatology at Tulane University School of Medicine, don't approve of this off-label use of Sculptra. It can cause lumpiness if overinjected, she warns, adding, "If a woman goes on to lose weight, she'll lose some of the cellulite and then for 3 years be left with lumps where the Sculptra was injected."
Surgery A surgeon slips an instrument similar to a pickle fork beneath the skin to cut the individual fibrous cords that cause cellulite's depressions. Then a little fat is injected to discourage those fibers from growing back.
"This technique is not great, but it's the best thing we have surgically," says Los Angeles plastic surgeon Peter B. Fodor, MD, president of ASAPS. He reserves the technique for the deepest dents and spot treatments remaining after liposuction.
In the past, a few surgeons experimented with cutting the fibrous cords, the tethers holding down the skin. In some cases, the results were disastrous, causing skin sloughing, or loss.
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RUB-ON SMOOTHERS
The newest creams combine ingredients to dilate blood vessels, break down fat, and/or firm the skin. "A good one can take half an inch off your thighs," says Peter T. Pugliese, MD, a skin physiologist.
Deflators Fat cells are actually less than 10% water, which is why efforts to cure cellulite with circulation-stimulating gadgets, detoxifying herbs, and water-eliminating diuretics alone have minimal impact. However, if your circulation is sluggish to begin with, even a little swelling can make cellulite worse.
For that reason, ingredients that dilate blood vessels (to stimulate blood flow) and lymph vessels (to shuttle fluid out of the tissues) may help temporarily. These include natural substances such as black pepper, ginger, green tea, cinnamon, cayenne pepper, and ginkgo. Find them in Spa MD Anti-Cellulite Cream, Avon Cellu-Sculpt, and Murad's Firm and Tone Serum.
Fat Burners In a landmark study published in Obesity Research, an ointment containing forskolin (the active ingredient in the herb coleus forskohlii) and aminophylline (an asthma drug) caused women to lose up to about an inch of flab from their treated thighs, compared with no loss on thighs rubbed with a placebo cream.
Caffeine, another fat burner, is commonly found in cellulite creams because "it's a second cousin to aminophylline," notes Lupo. Find forskolin and caffeine in Estee Lauder Body Performance Anti-Cellulite Visible Contouring Serum and Lipoduction from Osmotics.
Skin Firmers Slightly tightening skin helps camouflage the bumpy topography, which is why the same ingredients meant to build collagen and thereby counter skin laxity and diminish wrinkles—retinol, coenzyme Q10, and vitamin C—are used in cellulite creams. Moisturizers, such as those with marine extracts like carrageenan and alginic acid, help draw water into the skin: The idea is to inflate the valleys, not the bumps, of cellulite, making it less obvious. Among the new firmers: Lancome Body Sculptesse, L'Oreal Sublime Slim Day Gel and Night Gel, and Nivea Body Reshaping Treatment.
A common criticism of anything applied to the skin, whether anti-aging potions or cellulite creams, is that not enough—if any—of the active ingredients actually penetrates the skin barrier to make a significant difference. (Kneading and vigorously rubbing in creams will help absorption a little, says Lupo.)
A breakthrough delivery system may change that. A molecular envelope that disrupts the bonds between skin cells just enough to slip between them was developed at Hebrew University in Jerusalem. Osmotics licensed the technology—called an Ethosome—to carry the caffeine and forskolin in its Lipoduction cream directly to the top layer of fat.
No double-blind tests have been done yet. "We tried to set up a study at Mount Sinai Hospital and New York University, but compliance was a problem," says Osmotics President Francine Porter.
If you want proof that any cellulite cream works, you're it. "Buy the product, use it on your thighs, and if they look better in a month, keep buying it. If they don't, try another," says Lupo. Whatever benefit you see, though, will go away when you stop using the cream.
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DIET REMEDIES
Losing weight improves cellulite by shrinking fat cells, but special diets to boost water loss don't work. "Dehydrating connective tissue makes skin more lax...and part of the problem with cellulite is that the skin envelope is just not tight enough," says Young.
The same free-radical damage known to weaken skin, leading to wrinkles, also allows fat cells to push up where they don't belong, asserts Howard Murad, MD, an associate professor of dermatology at UCLA. Countering that damage improves skin firmness, he says. To that end he has patented a supplement that combines glucosamine and omega-6, among other things. Murad details the program in his new book, The Cellulite Solution, which also claims that eating lecithin-rich foods such as soy, eggs, and spinach helps strengthen cell walls, improving the appearance of cellulite.
Pugliese thinks soy may help, too, but for a different reason: Soy contains phytoestrogens, which prevent the release of collagenase, a collagen-destroying enzyme that chews up the fibrous septae, creating ripples in the skin's surface.
Nutritionist Elizabeth Somer, RD, author of Nutrition for Women, doesn't buy either theory: "There is nothing special about the fat of cellulite, so there is no unique diet trick to remove it."
EXERCISE PRESCRIPTION
Daily cardio workouts help eliminate the calories you store as fat, and strength training boosts fat burn even more. Logic suggests that a firm foundation would make for less jiggle.
