The latest literature review on aesthetic and cosmetic dermatology has been written by Wollina et al.^{(2, pdf)}  They address the application of hormone replacement therapy, Botulinum toxin (Botox) for brow lifting, three major approaches toward cellulite treatment, and body sculpting by lipotransfer and laser-assisted lipolysis.

Lipotransfer refers to moving excess fat from one region to another that needs it.  See examples of using autologous fat transfer (autologous means from self) to improve hollowed-out cheeks in older individuals in the article by Wollina et al. 

Laser-assisted lipolysis is a minimally invasive procedure using fine probes that use the heating effect of a laser to destroy fat cells jut beneath the skin, and the debris are then mechanically removed by another fine probe.  This process is for fine tuning fat deposits (see Fig 1) and has implications for treating cellulite though as of right now few physicians use it for treating cellulite.     

Fig 1. Laser-assisted lipolysis of the buttocks region of a woman.  Picture A show the initial appearance and picture B shows the appearance 23 month after treatment.

The kid of fat loss the woman is Fig 1 was looking for wouldn’t be easily achievable by exercise or dieting, and neither would it be recommended to her for the purposes of loosing body fat because she had a healthy amount of body fat to start with.

More articles will follow.

References

1. Draelos, Z. D., The facial rejuvenation algorithm, J Cosmet Dermatol, 5, 195 (2006).
2. Wollina, U., Goldman, A., Berger, U., and Abdel-Naser, M. B., Esthetic and cosmetic dermatology, Dermatol Ther, 21, 118 (2008).

A brief overview of laser and light-based treatment of cellulite was provided by Macrene Alexiades-Armenakas^{(1, pdf)} (information current as of late 2006) –  

Syneron Velasmooth – FDA (U.S. Federal Drug Administration) approved.  Involves infrared radiation, mechanical rollers and suction pressure.  The mechanical stressors add to the thermal (heat) stress.  

Cynosure TriActive – FDA approved.  Involves a laser and massage.

Synergie AMS – FDA approved.  Involves massage.

Thermacool – FDA approved for off-face wrinkle reduction; presumably would help cellulite.  Uses radiofrequency.

Alma Accent – Newer system compared to ‘Thermacool’; uses radiofrequency.  FDA approval was reported as pending.

Cutera ultrasound – FDA approval reported as pending; uses ultrasound for heating.

Ultrashape – FDA approval reported as pending; uses ultrasound for heating.

IllumiMed Photoactive – FDA approval reported as pending; uses light emitting diode for heating.

The common theme behind these approaches is causing mild heat injury to the collagen-rich connective tissue that enmeshes the fat cells immediately beneath the skin, and mechanical stressors may be added in some cases.  Some before and after pictures employing these methods will help illustrate how helpful they are.

Wanitphakdeedecha and Manuskiatti^{(2, pdf)} reported reduction in thigh and abdominal girth as well as improved appearance of the back of the thighs following the use of the Velasmooth system for treating these regions (e.g., Fig 1).

Fig 1. Before (top) and after pictures of reduced girth and smoothened skin following 8 heat-mechanical stressor treatments using the Velasmooth system.⁽²⁾

Sadick and Magro^{(3, pdf)} reported reduced thigh circumference and improved skin appearance in women undergoing thigh treatment using the Velasmooth system (e.g., Fig 2).

Fig 2. The outcome from 12 treatments employing the Velasmooth system spread over 6 weeks.⁽³⁾  Picture 1 shows a pretreatment picture, 2 shows the outcome 4 weeks after final treatment, 3 shows the outcome 8 weeks after final treatment and 4 shows the outcome 12 weeks after final treatment.

Fink et al.^{(4, pdf)} employed intense pulsed-light treatment with a retinyl-based cream (retinyl palmitate) and reported improved skin appearance using the light-based heating treatment alone or the combination treatment (e.g., Fig 3).  Vitamin A-derived retinyl compounds have been shown to improve the health and appearance of aged skin by stimulating increased collagen production.  The authors reported that the addition of the retinyl palmitate cream appears to help produce a better outcome though a definitive conclusion requires more trials.

Fig 3. The outcome from 12 treatments employing intense pulsed-light heating and 5-per-week topical application of retinyl palmitate, spread over 12 weeks.⁽⁴⁾  Before (left) and after pictures of a patient shown in row 1; row 2 shows another patient.

