Cellulite is the lumpy or “cottage cheese” appearance that typically shows up on the hips, thighs, and buttocks – and for the most part, cellulite is seen mainly in women, who make up the majority of patients seeking treatments.
Thanks to science and technology, there are several surgical and non-surgical methods offered by board-certified plastic surgeons, who claim that their clients reap great results.
These include body shaping with acoustic wave therapy, a laser treatment that utilizes thin beams of heat, the use of needles to break up the bands that cause us to see cellulite, and an external deep-tissue massage called Endermologie.
While experts say that there is no quick fix way to get rid of cellulite, there are ways that can help diminish this lumpy appearance for overall satisfaction.
We’ve gathered input from three top experts on this topic, including a Harvard-trained cosmetic surgeon, a board-certified plastic surgeon in 24 years of private practice, and a board-certified dermatologist who is also a Chief Medical Officer.
Keep in mind that this article is not intended as medical advice. Before you undergo any procedure for cellulite, talk to your doctor, first.
What Is Cellulite?
Cellulite treatment is sought out more by women than by men as they have a greater predisposition to cellulite, said Dr. Adrienne Lara, a Harvard-trained OB/GYN and cosmetic surgeon who owns the Celebrating Women Center for Health Beauty and Wellness in Oxnard, California.
“Cellulite is that lumpy skin appearance that is seen mainly in women, mainly on hips, thighs, and buttocks – if you notice you have it, you are not alone,” she said. “This is based on their higher body fat content and the location of fat distribution on their bodies and genetic background.”
Dr. Lara noted a 2014 review that showed 85% to 98% of women have cellulite, and that it starts to form post-pubescent. The causes of cellulite are many, but most prevalent are gender, genetics, and weight.
“Cellulite is formed from fat cells or pads under your skin that then are tethered down in areas by your connective tissue,” Dr. Lara explained.
She used an example of a down comforter full of feathers as being your fat. “Now, put in threads – that is the connective tissue and makes boxes in the comforter – those boxes are the cellulite.”
Cellulite – known as Gynoid lipodystrophy in medical jargon – is the uneven pitted surface or dimpling cottage cheese-like appearance of the skin commonly seen on the thighs of women, according to Dr. Aaron Stone, a board-certified plastic surgeon who has seen and treated many patients with this condition in 24 years of private practice at Aaron Stone MD in Beverly Hills, California.
Women are much more affected by cellulite than men and therefore comprise the vast majority of people seeking treatment, agreed Dr. Ted Lain, a board-certified dermatologist and Chief Medical Officer at Sanova Dermatology in Austin, Texas.
The same areas can also be affected in men, although at a much lower frequency, he noted.
“Men often focus on weight loss to treat cellulite, which may help, while women rarely find improvement using this method,” Dr. Lain said.
“While some treatments offer only temporary relief, there are good options to resolve cellulite permanently. Temporary methods include lasers, creams, and massage. More permanent treatments involve cutting or removing the strands that are pulling downwards on the skin.”
Predisposing Contributing Factors That Lead to Cellulite Development
There are many predisposing factors that contribute to cellulite development, Dr. Stone said. These include:
Gender: Women are more likely to develop cellulite due to the underlying structure of fat and connective tissue relative to the superficial fat layer with larger fat globules and fat layer scaffolding alignment.
Heredity: Empirically, it has been found that the degree and presence of cellulite, as with body habitus, often is similar among females within the same family.
Race: Caucasian and African-American women are more likely to develop cellulite than Asian women.
Age: Women begin to develop cellulite after puberty as part of normal anatomical and physiological development. Cellulite increases in severity with aging as a reflection of the thinning of the skin.
Cause of Cellulite
Causes of cellulite, according to Dr. Stone, include the following:
Swollen fat cells swell that push up into the overlying skin. Since the septal extensions are fixed or shrink with scarring and aging, this creates a puckered appearance on the skin surface.
“This is also called primary cellulite, or cellulite of adiposity, is not amenable to surgery and is usually seen in younger women,” Dr. Stone explained. “It is present when the patient is supine and erect and is, therefore, not related to skin laxity or gravity.”
Septal extensions or shortening of these septa resulting in pitting of the overlying skin.
“This is easily treated by cutting the responsible septa using a needle passed through the skin (subcision) or a Cellfina device to accomplish the same result,” Dr. Stone said.
Descent of the skin and fat that normally occurs with aging, resulting in skin pitting due to the pull of septa whose length is unchanged.
“This is more common in women who have an inherently weaker fascial support system to hold the skin up,” said Dr. Stone, further noting that this problem is aggravated by smoking, sun damage, massive weight loss or gain, and in some cases after liposuction.
“This is also called secondary cellulite, or cellulite of laxity and is surgically correctable by lifting techniques that tighten both the skin and the superficial fascia system,” Dr. Stone said.
