COMMENTARY

Abstract

COMMENTARY Cellulite is considered a secondary female characteristic1 and has even been demonstrated upon pinching a 6-month-old, female infant's thigh2 … therefore it is reasonable to believe that a significant challenge awaits those seeking to cure this “disease.” Hexsel et al3 should be commended for designing a unique, blinded investigation aimed at visualizing and quantifying the oft cited “fibrous septae” responsible for the pathognomonic peau d'orange appearance of cellulite. They demonstrate convincingly that a relatively thick (>2 mm) vascular and/or lymphatic fibrous tissue network permeates within the subcutaneous tissue underlying skin exhibiting cellulite. In order to be effective, therapeutic approaches for cellulite will have to disrupt these septae. It is unlikely that currently available injectable and superficial energy based devices4 will have a profound effect on these septae, effacing the skin dimpling bothersome to many patients. As this study and the work of others5 reveal, the architecture of fat and cellulite is complex. Despite its expense, MRI should be integrated into controlled studies of treatments intended to reduce the appearance cellulite, just as Goldberg and colleagues recently presented.6 Perhaps broader appreciation of anatomy and refining photography and other outcome measures in clinical studies will eventually lead to sophisticated methods that alleviate this benign but aesthetically bothersome condition. ADAM M. ROTUNDA MD *Newport Beach, CA