The potential side effects of these treatments include burns since heat is being employed.  Retinyl-based compounds may also cause skin lightening in the applied regions, which would be a problem for dark individuals, and increase skin sensitivity to sunlight.

Improved treatments can be expected in the future.  For instance, drugs that inhibit collagenase (an enzyme that breaks down collagen) may be of help in combating both cellulite and skin aging, but their application for treating cellulite will be a future discussion.

References

1. Alexiades-Armenakas, M., Laser and light-based treatment of cellulite, J Drugs Dermatol, 6, 83 (2007).
2. Wanitphakdeedecha, R., and Manuskiatti, W., Treatment of cellulite with a bipolar radiofrequency, infrared heat, and pulsatile suction device: a pilot study, J Cosmet Dermatol, 5, 284 (2006).
3. Sadick, N., and Magro, C., A study evaluating the safety and efficacy of the VelaSmooth system in the treatment of cellulite, J Cosmet Laser Ther, 9, 15 (2007).
4. Fink, J. S., Mermelstein, H., Thomas, A., and Trow, R., Use of intense pulsed light and a retinyl-based cream as a potential treatment for cellulite: a pilot study, J Cosmet Dermatol, 5, 254 (2006).

Sir:

I congratulate Dr. Munhoz and colleagues¹ on their modification of the central wedge technique, which I reported in 1998.² I applaud them for emphasizing the importance of preserving the natural labial borders to maintain a normal appearance and to prevent a possibly painful scar.

The authors used inferior wedge resection and superior pedicle flap reconstruction to perform a labia minora reduction. Although I agree that a wedge technique is preferable, I do not believe the inferior wedge gives a better result, for several important reasons. Women seeking this operation desire removal of the most bulky and protruding tissue. Removal of an inferior wedge leaves the bulky superior tissue as the labial edge. Often the inferior edge of the labium is the thinnest and least protuberant portion, as illustrated in their Figures 1 and 5. Removal of this area, therefore, is counterproductive. In contrast, a central wedge can be placed to remove the most objectionable portion of each labium. Perhaps the authors chose the superior pedicle as a solution to the difficulty in approximating the thicker upper labium, which is attached to a thick, convoluted, lateral clitoral hood to the thinner inferior labial edge. Approximating the inferior flap to the frenulum extension of the clitoris as it ends at the upper labial edge will solve this alignment quandary. Also, the outer wedge excision should then be curved laterally and anteriorly (“hockey stick” ) to excise this redundant lateral labium and excess lateral clitoral hood (if desired by the patient).³ Therefore, the internal and external V excisions are shaped differently, with the intervening subcutaneous tissue preserved while the leading labial edge is precisely re-approximated. Only enough subcutaneous tissue is excised to produce a good cosmetic result. This allows for better subcutaneous closure, which is necessary to prevent wound dehiscence and fistula formation.

The hockey stick lateral wedge excision allows for elimination of much of the unsightly lateral hood, which is a major aesthetic and often functional concern for these women; this issue is not addressed by these authors. In addition, the central wedge flaps are extremely healthy, with wide vascular bases that eliminate the tip necrosis problems seen with the superior flap technique. Therefore, a more predictable and better aesthetic outcome results with a central wedge excision combined with a lateral hockey stick V excision. A more detailed description of my technique and results will be forthcoming shortly.

Gary J. Alter, M.D.
Department of Plastic Surgery
UCLA School of Medicine
416 North Bedford Drive, Suite 400
Beverly Hills, Calif. 90210
altermd [@] altermd.com

References

1. Munhoz, A., Filassi, J., Ricci, M., et al. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast. Reconstr. Surg. 118: 1237, 2006.
2. Alter, G. J. A new technique for aesthetic labia minora reduction. Ann. Plast. Surg. 40: 287, 1998.
3. Alter, G. J. Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora. Plast. Reconstr. Surg. 115: 2144, 2005.

References

1. Munhoz, A. M., Filassi, J. R., Ricci, M. D., Aldrighi, C., Correia, L. D., Aldrighi, J. M., and Ferreira, M. C., Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction, Plast Reconstr Surg, 118, 1237 (2006).
2. Alter, G. J., Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction, Plast Reconstr Surg, 120, 358 (2007).
       

