As we transition into warmer temperatures, our thoughts turn toward summer vacations—and bathing suits. We become increasingly aware of cellulite — dimpled areas of skin often found on the thighs, buttocks, abdomen, breasts and upper arms. Although some treatments reduce the appearance of cellulite temporarily, no marketed options offer permanent results and most involve risk. Two renowned doctors offer perspective into the safety of common cellulite treatments and explain what works and what doesn’t.
What is Cellulite?
Rumors about cellulite abound, explains Robert Schnarrs, M.D., partner at The Hague Center for Cosmetic and Plastic Surgery. In 28 years of practice, Schnarrs has found that patients in general understand little about cellulite and the available treatment options.
One common misconception is that cellulite is a disease or symptom of a larger health issue, he says. Cellulite is naturally occurring. Even thin people can have cellulite, though it may be concentrated in certain areas of the body or you may have to pinch the skin to see it, he says.
Although people may not like the appearance of it, “There is no medical reason to take out cellulite,” he explains.
Cellulite appears in areas with high fat concentrations. When the body takes in fat, some of the fat is stored in a lower layer that develops into what people term “love handles” and “saddlebags.” The upper layer stores fat that becomes cellulite, Schnarrs says. He explains that cellulite occurs when the upper layer of fat pushes up while fibrous connective cords between the fat deposits pull down, creating an uneven surface. It appears more commonly in women than in men as men tend to have thicker skin that does not dimple. The thinner or more lax the skin, the more cellulite bulges.
Genetics play a key role in cellulite as people often develop it in the same areas as other family members, Schnarrs says. No evidence suggests that ethnicity or race influences who gets cellulite; however, culture and lifestyle often do. Frequent weight fluctuations, a diet high in carbohydrates and fatty foods, an inactive lifestyle and neglecting the skin can increase the likelihood of developing cellulite, he adds.
Treatment Options Examined
Patients typically seek cosmetic treatment for cellulite in their 30s and 40s, says David McDaniel, M.D., director of the McDaniel Institute of Anti-Aging Research.
McDaniel says the most common marketed cellulite treatments are topical, roller therapy/massage, lasers and light or energy treatments.
Although McDaniel is not aware of any good treatment comparison studies, he has found in his 29 years of practice that topical treatments are among the safest—yet least effective—options. “Many of the treatments that do give some ‘visible improvement’ are relatively transient in their effects and require periodic treatments,” he explains. “Retinol and other actives that increase dermal collagen in the skin may improve the fine texture or wrinkling of the skin … and thus indirectly reduce the appearance of cellulite in some people.”
According to Schnarrs, topical ointments and creams, purchased over the counter or obtained with a dermatologist’s prescription, are not strong enough to penetrate to the cellulite layer, where they would make the greatest change. If they did, they would pose a health risk, as they would have to be potent enough to pass through layers of skin, veins and other structures to reach the cellulite layer. “If you don’t get to the fat layer, how can you get rid of it?” he asks.
Roller massage treatments involve applying pressure to the skin’s surface and underlying fat layer to increase blood flow and circulation to areas with cellulite. Endermologie, a popular form of this treatment, can reduce the appearance of cellulite for a period, but despite its standing, McDaniel is not convinced that it gives long-term improvement. Cellulite wraps, offered by med spas, massage centers, estheticians and some cosmetic doctors, often involve wrapping the body in caffeine compounds known to impact fat cells and are thought to decrease fluid retention and improve the overall appearance of the skin.
McDaniel no longer offers wraps at his office because he was not impressed with the long-term results. However, he is aware that consumers have been using wraps for years and seem to enjoy the results. Wrapping does enhance the penetration of the topically applied agents, he adds.
Cellfina is the only FDA approved minimally invasive cellulite treatment that has proven clinical results. The procedure uses a minimally invasive, small needle-sized device to “snip” the cellulite-causing bands just beneath the surface of the skin that cause the dimpled look.
McDaniel feels that energy-based treatments, including laser, radiofrequency, freezing and infrared light, tend to be the most effective and therefore the most risky. Energy-based devices require skill to operate while the procedures themselves carry an increased risk for side effects.
In order for the energy to reach and alter the cellulite layer, it must be powerful enough to penetrate through blood vessels, skin, veins, nerves and other internal structures, Schnarrs says. External devices can burn and denature the skin protein while more invasive devices may cause damage that is less discernible.
Radiofrequency is another energy-based treatment offered by some dermatologists, plastic surgeons and other skin experts that uses heat in the form of radio waves to break up fat and connective tissue and tighten the skin.
Radiofrequency can be effective with the right candidates, McDaniel explains, such as those with more skin laxity.
The Safest Option
Although several treatments for reducing and eliminating cellulite are marketed to consumers, Schnarrs says there is no proven quick fix. There are no treatments on the market today guaranteed to provide lasting results.
“We all want ‘the magic pill,’” he says. But reducing and eliminating cellulite takes work.
The safest method for reducing and, in some cases, eliminating the appearance of cellulite long-term is exercising, eating a balanced diet and maintaining overall well-being, Schnarrs says. “The younger you are in general, the better your elasticity.”
Taking care of your skin is also important. Prolonged exposure to the sun, dieting, smoking and frequent weight fluctuations can damage the skin’s collagen and work against the skin’s elasticity. As Schnarrs notes,“The better we take care of our skin, the less it bulges.”
