2013, The Sunday TimesView PDF
Victoria Beckham, Kate Moss and even Princess Diana have all faced the moment when an unexpectedly dimply bum and thighs have been captured on camera for critical examination by a gleeful female audience.
Cellulite, the orange-peel effect of pitted fat, affects more than 8 out of 10 women, though rarely men. What causes it is not understood. Regardless of racial origin, being generally overweight makes it worse, but slender women can be just as badly afflicted, and for some, the condition emerges at the onset of puberty.
The fibrous septae — strands that connect the layers of tissue and fat below the skin - gradually harden and contract, while the fat between them does not. The result is an uneven, quilted surface that no amount of diet, exercise, massage or other remedies can permanently shift.
Now help may be at hand, thanks to the first scientifically validated laser cellulite treatment to win the approval of the Food and Drug Administration (FDA), which licences all drugs and medical devices in America. In January last yearn the FDA accepted the results of a year long trial of a laser technique called Cellulaze, which "melts" the fat and then breaks down the fibres anchoring the tiny fat pockets.
The study, conducted in the department of surgery of the University of Medicine and Dentistry of New Jersey, mentioned a group of women with an average age of 47, and showed that just one Cellulaze treatment prevented the return of cellulite for at least a year. There are even claims that the earliest patients have remained cellulite-free for three years.
The treatment, which costs upwards of £2,500, takes one to two hours and involves a local anaesthetic and mild sedation, followed by the insertion of a laser rod, like a fine knitting needle, just below the surface of the skin through a series of tiny cuts. Laser beams then transmit energy sideways from the rod to smooth out lumpy fat cells and heat dermal tissue. The method promotes skin thickening and tightening, resulting in tighter, smoother skin. The laser directly targets the lumps, it stimulates collagen production just below the surface, and in most cases, gives a smoother result than anything previously achieved by other anti cellulite treatments.
Hassan Shaaban, a consultant plastic surgeon at the Sthetix clinic in Liverpool, was the British pioneer, and has now become the principal specialist training other doctors from across Europe in the technique. He warns that not every patient will benefit. "We classify cellulite severity from one to four," he says. "This treatment works best on stages two and three. In other words, women with serious cellulite will first have to lose fat by other methods."
The cosmetic surgeon Angelica Kavouni, of the Cadogan Clinic London, underwent the training last December and has already treated 15 women.
I'm cautiously optimistic that it works, but I think most patients will also have to make lifestyle changes such as diet and more exercise to maintain the results.
Gina Nicholas, 50, a hairdresser from south London, who is slim but has had orange-peel legs since she was in her twenties, was one of the first patients. She is delighted with the results. She went back to work the next day, but admits the bruising and pain took six weeks to clear. "I did feel as though my legs had been punched, and there was quite a bit of swelling at the beginning, but overall the effect has been great and, if anything, it's continuing to improve" she says.
Jodie Hart, 26, a marketing consultant from southwest London who is a keen runner, says she was only 11 when the first dimples appeared, even though she has remained slim and fit. She underwent Cellulaze treatment on her thighs las September and says it is the only thing that has worked. "It did hurt and I couldn't run for a week afterwards, but now when I sit down or cross my legs, I don't have that puckering of fat."
Not every cosmetic doctor has been won over. Some question the technique's claimed efficacy, while some are concerned that other approaches may now become obsolete. Dr Mike Comins, former president of the British College of Aesthetic Medicine, says the early published results from Cellulaze look promising, but he points out that many women who think they have problem cellulite are actually suffering from undiagnosed lip oedema - a tendency for deeper fat cells to retain water. He suggests that women should get second and even third opinions from different doctors before embarking on any treatment.
Still, if you're prepared to go down the invasive route to reduce those lumps and bumps, then this laser-powered treatment may prove the smoothest way yet.
Cellulite is linked in some way to female hormones and gets worse with age as the production of collagen and elastin in the skin begin to fall.
Serious research to understand its origins has accelerated in the past decade, thanks to the boom in anti-ageing and cosmetic medicine.
Its appearance can be temporarily improved by aggressive massage to disperse the fat, but it generally reappears soon after.
Maddona reportedly spent £40.000 on an anti-cellulite Acoustic Wave Therapy machine a few years ago, and there are other lass and pulsed-light treatments for cellulite removal, but Cellulaze is the first minimally invasive treatment to win FDA approval.
One recent celebrity craze touted as a cellulite cure is cupping, where heated cups are placed on the skin to create a strong vacuum and increase blood flow. Viagra was even suggested because of its similar potential to improve microcirculation in the skin.
Detox wraps to "draw out" toxins and reduce water retention remains a favourite cellulite treatment, although any visible improvements are temporary.
Endermologie, a type of massage using special rollers, and aminophylline cream, an asthma treatment believed to shrink fat cells, are also still being offered as cellulite treatments, despite being tested and rejected in trials at Bradford University more than 10 years ago.
Caffeine, long used in cellulite remedies, appears able to penetrate the skin when applied in a cream and is believed to stimulate the breakdown of fat. However, the cosmetic surgeon Angelica Kavouni points to research showing that caffeine, along with alcohol, reduces lymph drainage, which naturally removes toxins and waste from the body.
Sadly, diet and exercise are likely to win out. "The nature of cellulite is that you can't treat it with precision" says Fazel Fateh, the former president of the British Association of Aesthetic Plastic Surgeon.
"It is difficult to recommend any treatment with any confidence that people will get good result."