Goodbye, Cellulite Thighs?

A new treatment may give new hope to reduce cellulite, the unsightly dimpling of thigh and buttocks skin, researchers say.

It works by injecting an enzyme naturally found in the body to help improve the skin's appearance.

A New York plastic surgeon reported on the new treatment Tuesday at the American Society of Plastic Surgeons annual meeting in San Francisco.

"It's not perfect," Alexander Dagum, MD, associate professor and chief of plastic surgery at State University of New York at Stonybrook, says of the new treatment, which uses the enzyme collagenase. "But most of the patients were quite happy with the results."

The study was small, including only 10 women. He says more work needs to be done to fine-tune the treatment.

Study Results

Dagum injected collagenase five times in a circular pattern at the top of the back of the upper thigh, the area typically most affected by cellulite. Photographs were taken before and after the procedure, and the researchers evaluated how much better the cellulite looked at several time points after the injections.

Within a day, the women had a 77% decrease in the appearance of cellulite, he says, and by one month it was an 89% decrease. "At three months, it was 86% and at six months, 76%," Dagum says. Six months was the end of the follow-up, he says, so "we don't know how often we have to redo."

What Causes Cellulite?

"No one really understands the cause of cellulite," Dagum says. One hypothesis about how cellulite forms, says Dagum, is based on the idea that the connective tissue lattice work under the skin is different in men and women. In women, the lattice work makes it easier for the fat to protrude.

Over time, the woman's lattice work in the thigh and buttocks areas weakens and scars more than a man's, resulting in further irregularities.

In areas with scars, valleys form, he says, and in areas of fat protrusion, hills. The result is the unsightly dimpled appearance. Think of it as a bowl of Jell-O, Dagum says. If you push down on one side (the scarring) it has to come up on the other.

The collagenase, when injected, is thought to break down the areas of scar tissue that hold down the fat and help cause the dimpled look. It also is thought to break down some of the fat tissue, causing them to protrude less, helping to even out the hills and valleys and to restore normal contours.
Side Effects Include Bruising

The 10 women studied had an average age of 41 and overall had an average body mass index of 28, or overweight (a BMI of 18.5-24.9 is deemed normal weight; a BMI of 25-29.9 is overweight; and a BMI of 30 or higher is obese). For reference, a person 5 feet 8 inches who weighs 160 pounds has a BMI of 24; at 185 pounds the BMI is 28.

Women in the study reported a lot of bruising the first week after the injections, Dagum says. They were advised not to do heavy lifting or vigorous exercise for the first couple of weeks. Other side effects included bruising and swelling at the injection area.

The manufacturer of the collagenase provided the materials for Dagum's study, and his university provided the research funds.

Second Opinions

What do other experts think of the collagenase treatment? "It shows potential," says Susan Evans, MD, cosmetic dermatologist in Beverly Hills, Calif. But, she adds, "it was a very small study, 10 people, and not [conducted] over a long period of time. It's really unclear if all the data could be supported or reproduced over the long term."

"From this data I don't think we have a new standard of treatment for cellulite," says Adam M. Rotunda, MD, also a dermatologist in Beverly Hills, Calif., and a clinical instructor of dermatology at the University of California Los Angeles and the University of Southern California.

More research is needed on this treatment and others, he says.

"Right now, there is no tandard out there," he says.

Among the other options for reducing the appearance of cellulite are topical skin treatments, laser treatments, injection of other substances, and massage.

What's Next?

Dagum wants to do a larger study and experiment with different amounts of collagenase.

He couldn't estimate the cost of the treatments at this point. He is hopeful that it may be available in the next few years.

What Else Helps?

"Physical fitness and weight loss to some extent will help," Dagum says. "If you put on weight, you will make your cellulite look worse. BMI has an effect. The larger you are, the more prominent the cellulite will be because you have more hypertrophy [enlargement] of the fat cells."

Whatever a woman's weight, he says, cellulite affects at least 85% of women to some extent.

SOURCES: Alexander B. Dagum, MD, associate professor and chief of plastic surgery, State University of New York at Stonybrook, Long Island, N.Y. American Society of Plastic Surgeons Plastic Surgery 2006 conference, San Francisco, Oct. 6-11, 2006. Adam M. Rotunda, MD, dermatologist, Beverly Hills, Calif.; clinical instructor of dermatology, University of California Los Angeles. Susan Evans, MD, cosmetic dermatologist, Beverly Hills, Calif.