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Dr. Mitchel Goldman Irons Out the Cellulite Removal Myths

Dr Mitchel GoldmanCellulite is a condition that affects nearly all women! Where does it come from? Why does it appear in women? What kinds of cellulite treatment options are there?

Dr. Mitchel Goldman answers all those questions and more about what you can do to reduce the appearance of cellulite.

Listen to the full interview, or read through the transcript below.

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Sharon Odom (SO): Hi everybody, this is Sharon Odom from Cosmetic Surgery Today and welcome to another episode of our continuing series Inside Cosmetic Surgery. Our special guest today is Dr. Mitchel Goldman, a double board certified dermatologist and cosmetic surgeon in San Diego, California and also a board member of the American Academy of Cosmetic Surgery. Hi Dr. Goldman, how are you?

Dr. Mitchel Goldman (DMG): I’m doing great. Thank you for having me.

SO: Excellent. Well, thank you for being here to discuss cellulite, which everyone has had trouble with.

DMG: Well, cellulite, it’s really funny. Ninety percent of women have cellulite and the other ten percent think they do. So it’s a very common occurrence, but you know what, it’s not a medical condition.

Every woman has it. Women are supposed to have cellulite. It’s basically a fat storage mechanism. So if you can think about it, women are the part of our race that basically has babies, and so in order to go through a pregnancy and then to have the ability to breastfeed, women have to store fat.

They have to be more efficient at storing fat and so the way the woman’s body is constructed is to have all these little sort of cells or honeycombs in certain areas of the body like the lateral thighs and inner thighs that basically are programmed to store fat and that’s what cellulite. It’s just a fat storage mechanism.

SO: So it’s no different from regular fat?

DMG: I tell you it really isn’t, and it’s only been in the last ten years or so that people are getting all caught up in cellulite. Cellulite has been around forever since the first woman was on this planet, but only with people showing off more skin and movie stars being shot on National Enquirer on the beach in their bikinis that people are really going for cellulite.

The good news is it’s very simple to treat. The bad news is it’s impossible to cure. So we have a number of treatments that can minimize the appearance of cellulite, but unfortunately, there is no way we are ever going to be able to cure cellulite.

SO: What causes women to get cellulite?

DMG: Well, women have those two X chromosomes and there is something on those X chromosomes that tells the female body that they have to be the ones to store fats so that they can have babies and breastfeed, and that’s what it is.

The best way, again, to think about it is a honeycomb. When bees make a honeycomb, the honeycomb is all these like little square boxes filled with honey. In a woman, the same square boxes are there that are lined by something called fibrous tissue, but instead of having honey in it, those are fat cells that are in it.

So when a woman gets fatter or has more fat cells or the fat cells get larger, it bulges out of the top which is were the skin is and that’s what gives it a cottage cheese appearance. So the only way to really prevent cellulite is to not have body fat. But if you don’t have body fat, you are not going to look like a beautiful woman, you are going to look like a 9-year-old kid and so it’s one of these things that happens.

SO: So, what about when a woman loses weight, does that help?

DMG: Absolutely, it will help. It won’t make it go away entirely because even our best athletes have about a 6-7% body fat weight, and those are with our best female athletes. So they still have some body fat, and of course, they will have much less cellulite, but they will still have a little bit if you look hard enough for it, you will be able to find it.

SO: If someone wanted to aggressively go after this cellulite, then first, they should lose weight and then go get treated?

DMG: Well, yes and no. It’s always a good idea to be at your ideal body weight for so many reasons besides cellulite. For heart and diabetes and just general health. If one loses weight and you still are concerned with the appearance of your skin with those little cottage cheese projections, then there are treatments that can be done. But you don’t have to lose weight.

We can still do the treatment even on patients that are not at their ideal body weight, and what the treatments do is they basically help to relax the honeycomb, relax the fiber standing, so that the fat goes underneath the skin laterally instead of popping up through the skin which gives you the cottage cheese appearance, and that’s probably the number one way to minimize the appearance of cellulite.

SO: What are those treatment options?

DMG: There are many options. The first option which is still popular to use is called endermologie. It’s a special type of massaging technique, and what the massaging technique does and it’s usually done with a machine, called an LPG machine, is that it stretches out those honeycombs or those fiber spans.

Now, many companies have improved upon that. There is a machine called Triactive that not only uses a suction massage, but also uses a low-energy laser light to also help to flatten out the skin, cause a little bit of skin thickening and also causing the fibrous bands or honeycombs to stretch out.

Another machine is called the SmoothShapes. It also uses a suction massage as well as two different types of laser lights to do the same thing.

Finally, there is another machine called a VelaShape and the VelaShape uses the suction again and the laser lights, but it also uses a radio frequency to cause a little bit of thermal damage of the fat cells. So those are the key ways to treat it.

We can also go more aggressively. There are surgical ways to treat cellulite. There is a procedure called subcision where the doctor actually under local anesthesia literally takes a very special type of a knife and breaks up all of the fibers banding. Now, that’s a much more aggressive procedure that usually leads to a woman bruised for 2-3 months, but whereas the other procedures, you can have a treatment done and go right to the swimming pool. You will look great.

So there are a variety of procedures that can be done. Finally, there is a laser that you could insert underneath the skin under local anesthesia that also helps to break up those fibrous bands. So there are lots of different ways to do it.

What I recommend to my patients is you want to do the least expensive, most pleasurable way to do it. You don’t want to have to suffer through treatments. You want to be able to go in and almost like you are having a massage, fall asleep during the treatment and have your cellulite go away at the same time.

But you do it knowing that it’s going to take a few treatments, up to six treatments or so to minimize the appearance of cellulite, and the treatments are done about every week or so, and then after six months, it starts coming back.

