Cosmetic expert Dr. Patrick Treacy examines the science of anti-aging medicine

1. BODY
WHAT IS
CELLULITE?
by Dr. Patrick J. Treacy
Cellulite is a bit a like a handbag, you never hear about
it in a man’s discussion, up to 80% of women carry
it around at any one time and most of them want to
change it for a newer texture. In America, the condition
is called mattress skin, in Australia it is colloquially known
as cottage cheese skin and in Europe it is called peau
d’orange. To the less cultured readers amongst us,
translated that means the orange peel syndrome. There
is no doubt, wherever you go or whenever women gather
together in one place the possibility exists that they are
talking about cellulite! Therefore, now that we know half
the world are talking about it, what is it, what causes it,
how do you grade it and is there any treatment out there
for the condition?
Even in the early
seventies, the
condition was still
largely unheard of.
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2. for their product. Of course, they could not and compression of the swollen tissues. The
provide any scientific evidence to validate product was marketed through television
their results when challenged. and it caused the U.S. Federal Food and
Drug Administration (FDA) and the Federal
Another company, Relax-Cizor, then Trade Commission (FTC) to take notice
appeared on the market with a type of and produce regulations and guidelines for
new cellulite machine, using iontophoresis the advertising of cellulitic products. The
paddles and Faraday current to remove the cellulite treatment industry quickly realised
offending dimples. It wasn’t long before that they needed to be more scientific in
they ran foul of the FDA who charged them their approach and they quickly produced
with fraudulent advertising. They forgot literature stating that caffeine used topically
to mention that the machine also was could actually reduce fat content in cells
responsible for inducing hernias, creating by blocking an enzyme that inhibits fat
abnormal cardiac rhythms, and inducing breakdown. As the pace of treatments
miscarriages. The machine was apparently quickened, others claimed that an alkaloid in
repackaged and later sold in Europe where cocoa called theobromine could penetrate
laws are considered not as stringent. It never to the subcutaneous fat layer and help
ceases to amaze me how these companies stimulate the release of stored fat. Into this
can flourish on this side of the big pond and new age of scientific enlightenment came
nobody seems to question them whenever other prophets who claimed that horse
they use eighteenth century terminology like chestnut contained a chemical called aescin,
the history of cellulite Faraday current or iontophoresis to describe
a simple thing like electromagnetism or
which could reinforce the strength of veins,
support circulation and prevent swelling.
electricity. Imagine trying to sell the latest Despite the rash of scientific opportunism,
personal computer to someone using Pascal there was little on the market that could
For a start, many may be surprised to
or Babbage terminology. It is fair to say most really reduce the cellulitic condition. It did
learn that the term cellulite is not actually
people would immediately recognise the not take a genius to realise that it would
a medical term and there is some dispute
spoof! require more than tablets to remove those
about the etiology of the condition. Some
stubborn fibrous bands of tissue.
people claim that French and Italian
However, this was not the case with
doctors used the term cellulitis over one
cellulite because nobody had bothered The use of mechanical devices
hundred years ago to describe a condition
to scientifically evaluate what exactly the
of fat deposits located under women’s skin,
problem was. In 1996, Dr. Neil Solomon from Around this time, another technology
which give a dimpled or peau d’orange
the Johns Hopkins University decided to entered the market, the use of mechanical
appearance. The condition was extremely
look more closely at the science behind the devices. The first machine started its life in
common and most physicians of the period
phenomena of cellulite. In a paper of this France as a deep tissue massage for horses
considered it to be normal and were more
period, this doctor concluded that under the until a company called LPG systems decided
interested in the fact that Felix Hoffman had
microscope cellulite looked no different from to try its effect on cellulite. The company
just invented Aspirin. The decades passed,
ordinary fat. In 1998, some researchers at the called the procedure, Endermologie® and
the world went to war twice and conventional
Rockefeller Institute examined the situation claimed it could increase circulation by
medicine was not interested in treating a
more closely and they concluded that there 200%, by expelling toxins and water build
condition, which did not reflect an underlying
was no significant difference between the up while the underlying connective fibres
illness.
appearance or function of fatty tissue or the were stretched. The product was again
regional blood flow between people who heavily marketed in magazines and on the
Even in the early seventies, the condition
had cellulite and those who did not. They TC networks. Despite many clinical trials,
was still largely unheard of. However, all that
also stated that there was some characteristic the clinical evidence of the procedural effect
was about to change in 1973, when New York
within female skin that made them more remains ambiguous. One study performed
beauty salon owner Nicole Ronsard wrote her
prone to developing the condition. in 1998, showed a mean index reduction in
book ‘Cellulite, Those Lumps, Bumps and
body circumference of between 1.34 and
Bulges you couldn’t lose before’. In America
1.83cms. Despite this evidence, another
the game was up...the condition cellulite was
now out in the open and the world would treatment of cellulite clinically controlled trial by Collins and
others, Cellulite Treatment, A Myth Or
never be the same again! Worse still, as
Reality. A controlled trial of two therapies
more and more women found out that they
Endomologie and Aminophylline cream’
too had these lumpy deposits all over their As women became increasingly worried
was published in Plastic and Reconstructive
bodies, many charlatan doctors and fly by about this new condition, the sale of miracle
Surgery. This study found no objective
night companies started offering all kinds creams containing caffeine, green tea,
difference in the thigh girth or thigh fat
of dubious cures and preyed them upon theophylline and theobromine from cocoa
depth of 52 women who were measured
their insecurities. One Italian chemist called continued and one company even produced
by ultrasound. It further showed that
Gianfranco Merizzi invented a new tablet a tablet that promised to take away cellulite
only 3 of 35 patients with aminophylline-
that contained ginko, soya, fish oil, evening while the patient slept. Things went from the
treated legs and 10 of 35 patients with
primrose oil, bioflavins, and many of the sublime to the surreal as another company
Endermologie® treated legs actually felt
other normal suspects with a promise that it promised to remove the cellulitic condition
that their cellulite appearance had actually
would cure the dreaded condition. The CEO by wrapping their clients in a type of snap
improved.
