Cellulite: What Works & What Doesn't

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Regrettably, most of us (women that is) have it to one degree or another. According to statistics, and this is really shocking, cellulite shows up on the thighs of more than 85% of females past the age of eighteen regardless of ancestry, although it is more common for Caucasian and Asian women. To make matters worse, for women, cellulite represents stored, hard to metabolize fat that is interdependent on estrogen. Ironically, weight isn’t part of the problem. Rather, any amount of fat (and we all need some of it in our bodies) can show up as cellulite on women’s thighs.
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Despite being a completely benign condition, much like wrinkles, cellulite is a major beauty concern of women worldwide with corresponding myths and deceptions taking the place of fact and reason. This means the cosmetics industry and lots of doctors and estheticians want to sell you products or provide treatments (particularly expensive ones) claiming to slim, trim, tone, and de-bump your thighs. Everything from loofahs, miracle ingredients, special washcloths, herbal supple-ments, vitamins, minerals, bath liquids, rubberized pants, brushes, rollers, body wraps, and toning lotions to electrical muscle stimulation, vibrating machines, inflatable hip-high pressurized boots, hormone or enzyme injections, and massage have been claimed to be successful cellulite treatments. Yet, as the anti-cellulite market increases, research regarding efficacy remains at a bare minimum and is often obscured by self-serving studies from those who peddle these cures. Sadly, the lure of these supposed remedies is hard to fend off because fighting cellulite is an uphill battle. For lots of women the mere hope or illusion that something may work is a powerful temptation, and that weakness is something the cosmetics industry counts on and exploits to the max.

Myth Busting

Trying to navigate and smooth out cellulite fact from fiction isn't easy but there is a small amount of good news: there are options that may make a difference. The bad news, is that even the treatments that have some potential of working (and I say potential of working very carefully) rarely live up to the claims asserted, but improvement as opposed to merely wasting your money is definitely a turn for the better. A great way to start is to straighten out some popular myths about cellulite:

Men don't get cellulite: To some extent that's true. Physiologically, women are far more prone to accumulating fat on the thighs and hips while men gain weight in the abdominal area. Plus, for women, the connective tissue beneath the skin has more stretch and is vulnerable to disruption, which is the perfect environment for developing cellulite. Some men do get cellulite—just statistically not as much as women.

Drinking water helps: If water could change skin structure and reduce fat I assure you no one would have cellulite, or would be overweight for that matter. Drinking water probably is beneficial (although there is really no research showing how much is healthy versus unhealthy) but there is no research showing water consumption will impact fat anywhere on your body, let alone the dimples on your thighs.

Arguments for high water intake are generally based on the assumption that because our bodies consist mostly of wa-ter (50-70% of body weight, about forty-two liters) and our blood, muscles, brain, and bones are made up mainly of wa-ter (85%, 80%, 75%, and 25%, respectively), we therefore need at least eight 8-ounce glasses of water each day. But assumptions aren't science and this one is a non-sequitur; it is similar to arguing that since our cars run on gasoline, they always need a full tank to run efficiently.

Water retention causes cellulite: It's ironic that low water intake is considered a possible cause of cellulite, and the polar opposite—retaining too much water—is thought to be a factor as well. There is lots of speculation of how water retention can affect cellulite but there is no actual research supporting this notion. Further, fat cells actually contain only about 10% water, so claiming to eliminate excess water won't make a difference and any measurable result would be transient at best. It is true that water retention can make you look bloated and feel like you've gained weight, but water itself doesn't impact fat or the appearance of cellulite.

Eating a specialized diet can help: A healthy diet that encourages weight loss may help your entire body look better. How-ever, because weight in and of itself is not a cause of cellulite, dieting won't change the skin structure of your thighs, which causes the dimpled contours to show. For some people cellulite is made worse by the accumulation of extra fat. In those cases, weight reduction may decrease the total area and depth of cellulite.

Cellulite is different from fat on the rest of the body: Theories abound about how cellulite differs from regular body fat. However, few studies show how cellulite clumps differently than other fat on your body. But overall, most researchers feel cellulite is just fat, plain and simple. Besides, even if cellulite is different in how it congregates, what you can and can't do about fat on any part of the body remains the same.

Exercise can help: Exercise helps almost every system in the human body, but it won't necessarily impact the appearance of cellulite. Exercise doesn't improve skin structure and it can't affect localized areas of fat. In other words, you can't spot reduce fat accumulation in a specific area.

