A Myth or Reality: A Prospective Randomized, Controlled Trial of Two Therapies, Endermologie and Aminophylline Cream
Collis, Elliot, Sharpe et al.
Plastic and Reconstructive Surgery Volume 104, Number 4, September 1999, pages 1110-1117
Reviewed by James J. Romano, MD
There are few words I know of in skincare and plastic surgery that create more interest and yet more confusion than cellulite. It is hard to appreciate the etiology, and even more elusive are the methods for predictable and long-lasting treatment of this condition. This article and the excellent discussion and references are welcome additions to quality peer-review journals as a sign that literature surrounding this topic has moved from just anecdotal reports to more scientific studies with the hope now of yielding more objective data.
In this study conducted in England on 69 women over 12 weeks, patients were randomized to treatment with aminophylline cream twice-daily alone, twice-weekly treatments of Endermologie alone, or a combination of both. Results were assessed subjectively by the patients, the doctors, and photographs, and then graded. They conclude that there were no statistical differences in measurements in any of the treatment groups and, therefore, they do not believe that either of these treatments are effective in improving the appearance of cellulite. Their findings suggest that contour changes are due to weight loss alone.
Excellent anatomic studies have suggested that cellulite as we know it is mostly a female-related phenomenon and is due to the gender-specific orientation of the ligamentous connections between the deep fascia and the overlying skin. This network creates fatty compartments where the point of ligamentous attachment to the dermis tethers and the puffiness of the fat within this compartment bulges so that in combination this creates the dimpling or cobblestone cellulite appearance. Some describe this as “herniation” of the subcutaneous fat into the dermis. This is believed to be exacerbated by fluid excess, toxic waste buildup, or poor drainage in these compartments. The time-honored treatments have been aimed at nutritional and dietary management, lymphatic massage, and edema control. These interventions alone still provide results. Aminophylline cream applied topically as a treatment is believed to increase blood flow in the compartment and thus drainage, and may have some effect on breaking down fat cells. None of this has been proven. Endermologie is a mechanical manipulation where the machine essentially sucks up a fold of skin and massages it between two revolving rollers, theoretically squeezing out the excess fluid, progressively disorganizing the fat cells, and gradually smoothing these areas.
I would submit that we consider cellulite and Endermologie from several other perspectives before we rely on the conclusions of this article. Many believe that it is very operator- and time-dependant in order to obtain results, and other investigators have found very differing and gratifying results. With Endermologie there is growing evidence suggesting that lymphatic and subcutaneous blood flow is enhanced, new collagen deposition occurs, and firming and toning of the skin and subcutaneous tissue develop. The duration of treatment and the duration of results after treatment are still unknown. And besides, it fundamentally causes no harm, and it is a soothing and comforting treatment for the client.