Key Words: Lymphedema, Lipedema, Cellulite, Massage therapy, Lipo Massage
This is a new therapy originally designed and used to treat cellulite.I have included a brief article on it because lymphedema patients have submitted questions regarding its use for lymphedema and it is now actually being used experimentally to treat our condition.
The concept behind the treatment is that as a result of the roller massage of the affected areas, and the increase in body circulation fat cells are broken down and removed by the body process. The treatment is not permanent and cellulite patient may require numerous future treatments to maintain their appearance.
According to the proponents endermologie is non-surgical and non-invasive. It involves the use of a motorized device with two adjustable rollers and controlled suction, which creates a symmetrical skin-fold. The skin gently folds and unfolds under the continuous action of the rollers allowing for smooth and regulated deep tissue mobilization. As the viscosity of the subcutaneous fat layer decreases, blood flow and lymphatic drainage increase, facilitating the elimination of excess fluid and metabolites, while improving overall cellular function. (1)
There is a newer version of endermologie, called Lipo Massage being marketed today that claims to help breakdown not only cellulite, but claims to help breakdown the tissue fibrosis of post-mastectomy arm lymphedema. I did find one preliminary study which is shown below. I have found no other study for lymphedema or lipedema. There are no studies for leg lymphedema.
My frustration in attempting to find information is double-fold. First, studies on endermologie are quite old, most being in the 1900's. Secondly, the one clinical study that has been for for arm lymphedema was conducted by one of the very individuals now marketing the treatment modality, so there could be doubts as to its "blind" or "independent" status.
There are no controlled clinical studies available the demonstrate this therapy is in fact appropriate or successful in the treatment of lymphedema. The concepts of massage and the breaking down of fibrosis is "somewhat" similar to decongestive therapy, however with no substantial evidence, I must remain somewhat of a skeptic. It is noted also, that even with this treatment, first, it must be followed up by MLD/CDT and to keep swelling down you would still be required to use the prescribed compression garments and compression bandages. More studies are called for.
This treatment might indeed help in body contouring, but there are no studies indicating it is any type of solution to lipedema.
The same statement I made for lymphedema is for lipo-lymphedema (lipedema with lymphedema). It is noted also, that even with this treatment, first, it must be followed up by MLD/CDT and to keep swelling down you would still be required to use the prescribed compression garments. More studies are called for.
I understand the concept that by rolling the tissue, you help move fluids of of them and perhaps soften the tissues, but until further totally independent studies are conducted, I remain somewhat skeptical on its over value.
According to the information I could locate, this isn't even a permanent solution for cellulite. All it seems to do is move fat around in body sculpturing. It doesn't remove excess fat cells from the body, nor is the smoothness achieved by this treatment permanent. You must continouslly go through treatments to maintain what was originally produced.
It is also noted that many times lipomassage/endermologie is used in conjunction with liposuction to achieve the desired longer term results. This dramatically changes the claim that it is a non-invasive procedure.
Update April 19,2008
Clinical Studies and Abstracts:
Endermologie (with and without compression bandaging)--a new treatment option for secondary arm lymphedema.
Lymphology. 2007 Sep
Department of Surgery, Lymphoedema Assessment Clinic, Flinders University and Medical Centre, Bedford Park, Adelaide, South Australia.
Two treatment protocols are presented using the LPG Endermologie system in combination with compression bandaging as a new treatment option for secondary arm lymphedema. Both protocols were applied 4 days a week for 4 weeks but differed in Trial II in time spent clearing the regions of the trunk adjacent to the swollen limb and the addition of a larger treatment head so that a greater area could be covered more quickly. The first protocol involved 24 women and the second involved 10 women. At the end of the treatment period, both protocols demonstrated overall reductions in limb volume (134mls; 18.3% p = 0.000 and 185mls; 28%, p = 0.002), limb fluid (182mls; 28%, p = 0.000 and 216mls; 33%. p = 0.014), truncal fluid (342mls; p = 0.002 and 290mls; p = 0.066), improvements in fibrotic induration in some lymphatic territories, and significant improvements in subject reporting of heaviness, tightness, tissue hardness and limb size. Trial II demonstrated additional benefits in terms of reduction in whole arm volume at 24 hours, improved fluid and arm volume reductions, and a significant improvement in subject reported arm range of movement. The additional time spent clearing the regions adjacent to the swollen limb in the second protocol appears to produce an increase in limb volume and limb fluid loss compared to the original treatment protocol.