Detoxifying the body reduces the appearance of cellulite: Detoxifying the body for consumers has taken on the meaning of purging it of pollutants or any other problem substances in the environment or in the foods we eat. In terms of the way this concept has been mass marketed, there is little research showing credible efficacy as to whether or not detoxification of the body is even possible. However, "detoxifying" the body as it is used in the scientific community describes the process of reducing cellular damage primarily by antioxidants or enzymes that prevent certain abnormal or undesirable cell func-tions from taking place. There is no doubt this is helpful for the body. Whether or not this reduces cellulite is completely unknown because skin structure and fat accumulation are not caused by toxins in the environment. Furthermore, there are no studies showing toxins of any kind prevent fat from being broken down.

What We Do Know

There are three leading theories about cellulite formation:

  1. Women have unique skin structure on their thighs, which causes cellulite to easily form.
  2. The connective tissue layers on the thigh are too weak or thin to maintain a smooth appearance—allowing fat contour to show through.
  3. Vascular changes and possible inflammatory conditions may be to blame.

Most cellulite products come in the form of lotions and creams with a vast array of either exotic-sounding or lab-synthesized ingredients. Beyond topical products there are devices such as endermologie and microdermabrasion, medical treatments such as lasers and mesotherapy (a procedure involving repeated injections, which is claimed to break down fat).

Lotions, Creams & Extracts Galore

As far as skin-care products for the body are concerned, the litany of options is mesmerizing. Yet there is almost no uniformity between formulas. It would appear, if the claims are to be believed, a wide variety of unrelated plant extracts can deflate or break down fat and/or restructure skin. Looking at the research, however, most articles suggest there is little hope that anything rubbed on the skin can change fat deposits or radically improve the appearance of cellulite.

The hope that botanicals have the answer is odd because not one study points to what concentration of an ingredient needs to be in a formulation, what physiochemical characteristics particular to each active ingredient need to be present, or whether or not these ingredients retain any standardized properties between batches.

A Bevy of Anti-Cellulite Ingredients

From aminophylline to Visnaga vera extract, cosmetics companies will claim that just about anything can treat cellulite! Our Cosmetic Ingredient Dictionary is a rich resource of research-driven ingredient defnitions to help you understand if that fancy-sounding exotic ingredient can really do what the label claims.

Mesotherapy

Mesotherapy is a procedure, which has been claimed to dissolve fat from the repeated injection (and I mean lots and lots of injections) of various substances into the fat layers of skin. Mesotherapy actually got its start 50 years ago in France through the work of a physician who was trying to find a cure for deafness. From there it gained notoriety in the United States after singer Roberta Flack appeared on ABC's 20/20 claiming mesotherapy helped her lose 40 pounds (although she said she also dieted and exercised, what stood out for lots of people was the part that didn't involve diet and exercise).

Some of the substances being injected are homeopathic and some are pharmaceutical. Strangely, there isn't necessarily any consistency, and the cocktail of ingredients can vary from practitioner to practitioner. The fact that the material being injected isn't consistent and not everyone discloses exactly what they are using makes this treatment very hard to evaluate. The most typically used substance in mesotherapy is phosphatidylcholine, but it can also be combined with deoxy-cholate. A handful of studies have shown that this can successfully reduce fat when injected into the skin, with one study demonstrating this for the undereye area. Theoretically, the reduction of subcutaneous fat may be caused by inflammatory-mediated cell death and resorption.

However, mesotherapy isn't without risk. One study explained, "Side effects included burning, erythema, and swelling at the injection site. At follow-up averaging 9 months, 50% of patients reported persistence of benefit, 20% experienced some fading, and 30% [received no benefit at all]." It also concluded that "Larger studies evaluating long-term safety and efficacy of phosphatidylcholine for cosmetic purposes are warranted." Another study states, "Until further studies are performed, patients considering mesotherapy for cellulite must be aware that the substances currently being injected to treat this cosmetically disturbing, but medically benign, condition have not been thoroughly evaluated for safety or efficacy."

Finding out if this would work for you isn't inexpensive. Mesotherapy costs $300-$500 for each treatment and about ten to fifteen sessions are recommended, so it ends up being more expensive than liposuction.

Endermologie

Searching on the Internet, you would think endermologie was nothing less than a cure for cellulite. Physicians, spas, salons, and just about anybody else with the money to buy one of these machines want you to believe in their exaggerated, over-the-top claims. Developed in France in the 1980s, the FDA approved this high-powered, handheld massage tool in 1998. It consists of two motorized rollers with a suction device that is moved over the skin, somewhat like a mix between an old-time, wet-clothes ringer and a vacuum cleaner. (By the way, European women are confounded by cellulite, too, even though they tend not to have the weight problems Americans do. But remember, weight and cellulite are not directly related.)

