Cellulite – the dimpled, uneven skin that mars the backsides and thighs of women everywhere – is a scourge to bikini-wearers and a squelcher of lights-on romps in bed. No wonder the search for a solution has women shelling out millions. Some of the new light was shed recently in a New York Times article by a few cellulite experts.

Miracle cures advertised on billboards and all over internet are greatly exaggerated. “At this point, there is no outstanding treatment for cellulite,” said Dr. Molly Wanner, an instructor in dermatology at Harvard Medical School and an author of an evidence-based review of existing treatments in 2008. A lasting remedy would have to address the interplay between skin, fat, connective tissue and underlying muscle.

Still, treatments abound, from contour-refining lotions and liposuction to massage machines with lasers and light sources. And there’s no shortage of takers. The market for cellulite-reduction devices in the United States was more than $47 million in 2008, said Amy Krohn, a spokeswoman for the Millennium Research Group. It is projected to grow to $62 million by 2013.

But no treatment has emerged as the gold standard. “Most studies show a 25 to 50 percent improvement after multiple treatments,” Dr. Wanner said. “Some patients have even less improvement, and the effects may go away over time so patients may require additional treatments.”

Cellulite is a telltale sign that life is a crapshoot. Most women get cellulite after puberty. But men usually don’t. That’s because the connective tissue bands under men’s skin are crisscrossed like a net, keeping their fat more evenly restrained. By contrast, women’s tissue bands are organized in vertical columns, so fat may bulge irregularly.

“At a normal weight your fat cells fall nicely into valleys of connective tissue,” said Dr. Michael D. Jensen, a clinical professor of medicine at the Mayo Clinic, who has studied fat for 25 years. “When you get too many fat cells or too big of fat cells now they push up on the roof.” Or, your skin.

What’s more, women don’t have as thick a roof as men, all the better to show dimples. And thanks to estrogen, women have more fatty reserves.

It doesn’t stop there. As we age, the connective tissue strands between our skin and muscle, which used to stretch to accommodate weight fluctuations, become inflexible. “Some of the bands tighten down and you get pockmarks with bulges next to them,” said Dr. Brian M. Kinney, an assistant professor of plastic surgery at the Keck School of Medicine at University of Southern California. Voilà, cottage cheese.

Traditional liposuction removes the fat, but it does not do anything to the inflexible connective tissue or too-thin skin. Laser assisted liposuction does a better job by heating and damaging collagen, which in turn causes connective tissue re-growth. New connective tissue is likely to have a much better flexibility and may result in tighter skin.

Cellulite is an uphill battle and no single treatment or laser modality can offer a complete cure. Cellulite reduction calls for a complex approach involving multiple laser and non-laser treatments and laser modalities. Few doctors can confidently claim that they have completed the puzzle.