Most women are all too familiar with cellulite - skin dimpling and surface irregularity of the buttocks and thighs that seems to defy all efforts at treatment. Over the years women have tried a variety of unsuccessful gimmicks, from rolling pins to topical creams to tight polyester pants. Only the latter has been partially successful (depending on the size and depth of the dimples), that is, until the advent of Endermologie.

Endermologie originated in France about ten years ago and quickly spread throughout Europe. It is logical that a treatment for cellulite would arise in the land of French wines and cheeses, the sunny Riviera and abbreviated swimwear. The French have long revered the buttocks and thighs. But while "full-bodied" may be acceptable in a Cabernet, it is less so in a bathing suit. A hand-held vacuum cleaner was added to the previously unsuccessful rolling pins, and voila! , the Endermologie machine was born.

The concept of Endermologie is simple. The vacuum draws a roll of skin and fat up between the machine's rollers. A kneading action of the rollers massages the skin and munches on underlying fat lobules to give the desired result.

There is a paucity of basic scientific research on Endermologie. No one knows exactly how or why the technique works, but the theory is that individual fat cells lose their contents in response to the munching action of the Endermologie machine and therefore shrink. The kneading and massaging action on the skin milks out stationary tissue fluid and stretches the fibrous bands between fat lobules that attach to the underside of the skin and cause the cellulite dimples. Stretching the bands relieves some of the downward pull at the anchor points of the dimples and can improve cellulite.

Endermologie came to the U.S. about two years ago and quickly spread from coast to coast. We helped introduce it to this area in March of 1997 when we began offering it at Dermatique Skin and Body Salon in Monroe. In the remainder of this article, I will try to dispel some myths surrounding Endermologie, and share what we have learned about patient selection, expected outcome and patient satisfaction from the 700 hundred treatment sessions performed at Dermatique over the past ten months.

Myth #1 - Endermologie is a substitute for liposuction. Endermologie and liposuction address two separate and distinct problems. Endermologie addresses surface irregularity (cellulite) and may have a minor tightening and toning effect on the skin. It does not remove fat cells from the body. It is not a good treatment for localized fat collections of the hips and thighs (a.k.a. "pones"), and is not as effective as circumferential liposuction at reducing the size of the thighs. Endermologie is most effective in patients who have reasonable skin quality, do not have prominent localized areas of fat and have cellulite as their primary problem. Liposuction, in contrast, specifically addresses localized areas of fat excess. Liposuction actually removes fat from the body and the fat cells removed by liposuction are gone forever. On the other hand, liposuction has never been a good treatment for cellulite, and in some cases can actually make it worse. Liposuction is best for patients who are most bothered by localized fat collections, where improvement in body contour after liposuction will out weigh the potential negative of persistent cellulite. I have found that these patients also benefit from post-operative Endermologie, starting three weeks after liposuction, to speed the resolution of swelling and smooth out the results. The two techniques are not mutually exclusive and often can be used together for optimal results.

Myth #2 - Endermologie is a weight reduction technique. While many Endermologie patients lose weight during treatment, this is probably due to a concomitant regimen of diet and exercise and not to the Endermologie treatments themselves. If weight loss is the primary goal, Endermologie is not the answer. In fact, in patients more than 30-40 lbs. over their ideal body weight, we recommend diet and exercise alone.

Myth #3 - There is such a thing as a "licensed endermologist". Advertisements that tout "licensed endermologists" are false and misleading. They imply that there is an organized licensing process one must follow before being certified to perform Endermologie. Endermologie is taught at weekend seminars, and all attendees receive a certificate of completion. There is no licensing exam and no state licensing board for Endermologists. There doesn't need to be. The technique is conceptually simple and the risks are minimal. Hands-on experience and long term follow-up, not a weekend seminar, are the most important factors in helping the technician develop a consistent Endermologie routine. At Dermatique, we stand on our experience - 700 sessions over the past 10 months, not on fabricated credentials.

Myth #4 - Everyone is a candidate for Endermologie. While the technique is essentially risk-free and can be safely performed on just about anyone, good results are heavily dependent on appropriate patient selection. We have found that 15 - 20% of patients seeking Endermologie are not good candidates for the procedure. These individuals fall into three groups: Patients who are obese and simply need diet and exercise. Patients who are elderly and have saggy, redundant skin with poor skin tone. Patients who have minimal cellulite, but prominent localized fat collections. The latter are best served by liposuction. At Dermatique, potential Endermologie patients are evaluated by plastic surgeons, body contouring experts who have undergone years of training and are uniquely qualified to give an honest opinion on whether or not Endermologie is right for you.

Myth #5 - Endermologie works in every patient who is considered a good candidate. While we have seen good results in about a third of our patients, even with careful patient selection there are clearly non-responders. The patient education materials that come with the Endermologie machine include before and after pictures of patients treated in Europe and elsewhere. These are spectacular results, probably representing the upper 1-2% of all patients treated. We have not seen results this spectacular thus far in our experience at Dermatique. Even though we have not seen "home run" results, patient satisfaction with Endermologie is very high. We recently surveyed our Endermologie patients and found that of the respondents, over 95% were not only happy with the results, but would recommend Endermologie to a friend.

In conclusion, Endermologie is probably here to stay, though its precise role in body contouring is being refined with time and experience. It is definitely not a magic bullet that will melt away pounds, inches and cellulite while you eat Bon-Bons and watch TV. Several issues, however, are clear. If you are more than 40 lbs. overweight, your money is better spent on dietary counseling and a personal trainer. If you have localized fat collections and minimal cellulite, you will be better served by liposuction. If you are a fitness conscious patient with cellulite as your primary problem, and you view Endermologie as an adjunct to diet and exercise, then this may just be the treatment you've been waiting for. We invite you to come by Dermatique for a free consultation - not by a "licensed endermologist" but by a board certified Plastic Surgeon.

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