While claims abound, legally those advertising endermologie treatment are only permitted to promote it for "temporarily im-proving the appearance of cellulite." Of course, somehow the word "temporarily" never is seen in the ads or Web sites pro-moting this device. Finding out if this works is time consuming and pricy. Anywhere from ten to twenty treatments are recommended plus one or two maintenance visits per month are required to preserve any results. There is no typical cost, and depending on where you go, prices can range from $75 to $200 per session.

Attempting to portray endermologie as a serious effective treatment for cellulite, it is often presented as being FDA-approved as a Class I Medical Device and therefore approved by the FDA for its intended purpose. While endermologie machines are indeed Class 1 Medical Devices, this has no meaning in terms of efficacy. Class I status is a designation indicating there is "minimal potential for harm to the user." No other aspect of the machine is approved or sanctioned by the FDA. According to the FDA, "Class 1 Medical Devices are subject to the least regulatory control … Foreign establishments … are not [even] required to register their product with the FDA…. Examples of Class I devices include elastic bandages, examination gloves, and hand-held surgical instruments." The FDA attributes no efficacy value to endermologie machines. Whether or not these devices are harmful depends on how they are operated, meaning how aggressively they're used.

Despite the FDA's lack of recognition (and some warning letters admonishing those making false claims) you will often see lists of "studies" claiming to prove endermologie's effectiveness. Yet, some of these "studies" were neither published nor peer-reviewed. Rather, they were lectures presented worldwide at various medical conferences. These types of presentations are not studies. The information presented is one sided, and more often than not, paid for by the company that owns the device with the presenter receiving financial compensation for the endorsement. Such presentations are not held to the same scientific standard as published, peer-reviewed research. What you will certainly not see listed are the published studies indicating that endermologie doesn't work.

Regardless of conflicting evidence, endermologie and similar machines, such as ESC's Silhouette SilkLight Subdermal Tissue Massage System, are here to stay. It is an easy procedure to offer clients and, for the most part, it seems to make women happy. Whether or not this is psychological doesn't seem to matter. In the long run, complications are few and far between, so the only real downside is the potential waste of money, which doesn't stop those in the pursuit of perfection.

Non-Ablative Lasers & Light Systems

Lasers may very well be the next generation in the world of cellulite therapies, but a lot more research is needed before this evolving treatment proves itself to be effective and worth the money. Ever since the FDA approved TriActive Laserdermology (Cynosure Inc, Chelmsford, MA) as a Class II medical device that "temporarily reduces the appearance of cellulite," lots of companies have wanted in on the action. TriActive combines a diode laser (at a wavelength of 810 nanometers) with localized cooling, suction, and mechanical massage (sort of a cross between a laser and an endermologie machine). Treatment protocol varies, but generally the process is three times a week for two weeks and then biweekly treatments for five weeks. A Class II medical device status indicates this laser can be sold and used without physician supervision, which means a growing number of salons and spas are advertising its success and changing the FDA classification of "temporarily reduces" to a more alluring "reduces" cellulite.

Another device approved by the FDA is the VelaSmooth system (Syneron Inc, Richmond Hill, Ontario, Canada). It combines near infrared light at a wavelength of 700 nanometers, continuous wave radiofrequency, and mechanical suction. Twice-weekly treatments for a total of eight to ten sessions have been recommended. One of the only studies demonstrating this machine's efficacy included twenty women, and eighteen of the twenty personally thought they saw improvement. Yet the actual measurements only showed a 0.3-inch reduction in thigh circumference. Hardly sweeping results by any standard, making it clear that larger-scale studies are needed, especially before you decide to spend $1,000 or more to see if these kind of machines can get you what you want, namely smoother thighs, not a lighter wallet.

Electrical Muscle Stimulators (EMS) & Iontophoresis Devices

According to quackwatch.com, "Muscle stimulators are a legitimate medical device approved for certain conditions—to relax muscle spasms, increase blood circulation, prevent blood clots, and rehabilitate muscle function after a stroke. But many health spas and figure salons claim that muscle stimulators can remove wrinkles, perform face lifts, reduce breast size, reduce a 'beer belly,' and remove cellulite. Iontophoresis devices are prescription devices that use direct electric current to introduce ions of soluble salts (i.e., medications) into body tissues for therapeutic or diagnostic purposes. The FDA considers promotion of muscle stimulators or iontophoresis devices for any type of body shaping or contouring to be fraudulent."

