Cellulite treatments

Caffeine is known to promote lymphatic drainage from tissues (i.e. remove excess fluid) as well as increase lipolysis (promote breakdown of cellular fat). In theory, this could counteract some of the factors contributing to cellulite. Hence, creams with caffeine or somewhat similarly acting substances (such as aminophylline) have been used to treat cellulite. As of the time of this writing, no independent study has demonstrated the effectiveness of topical caffeine for cellulite. A few studies demonstrating some benefit have been commissioned by skin care companies and cannot be considered unbiased. A single study demonstrating the effectiveness of aminophylline was small and its principal investigator appears to have had a conflict of interests.

More research is needed to determine whether topical caffeine or its cousins have any benefits for cellulite and, if true, which concentrations, vehicles and usage methods are optimal. Even if caffeine is proven effective, the benefits are likely to be modest.

Diet

A number of cellulite diets are being promoted by some skin care and/or nutrition experts - mainly in conjunction with sales of topicals, supplements and dieting materials. The more rational of these diets recommend foods and supplements that reduce inflammation, improve microcirculation, strengthen connective tissue and activate fat metabolism, i.e. allegedly address the key factors in the development of cellulite. The problem is that there is no proof that any diet has any effect on cellulite. Until there are any decent studies, dietary treatment of cellulite will remain a wishful thinking.

Still want to try to defeat cellulite with diet? Then pick the one that makes the most sense in terms of general health: plenty of fresh fruits and veggies, high in fiber, rich in omega-3 fat, low-glycemic and so forth. You may not cure your cellulite, but at least it wouldn't be a wasted effort.

Keep in mind that losing weight does not eliminate cellulite. However, it may modestly reduce the appearance of cellulite because it makes fat tissue shrink.

Directed energy: light, laser, radiofrequency

Directed energy treatments have been making inroads into the cellulite treatment business. Some of the claims are plausible because certain forms of directed energy can reach the junction between the skin and fat tissue and even further.

One such device called TriActive incorporates a low-energy laser, a skin-cooling mechanism, and suction massage. The goal is to stimulate collagen, circulation, and lymphatic drainage in the lower skin layer and below while protecting the skin by cooling. TriActive is not considered to be a medical device (because only a low-energy laser is used) and thus does not require FDA approval or a licensed physician to operate. Early results seem encouraging but the effectiveness data is scarce and the durability of improvements remains unclear. A course of treatments with TriActive may cost up to $1,500.

Another device VelaSmooth used a combination of radiofrequency energy, infrared laser and suction-based massage. Radiofrequency radiation deep-heats fat tissues causing some fat cells to burst; infrared light heats the juncture between skin and fat, improving circulation and inducing connective tissues remodeling; suction-based massage evens out the newly softened tissue and stimulates drainage. All of the above allegedly reduces cellulite by 50% or more over a series of ten $200 sessions ($2,000 total). VelaSmooth is considered a medical device because is uses potentially dangerous high-energy equipment; it has been approved by the FDA and can be operated only by a licensed physician. However, while drug approvals require equally convincing evidence of both safety and effectiveness, medical devices are often approved predominantly based on safety. The effectiveness of VelaSmooth remains to be proven in solid studies.

It is likely that TriActive and VelaSmooth will prove to be at least somewhat effective for cellulite - at least more so than topicals. VelaSmooth is likely to be more effective (and possibly more risky) of the two as it employs higher energies and deeper penetration. However, only rigorous studies with good follow up will determine the place of these new devices in the anti-cellulite armory.

Mesotherapy

In essence, mesotherapy involves injecting a cocktail of chemicals, which may include vitamins, herbal extracts and off-label drugs (i.e. drugs approved for other purposes), into the area affected by cellulite. The rationale of this approach is the idea that delivering active chemicals directly to the source of the problem should be more effective than applying them topically and hoping that meaningful amounts will penetrate. The active chemicals are selected by their ability to soften connective tissue, break up fat, stimulated remodeling, circulation, drainage and so forth.

The problem with mesotherapy is that there are no scientifically established standards or best practices, no reliable data on safety and effectiveness. Different practitioners use different cocktails. Even though the drugs they inject are approved for other indications, the risks of injecting them in a complex cocktail are unknown. It is also unclear, which, if any, of the commonly used mesotherapy cocktails are effective and how they stack up against one another.

The most prudent approach is to wait until more studies are performed to determine safety, effectiveness and best practices for mesotherapy. Or at least try other things first.

Mesotherapy is typically performed in a series of 5-10 sessions, costing about $150 each.

Specialized massage

Many salons offer anti-cellulite massage, which usually employs rollers, shakers, suction, vibration and so-forth. Such massage does not seem to cause any sustained tissue restructuring and at best can achieve some degree of short-lived smoothening. Or just even out your excess cash.