SINGAPORE - For something so innocuous, cellulite does a lot of harm to women's self-image.
So, the market for creams, supplements and treatments to get rid of the bulging fat deposits which result in "orange-peel skin" easily amounts to many millions.
The latest entrant to the fray was not dreamed up in a research lab, but discovered by accident when doctors treating the joints of female athletes with acoustic wave therapy noticed an unexpected side effect - smoother thighs.
The non-invasive therapy, also known as extracorporeal shock wave therapy, sends pulses of sound waves to the treated area at a set penetration depth.
It is a procedure which has been used in the medical world for more than 30 years - initially to pulverise kidney stones and since the 1990s, to treat orthopaedic conditions such as tendon and muscle disorders.
At the Changi Sports Medicine Centre in Changi General Hospital, acoustic wave therapy is used to treat injuries such as plantar fasciitis (heel pain) or heel spur, while it is used at Tan Tock Seng Hospital (TTSH) to treat kidney stones and musculoskeletal conditions.
"In musculoskeletal indications, it has the effect of decreasing the sensitivity of the nerves which conduct pain signals," said DrJason Chia, head of the sports medicine and surgery clinic at TTSH.
"It also stimulates the release of chemicals which encourage tendon repair. Efficacy of the treatment varies, depending on the condition and the severity."
For kidney stones, the sound waves are focused on the stones to pulverise them into tiny sand-like particles, which are then passed out through urine.
As a treatment method for cellulite, it is just gaining traction here.
The distributor in Singapore for the D-Actor machine by Swiss manufacturer Storz Medical - a leading company in shock wave technology - said 10 clinics have acquired it in the past two years, including five for aesthestic purposes.
Wave goodbye to cellulite
Wave goodbye to cellulite
Cellulite forms mostly on the buttocks and thighs, though it can also be found on the inner knees, hips and abdomen and underneath the arms.
It occurs when the fibrous tissues that connect the skin to the underlying muscle harden, and the fat cells lying in between expand and bulge up, making the skin appear dimpled.
It affects mostly women and rarely men because women usually have more fat deposits below the skin than men.
Cellulite is believed to be linked to stress, an inactive lifestyle, an unhealthy diet, genetics and hormones.
Acoustic wave therapy is believed to work by delivering shock waves to the fibrous connective tissues to relax them, while stimulating the blood circulation around the tissue, said Dr Bernie Liu, a general practitioner with an interest in pain management and sports injuries.
The treatment also reduces the size of the fat cells, he said.
Over time, this treatment method is expected to give the skin a smooth look and restore the elasticity of the skin and connective tissue, he added.
Last year, housewife B.Y. Kim, 37, tried a treatment method which uses radiofrequency and ultrasound technology to break down fat cells through controlled heating.
She underwent three sessions - on her thighs, love handles and her arms - but felt that her cellulite was still visible.
When she heard about the acoustic wave treatment, she signed up immediately and has completed three sessions on her thighs.
"I wear a bikini with my kids at the pool and cellulite just ruins the look," she said.
"The radiofrequency and ultrasound treatment basically reduced the circumference of the thighs. But the acoustic wave therapy took it a level higher. It smoothed out the skin... It is a real cellulite buster."
She plans to have her arms treated too.
The good thing about acoustic wave therapy is that it is quick, painless and has no down-time so patients can immediately resume their usual activities. It is also low-risk as the energy is kept at a very low level.
Unfortunately, the effect is not permanent and the treatment is not cheap.
Several sessions, about three or four days apart, are needed.
The protocol for cellulite treatment is up to eight sessions, twice a week, though patients often report improvements in skin tone and texture by the fourth session, said Dr Liu.
He likens the treatment to maintenance therapy to keep the skin supple, so it is best to go for one repeat session every six to 12weeks, he said.
Clinics usually charge between $250 and $500 for a session to treat one part of the body, which can be both arms or thighs, for instance.
Various studies have shown that acoustic wave therapy can be effective in treating cellulite, but mainstream medicine has generally not been very encouraging about its use in cellulite treatment.
Associate Professor Chua Sze Hon, senior consultant dermatologist at the National Skin Centre, said these studies may not have been well-designed.
He said: "The cause of cellulite remains poorly understood, although various theories have been proposed. Without a definite cause of cellulite identified, no scientifically proven technique exists to correct this condition.
"Cellulite treatment remains difficult and current technologies have not proven to give consistent and cosmetically significant results."
Nevertheless, it has not stopped the proliferation of products as well as methods in the market over the years, including lipomassage or endermologie, a technique introduced by French company LPG Systems and performed by a device with motorised rollers.
As excess fat under the skin is a major contributing factor to cellulite, staying within one's ideal body weight by eating healthily and exercising will certainly help, Prof Chua said.
Dr Rohan Mendis, a general practitioner who has been offering non-invasive aesthetics treatment for 13 years, agreed. To have good skin and minimal cellulite, the basic way is to eat right, exercise and maintain a healthy lifestyle, he said.
No single treatment method has been found to give consistent results, possibly because multiple factors cause the formation of cellulite, he added.
But he has found that using both acoustic wave therapy, and the radiofrequency and ultrasound treatment method, as well as getting the patient to keep to a healthy diet and lifestyle, have worked in reducing the appearance of cellulite.
Since August, he has treated 14 patients with a combination of acoustic wave therapy and radiofrequency waves to contract collagen fibres under the skin in order to tighten them.
Ms Kim, however, is under no illusion she has found a permanent fix. She exercises every day and watches what she eats.
"I have a balanced diet, drink a lot of water, try to get a lot of sleep and manage my stress," she said.
"I am not going to do acoustic wave therapy and eat a doughnut after that."
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