Body Wrapping

Many salons and spas offer a cellulite/weight- loss service where the body is tightly wrapped or dressed in special garments with or without a "specialty" cream or lotion applied first. Promising to take inches off your body, the cost for these treatments range from $65 to $500 depending on the salon and if the clientele is elite enough to warrant the steep price. Scientific-sounding information makes this process seem legitimate, but in the long run all it is doing is temporarily compressing your skin (you could probably do this yourself with plastic wrap), which will then return to its original shape in a matter of time, how much time depends on your skin's response. Impressive results often are delivered after measuring several parts of the body and adding up small incremental changes, which in total, end up sounding far more impressive than it really is.

Infomercials, Internet sites, and some multilevel marketing companies sell at-home systems claiming to eliminate toxins and squeeze water-logged fatty tissue dry. You can't squeeze toxins out of a cell. While you may be able to squeeze water out of a cell that same pressure would concurrently injure other cells, which isn't good for your skin. Plus, the water content would return to whatever level is natural for the body fairly soon due to homeostasis. All in all, there is no research whatsoever showing that body wrapping does anything positive and it will not get rid of fat or cellulite.

Skin Patches

According to the Federal Trade Commission (FTC), it "…has continued its attack on bogus weight-loss claims by suing a diet patch manufacturer and a retailer that marketed the patch directly to Spanish-speaking consumers. In two separate federal court actions, the FTC charged that the patch manufacturer, Transdermal Products International Marketing Corporation, and the retailer, SG Institute of Health & Education, Inc., falsely claimed that the skin patch causes substantial weight loss. The FTC complaints in both cases also challenged false claims that the patch or its main ingredient, sea kelp, has been approved by the Food and Drug Administration (FDA). The FTC further alleged that Transdermal Products provided retailers with deceptive marketing materials that could be used to mislead consumers."

The defendants in both cases allegedly used one or more of the seven bogus weight-loss claims that are part of the FTC's 'Red Flag' education campaign announced in December 2003." The ongoing Red Flag campaign provides guidance to assist media outlets and others in spotting false claims in weight-loss ads. According to the FTC, one of the most common false weight-loss claims is that diet patches, topical creams and gels, body wraps, and other products worn on the body or rubbed into the skin can cause substantial weight-loss.

Liposuction

Liposuction has been used to reshape and reduce the appearance of accumulated fat layers and cellulite. However, the primary function of this procedure is to remove fat in localized areas, not cellulite. In cases where liposuction involves the removal of large quantities of stored fat, it can sometimes worsen the appearance of cellulite by creating unsupported and slackened skin, which will allow any remaining fat (and some always remains) to show through.

Sources: Cosmetics & Toiletries magazine, October 2004, page 49; Dermatologic Surgery, July 2005, pages 866-872;  Journal of Cosmetic Laser Therapy, December 2004, pages 181-185; Journal of Applied Physiology, April 2002, pages 1611–1618; and Skin Research and Technology, May 2, 2002, pages 118-124; Journal of Cosmetic Science, November 2005, pages 379-393; Journal of Cosmetic Science, March-April 2005, pages 105-120; Clinical Dermatology, July-August 2004, pages 303-309; http://www.quackwatch.org/01QuackeryRelatedTopics/cellulite.html; British Journal of Plastic Surgery, April 2004, pages 222-227; Journal of Endotoxin Research, April 2005, pages 69-84 and Journal of Biochemistry; Journal of Cosmetic Laser Therapy, December 2005, pages 147-154; Morbidity and Mortality Weekly Report, November 2005, pages 1127-1130; http://www.fda.gov/cdrh/pdf3/k030876.pdf; Securities and Exchange Commission Information, http://www.secinfo.com/dsvRx.z4y6.htm; Journal of Cosmetic and Laser Therapy, June 2005, pages 81-85.

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About the Experts

Paula Begoun is the best-selling author of 20 books on skin care and makeup. She is known worldwide as the Cosmetics Cop and creator of Paula's Choice. Paula's expertise has led to hundreds of appearances on national and international television including:

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The Paula's Choice Research Team is dedicated to helping you find the absolute best products for your skin, using research-based criteria to review beauty products from an honest, balanced perspective. Each member of the team was personally trained by Paula herself.

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