It usually appears after 35 years of age and is present when the patient is standing but not when lying down.
“The appearance improves dramatically when the skin at the hip level is pinched to correct the laxity,” Dr. Stone said. “The body areas with the least adherence between the skin, fat, superficial fascial system and bone or muscle will have the greatest degree of skin laxity.”
One can improve the appearance of cellulite, but can never rid themselves of the cellulite, Dr. Lara noted, adding that fortunately, “there are many, many treatment options for cellulite.”
Clinical Treatments for Cellulite
The most current treatments for cellulite at Dr. Lara’s practice include acoustic wave therapy, laser, subcision, and vacuum-assisted precise tissue release.
“These treatments can range in price from $300 to $1,200 per session and definitely include multiple sessions,” Dr. Lara said.
Acoustic Wave Therapy
Studies show that this body shaping and fat reduction treatment can reduce the appearance of cellulite.
According to a randomized, controlled clinical study that investigated the safety and efficacy of acoustic wave therapy in body contouring published by the US National Library of Medicine, results showed a reduction in both thigh circumference and subcutaneous fat layer thickness, measured through ultrasound.
The study, which involved acoustic wave therapy performed on the lateral thigh areas of 15 female patients, was performed using the planar and radial pulse hand pieces, with 8 sessions performed within 4 weeks. Follow-up visits were performed 1, 4, and 12 weeks after the last treatment.
The conclusion of the study noted that acoustic wave therapy is “safe and efficacious” for the treatment of localized adiposities in the saddlebag area – however, the results obtained were not statistically significant.
The authors of the study also found an improvement in the appearance of both cellulite and skin firmness after the treatments.
This laser treatment involves utilizing thin beams of heat, which are used under the skin to break up the bands that form the cellulite. The appearance of cellulite can improve with this laser, as it can thicken the skin where it has thinned with cellulite.
The effects last for about a year, and further studies are needed, Dr. Lara noted.
According to a study published by the US National Library of Medicine, the Cellulaze laser system provides “a sustainable improvement” in the appearance of cellulite for at least 1 year.
The study also noted that other publications have shown results maintaining at least 3 years, and data to date have shown this single laser procedure to have “an outstanding safety profile with a high satisfaction rate” for both physicians and subjects.
During this subcision (a minor surgical procedure) a needle is placed under the skin to break up the bands that cause us to see cellulite, and as been shown to improve the appearance of cellulite. In a small study of 332 patients, 99% said they were "satisfied.” Results can last up to 3 years, and further studies are needed.
In a review about cellulite with a focus on subcision published by the US National Library of Medicine, it was noted that subcision is an established therapy that can lead to “significant improvement” in the clinical appearance of cellulite with a low adverse event profile.
Vacuum Assisted Precise Tissue Release
This procedure involves small incisions with blades that are used to break up the bands that create the appearance of cellulite. The vacuum then pulls up the skin to fill in the dimpled spaces. Early small studies are showing up to 3 years of improved appearance, and further studies are needed, Dr. Lara noted.
In a multicenter pivotal study of vacuum-assisted precise tissue release for the treatment of cellulite published by the US National Library of Medicine, adult women with moderate to severe cellulite underwent a single treatment. Post-treatment assessments were performed after 3 and 14 days; 1, 3, and 6 months; and at 1 year.
Results showed the mean baseline Cellulite Severity Scale score of 3.4 decreased to 1.3 at 3 months; and 1.4 at 1 year. Subject satisfaction was 85% at 3 months and 94% at 1 year. The study also noted that transient treatment-related adverse events were “mild in severity.” These results supported the Food and Drug Administration clearance of the device for the long-term reduction in the appearance of cellulite.
“As with any cosmetic procedure, it is important that expectations are realistic and discussed thoroughly between the doctor and patient – this is informed consent,” Dr. Lara said. “Every patient, every body, every case is different and should be approached accordingly. A patient’s individual needs, concerns and desired outcome should be addressed prior to the procedure.”
Endermologie is a French-designed form of external mechanical deep-tissue massage that the Food and Drug Administration has approved to diminish the appearance of cellulite.
During the massage, suction is used to pull the skin into a handheld machine where the skin is compressed and rolled to increase blood and lymphatic flow, and to modify the underlying connective tissue, Dr. Stone explained.
“This therapy is done in a series of 30- to 45-minute sessions over a period of months,” said Dr. Stone, further noting that the cellulite-minimizing effect of all forms of deep-tissue massage is temporary, and therapy must be continued to maintain results.
“The massage stimulates the body to thicken the superficial fascial system by laying down more collage and ruptures some fat cells,” said Dr. Stone, adding that there has been no evidence to date whether or not after a certain number of treatments you can stop and will have a permanent reduction of cellulite.