Fig. 1. Attractiveness ratings as a function of body mass index (BMI; weight in kilograms divided by square of height in meters).  In figure a, the Sabah men’s ratings are represented by the stars and red, dotted line, and the Kuala Lumpur men are represented by the triangles and blue, solid line.  In figure b, the Sabah men’s ratings are represented by the stars and red, dotted line, and the British men are represented by the squares and green, solid line.

Fig. 2. Attractiveness ratings as a function of waist-to-hip ratio (WHR).  In figure a, the Sabah men’s ratings are represented by the stars and red, dotted line, and the Kuala Lumpur men are represented by the triangles and blue, solid line.  In figure b, the Sabah men’s ratings are represented by the stars and red, dotted line, and the British men are represented by the squares and green, solid line.

Judgments by men in Britain and Kuala Lumpur were similar.  The optimum BMIs for the three groups were 20.35 (Kuala Lumpur), 20.74 (Britain) and 25.15 (Sabah).  Sabah men had a liking for heavier women.  Men in Kuala Lumpur preferred women with lower WHRs.  A similar trend can be seen in the British sample, but the find wasn’t statistically significant.  In the Sabah men, there was also no statistically significant relation between attractiveness ratings and women’s WHRs.  For the stimuli used, BMI was much more strongly related to attractiveness than WHR.

The authors noted that the cross-cultural comparisons using photos of women in front view (another study) resulted in similar finds to that in the present study, and then had this to say–

Why, then, did Marlowe et al. (2005) find a preference for lower profile WHR among the Hadza of Tanzania than among American men? The answer may lie in the stimuli they used. In their line drawings,WHR and body weight were covaried: the line drawings with lower WHRs (more protruding buttocks) also appear to have heavier body weights, and Hadza men may consequently be showing a preference for heavier figures rather than, or in conjunction to, lower profileWHRs. In other words, the apparent preference for low profile WHRs found by Marlowe et al. (2005) could be explained by a preference for a heavier body mass, low WHRs or both.

The Hadza are a sub-Saharan African population.  Swami et al.⁽¹⁾ have referred to these stimuli used by Marlowe et al. (2005).⁽²⁾

The answer that Swami et al. are looking for does not lie in the nature of the stimuli used but in anatomical differences between European and sub-Saharan African women.  Sub-Saharan women have wider waists plus narrower hips in front view, and more protruding backsides compared to European women.  So aesthetic preferences regarding waist-hip proportions may differ along these lines.  In another rural population from Bakossiland, Cameroon (Sub-Saharan Africa), men’s optimum female WHR in back view was 0.8, clearly higher than among European men.

In the second study,^{(3, pdf)} photos of British women in front view were shown to adolescent males in London, a high SES group from Apia (Upolu, Samoa) and a low SES group from Savai’i, Samoa.  The optimum BMIs reported by the males were 20.87 (Britain), 21.29 (Apia) and 21.30 (Savai’i).  Males from Savai’i had higher ratings for overweight women.  Males from Britain and Apia preferred women with lower WHRs, but this was not documented among the Savai’i group.  Traditionally, a large body size has been favored in Samoan women,^{(4, link)} but exposure to Western culture has resulted in some change.

So these two studies offer additional evidence for the impact of Western culture, but this should not be taken as people’s preferences being heavily shaped by culture.  Most Westerners strongly prefer above average femininity in women and a body size clearly larger than what is seen among the typically masculine and very thin high-fashion models, women with the highest status among models.  Instances of culture appearing to mold preferences are any of the following: 1) intrinsic majority preferences manifesting as culture, 2) peculiarities associated with high socioeconomic status, 3) trivial issues and 4) a people more clearly realizing latent preferences upon contact with another people/culture.

References

1. Swami, V., and Tovee, M. J., The relative contribution of profile body shape and weight to judgements of women's physical attractiveness in Britain and Malaysia, Body Image, 4, 391 (2007).
2. Marlowe, F., Apicella, C., and Reed, D., Men's preferences for women's profile waist-to-hip ratio in two societies, Evol Hum Behav, 26, 458 (2005).
3. Swami, V., Knight, D., Tovee, M. J., Davies, P., and Furnham, A., Preferences for female body size in Britain and the South Pacific, Body Image, 4, 219 (2007).
4. Pollock, N. J., Cultural elaborations of obesity - fattening practices in Pacific societies, Asia Pacific J Clin Nutr, 4, 357 (1995).

