CELLULITE: THE VISITOR THAT WON'T GO AWAY READERS' TREATMENTS DIDN'T WORK, PLASTIC SURGEON SAYS BYLINE: Cara Anna Palm Beach Post Staff Writer DATE: August 14, 1999 PUBLICATION: The Palm Beach Post EDITION: FINAL SECTION: ACCENT PAGE: 4D Dr. Fredric Barr shuffles through the "before" and "after" photos on his desk. He does not look happy. "I see nothing," he says. Shuffle, shuffle. "No change at all." More shuffling. "Unfortunately, no change." The plastic surgeon was recruited to judge whether four Post readers had success with various cellulite treatments - Cellasene, Endermologie and Clarins firming cream. Barr wasn't told which product each woman was using. All he had were the women's thigh measurements and photos. As it turned out, no woman's thigh circumference decreased. And the photos, he says, show no sign of cellulite smoothing. Barr, who as a male has no cellulite of his own, ticks off the body weaknesses that lead to the condition: Loosening skin. Extra fat. Attachments between skin and muscles that tighten and pull on the skin, causing dimples. What to do? "You could tighten the skin," Barr says. "You could loosen or reduce the fat." But as for how to loosen the skin-muscle attachments and erase dimples, he has no idea. "That's where the final frontier is," he says. Until then, doctors say, everything regarding cellulite treatment is iffy. And, yes, frustrating. Pigs used as test subjects No other animal on Earth has cellulite. So when Dr. Bruce Shack, a professor at Vanderbilt University in Nashville, wanted to test a cellulite treatment called Endermologie, he picked Yucatan mini-pigs for their similar-looking flesh. Once or twice a week, he and colleagues used an Endermologie machine - a suction device with rollers that knead the skin - to massage a portion of the pigs' backs. They found this: Endermologie's claim of breaking up fat, to be flushed out of the body with lots of water, was wrong. But they had a surprise: The more treatments a pig had, the thicker a new layer of collagen, a connective tissue below the skin, became. Combine that with how Endermologie slightly loosens the area between fat and muscle, and there could be a smoothing effect on the skin, the group reported in Aesthetic Surgery Journal in May. "The machine does do something, but it takes several treatments," Shack says. And, he points out, any change might only be temporary. The Post reader on Endermologie had six treatments with the machine. "Your woman was just at the beginning," Shack says. Guaranteed not to work Meanwhile . . . This spring, Rexall Sundown introduced a dietary supplement called Cellasene, saying studies in Italy had shown that the pill reduces thigh circumference. The company held a news conference in May to release data from a study of 10 women in New York. After eight weeks of taking Cellasene, the women's thigh circumference decreased by an average of 0.87 inches. While Cellasene and Endermologie are two popular anti-cellulite products of the moment, firming creams such as the one by Clarins are low-priced standbys. There is no published research on whether Clarins works, though. And then there's the pricey anti-cellulite choice, liposuction, which costs $2,000 and up and is the most popular form of plastic surgery. Liposuction removes fat cells. Reverse liposuction uses portions of a woman's fat to fill ripples or soften bulges in other areas of the skin. But neither comes with a guarantee against cellulite, Barr says. Sorry. "I'm unsure results can be had once you stop using (liposuction)," he says. Plus, the process is incomplete. Barr picks up one of the before-and-after photos on his desk and points to a thigh. Liposuction can decrease fat above the knee and in the inner and outer thigh areas, "but," he asks, pointing to the skin's ripples and dimples, "what are you going to do with the stuff here?" Try diet, exercise So here's the bad news. Cellulite is genetic, doctors say. Women can't avoid it. What can they do with it? "I congratulate (the Post readers) on their spirit of adventure," Barr says. "I don't discount them for having tried something that sounded easier. But . . . nothing is accomplished without work." Shack recommends "diet, exercise, Endermologie, maybe liposuction." Barr says watch your calories, and consider visiting a dietitian or nutrition counselor. Do exercises for weight reduction and body toning, but not for muscle bulk, which stretches the skin. See an endocrinologist to check your metabolism. "Then, if you have reached the wall with that, it is very appropriate to come in and consult with a board-certified plastic surgeon," he says. Illustration: GRAPHIC (B&W) STAFF GRAPHIC What's dimpling my thighs? A look at how cellulite `works' As stored fat increases, the skin bulges Expanding fat storage areas can crowd blood and lymph vessels, slowing down circulation As vertical connective fibers age, they shrink Connective tissues in the skin shorten and pull down the skin, causing dimpling The epidermis is the outer, protective layer of skin The dermis contains nerve endings, connective tissue and blood vessels The hypodermis contains the fat storage areas and more blood vessels The collagen layer supports and gives structure to the skin The subcutaneous tissue contains more fat Source: Dr. Bruce Shack, Vanderbilt University, Aesthetic Surgery Journal Copyright 1999 Palm Beach Newspapers, Inc.