Cellulite

NEW YORK, NY (Nov. 22, 1999) Most women, to varying degrees, are plagued with cellulite, a condition that gives the skin a dimpled appearance and usually is most prevalent in the thigh, hip and buttock areas. Patients consulting with board-certified plastic surgeons for body contouring frequently ask what can be done to reduce the appearance of cellulite. Currently, there is no ideal treatment for this problem.

What causes cellulite remains a matter of controversy. Some research suggests that the cause may be structural. According to a study presented at a 1997 scientific meeting of the American Society for Aesthetic Plastic Surgery (ASAPS), individuals with cellulite have a diffuse pattern of irregular and discontinuous connective tissue immediately beneath the skin, while this same layer of connective tissue is smooth and continuous in individuals without cellulite. Affected individuals also demonstrate a diffuse pattern of areas where the underlying fatty tissue protrudes into the deeper layers of the skin.

Liposuction will not reduce cellulite and sometimes may make it appear worse. However, some surgeons have reported performing a technique of cellulite lysing (breaking up) using a liposuction cannula that features a smooth, round-tipped tunneling rod inserted in a hollow casing with a sharp, V-pronged cutting edge. The tunneling rod assures passage through normal subcutaneous anatomy to the area to be lysed, while the curette fork extends at the tip to sever only the dimple-causing connective tissue system.

When required, injection of autologous fat harvested from donor sites in the abdomen and flank areas may fill in any remaining depressions. However, the results of fat injections often are not permanent. In addition, the cutting and scraping technique could result in complications if performed too close to the skin. For these reasons, as well as a lack of proven, consistent results, the cellulite lysing technique, which was first reported by ASAPS in 1991, has not been widely adopted by plastic surgeons.

Another surgical treatment, the "cellulite lift," was published by ASAPS in 1990. This technique, which has evolved today into the "lower body lift," was designed to replace the thigh/buttock lift, a procedure that frequently results in aesthetic problems such as scars that are visible when wearing a bathing suit and recurrence of skin laxity. The lower body lift requires an incision around the entire circumference of the abdominal area, so that excess skin can be removed and the entire flank, thigh and buttocks areas can be lifted. The incision can usually be placed discreetly within standard or high-cut bikini lines. The result of the procedure is tightening of the back, flank and abdominal tissues, and reduction of cellulite in the lifted areas. Obviously, the lower body lift is a major surgical procedure that requires a lengthy recovery and leaves an extensive, though well-positioned, scar. For this reason, it requires careful patient selection and informed consent.

Mechanical roller massage therapy, also called Endermologie®, has recently gained popularity. The mechanical device consists of two moving rollers that travel across the skin with a suction-generated vacuum between the rollers. The rollers exert a positive force on the skin and subcutaneous tissues, and the suction draws a fold of skin and fat into the vacuum space. The roller/suction motion massages the tissues more deeply than manual massage. Introduced in the United States in 1996, Endermologie® has been claimed to have benefits including softening of burn scars and connective tissue, increase in blood flow to the skin and in lymphatic flow, and improvement in cellular nutrition and waste elimination.

Endermologie® has been proposed as a treatment for cellulite and as an adjunct to liposuction. Treatments may produce temporary improvement in the appearance of cellulite, but long-term results of this noninvasive therapy have not been established, either clinically or scientifically.

The dietary supplement Cellasene® (Rexall Sundown Corporation, Boca Raton, Fla.), claimed to reduce cellulite, was introduced in the US in March 1999. Controversy has focused both on its effectiveness and on the manner in which it has been marketed to the public. Dietary supplements are not regulated by the US Food and Drug Administration (FDA) as long as they pose no unreasonable risk and are not marketed as a cure for a disease or medical condition. For this reason, the marketing campaign for Cellasene® has, so far, been virtually unrestricted, and competing companies have been quick to introduce similar products.

The claim that cellulite is caused by a combination of factors that include bad diet, a sedentary lifestyle, and 'sluggish' blood and lymph circulation is unsubstantiated by scientific studies. However, the makers of Cellasene® state that its effectiveness in treating cellulite is due to its ability to reduce swelling, boost metabolism, and improve circulation. Cellasene's® ingredients include ginkgo biloba extract, which has been shown to stimulate metabolism in rodents (but not in humans); sweet clover extract, which is claimed to increase blood circulation; grape seed bioflavonoids, thought to protect cells and blood vessels from damage; fucus vesiculosus (bladderwrack) extract, which is reputed to stimulate metabolism and help reduce localized fats; evening primrose and fish oils, said to stimulate metabolism and reduce saturated fatty acids; and soy lecithin, which is thought to help break down fats.

Cellasene® was investigated in two small, short-term studies in Italy, but the results of these studies have not been published or peer-reviewed. Critics point out that the size of the trials was insufficient to justify any significant conclusions and that the studies were not rigorously conducted.

Although the US Federal Trade Commission (FTC) does not officially comment on its investigations, an Associated Press article published on May 27, 1999 reported that the FTC was examining whether Cellasene's® manufacturers have enough evidence to substantiate their claims. Amid all the controversy, it is clear that doctors and patients need to develop a true understanding of the difference between proven science and hearsay. Until reliable data is provided concerning Cellasene®, consumers should maintain a healthy skepticism. They should also be aware that many herbal and dietary supplements carry risks of their own.

Cellasene® contains significant levels of iodine and therefore should be avoided by those with thyroid conditions. In addition, because the product contains ginkgo biloba and sweet clover, it should not be mixed with aspirin, acetominophen (Tylenol®), or monoamine oxidase (MAO) inhibitors (antidepressants). Use of Cellasene®, as well as any other herbal or dietary supplements and medications, should always be disclosed to one's doctor when considering any type of surgery.

About ASAPS
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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