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Cellulite, like its close cousin stretch marks, is a cosmetic scourge for many women. While there is no medical reason to treat cellulite, which is normal in the skin of many females and is not associated with any health risks, many women are concerned about it anyway. The unsavory presence of skin irregularities, lumps and bumps, and a ‘cottage cheese’ appearance across the thighs and buttocks run contrary to the smooth skin of endless beauty ads.



It is a  regular question from many female patients and some consults are exclusively about a surgical treatment or solution to the cellulite problem. As a result, treatment offerings for cellulite is a multibillion-dollar industry… of largely unproved therapies. Some machine or device-based treatments that claim to lessen cellulite do have some minor but temporary improvements. But their effects or benefits are not permanent and many of the touted clinical studies have some serious flaws in their design and reporting. It does not help that the quantitative assessment of cellulite is difficult and patients are more interested in eradication than a percent visual improvement.

Many patients misunderstand cellulite, believing that it is somehow a medical condition or defect in the skin. In reality, it is simply a gender-related difference in the structure of the subcutaneous fat lobules and the connective tissue septae that divide them. The constricted septa create bulging lobules creating the classic skin appearance. This is most manifest in the thighs. Cellulite is nearly universal in postpubertal females even if they are lean, but interestingly most obese males do not have cellulite unless they have androgen deficiency. Trying to correct this normal element of subcutaneous anatomy is much more challenging than treating an abnormality.

While I realize that women do not like the appearance of cellulite, it is important to understand that it is a totally normal condition. There is nothing wrong with embarking on many of the offered treatments but they are at best only mildly helpful and only for a short period of time. To keep up any effects of these various treatments, they must be maintained. None of them have any harmful effects other than potentially on your pocketbook. As new cellulite treatments appear, it is important to remain skeptical. Past history has shown a consistent pattern of overstated and unsubstantiated claims of results.

One misconception is that liposuction will improve the appearance of cellulite. This has become particularly prevalent since the emergence of Smartlipo or laser liposuction. Because of its potential skin tightening effects, it is believed that it will help cellulite as well. Liposuction methods, however, have no permanent effect on cellulite (it may temporarily look better due to swelling) because it can not eliminate the presence of the connective tissue septae.

 It is also important to realize the weight and exercise, two lifestyle issues in which we do have control, are not unfortunately effective at improving cellulite. You can’t exercise or burn cellulite off since it is not primarily a fat accumulation problem.

Dr. Barry Eppley

Indianapolis Indiana

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