Noninvasive mechanical body contouring: (Endermologie) a one-year clinical outcome study update.
Chang P, Wiseman J, Jacoby T, Salisbury AV, Ersek RA.
LPG Endermologie is a machine-assisted massage system that allows positive pressure rolling, in conjunction with applied negative pressure to the skin and subcutaneous tissues (LPG Endermologie U.S. A. (800-222-3911). Endermologie was originally developed in the late 1970s in France to soften scars and standardize physical therapy; however, patients treated with the LPG machine also showed improvement in body contour and skin texture. Since then, Endermologie machines have been used in France, the United States, and many other nations as an alternative method to altering fat distribution in the subcutaneous plane. The authors have continued their study of determining the safety and efficacy of this machine. Since our last report in March 1997 (Ersek RA et al., Aesth. Plast. Surg. 21(2):61-67, 1997), we have compiled records of 85 additional patients. With this larger patient pool, we can expect more statistically accurate results. This study is composed of 85 women between the ages of 21 to 61. The study group exhibited a wide range of body habitus, initial weights, and final results. Out of 85 patients, 46 patients completed seven sessions of treatment and showed a mean index reduction in body circumference of 1.34 cm, while 39 patients who completed 14 sessions of treatments showed a mean index reduction in body circumference of 1.83 cm. A decrease in mean body circumference index was seen regardless of loss or gain in patients' weight in most cases
Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream
Plast Reconstr Surg. 1999 Sep
Department of Plastic Surgery, Bradford Royal Infirmary, West Yorkshire, England, UK. email@example.com
Cellulite is a common phenomenon that particularly affects the thighs and buttocks of women. Little scientific evidence exists to support any of the many advertised treatments for it. A total of 52 of 69 women, who were divided into three groups, completed a 12-week, randomized, controlled trial in which the effectiveness of two different treatments for cellulite was assessed. The patients acted as their own controls. The treatments investigated were twice-daily application of aminophylline cream and twice-weekly treatment with Endermologie ES1. Group 1 (double blind) received aminophylline to one thigh/buttock and a placebo cream to the other. Group 2 (singly blind) received Endermologie to one thigh/buttock. Group 3 received Endermologie to both sides and used the same cream regimen as group 1. Results were assessed subjectively by the patient and by clinical examination and photographic assessment by the surgeon (before and after the trial). Morphologic assessment included body mass index, thigh girth at two points, and thigh fat depth measurement by ultrasound. No statistical difference existed in measurements between legs for any of the treatment groups (paired t test, p > 0.4). The best subjective assessment, by the patients themselves, revealed that only 3 of 35 aminophylline-treated legs and 10 of 35 Endermologie-treated legs had their cellulite appearance improved. The authors do not believe that either of these two treatments is effective in improving the appearance of cellulite.
Study Documents Effects Of Cellulite-Smoothing Technique
Source: Vanderbilt University Medical Center
A Vanderbilt University Medical Center study shows Endermologie, a technique of using a system of rollers and a vacuum device to manipulate the skin, works to smooth cellulite.
According to the results in the study, the cellulite-smoothing effects are not a result of reduction in fat or the growth of new blood vessels but some other, less understood mechanism.
"The technique has been in wide use for a number of years but this study is the first scientific evidence that Endermologie does something," said Dr. R. Bruce Shack, professor and chair of Plastic Surgery, who conducted the study along with Lillian B. Nanney, Ph.D., professor of Plastic Surgery, and others in the department.
Anecdotal evidence from both Europe, where the Endermologie device was invented by a French company about 10 years ago, and the U.S. had indicated a lessening of the appearance of the "cottage-cheese-like" appearance on the skin of those who underwent a series of treatments. But there had been no scientific evidence of how this apparent effect was achieved.
The findings of the VUMC study, which were based on studies with Yucatan mini-pigs, were published in the November/December edition of the Aesthetic Surgery Journal.
