How big a role do genes play in cellulite levels?
There is a genetic component or predisposition to cellulite. But just because you have the genetic component doesn't mean you have to develop it if you do the right things: eat a healthy diet, exercise, and skip restrictive underwear.
Do creams—thigh creams, caffeine creams—really work?
Most all creams will only address the fat. So the Nivea [Good-Bye Cellulite Gel-Cream] and others with L-Carnitine transports fats into the [cells'] mitochondria to be used as energy. Caffeine creams will help by blocking the making of fats by the alpha receptors. Some creams have aminophylline, (a compound in some respiratory drugs) which, like caffeine, works by blocking the alpha receptors. In most creams, you find some way of targeting only the fat cells [and not addressing the connective tissue or circulation aspects of cellulite].
What other treatments are there for cellulite?
There are three treatable components of cellulite: You have to address the collagen; you have to reduce the fat, and you have to increase circulation.
But it depends on the grade of cellulite you have. There are four grades, ranging from zero to three: Grade zero is no visible cellulite. If you pinch the skin and see a cottage cheese–like texture—that's grade one. Grade two is if cellulite is visible on the legs of someone standing. Grade three is if you see cellulite when you look in the mirror or lie down. I call grade three "terminal," because it's very hard to treat, although the good news is that I don't think anyone's ever died of it.
Machines to treat cellulite include vacuum rolling and radio waves to break up the fat. The first one of them on the market was Endermologie. When you're vacuuming and rolling [the skin], you're increasing circulation, and the heat helps to break down the fat, which smoothes out the skin.
The downside to the machines is you have to go once a month [for at least several years].
What about lasers, injections and surgery?
Laser treatments are combined with massage and rolling; they either do suction or rolling and use radio waves and heat up the fat—put fat on a stove in a frying pan, and it melts. [Those treatments] heat it up and hope we can break it down that way, and use section and rollers to try to force it out [of the puckered near-skin area].
"Subcision" surgery was invented to get rid of indentations in the face (such as acne scarring), and one dermatologist took that technology and applied it to dimples in the buttocks. For subcision, you anesthetize the area, then you take a special needle—a Nokor needle, which looks kind of like a little hatchet—so you can make a small incision and, moving it back and forth, you can cut the skin from the tissue holding [it] down, getting rid of the dimples.
I've see women who have had fat injected into their thighs, buttocks, bellies and anyplace else they have cellulite in an attempt to even out the texture—and it was like a bump sticking out of the leg. Other injections you have to have every few months.
The bad thing about silicone [and fat-transfer] injections [that aim to fill in the dimples] that they can move and can get absorbed—and you can't get rid of it. As for liposuction [when plastic surgeons literally suck out the fat through a tube], you'll find tons of women who complain that the procedure actually made their cellulite worse. Liposuction has only been proven to work for body sculpting [changing the body's contours by removing excess fat from some areas of the body, which doesn't have much—if any—effect on the texture of fat that will remain below the skin]. If you have a doctor telling you that you can get rid of cellulite with liposuction, run out that door and don't ever look back.