Fig 1. Guess which nose belongs to men and which to women; average nose shapes.  See text for details.

When the sex-specific nose averages were presented individually, the judges could generally not assign the correct sex to them.  In Fig. 1, the first two images on the left represent the average for women and the other two the average for men.  The differences are discernible in comparison; e.g., women have less projecting noses and a lower nasion (more on the nasion)

The authors made 3 composite images of a) both men and women who were satisfied with their noses (optimal), b) average noses (average) and c) those who were dissatisfied with their noses (unpleasant) (Fig. 2).

Fig 2. The columns depict averages for women (left) and men.  Top row depicts the averages for those satisfied with their noses, the middle row depicts the averages for the entire sample and the last row depicts the averages for those dissatisfied with their noses.

Those most dissatisfied with their noses had a nasal hump and lower tip rotation (which, taken to an extreme, will lead to a hooked-nose appearance) and heavier nose tip cartilage.  The study confirms a dislike for hooked noses and broad nasal tips in Europeans.

The authors also had the 3 composite nose averages for each sex rated for attractiveness by the judges.  The judges rated the women’s averages as optimal > average > unpleasant, and men’s averages as average > optimal > unpleasant.
   
The noses that went toward the averages/composites belonged to 311 individuals, which comprised of 128 men and 128 women that were selected randomly from Germany and Australia.

Among the women, 41.0% had a nasal hump, 42.9% had a straight profile, 11.8% had a concave profile and 4.3% did not fit in any of these categories.  Among the men, 36.4% had a nasal hump, 43.2% had a straight profile, 15.4% had a concave profile and 4.9% did not fit in any of these categories.  The nasal features found in the optimal composites were found in 15.4% of women and 43.2% of men.

See the article for miscellaneous measurements pertaining to optimal noses for men and women in the neighborhood of average height.  These will be handy for those considering rhinoplasty (nose job) though better articles on the topic have been addressed at this site before.  This study was from the perspective of the plastic/cosmetic surgeon and did not concentrate on documenting the subtlety of sex differences in nose shapes for anthropological purposes.

References

1. Springer, I. N., Zernial, O., Nolke, F., Warnke, P. H., Wiltfang, J., Russo, P. A., Terheyden, H., and Wolfart, S., Gender and nasal shape: measures for rhinoplasty, Plast Reconstr Surg, 121, 629 (2008).

This site was suspended for nearly a day, likely because someone posted a direct link at digg.com.  Please don’t place direct links to this site at very high traffic sites such as Digg or Slashdot.  The kind of traffic this site attracts does not leave much room for handling a large surge.  As of current it can handle, say, 7,000 additional unique users per day, but placing direct links to this site at very high traffic sites will result in this increase within a few hours.

Here is how to place links to this site at very high traffic sites.  Suppose you want to post the following url:

http://www.femininebeauty.info/news.php/weblog/comments/cellulite-skin-aging/

Post this address as:

http://www.femininebeauty.info.nyud.net/news.php/weblog/comments/cellulite-skin-aging/

This will send surfers to the Coral mirror of the webpage.  It is simply a matter of appending “.nyud.net” without the quotes to the url between the info and /. 

How to make wearing high heels less of a strain/burden.

It is generally advantageous for women to appear to have longer legs.  Wearing high heels helps achieve this illusion, but high heels result in mechanical stressors due to the transfer of more of the body weight to the balls of the feet.  This weight transfer can be reduced by using an insole as shown below.

The insole insert can be obtained in the form of a product known as insolia.

Some issues regarding the display of women’s breasts in public

Issues related to the display of women’s breasts in public are interesting.  For instance, a woman who nurses her baby in public in the U.S. can be arrested because of the breast exposure; Mary, mother of Jesus, is depicted fully clothed; but, one can buy magazines containing topless women at any convenience store.  On the other hand, in some developing nations, women can be seen nursing babies in public, Goddesses may be depicted topless, but pictures of topless women are difficult to obtain/suppressed.