"The pig has long been known to be the best model for human skin," Nanney said. "It doesn't have any fur, and it's relatively fat."
The most commonly advanced theory about how Endermologie achieves its apparent effects was that the machine, which resembles a high-tech vacuum cleaner with rollers on the hose nozzle, broke up fat, which was excreted, and also led to the formation of new blood vessels.
"We found nothing of the kind," Shack said. "There was no evidence of fat metabolism or excretion, no decrease in the thickness of the subcutaneous tissue that we could measure, and there was no evidence of new blood vessels.
"What we saw was an absolute and total surprise to all of us. There was the creation of collagen bands that run parallel to the surface of the skin." Shack said the formation of these bands was more marked in the pigs who were treated more often, adding weight to the idea that the changes were the result of the Endermologie treatments.
"We're convinced that this response we are seeing in the pigs is real, we just don't know what it means," he said. "If this collagen is deposited in the deep layers of the skin running parallel to the surface of the skin, as that collagen contracts, and if there has been a loosening of the fat-fascial interface, you could speculate that that might have a smoothing effect on the surface of the skin."
Dr. David Adcock, a research fellow in Plastic Surgery who worked with Shack and Nanney on the published study, noted that the skill of the machine's operator could have a great deal to do with the effectiveness of the treatment.
"Nobody has done anything to measure the force that's exerted on the tissue," he said. "It's the kneading itself that generates the most force on the tissue."
Shack said future studies on both pigs and clinical studies on humans are being planned to investigate issues such as the role of the operator in the effectiveness of treatment, and how long effects of treatments last. Elsewhere, Endermologie is also being investigated for its possible use in treatment of burn scars and lymphedema.
Endermologie: humoral repercussions and estrogen interaction.
Aesthetic Plast Surg. 1999 Sep-Oct
Noninvasive mechanical body contouring: (Endermologie) a one-year clinical outcome study update.
Aesthetic Plast Surg. 1998 Mar-Apr
Noninvasive mechanical body contouring: a preliminary clinical outcome study.
Aesthetic Plast Surg. 1997 Mar-Apr
Endermologie uses mechanical roller and regulated suction to create symmetrical skin folds, temporarily stimulating circulation to the area. Each Endermologie treatment lasts 30 to 45 minutes, and patients typically need dozen or more treatments for visible results. After the desired effect is achieved, the patient will need to maintain the effects of the cellulite treatment with additional Endermologie sessions at less frequent intervals. Because this cellulite treatment addresses only the appearance of cellulite, and not the root causes, bumps and dimples may reappear in the months after Endermologie treatments cease unless maintenance sessions are performed.The long-term results of this noninvasive treatment have not been established, but Endermologie has been used as a method of cellulite treatment since 1996 in the United States, and users claim that it can also be used to soften burn scars and connective tissue. When Endermologie is used in order to treat the appearance of cellulite, it is often combined with liposuction to improve results. Because Endermologie is, in fact, able to improve the appearance of cellulite, its popularity continues to grow, and the treatment is now widely available, with many cosmetic surgeons offering the service in their clinics or offices.
For Further Information:
American Skin Care and Cellulite Expert Association
is a non-invasive technique for reducing the appearance of cellulite.
Cellulite often shows up as dimpling on the skin, sometimes called the
cottage cheese look, even in those who are fit. The look of cellulite
does not necessary diminish with weight loss and liposuction fails to
address this top layer of fat under the skin.
French plastic surgeons developed the techniques used in endermologie. The process is now patented in the US as well. Endermologie uses rollers that often feel like deep tissue massage, over problem areas of the skin. At the same time, suction is used to redistribute the skin and remove dimpling. Those opting for endermologie usually need about 14 to 28 45-minutes sessions to see results and must also have monthly treatments afterwards to maintain the smooth skin look.
Endermologie works best on candidates who are fit, and who are usually between the ages of 30 to 45. Those who do not regularly exercise may see only temporary results and those over 30 pounds (13.60 kg) overweight tend not to benefit from the procedure. Beyond regular exercise, drinking water on the day of procedures helps yield a better result. Doctors frequently ask patients to drink eight glasses of water prior to the procedure, and to maintain this habit daily afterwards.
