NEW ORLEANS -- It's often thought of as a weight issue, but it's really a skin condition. But no matter how you look at cellulite, people don't want it.

Now the Food and Drug Administration has approved a machine that may be able to help.

It makes tabloid headlines. The rich and famous, those who can afford top fitness experts and even super lingerie models get called out for having cellulite. And in a day when people claim to want to look natural, they don't want cellulite, something doctors say occurs naturally.

'Cellulite is a defect in the skin. Skinny people have cellulite. Fat people have cellulite and people of all different sizes in-between have cellulite. Cellulite means that the skin is thick in some places and thin in other places so you get bulges and dimples. If you treat the fat, that doesn't help cellulite,' said Dr. William Coleman, a dermatologic surgeon in Metairie and editor of the medical journal 'Dermatologic Surgery.'

'Cellulite is complicated and we don't really, totally understand it. But what we do know is that there are problems with the connective tissue that holds the fat in place,' said Metairie Dermatologist Dr. Patricia Farris, who is a spokeswoman for the American Society for Dermatologic Surgery. 'There are things called fibrous septa that hold the fat in compartments and in cellulite; we think it's those fibrous septa running at different angels, tugging on the skin that give the skin the dimpled appearance.'

'As much weight as I would lose, I was still kind of lumpy on my legs,' said Paula, a patient who did not want to give her last name.

Paula lives on the West Bank and was tired of cellulite and not seeing her clothes fit better after she started a diet and exercise routine, so her dermatologist, Dr. Mary Lupo, recommended a new machine on the market called SmoothShapes, which recently got FDA approval for the reduction of the appearance of cellulite.

'It smoothed out my legs a whole lot and I dropped two sizes,' said Paula.

'I would say that Paula's experience has been outstanding and that we do have a portion of patients who get the home run out of the ball park result from SmoothShapes. They actually get dimensionally smaller. They look thinner as if they got liposuction. We don't tell people that. Paula has gotten the best possible result,' Lupo said.

One of Lupo's staff members demonstrated how SmoothShapes works.

The machine has one laser wavelength that dilates the pores of the fat cells, allowing them to become more permeable, and a second laser wavelength melts the fat in the cells. Then the vacuuming or mechanical manipulation of the skin breaks apart those septa bands that pull the skin unevenly causing dimples.

The result is a smooth effect. There may be a little bruising, but people generally can go right back to work. And since cellulite is a skin condition, liposuction doesn't help, and if not done right liposuction can make it worse.

SmoothShapes can help post-liposuction too.

'We can tell you that we've been using the technology for about six months in the practice and patients have been very, very pleased,' Lupo said. 'We of course manage expectations. We do not say that SmoothShapes will make you skinnier. SmoothShapes will improve the appearance of cellulite, and most of our patients who come in are in pretty good shape and have pockets of cellulite that they would like to get rid of.'

'You're going to do two things. You're going to affect the fat and you're going to generate collagen. So much like we've done with our nonablative lasers where we beef up the collagen to improve wrinkles, with a laser used on the fat, we beef up that collagen to improve the contour of the skin,' Farris said.

Doctors say it's important to know that anything that helps the skin make more collagen makes the skin look better. Prescription retinoids, such as Renova, Retin-A and Tazorac, that help smooth wrinkles in the face also help smooth cellulite. And sun bathing and tanning beds that destroy collagen cause wrinkles in the face and cellulite on the body to get worse.

'The worst thing you can do if you have cellulite is go in the sun. And we have patients come in all the time, 'I'm going to the beach and I want my legs to looks better. You know that my cellulite looks better when it's tan.' But in reality, they are breaking down that collagen and we know when you break down collagen you reduce the supporting structure of the skin. What happens, the fat herniates out,' Farris said.

Coleman is not convinced the results are long lasting.

'It may make your skin look better for a few days. So if you're getting married and you're going to be on the beach tomorrow and you have a treatment you want to look better on your honeymoon, maybe for a few days your skin would look better,' Coleman said. 'But long term, it has no benefit at all.'

Lupo said she is seeing 80 percent patient satisfaction with this new technology.

'We see such an improvement in the skin texture after SmoothShapes that we've actually found that it improves photo-aging of the thighs in people who have gotten a lot of sun burns on their thighs and they get sort of a creepy texture of their skin. We've actually seeing SmoothShapes help that as well,' Lupo said.

But since cellulite is determined by the skin you inherit and your hormones, it may require some maintenance with this machine. Paula has now finished the treatment on her thighs, and since she's one of the patients whose skin is responding, she has started it on her abdomen and is already noticing a difference.

'They did only one and it made a big difference, because Christy (a Dr. Lupo staff member), actually said, 'Oh, you wore a skinnier top.' I said, 'Well actually I had to because the others were way too big this morning,'' Paula said.

The treatment costs $150 for each session. You'll need eight treatments -- two a week for four weeks.

Dr. Patricia Farris is no relation to Medical Reporter Meg Farris.

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