Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page.

Cellulite and liposuction

Dear Dr Margaret
Creams to get rid of cellulite seem very expensive. Are they worth buying? I’m thinking about liposuction - would you advise it?

There seems to be a lot of confusion about what cellulite is. I have talked to several dermatologists about this, and they all agree that cellulite is ordinary fat - there is nothing special about it. Even thin people have some body fat stored beneath their skin. Running through the fat, there are bands of firmer, more fibrous ‘connective tissue’. In some people the fat bulges against the connective tissue, giving a dimpling effect on the surface. Whether or not this happens depends mainly on how the bands of connective tissue are arranged, and how thick your skin is - so you can blame your genes if you have cellulite. Also, of course, the more fat you are carrying, the more it will bulge against the connective tissue. Age is also a factor. As we get older, the connective tissue becomes less flexible, so the fat is more squeezed and looks more puckered.

To reduce cellulite, you would have to reduce the amount of fat or soften the connective tissue bands. I have not seen any scientific evidence that cellulite creams have any such effects. You would do better to spend the money on a good self-tanning preparation, because cellulite is much less obvious on darker skin. Losing some weight would also help.

I have seen massage promoted as an anticellulite treatment but, again, I don’t think there is any evidence that it has a real effect on cellulite. One of my dermatologist colleagues said that it may seem to work for a few hours because it can cause a very slight swelling of the skin, which would smooth out the puckering temporarily.

The other option is liposuction. This is expensive, but is the only method I know of that removes fat from a specific area of the body. Although the fat cells are removed permanently, those that remain will expand in time unless you are very careful not to gain any weight.

You may be imagining that your fat is rubbery in texture. In fact, it is almost liquid, so it can be sucked out. A tube is inserted through a small skin incision, and attached to a vacuum pump. The tube dragged to and fro through the fat to suck it out. A general anaesthetic is not necessary. Afterwards a tight dressing is applied. Expect some swelling, bruising and discomfort possibly for a few weeks afterwards, and numbness over the treated area for several months, but you should be able to go back to work 2 or 3 days after the procedure.

After the fat has been removed, the natural elasticity of the skin tightens it over the area. The older you are, the less elastic your skin. For this reason, many cosmetic surgeons are reluctant to do liposuction on anyone over the age of 50.

Liposuction is a cosmetic surgery procedure, so look at our section on Choosing a cosmetic surgeon. If done by an experienced doctor, it is usually a safe procedure, but problems can occur. For example, the surgeon may accidentally cause damage with the suction tube, and removal of the fat can upset the fluid balance of the body (which is why you need to be carefully observed afterwards - it is not a lunchtime procedure). Also, the cosmetic result is not always good.

Clinics make a lot of money from liposuction, so there are some cowboys around. A couple of years ago, a doctor was struck off the UK Medical Register because of botched liposuctions. At the time, a leader in The Times newspaper described liposuction in these words: “skin may be left sagging wrinkled or dimpled, and muscles numbed. Bowels and abdomens may be ruptured, spleens perforated and patients can go into shock and die. For this ghastly procedure, the average cost is £3,000 - about £500 per shed pound”. My view, which applies to all cosmetic surgery, is that you should avoid it if possible, and undertake it only if the problem is causing you enormous distress.

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