By Liz Krieger
They say you don’t get out of this life alive, but for women, one might add, “and without cellulite.”
Groans about dimpled rumps and undulating thighs can be heard from the teen to the golden years, with nearly 90 percent of all women experiencing it to some degree, according to the American Society for Aesthetic Plastic Surgery. The ubiquity has bred enormous demand for ways to get rid of it. Sales of department store cellulite-firming and other products alone (many of which use the temporary skin-tightening power of caffeine) totaled nearly $13 million in 2011. And demand for nonsurgical treatments (things like massage, suction, and radio waves) has remained steady, despite mixed reviews.
Enter Cellulaze, a new laser recently cleared by the Food and Drug Administration. Unlike other treatments that work on the surface of the skin, Cellulaze goes under the skin to change the “problematic” structure at play. How does it work? Read on for a little background on the dreaded dimples.
Cottage cheese 101
Whether you’re fat or thin, muscled or jiggly, cellulite doesn’t discriminate, and endless squats or weight loss won’t change the core issues at play. After all, fighting dimpled skin means doing battle with three formidable opponents -- the structure of the female body, hormones, and those pesky hands of time.
A bit about those opponents: The telltale undulations and indentations are caused in part by the architecture of female skin, says dermatologist Mathew Avram, director of the Dermatology Laser & Cosmetic Center at Massachusetts General Hospital in Boston. First, the septae -- vertical bands of tough connective tissue that pull down on skin -- cause existing fat pockets to bulge upward. Think of it like a mattress surface, says Melanie Grossman, a New York dermatologist and a laser pioneer. The coils of a mattress are similar to those bands, holding the stuffing in place, she says. And the older the “mattress,” the worse the surface of your skin looks. (Of course, men are usually blissfully exempt from cellulite, the biggest reason being that their septae are arranged in a more diagonal, crosshatch pattern, says dermatologist Bruce Katz, a clinical professor at Mt. Sinai School of Medicine and director of the Juva Skin and Laser Center in New York.)
Hormones also play a role, says Avram, in large part because they are what kick-start these physical issues. “Cellulite often starts around puberty, when estrogen levels increase,” he explains. “I wish people would see cellulite for what it really is: a secondary sex characteristic. It’s no different from other markers, like breasts or body hair.” The estrogen connection is not completely understood, but one theory is that it may harden the septae, making them shrink and pull down on the skin. The appearance of cellulite can also fluctuate with your monthly cycle, notes Grossman.
The new technique
So far, there’s simply been no transformative, permanent fix for this problem, which is what’s heightened the buzz about Cellulaze.
Here’s how it works: After injecting you with local anesthesia (read: you’re fully awake), the doctor threads a laser fiberthrough a pencil-lead-thin cannula and “snips” the septae, melts your fat pockets, and heats the skin from the inside out, which encourages collagen and elastin growth.
Barry DiBernardo, aplastic surgeon in Montclair, New Jersey, who was the lead investigator of Cellulaze, describes the procedure: “We are able to turn the laser fiber 90 degrees, so it’s horizontal with the skin; we use it to divide the tough septae that’s pulling the skin down, creating dimpling. Then we turn it 90 degrees down to vaporize the fat. Finally,we turn it toward the surface, where the heat can thicken the skin.”(This is a good thing.)
Once those septae are severed, they won’t grow back in that problematic vertical pattern, says DiBernardo. What’s more, the new, eventual collagen and elastin growth (as a result of the laser heat) will leave your skin, on average, 29 percent more elastic than before. “Treat the problem at the root,” says Katz (who also led some of the clinicaltrials), and you have “a solution that truly works, that doesn’t just mask it briefly. ”Downtime is minimal; most patients can go back to work the next day, although they need to wear a compression garment (think supertight bike shorts) for at least a week. Bruising and soreness can also take up to a week or two to dissipate.
In as little as two weeks, patients begin to see a change, he says, and most experience final results within four to six months, when the spike in collagen and elastin has been fully achieved. The best part, says DiBernardo: It lasts. “I have patients who had it three yearsago, and they have no recurrence of their cellulite,” he says. Cost: $2,500 and up.
Johanna Petrycki, a 35-year-old physician’s assistant in New York, had Cellulaze on her thighs in November 2010. Troubled by her dimpled legs since she was 12, Petrycki loathed going to the beach. Despite diet and exercise (she’s five foot two and a trim 100 pounds), the problem persisted, so she didn’t hesitate to try Cellulaze.
“Afterward, there was some bruising and soreness, and the compressiongarment becomes your BFF for a week,” she says, “but it’s a small price to pay.”
After a month, the results started showing, and now she’s thrilled, claiming that her cellulite is “75 percent improved.” As evidence of her new confidence, she simply lists her recent beach destinations: Zanzibar, St. Thomas, and St. John.
Of course, as with any invasive procedure, there are risks such as infection, some temporary numbness or tingling in the treated areas, and the potential for scars. But with one-millimeter incisions, the only thing that most patients notice after is a little dot, says DiBernardo.
Not everyone is a great candidate for this procedure. Early trials yielded valuable information: Women with what DiBernardo calls “extreme contouring issues” -- that is, large pockets of fat or rather doughy, saggy skin -- may see their cellulite diminish, “but without liposuction or other body contouring, the look will not be satisfactory,” he says. And those with very visible veins may have more intense bruising.
Skeptics point out that Cellulaze maybe just another in a long line of highly anticipated but ultimately unsatisfying treatments. But Katz and DiBernardo see it differently. “The proof is in the pictures,”says Katz. “We have 3-D imaging and ultrasounds to quantify the changes. The FDA takes claims about efficacy seriously, and these ones are borne out.”
For some people, it’s a change of mindset, adds DiBernardo. “There seem to be things we’ve all been trained to assume ‘Oh, we’ll never cure that,’ but that doesn’t mean it’s not possible. Two months ago, I treated the upper thighs of a trim and toned 53-year-old woman who said she literally had never worn shorts. Now that’s possible for her.”
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