Within any population, there also is great diversity of viewpoints regarding exposure of women’s breasts in public.  Some people who visit this site have complained about the censorship of women’s nipples whereas others have complained about excessive exposure of women’s bodies here.  Many feminists complain about the “double standards” whereby it is okay for men to expose their breasts but not women, and these feminists do not want women’s breasts to be a sexual object.

Recently, authorities in Copenhagen allowed women to bare their breasts in and around public pools.  Here are some interesting excerpts:

Swedish protesters carried out several full-frontal marches in their country but are still campaigning for bare-chested equality.

One of their leaders, 22-year-old Ragnhild Karlsson, said: “We want our breasts to be as normal and desexualised as men’s, so that we too can pull off our shirts at football matches.”

Activists expect a flurry of similar campaigns-across Europe, including in Britain.

The only protest against the move came from lifeguards who said they had problems knowing what to hold when rescuing swimmers in difficulties.

Frank Hedegaard, of the Socialist People's Party, said: “I cannot understand what some people find so offensive about women's breasts. This decision is important in order to stop the idea that women's bodies are only sex objects.”

These issues can be understood better by considering the basic anatomy of women’s breasts.  Women’s breasts primarily comprise of fat tissue, connective tissue to hold/shape the fat, and glandular tissue for producing milk.  The fat tissue-plus-connective tissue that enmeshes it is not required for producing milk.  Whereas fat tissue has energy reserves that can be used to produce milk, this fat does not need to be in the breasts.  In addition, the ideal breasts for suckling are those with long teats/nipples and a small amount of fat so that babies can breathe easily while they are nursing.

If the basic structure of women’s breasts is seen light of men’s preferences regarding women’s breasts, then it is clear that the shape component of women’s breasts that is feminine is for the purposes of sexual appeal.  Hence, much as feminists try to desexualize women’s breasts – which they will attempt by exposing their breasts in public – they cannot succeed in taking away the sexual appeal/value of well-formed women’s breasts.

So, many of the issues pertaining to the regulation of/cultural diversity associated with/oddities related to the depiction in public or exposure of women’s breasts are related to the sexual appeal of youthful/well-formed breasts.  In my case, the justification for the typical censorship of nipples within this site is that this helps reduce the titillation factor, which is not what this website is about, and makes browsing the site more palatable to a wider audience.

Another issue that is seldom discussed when it comes to displaying women’s breasts in public is the disturbing looks of the breasts in obese women and many old women.  It is for this reason that I do not have a problem with allowing women to bare their breasts in public as long as they are not old or obese.  Whereas not all old women have breasts that are disturbing to look at, if my attitude were translated to legislation, then there would be the question of how to objectively demarcate disturbing from non-disturbing breasts in old women.

So here are the issues.  Well-formed breasts have sexual appeal that no amount of exposure to malformed breasts will take away.  Some breasts are disturbing to look at, whereas other breasts are neither disturbing nor particularly appealing.  So the basic sketch of sound legislation in my opinion is that women with breasts than neither disturb nor especially appeal could be allowed to expose their breasts in public, women with well-formed breasts could be allowed to expose their breasts in public in only designated areas such as public pools or beaches, and women with breasts that are disturbing to look at banned from publicly exposing them. This legislation is mere fantasy, and drawing a fine line between appealing, neutral and disturbing breasts will be difficult, but a reason the restrictions appeal to me is that women most likely to defy this legislation will be feminists, and given the breasts many of them have, we are looking at an easy opportunity to put more feminists in prison.

Fig 1. Cellulite in a young woman (age between 21 – 30) and a middle-aged woman (age between 51 – 60); back of the thigh.

In younger women, the dimpled surfaces are larger and fewer in number.  Fig. 1 is a good reason why it is helpful to treat cellulite.  But is there an interaction between cellulite and aging?  Ortonne et al.^{(1, pdf)} investigated this question by assessing women, ages 21 – 60, with or without cellulite.  The results, for the skin of the thigh, are shown in Fig. 2.

Fig 2. Changes in skin parameters with age as a function of the presence or absence of cellulite.  See text for explanation.