Side effects are minimal and may involve bruising or soreness in the areas treated. Many patients like the feel of endermologie and find this temporary soreness a small price to pay. Those who are extremely sensitive to pain may find the pressure exerted by rollers very uncomfortable.
Price of endermologie, when adding up all sessions, is somewhat comparable to one session of liposuction. Liposuction of a small area tends to cost about 2000 US dollars (USD) or more. An endermologie session costs about 90 USD. The minimum 14 visits and monthly follow-ups tend to be slightly under 2000 US dollars. However, those needing more treatments may ultimately pay more than a single liposuction session. Proponents of endermologie feel the procedure is still economically sound, and since it addresses an area which liposuction tends not to resolve, it is an excellent treatment. Since the procedure is cosmetic, it usually is not covered by health insurance.
However, if one does not maintain monthly maintenance sessions, endermologie will not permanently reduce the dimpled effect of cellulite. The effect is temporary and must be maintained. Those who do not plan to maintain the look may waste their money on initial endermologie sessions. The cellulite in reality is not gone and will come back.
Endermologie: Can You Knead Fat Away?
A Contrary Opinion
is a treatment in which a machine
rolls, pulls, suctions, and massages parts of the body in the attempt
the appearance of cellulite. There isn’t a shred of evidence that these
machines have any effect on cellulite, fat, collagen, or skin. The
itself would actually be laughable if so many women weren’t taking it
seriously and spending their hard-earned dollars on treatments. Most
that there are even some physicians who advertise that they offer
What may catch your attention is that these machines are often advertised as being FDA-approved as Class I medical devices for the treatment of cellulite and are therefore safe, effective, and approved by the FDA for that purpose. Nothing could be further from the truth. While Endermologie machines are Class 1 Medical Devices, that is hardly noteworthy. According to the FDA (www.fda.gov) “Class 1 Medical Devices are subject to the least regulatory control … Foreign establishments … are not [even] required to register their product with the FDA…. Examples of Class I devices include elastic bandages, examination gloves, and hand-held surgical instruments.” It is shocking to consider that examination gloves are equal in quality control to Endermologie machines. The FDA attributes no efficacy value to Endermologie machines.
Salons and web sites touting Endermologie’s amazing results often refer to the existence of thousands of studies demonstrating its effectiveness. But those studies simply don’t exist. If anything, the published research proves just the opposite. The authors of an article in the Aesthetic Surgery Journal, November 1998, concluded that “Endermologie treatment does not cause fatty tissues to be broken down, mobilized, or excreted . . . Although adipocyte [fat] injury occurs, there is no net decrease in subcutaneous tissue thickness.” The only research showing any improvement was published in Aesthetic Plastic Surgery (July 1998), stating that “From our observations we conclude that LPG Endermologie system is [a] mildly effective method for fat mobilization and contouring.” But this study only observed 22 women, it was not done double-blind or with placebo, and there was no other analysis done on whether or not anything took place under the skin. Further, a rebuttal article challenging this study was published in this same journal in November 1998, concluding that no real improvement took place. And finally, a study published in Plastic and Reconstructive Surgery (September 1999, pages 1110-1114) concluded that Endermologie treatment is not effective in improving the appearance of cellulite. If other research exists I have yet to be sent any despite requests to companies selling these machines.
Wasting money on seductive beauty treatments that don’t actually work seems to be a weakness for lots of women the world over. The false hopes these products and procedures provide are definitely alluring, but there are so many better ways to spend our time and money. Endermologie is simply a sad reminder of our vulnerability around spurious promises of youth and beauty.
Paula Begoun link no longer available
Basic Questions from Plastic Surgeons regarding Endermologie for patients
Index of articles for Lymphedema Treatment :
Complex Decongestive Therapy
Flexitouch Device - Initial Observations
Flexitouch Device for Arm Lymphedema
Kinesio Taping (R)
Laser Treatment - Sara's Experience
Light Beam Generator Therapy
Lymphedema Treatment Programs Canada
Lymphedema Treatments are Poorly Utilized
Short Stretch Bandages
Why Compression Pumps cause Complications with Lymphedema
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