So my patients will usually come in in the spring and they get looking beautiful for the summer, or if you are going to go to Hawaii or on a cruise or getting married. You do it about a month or so before one of those special events and then you can look at much more beautiful for that special event, but knowing the cellulite is going to come back no matter what treatment you have. So every year or every special event, you’ve got to do the treatment again.

SO: So there is no permanent treatment?

DMG: No, the beautiful female body was never designed not to have cellulite. It was designed to have cellulite and our job is just to try to minimize the appearance in the most pain-free, pleasurable way.

SO: Is it treated by hormone therapy?

DMG: No. Hormones really don’t have much to do with cellulite. Some people were putting topical hormones on, and actually, it could make it worse, and I have not seen any studies whatsoever in the medical literature that say that hormone therapy does anything good or bad for cellulite.

SO: What about all those creams and things that we’ve been hearing about through the years?

DMG: Yeah. Well, when Madison Avenue and when all the news media makes a big thing out of this normal condition called cellulite, it doesn’t take the skin care industry very long to put together a bunch of creams.

And the creams do work somewhat. None of them work really well, and the creams to work have to be used. So the [cellulite creams] have to be put on twice a day to have any effect, and what these creams do is they tend to help the body dissolve some of the fat. Not a lot, but some of it, and then the medicine that’s usually used is caffeine, so you think, “Oh, maybe, I’ll just go to Starbucks and rub some coffee on the legs.”

But the problem is you’ve got to get the caffeine to penetrate a little bit, and so that’s one of the things. There is a whole host of other types of ingredients that are also used, again, to stimulate blood flow, to sort of take away a lot of the congestion or the edema or the swelling that can occur, especially at a certain times of the month in women.

But finally, some of the creams have something called retinol, which is a type of an agent that causes the skin to be a little bit thicker and that also will help minimize the appearance, but the best that these creams could hope for is about a 20 to at the very, very most 30% decrease in the appearance of cellulite. So you are not doing that much with the creams, but it’s better than doing nothing.

So what I advise for my patients is you don’t want to run out and buy the most expensive creams in the world. You want to buy something that’s reasonably priced that feels good on your legs, like a moisturizer, and if it’s going to also help with the appearance of cellulite, so much the better.

SO: Honestly, I’m surprised that the creams can do anything. I always thought that those were bogus products and just people trying to make a fast buck. So I’m happy to hear you say it actually do work a little bit.

DMG: I was just as surprised and then I actually did controlled clinical studies that were published in the medical literature about eight years ago where I analyzed a number of the different creams and they do do something. It’s not an all hocus pocus. But do they make cellulite disappear? No. They improve it. Do they do it for a long time? No. They only do it for the amount of time you are putting the cream on.

SO: The treatment options that we discussed earlier, will the cellulite actually disappear or mostly disappear?

DMG: Like any of the treatments, even the most drastic surgical treatments, will only minimize the appearance. So the best any clinical study reported in the medical literature could claim is a 50-70% decrease, so nothing goes beyond that. But oftentimes, if you make the appearance 50% better, patients are pretty happy with that. But there is no way with anyone that I’ve ever seen has been able to get above the 70% improvement.

SO: Well, do you have any patient stories?

DMG: Well, yeah. I do, including, of course, my lovely wife who I always talk about. When we go to Hawaii or some place nice, she always wants to look better and so she’ll use some of the creams to feel good and then she’ll have some of these treatments with either the Triactive or the VelaShape and it definitely minimizes the appearance and it makes her feel less self-conscious.

But let’s face it, the thing that makes women feel self-conscious is the news media trying to tell them that this is a horrible disease. But you know you’ve got to stay in shape and you stay on top of it and you can look prettier and you can be confident about it.

SO: Great. Is there anything else you’d like to tell our listeners about cellulite or your practice or anything else?

DMG: Yeah, the only other thing is that men don’t get cellulite. Again, we’ve got that little Y chromosome and it probably prevents that from happening so cellulite really is only a condition, not a disease, a condition of women.

It starts to occur after puberty when all the hormones start getting in there and women start getting into that mode where they are able to have babies, and then interestingly as one gets older, cellulite actually doesn’t go away. Even if you are postmenopausal, the cellulite still can be there and the reason for that is that the skin becomes a lot thinner.

So what I’m really waiting for is for treatments to come about that tightens the skin. We have a few treatments now that are tightening the skin that may do better at minimizing the appearance of cellulite.

There is a radio frequency treatment called Thermage that has some hope, and then there is a brand new treatment that we’ve been using with focused ultrasound called Ulthera. The jury is still out, but those are the two treatments that I think will have the highest probability of getting the best results for body shaping and the treatment of cellulite.

One more I forgot to mention is called the Exilis, and that’s another radio frequency treatment. So doctors are still trying to figure out the best ways to cure this and women are still coming in wanting doctors to improve the appearance. So I would look forward in the coming years to more effective treatments for the minimizing the appearance of cellulite.

SO: Excellent. Thank you very much, Dr. Goldman. Would you like to tell people where they can find out more information about you and your practice?

DMG: Sure. We do have information on our website. It’s gbkderm.com. On our website, we will have the before and after pictures as well as descriptions of a variety of our devices that are used for the treatment of cellulite. Of course, the internet is a wonderful place to get information, but when you go to the internet, you’ve got to take everything with a little grain of salt.

It’s because you want to be able to discuss what you see in the internet with your physician so that he or she can allow you to make the best informed decision as possible regarding the treatment of cellulite.

SO: Great. Well, thank you, Dr. Goldman, so much for your time. We really appreciate it, and we will talk to you soon.

DMG: Thank you. It’s wonderful to be here.

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