The echogenicity of the dermis is an ultrasound measure of the density of the dermis (a skin layer).  As one ages, collagen decreases in the skin, making it less dense, but this effect is especially observable after age 60, which the authors didn’t study.  In Fig. 2 it looks likes the dermis is becoming denser with age in women without cellulite, but this is a sampling issue or a methodological issue that is addressed in the article.  The interpretation should be taken as good stability of dermal density in the cellulite-free women, whereas the dermis becomes less dense with age in women with cellulite.

Note also that cellulite-free women retain skin elasticity better with age.  The extent of wrinkling was unrelated to whether the women had cellulite or not.

In the women with cellulite, the total skin thickness was greater but the minimal thickness of the skin was lower because the hypodermis (layer just below the dermis) was pushed up into the dermis, presumably by the fatter fat cells lying just beneath the skin surface.

Whereas this is not a longitudinal study, i.e., a study where participants are followed as they age, it is quite likely that cellulite is associated with premature aging of the skin on some measures.  So is there a non-cosmetic reason to treat cellulite?  Possibly.

References

1. Ortonne, J. P., Zartarian, M., Verschoore, M., Queille-Roussel, C., and Duteil, L., Cellulite and skin ageing: is there any interaction?, J Eur Acad Dermatol Venereol (2008), doi:10.1111/j.1468-3083.2007.02570.x.

Azelaic acid for treating acne

Here is the abstract for the study on azelaic acid–^{(1, zip)}

Azelaic acid (AzA) 15% gel is approved for the treatment of rosacea in the US, but also has approval for the treatment of acne vulgaris in many European countries where it has demonstrated success. Two randomized, multicenter, controlled clinical trials compared the effects of AzA 15% gel with those of topical benzoyl peroxide 5% or topical clindamycin 1%, all using a twice-daily dosing regimen. The primary endpoint in the intent-to-treat analysis was a reduction in inflammatory papules and pustules. AzA 15% gel resulted in a 70% to 71% median reduction of facial papules and pustules compared with a 77% reduction with benzoyl peroxide 5% gel and a 63% reduction with clindamycin. AzA 15% gel was well-tolerated. In addition, a 1-year European observational study conducted by dermatologists in private practice evaluated the safety and efficacy of AzA 15% gel used as monotherapy or in combination with other agents in more than 1,200 patients with acne. Most physicians (81.9%) described an improvement in patients' symptoms after an average of 34.6 days, and 93.9% of physicians reported patient improvement after an average of 73.1 days. Both physicians and patients assessed AzA 15% gel to be effective with 74% of patients being "very satisfied" at the end of therapy. AzA 15% gel was considered "well-tolerated" or "very well-tolerated" by 95.7% of patients. The majority of patients were more satisfied with AzA than with previous therapies. AzA 15% gel represents a new therapeutic option for the treatment of acne vulgaris.

So what is the good news about azelaic acid?  From the report–

It is well-tolerated by itself or in combination with other agents.  It has a clinical profile that is compatible with long-term use, including sustained efficacy, the inability of bacteria to become resistant to it and patient acceptance.  It is not teratogenic (tending to cause birth defects) or mutagenic (tending to alter the genetic code), and consequently can be used safely during pregnancy.  So azelaic acid is a good choice to treat papulopustular acne vulgaris.

Photopneumatic technology for treating acne

People have successfully used light sources to combat, to some extent, mild to moderate acne.  Blue light kills the bacteria that infect acne-laden skin and red light reduces inflammation.  The light sources can be bulbs or light-emitting diodes emitting a narrow range of colors or a laser emitting a single frequency light. 

Here is a basic review of the traditional light-based treatments–

Blue light exposure. Blue light is used to target the bacteria, but this is of limited help for dark-skinned people or people in whom there is a lot of blood flowing close to the skin surface since melanin (brown pigment) and hemoglobin (red pigment) will absorb a lot of the light.  To make the light penetrate farther, one has to use higher energy lasers, which makes the treatment painful, necessitating the use of anesthetics.  

Pulsed light and heat treatment. This combines pulses of light with heat.  The light targets the bacteria and the heat targets the sebaceous glands (oil-producing glands in skin), shrinking them, but there is a risk of heat-related damage to surrounding tissue.

Photodynamic treatment. 5-aminolevulinic acid or methyl aminolevulinate is applied to the skin for 15 – 60 minutes to make the skin more sensitive to light.  Then the skin is cleaned and exposed to blue or red light.  Side effects include temporary reddening, skin swelling, increased pigmentation of skin and sometimes vesiculation (the papules start becoming vesicular or like a vesicle).

