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By Eirish Sison

You've done everything right in the fight against cellulite — you drink plenty of water, you eat a low-fat diet and you work out. You even do the occasional butt lift exercise at the gym. But when you turn to look in the mirror, you're confronted with the dreaded cottage cheese bottom — dimpled, lumpy skin on your thighs and rear.

Take a deep breath, put down the expensive, age-defying cream and know that you're not alone. Nearly 90 percent of women over 30 find themselves in a seemingly never-ending battle with cellulite — body fat that is deposited in pockets underneath the skin, usually in the hips, thighs, upper arms and bottom. Cellulite is no different from other fat deposits — it just looks bumpy or dimpled because it's pushing through the tissue that usually keeps your skin looking smooth and even.

So should you raise the white flag and surrender to cellulite? Is it a natural part of aging that most women — and some men — have to accept, or is there any way to really reduce its appearance? Experts suspect that genetics, poor diet, crash dieting, dehydration or hormone changes may play a part in the formation of cellulite, but the exact cause is still unknown - which can make its appearance even more frustrating. We asked Dr. Michael Wolfeld, practicing aesthetic plastic surgeon in New York City and MedHelp's cosmetic and reconstructive surgery expert, to review six popular treatments and rate their effectiveness in getting rid of cellulite for good.

Endermologie

Endermologie is a treatment that aims to smooth out fat underneath the body's connective tissues, distributing it more evenly under the skin, smoothing out any bumps and dimples. The treatment is delivered by a machine with two rollers and a suction that folds skin in the areas where cellulite exists and feels like a deep massage. Endermologie is performed twice a week at a dermatologist's or plastic surgeon's office, with each pain-free session lasting anywhere from 10 to 45 minutes.

While the Food and Drug Administration endorses endermologie as an effective temporary treatment for cellulite, Dr. Wolfeld says there is little scientific evidence that the treatment is effective for permanently reducing or eliminating cellulite.

Subcision

Subcision is performed by inserting a needle into the skin to cut the connective tissues that have been pulled downward by fat cells. Severing those bands helps reduce the appearance of dimples in the skin.

While this method can also temporarily improve cellulite, Dr. Wolfeld said this method may not provide any long-term improvement in the appearance of cellulite.

Mesotherapy

This technique claims to reduce cellulite by injecting medicines, vitamins, plant extracts and other substances into the skin to "melt" fat cells. Many doctors avoid mesotherapy because there is no precise protocol for administering the treatment, the outcome is unpredictable and the risk of side effects (including swelling, bruising, infection and irregular skin contours) is high, according to Dr. Wolfeld. In addition, he says that few studies have shown any clinical benefit from mesotherapy.

Cryolipolysis^TM

This method, also called ZELTIQ® CoolSculpting®, uses cooling technology to destroy fat cells. Fat cells crystallize at a lower temperature than the other cells of the body, making it possible to target them specifically in this type of treatment. (Read Dr. Wolfeld's description of Zeltiq here).

Dr. Wolfeld describes Cryolipolysis^TM as a newer, noninvasive treatment option for targeting fat in specific areas of the body, but further study is needed to determine whether it can improve the appearance of cellulite.

Liposuction

Liposuction is plastic surgery to remove fat from the body. While liposuction has been proven to reduce the amount of fat deep beneath the skin, Dr. Wolfeld doesn't consider it an effective option for removing fat that is closer to the surface of the skin, like cellulite. In fact, liposuction can actually lead to more problems with skin dimpling, not less, because removing fat loosens up the skin.

Topical Treatments

There are several lotions on the market today that boast cellulite-reducing properties. However, according to Dr. Wolfeld, there are no large-scale studies that back up their effectiveness.

What does he recommend? A retinol cream. Retinol is a form of vitamin A, and Dr. Wolfeld says that applying a retinol cream daily over a period of 6 months or more has been shown to improve cellulite - possibly because of chemical compounds in the cream that help increase the thickness of skin layers and improve the contour of the elastic fibers that keep fat smooth and evenly distributed.

Eirish Sison is a health writer based in the San Francisco Bay Area.

Published October 17, 2011.

See also:

• Share your experiences in our Cosmetic Surgery health community
• Still curious about the procedures we mentioned? Ask a doctor in our expert forum
• Dr. Michael Wolfeld explains more about ZELTIQ® CoolSculpting® for weight loss
• Does a tummy tuck get rid of stretch marks?
• Learn how to sculpt a sexy body from head to toe with these 16 great moves