of the company, Rexall even went on CNBC wrap that caused water loss by perspiration
in March 1999 claiming 90% success rate
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3. most
The authors concluded that neither of the The treatment was not comfortable. The
two treatments was effective in improving areas surrounding the injection sites will be
the appearance of cellulite. Despite these inflated for 10 to 20 minutes as CO2 is being
doctors now
findings, the Endomologie® procedure infiltrated. The level of comfort will decrease
continues to be widely marketed and the during the procedure. Between 10 and 20
process has gained popularity in some sessions are necessary to eliminate cellulite.
quarters. My own impression from the
experience of many colleagues is that the
procedure does work. However, it usually
Ideally they should be carried out every other
day, although sometimes two or even one
session per week will be sufficient due to the
agree that
takes 10 to 20 treatments to see any
results and the patient has to do one or
two maintenance treatments per month to
level of pain. This will depend on the extent
of your cellulite. Each session lasts between
10 to 15 minutes. After the fifthz session
cellulite is
maintain any beneficial effect. you will see that your skin looks noticeably
healthier. Around the 8-10 session mark, you more often
seen in
In 2003, the Lipodissolve® procedure was will appreciate that your subcutaneous tissue
introduced to the Irish market. During this is firmer. Before the treatment program ends
procedure, phosphotidyl choline is injected you will have firmer, cellulite free skin.
women due
directly into subcutaneous fat in an effort In 2007, Ailesbury ran the European trials
to dissolve it. It is not surprising that this for a new medical device, which promises
method would be evaluated in an effort to to be the most interesting development
to hormonal
see its effect on cellulite. In 2004, Network to date in the battle against cellulite. This
Lipolysis invited me to become European product was called the VelaSmooth® and
Group Leader for the evaluation of this the machine had already undergone rigorous
reasons
pharmaceutical in the treatment of cellulite. medical testing in the United States. The
The injections are quite painful and in my products works by using a combination of
experience not always successful in treating bipolar Radio Frequency, Infrared light, and
the resilient condition. It takes multiple suction in an effort to safely and effectively
treatments to see any reduction in size and re-contour the skin surface. In clinical trials in
the dimpling effect often remains. By 2009, both Israel and the United States, it appears know that the ‘dimpling’ is made worse
Ailesbury had treated nearly 700 patients to be the most effective treatment available because of underlying water retention and
with this compound in differing areas to date to date. The device apparently works by fibrosis caused by impaired circulation and
and our results will soon undergo scientific allowing radiofrequency to heat fat tissue destruction of the tissues in this area. This is
evaluation as part of a European trial. to a depth of 10mm and the makers claim the main reason that many treatments can
this process increases oxygen intracellular give a temporary solution to the problem.
Carboxytherapy® entered the cellulite diffusion.
marketplace in 2006. This technique claimed
to improve the appearance of cellulite by The infrared light part of the product heats The effect is only temporary because in
improving local tissue metabolism and subcutaneous fat to a level of 3mm and effect, cellulite is localised fat ‘caught in a
perfusion. Treatments were rapid, but increases skin elasticity. The suction device jail’ of surrounding scar tissue and these
uncomfortable. Carboxytherapy® was is similar to Endomologie® in that it can fibrotic walls must be broken down before
technically a non-surgical method where manipulate and smooth out the skin. The we can see a more long-term solution to the
carbon dioxide (CO2) was infiltrated into procedure requires two treatments a week problem.
the subcutaneous tissue through a tiny for five to six weeks and the effects last
needle (0.3mm in diameter). From the about six months before requiring a top up From my personal point of view, one is still
injection point, the carbon dioxide diffuses treatment. The overall cost is about €750 for advised to sign up a course of treatments.
easily into adjacent tissues. The patient felt the complete package. However, I feel it will take a combination
the parts being treated balloon as the gas of the above treatments to eventually
being flowed in by puncture holes made by solve the problem of cellulite. Like the old
needles. The device claimed to work in two spaghetti westerns, we probably require a
complimentary ways. Firstly, and quite simply the future of Cellulite technology like Velasmooth® to break down
carbon dioxide mechanically kills fat cells the walls of the jail and a compound like
but supposedly bursting them. Secondly, phosphotidylcholine to dissolve the baddies
it causes dilation of blood vessels on the So where does that leave us? There is contained within. The trials surrounding this
capillaries in the area. Wider vessels mean no doubt; most doctors now agree that combination therapy have already begun
bigger and stronger blood flow to the area, cellulite is more often seen in women due in Canada and Italy and slowly but surely
which means more oxygen. The increase in to hormonal reasons. The scientific rationale patients are beginning to see medicine
oxygen is important because it eliminates behind this has not been fully evaluated. and doctors at last becoming interested in
the built up fluid from between the cells. We know that cellulitic fat is arranged in dealing with this tenacious condition.
The end result is fewer fat cells and firmer large chambers of macromolecules that are
subcutaneous tissue. separated by columns of collagen fibres. Dr. Patrick Treacy is Medical Director of the
Whenever excess fat is stuffed into these Ailesbury Clinic. For further information log
fibrotic compartments, it will cause them onto www.ailesburyclinic.ie
to bulge out, giving the surface dimply
appearance of cellulite. Scientists also
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