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Contrary to popular belief, the appearance of cellulite has little to do with overall weight, and can appear in thin as well as obese women.
The histology of the adipose tissue from an area of cellulite does not demonstrate any abnormalities when compared with normal fat tissue areas; hence, the problem does not lie within the adipocyte itself, yet in its position in the skin. Many researchers have suggested that it stems from a herniation of adipose tissue into the dermis.
Others imply a hormonal etiology, as men with cellulite typically have associated hormone abnormalities, or are on supplementation.
Still others attribute the cause to altered microcirculation and accumulation of water and lymph leading to edema.
Available therapies focus on these three proposed etiologies as they target cellulite.
The first in-office treatment targeting cellulite was a computer-driven, hand-held device termed LPG (Louis Paul Guitay) - also called Endermologie. The science behind this device is not well-defined, but the goal of LPG is to use suction and deep massage to increase the circulation to the areas of cellulite. The device is approved by the Food and Drug Administration for the temporary treatment of the appearance of cellulite. One single-blinded trial found no significant improvement with the use of this device (Plastic Recons Surg. 1999).
Other controlled studies are essentially lacking. Our clinical experience is that after 10 to 20 treatments, a few patients may notice a mild improvement in cellulite appearance, but no loss in size or total fat content. Results are typically temporary, and return to baseline a couple of months after discontinuing therapy.
Despite the inconsistent results seen with LPG, two of the newer devices employ the suction and massage technique with the addition of light and/or radiofrequency. Tri-Active Laser Dermology (Cynosure) uses three different methods to target cellulite, and hence the name. Massage, suction and deep laser stimulation are combined in one treatment. The use of the massage and suction is aimed at increasing vascular and lymphatic circulation, and the 810 nm diode laser with epidermal cooling is for deep tissue heating. Deep tissue heating is to promote collagen formation, which can lead to textural changes. Improvement in the clinical appearance of cellulite was demonstrated in a published trial after 12 treatments using the Tri-Active system (Boyce et al. Am J of Cosmet Surg.).
Another device, which also uses laser light and massage, is the VelaSmooth (Syneron Medical). The VelaSmooth, however, also adds bipolar radiofrequency (RF) to its device. The laser used in the VelaSmooth system emits wavelengths between 700 nm and 1,500 nm. The addition of RF is for tissue tightening.
Two published studies with the VelaSmooth have demonstrated a thigh circumference reduction of 1 cm to 2 cm with eight treatments. (Alster J. Cosmet Laser Ther. 2005. Saddick NS. J Cosmetic LaserTher. 2004). As with the Tri-Active and LPG systems, a series of eight to 16 treatments is required. Side effects include transient erythema and edema and bruising. There are no published reports of scarring or dyspigmentation with either of these systems. One side-by-side comparison shows improvement of cellulite with both systems, and no significant differences between the two systems with respect to clinical results (Nootheti et al. Lasers Surg Med. 2006).