Medical professionals may say it's perfectly normal and poses no health concerns, but cellulite has troubled women since the advent of skimpy swimwear, short shorts and miniskirts.
Diet and exercise can help, but there's no surefire fix for those puckered patches of skin that resemble cottage cheese.
"It's an ongoing search for the holy grail," said Dr. Kaveh Alizadeh, a plastic surgeon who's president of Long Island Plastic Surgical Group, which has offices in Garden City, West Islip, Manhattan and Brooklyn.
Fat typically finds a home in women's thighs, hips and buttocks, and that's where cellulite tends to show up. Some women have more visible lumpiness than others. No one knows just why.
Cellulite affects 85 to 98 percent of women and adolescent girls, and it doesnt discriminate by race, according to research published in the Journal of Cosmetic and Laser Therapy in December 2004.
That's partly due to women's physiology. Beneath the skin's surface, fibrous tissue called "septa" connect muscle to skin and hold fat in place, Alizadeh explained. In women, the septa pull fat into pockets, much as buttons tuft upholstery, resulting in a cluster of bumps and depressions. Weight gain only exacerbates the problem.
Men's tissue structure differs from women's and is less likely to develop that orange-peel texture, he said.
Women with baby-smooth skin, then, probably have other factors working in their favor. Everyone else is fighting a battle against nature.
"It's probably hormonally related, or it could be genetically related," said Manhasset- and New York City-based plastic and cosmetic surgeon Dr. Arnold Breitbart, an assistant professor of clinical surgery at Columbia University College of Physicians and Surgeons.
Because multiple factors influence its development, treatments for cellulite vary widely. Nothing will permanently erase cellulite, but plastic surgery experts believe it's possible to minimize its appearance.
Be sure to seek a specialist you trust, they say, and get more than one opinion.
The American Society for Aesthetic Plastic Surgery has a tool on its Web site (surgery.org) to help people find a plastic surgeon certified by the American Board of Plastic Surgery or an equivalent peer-review organization. The American Academy of Dermatology has a similar service on its site (aad.org) to help people find a certified dermatologist.
THE LONG ISLAND SCENE
Breitbart uses "SmartLipo," a laser-assisted liposuction technique that helps break up the fat and connective tissue in cellulite. He said results last a year or longer.
Liposuction may not be recommended for everyone with cellulite, Breitbart acknowledged, but he said that many of the patients he treats also have excess fat. "The patients who have extra fat who are candidates for liposuction - and incidentally also have cellulite - often get improvement of their cellulite with the SmartLipo," he said.
Alizadeh is leading a clinical study to assess the effectiveness of "Sculptra Aesthetic," an injectable, collagen-stimulating treatment to reduce the appearance of cellulite.
He also uses "VelaShape," a nonsurgical therapy involving radio frequencies, infrared light, massage and suction. Patients can expect a smoother appearance for about a year, he said.
But people must be realistic, Alizadeh cautioned. "You can't be 300 pounds with cellulite and say, 'I want to look smooth,' " he said. "Well, first you've got to lose the weight."