These approaches have been recommended for mild to moderate acne.  The most effective treatment has been a combination of pulsed light plus heat treatment and photodynamic treatment.  Now a more effective light-based technology employing a photopneumatic (light + suction pressure) device has been approved for treating mild to moderate acne as well as pustular and comedonal acne.  A study has shown that it improves even severe nodular acne and severe cystic acne.^{(2, pdf)}  And the good news is that no anesthesia is required since the process is not painful.

Basically, this device is put on the skin and sucks some of it in, and then the oily contents are mechanically removed.  The surface of the sucked-in skin expands, better allowing light to penetrate it.  Blue light destroys the bacteria and red light reduces inflammation.

Pictures say it–

Fig 1. After 2 treatments, spaced 9 weeks apart.

Fig 2. After 3 treatments.

Fig 3. After 4 treatments.

Fig 4. After 4 treatments.

References

1. Thiboutot, D., Versatility of azelaic acid 15% gel in treatment of inflammatory acne vulgaris, J Drugs Dermatol, 7, 13 (2008).
2. Shamban, A. T., Enokibori, M., Narurkar, V., and Wilson, D., Photopneumatic technology for the treatment of acne vulgaris, J Drugs Dermatol, 7, 139 (2008).
   

The cottage cheese appearance of cellulite is caused by fat cells bulging out against connective tissue strands.  Since these fat cells are close to the skin surface and localized over a small region, one could try to either use a topical preparation of a lipolytic agent or inject lipolytic agents just beneath the skin (referred to as mesotherapy) to shrink them and improve the appearance of the skin.  Caruso et al. evaluated the efficacy of various drugs in breaking down fats in a culture of human fat cells.^{(1, pdf)}  Whereas this was not an example of actual application of product on women, some of these drugs have been successfully used on women, as cited in the article.

In the table below, the first column lists the drugs used that may be used singly or in combination.  The assay buffer is just a lipolytic-agent-free solution that is used as control or as a baseline reference.  The third row is labeled fold induction, and this is a measure of the extent of fat breakdown.  The control/baseline value is 1.0.  Values higher than 1.0 imply fat breakdown.  It is possible that a value of 1.2 is obtained by chance rather than fat breakdown, but a value of 2.5 is unlikely to be obtained by chance.  So the fourth column lists the probability that the listed value results from chance alone rather than genuine fat breakdown.  If this probability value is less than 0.05 or less than 5%, then the likelihood of the higher-than-one value resulting from chance alone is so low that most likely we are looking at genuine fat breakdown.  So we can be confident that in all trials except that described in the row before last there was genuine fat breakdown.

Note the last two rows in the table.  The drug combinations in the last two rows produced the lowest values (one was ineffective, the other barely effective).  These low values result from lidocaine, an anesthetic.  Curiously, topical applications sold to combat cellulite usually contain anesthetics such as lidocaine, procaine and prilocaine, and topical anesthetics tend to suppress fat breakdown.  So one shouldn’t be using products containing topical anesthetics.

There also is the issue of side effects, but I am guessing that with some exceptions the side effects are typically minimal because one doesn’t need a prescription for most of these drugs.  The one problem that I see would be isoproterenol.  If a sufficiently large amount of it were absorbed by the body then it would cause enlargement of the skeletal muscles and heart, but the amount needed for mesotherapy may not be reason for concern.  I will see if I can find more information because as seen from the table, a combination of Aminophylline and Isoproterenol was the most potent.

There are bound to be many more drugs that will work.  They would need to be absorbable by the skin if applied topically and have lipolytic activity, and of course minimal side effects. 

Looking at the table, chances are that some topical applications could be made at home or at least the informed reader can do some smart shopping to avoid wasting money on products by big companies that make one pay for their advertising costs.

References

1. Caruso, M. K., Roberts, A. T., Bissoon, L., Self, K. S., Guillot, T. S., and Greenway, F. L., An evaluation of mesotherapy solutions for inducing lipolysis and treating cellulite, J Plast Reconstr Aesthet Surg (2007), doi:10.1016/j.bjps.2007.03.039.