“For less severe forms of cellulite, endermologie may turn out to be the treatment of choice,” he said. “This is the only FDA-approved massage roller than I know of for the treatment of cellulite.”
With Endermologie, yearly maintenance treatments are needed following resolution.
“This has virtually no downtime or side effects,” Dr. Stone said. “Twelve 30 to 40-minute sessions would cost $1,500 and the garment that is worn after treatment cost $25.”
As far as cellulite vacuum cups are concerned, Dr. Stone does not recommend these, “because it is the needing of the scaffolding that makes the endermologie work. You don’t get that with suction alone. You need the rolling mechanism as well.”
Dr. Stone added that in 2016, the FDA approved Profound, a minimally invasive, fractional radiofrequency microneedling device with a 75-degree subcutaneous handpiece and cartridge for treating the appearance of cellulite.
Generally, the cost of Profound ranges from $800 to $9,500, depending on the size of the areas being treated.
“In 50 women enrolled in a clinical study there was an improvement in cellulite severity in dimples and/or undulation irregularities in 94% of treated thighs at 3 months follow-up in a blinded review,” Dr. Stone noted. “At 6 months, sustained improvement was seen in 93% of treated thighs.”
Thermi and Cellulaze
Dr. Stone also offers minor surgical procedures that can be performed in a treatment room under local anesthesia.
This category includes Thermi (radiofrequency) and Cellulaze (laser), where a narrow string is introduced through a needle poke to melt fat and divide or shrink the septal scaffold.
“The result lasts years but it is not clear if it is permanent,” Dr. Stone noted. “The treating surgeon has to be skillful because there is significant risk of skin burns and nerve damage. The cost is $4,000 for outer thighs, $8,000 for circumferential thighs and the garment worn afterward is $25.”
Needle Subcision and Cellfina
Needle subcision and Cellfina are best for indents that deepen with muscle action because the process divides the connecting septal scaffold between muscle and skin, Dr. Stone said.
“The main potential side effects are temporary bruising and swelling,” he noted. “The best candidates for the procedure are younger, reasonably fit with stable weight and have stubborn, discrete, dimple-like cellulite present since early adulthood on the buttocks.”
Dr. Lain also incorporates the use of Cellfina at his practice.
“After numbing the area, a very small incision is made near the dimple, and a specialized needle is introduced,” he explained. “The needle is swept side to side by the physician in order to cut the offending tissue strands.”
Clinical studies have shown 98% visible improvement and 93% satisfaction rates at 3 years following a single treatment, Dr. Stone said, and the cost is $700 per dimple, with discounts for additional multiple dimples.
Major Surgical Procedures for Cellulite
In the operating room, the only applicable procedure is a thigh lift for the legs, or a belt lipectomy body lift for the thighs and buttocks, Dr. Stone said.
By removing a circumferential section of excess skin (that isn't addressed by the above described modalities) the septal scaffolding is realigned perpendicular to the muscle rather than tangential resolving the pitting appearance.
“Historically this was recommended for cellulite with or without significant skin excess but with all of the other modalities now available this is best reserved for cellulite with significant excess skin,” Dr. Stone explained.
The cost is significant: up to $18,000 for the surgery, $2,000 for anesthesia, $4,000 for the operating room, and $900 for an overnight stay in a nursing facility. The recovery time is 3 to 4 weeks, and the main potential side effects are visible non-cosmetic scars, separation of the suture lines, or infection prolonging recovery.
“For those over age 45 or who have medical conditions medical clearance is required and adds to the cost,” Dr. Stone noted.
If the skin excess is severe, as in after massive weight loss, self donating blood prior to surgery for transfusion during surgery is the safest approach, because the skin that is removed contains blood within it, he added.
“That would also add to the cost of the surgery,” said Dr. Stone.
Non-Surgical Procedures for Cellulite
Everyone has seen the multiple advertisements for creams, exercises, and other tools for helping to remove cellulite, Dr. Lara said.
However, “nothing really removes cellulite.”
Therefore, Dr. Lara said the following non-surgical modalities are aimed at improving the appearance of cellulite:
Weight Loss: Excessive or extra weight may make the cellulite more visible, therefore weight loss can improve the appearance. “If loose skin develops, it can make the cellulite more apparent,” Dr. Lara said.
Exercise: Toning the muscles underlying the cellulite can make the skin look smoother. “Replacing fat with muscle can approve the appearance,” Dr. Lara noted.
Creams and Lotions. Creams with caffeine can dehydrate the area and may make the skin seem smoother.
“You need to use these creams on a daily basis,” said Dr. Lara, adding that creams with retinol .3% can make the skin thicker and create a smooth appearance.
“Retinol takes 6 months of treatment before results are seen,” she said. “Before using any cream, you should do a spot check and make sure your skin can tolerate it and doesn't have a reaction.”