Although there are no randomized studies comparing the cellulite on exercisers with that on couch potatoes, Leslie Baumann, MD, a professor of dermatology at the University of Miami School of Medicine, says working out improved her "mild" cellulite. "I never had the guts to grade my cellulite, I just knew I did not want to wear shorts," she says. "So I did an hour of weights on the machines and 30 to 45 minutes of cardio, three or four times a week, for 2 years. I'm two sizes smaller now, and I wear shorts!"
Pilates—which combines strengthening and stretching—has become Hollywood's anti-cellulite workout of choice, says Lancer. "It uniformly strengthens and stretches muscles and redrapes the fascia that covers muscle like the casing on a sausage. The vertical tethers that cause dimpling are connected to the fascia, and when it stretches, the tethers stretch. Pilates is like ironing the sheets."
The bonus: Losing some of the fat on your butt may even help your heart, if new theories about how fat tissue contributes to inflammation pan out. A recent study of 34 obese women at Wake Forest University School of Medicine found that 6 months of diet and exercise—though not diet alone—not only broke down fat in the abdomen and buttocks, but it also decreased levels of certain inflammation markers in the blood. And chronic inflammation can lead to chronic conditions like heart disease.
There's one solution on which cellulite experts—even the FDA—agree: Losing weight will improve ripples and dimples. True, even thin women can have cellulite, but if you're a woman who stores fat in your lower body, diet and exercise will help smooth the surface of your hips, thighs, and butt. Besides, it's the cheapest cellulite "cure," and you can do it yourself.[pagebreak]
WHAT LIES BENEATH
Imaging techniques like MRIs and ultrasound have turned out to be too expensive and impractical to evaluate cellulite treatments, but the images have given experts an appreciation for the complexity of the problem.
The single most important component of cellulite is fat, says dermatologist Mitchel Goldman, MD. Judging from MRI studies, the top layer of fat (there are three) is largely to blame.
"The second most important factor is the fibrous septae," he says. These vertical fibers attach the skin above the top fat layer to the parallel connective tissue fibers among the lower layers of fat and covering the muscles of the thigh, hip, and butt. MRIs show that the vertical fibers correspond to depressions in the skin's surface. Overweight women who have fewer vertical fibers may be more troubled by cellulite than others, because overstuffed fat cells are freer to bulge upward. (The number of fibers you have per square inch is probably genetically programmed and not affected by variables such as hormones, exercise, or diet.)
A third contributor to cellulite is the thickness of the connecting fibers. A small pilot study done by the National Research Council Canada and funded by Procter & Gamble indicates that men have a denser network of fibrous septae than women do, preventing the fat cells from protruding upward. That observation--if proved accurate by larger studies--may explain the gender gap: Most women have cellulite, while it's rarely spotted on men.
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WEAPONS IN THE WAR ON CELLULITE
How much cellulite you have—and the thickness of your wallet—will help determine your treatment options. Keep in mind that so far, no treatment can permanently smooth your thighs. Without maintenance, whatever benefits you get will go away.
Creams
Claim: Depending on ingredients, some version of: "Within 4 weeks the appearance of dimpled skin is reduced and skin is tightened"
Time investment: 5 minutes once or twice a day
Cost: $10 to $50 a jar or tube
Effects last: 24 hours with cumulative effects; don't skip an application.
Expert opinion: "The benefits are temporary and the changes are subtle," says Leslie Baumann, MD.
Endermologie
Claim: "Temporarily reduces cellulite and measurements in cellulite-treated areas"
Time investment: 14 to 21 1-hour sessions
Cost: $85 to $125 a session
Effects last: 1 month plus monthly maintenance
Expert opinion: "My patients are happy with the results, and I see some improvement," says Peter B. Fodor, MD.
Tri-Active Laser
Claim: "Smooths and tightens the appearance of cellulite"
Time investment: 10 to 15 treatments
Cost: $150 a treatment
Effects last: Long-term with monthly maintenance
Expert opinion: "Lasers have a lot of potential," says Mary Lupo, MD.
Velasmooth Claim: "Reduces the appearance of cellulite and circumference of treated...regions"
Time investment: 8 to 10 30- to 45-minute treatments
Cost: Up to $250 a treatment
Effects last: Long-term with monthly maintenance
Expert opinion: "The closest device I've come across that works," says Washington, DC, dermatologist Tina Alster, MD.
Injectable fillers Objective: To fill in isolated large dimples
Time investment: Two or three sessions, depending on number of dimples treated
Cost: About $1,500
Effects last: 2 years or longer, depending on the material, with maintenance if a new dimple appears
Expert opinion: "I don't recommend Sculptra; it can cause lumping if over-injected," says Lupo. Weight loss can also leave lumps behind. Fat injections show real promise, says V. Leroy Young, MD.
What were they thinking?
We've been looking for the effortless thigh reducer for decades. Witness these classics that have fallen by the wayside: In the 1930s, actress Terry Walker let moving bands give her a passive workout. And in the 1950s, the Relaxacizor aimed to "streamline" a woman's figure without her having to move a finger. Electrical muscle stimulators still appear from time to time, though these days they claim to tighten abs more often than thighs. But wherever you use them, these devices won't "create a major change in your appearance," says the FDA.