Other non-surgical treatments for cellulite include Ionithermie, a spa treatment with algae and clay, electrodes and plastic wrap. This can be painful, Dr. Lara noted, with varied results – typically the results last 12-18 hours.
Another treatment called carboxytherapy uses CO2, inserting gas underneath the skin. In one study, 8 women required 10 treatments and saw little reduction in cellulite, Dr. Lara said.
As far as supplements are concerned, “there is no clinical evidence that any supplements – caffeine, grape seed extract, and gingko biloba work.” And if people are considering ultrasound, there is “no evidence that ultrasound alone can work. Some improvement is seen when used with other modalities – more are studies needed.”
Dr. Lara added that there are two methods that she does not recommend: Cryolysis, which involves freezing fat; and Mesotherapy, which involves multiple injections.
Do Cellulite Creams Really Work?
According to Dr. Stone, “my general impression is they do not work and are a waste of money.”
Every year more topical gels, ointments, foams, creams and lotions for treating cellulite are introduced into the marketplace, he said.
“Most active ingredients, including antioxidants and blood vessel dilators, are included to increase blood flow and lymphatic drainage,” Dr. Stone explained. “Some irritate the skin to cause skin swelling and thereby camouflage the cellulite. Other agents may actually promote the breakdown of fat cells or attempt to locally increase cell metabolism.”
Some topical ingredients, such as vitamin C, and vitamin A derivatives have been included to stimulate circulation, and affect the superficial fascial system.
“Some have tried to increase the effectiveness of anti-cellulite creams by using bio-ceramic-coated neoprene garments to increase the penetration of the active ingredients in the various creams,” Dr. Stone noted.
The best subjective assessment, by the patients themselves, revealed that only 3 of 35 aminophylline cream-treated legs had their cellulite appearance improved after 12 weeks of treatment.
“There is no difference in fat metabolism in areas of cellulite versus areas without cellulite,” Dr. Stone said. “Thus, aminophylline, resveratrol and other such creams have no effect. Save your money and stay away from these.”
Some creams contain anti-estrogen compounds usually derived from plants, he added.
“These may prevent the onset or progression of cellulite by blocking the effects of body hormones on the superficial fascial system,” Dr. Stone said, adding that “once the damage is done, it is unlikely that these could be effective.”
» For Further Reading: Best Cellulite Creams That Can Potentially Diminish Dimpling Appearance
Cellulite in the Arms
Dr. Lara’s practice offers High Definition liposuction for the arms, which involves the removal of fat.
“Liposuction reduces fat and shapes the arms,” she explained. “Some cellulite responds to liposuction – liposuction is currently being studied as a treatment for cellulite.”
The treatments for cellulite that Dr. Stone uses for the thighs and buttocks can also be used for the appearance of cellulite in the arms.
“The main difference is cost of surgery,” he said, noting a procedure called an “arm lift,” which involves the removal of excess skin and fat from the underarms between the armpit and elbow.
The cost is up to $8,000 for the surgery itself, $1,000 for anesthesia, and $2,400 for the operating room, Dr. Stone said.
Unfortunately, there is no “fast, walk in the door with cellulite, and walk out without it,” Dr. Stone said.
“The closest to this is the subcision or Cellfina, but that choice is not optimal in all cases – it depends on the cause,” he said.
Is there hope for people unhappy with their appearance of cellulite?
“Absolutely,” Dr. Lain said. “Cellfina has truly revolutionized the way we treat cellulite in the office. Other treatments are in development which will achieve the same results as Cellfina but much less invasively, using only injections.”
Before you decide to do any treatment for cellulite, Dr. Stone has the following recommendations:
- Choose your surgeon wisely
- Don’t opt for a treatment that is more aggressive than is warranted
- Make sure the right treatment modality is chosen for your specific condition/cause of cellulite
- Follow the after treatment restrictions closely and allow time for healing after treatment
Whereas there is no proven treatment to remove cellulite, many of the treatments mentioned earlier in this article can temporarily improve the appearance of cellulite just as weight loss and exercise can help, Dr. Lara said.
“The bigger picture for women is to evaluate how they feel about their bodies and themselves,” she emphasized. “Are you being realistic and fair to yourself and showing self-love? If the answer is yes, and you want to work on your cellulite, then it is well-worth exploring your options.”
Dr. Lara’s advice is to do your due diligence – and research what works and who provides experience with any surgical procedure you choose.
“Remember, the more a surgeon has performed a procedure, the better they are at it,” she said.
Dr. Lara concludes with the following recommendations.
“If you stop and realize you are being too hard on yourself and your cellulite is not the overwhelming concern, well then start to list all of your positive attributes, physically, mentally and spiritually,” she said.
“Evaluate you for you – not against some yardstick of others, you are your own yardstick,” Dr. Lara added. “Start to appreciate your goodness and work on areas you feel you need to improve. After all, we are all a work in progress.”
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