When it comes to health, there’s another “C word” besides cancer — and that’s cellulite. Mention it and you might get gut sounds from the throats of people around you. However, what can one do about those dimples and depressions in the skin of the thighs, hips and buttocks?
One website claims that foods that increase hydration, boost antioxidants, and flush out toxins (no such thing) can reduce cellulite. The truth is, you could get water intoxication and your cellulite won’t budge.
Another website urges people to browse the expensive catalog of elite cellulite-fighting department stores. There are potions to drink, pills to pop, lotions to rub on and devices that are supposed to shake off that cottage cheese look.
There are beauty salons that also promise transformation for the “simple price” of a college education. Good luck getting an appointment – they’re all booked up.
All of these, and most other methods that promise to reduce cellulite, have one thing in common: they do not work, or there may be only a small, temporary improvement. Over time, the skin returns to its pre-treatment appearance. Some newer treatment methods, however, show promise.
So, is there any way to really get rid of cellulite? In June 2023, the Journal of Cosmetic Surgery Open Forum posted “Cellulitis: Current understanding and treatment.” Let’s examine the current state of cellulite research from a medical perspective.
What is cellulite?
Cellulite is a skin condition that affects an estimated 80 to 90 percent of women after puberty. It appears as uneven surface skin changes, especially in areas of the body that tend to store fat, such as the thighs, buttocks and hips. The condition causes dimples, depressions or nodules, which give the skin a cottage cheese or orange peel appearance.
Although cellulite is a painless condition, due to its unattractive appearance, cellulite is associated with significant psychosocial distress, anxiety and reduced quality of life. Many women seek treatment. In 2021, more than 86,000 minimally invasive cellulite treatments were performed by American Society of Aesthetic Plastic Surgeons.
There are many treatments for cellulite. However, treatment remains a challenge, in part because it is a complex disorder with a unique pattern of development and in part because of the lack of effective treatments.
Little is known about the number of people with cellulite, as well as the risk factors for developing it because there is a lack of data. Women of all races and ethnicities are affected, although Caucasians are more susceptible than Asians or African Americans. Cellulite usually appears between the ages of 20 and 30, although it can appear at any age after puberty.
Much of the process by which cellulite develops is a mystery, but the study of cadavers reveals that disordered anatomy is the culprit. Underneath the skin (dermis) is a layer of fat and collagen (subcutaneous tissue.) Now, think of a layer of fishnet stockings between the dermis and subcutaneous tissue. The thin filaments are called septa, some of which are longer than others. The increase in body fat shows the fat lobules being compressed through the more elastic long septa, outward towards the dermis, while the shorter septa are anchored, pulling inward. The imbalance of forces is thought to create an uneven surface of the overlying skin.
Estrogen plays an important role in the creation of cellulite, as do conditions with high estrogen content, such as pregnancy, breastfeeding, chronic oral contraceptive use, or hormone replacement therapy in postmenopausal women. These accelerate the progression of cellulite.
The following factors are associated with the risk of developing cellulite:
- Genus
- Age
- Genetics
- Race
- Increased subcutaneous fat
- High carbohydrate diet
- Sedentary life
- Pregnancy
- Alcohol consumption
Experts have developed various scales for the severity of cellulite, with higher numbers indicating greater severity. The numbers quantify the effectiveness of the treatment. The larger numbers, however, serve to make a non-physically threatening situation even more psychologically distressing.
| Kind | Description of cellulitis severity |
| No. depressions |
0 = no depressions |
| Depth of depression |
0 = no depressions |
| The type of skin surface changes |
0 = no raised areas |
| Skin laxity |
0 = no laxity |
How can you treat cellulite?
Cellulite treatment involves targeting various steps and pathways believed to contribute to cellulite formation. Although combination treatments have been tried, there has been no consistently effective treatment or combination of treatments identified.
What about lifestyle changes?
Lifestyle modification is the most important step in treatment for people with a genetic predisposition and in preventing cellulitis from worsening. Being overweight increases the appearance of cellulite. In some people, losing weight and keeping it off can reduce cellulite. A low-fat, low-sodium diet, exercise, and limiting smoking and alcohol are recommended for both managing cellulite and improving general health.
Exercise is essential therapy for cellulite, to prevent the increase of body fat. Regular exercise is also recommended to maintain muscle mass.
Do topical treatments work?
Most topical formulations are available as gels or creams without a prescription. The main ingredients are caffeine, methylxanthines, retinol, ascorbic acid, alpha-disabolol, Carica papaya extract, other plant extracts, plant oils, urea and squalene. These treatments are said to work by causing reduced fat production, improved circulation, reduced inflammation and increased fat breakdown. Usually, several substances with different mechanisms of action are combined in one preparation. Caffeine is used in topical preparations because of its lipolytic (fat-breaking) action.
More evidence from larger clinical trials is needed to develop specific topical formulations to treat cellulite.
Are laser and light treatments real?
The laser energy penetrates the dermis or subcutaneous tissue depending on its wavelength. Local tissue heating improves microcirculation and collagen remodeling. A multicenter study involving 37 patients using the latest laser, called 1140 NM Nd:YAGresulted in high satisfaction scores for both physician and patient and was sustainable one year after treatment.
What is affiliation?
Subcision is recommended for cellulitis depressions that are present only at rest, not for depressions that are visible during muscle contractions. This surgical technique cuts the fibrous septal bands that connect the dermis to the subcutaneous fatty tissue. By cutting the fibrous septa, the biomechanical forces within the subcutaneous layer are redistributed and the fat lobules are also redistributed into spaces created by the procedure. Fat protrusion is reduced, resulting in a smoother skin surface. The undercut can be done manually, by a plastic surgeon, or it can be done with a vacuum or laser. More recent techniques include chemical subcision using collagenase enzymes and acoustic subcision.
How do dermal fillers work?
Calcium hydroxyapatite and poly-L-lactic acid (PLLA) are used to smooth skin affected by cellulite. It also helps increase the thickness of the skin to make it harder for fat to penetrate the skin.
Asterix, another filler, was reported to show noticeable skin tightening and an increase in the density and thickness of abdominal skin, making it more difficult to form lobes.
PLLA is a biological filler which stimulates the body’s own collagen production, tightening the skin. A study involving 24 patients, when combined with subcision, showed consistent improvement at a two-year follow-up assessment.
Can you dissolve cellulite with ultrasound?
High frequency sound waves that deliver acoustic energy to increase tissue shrinkage and induce collagen and elasticity have been used for body sculpting. The superficial skin is heated to 60–70°C, resulting in tissue coagulation that activates the body’s wound healing process. It also causes collagen contraction, creating short and thick fibers and stimulates the production of new collagen.
High-frequency ultrasound, used in conjunction with vacuum drainage, suction, and massage, has shown mild improvement in abdominal cellulite. One study showed a significant reduction in abdominal girth, seen with ultrasound fat breakdown. A combination of radiofrequency and ultrasound showed improvement in abdominal cellulite. Overall, there is no convincing evidence to suggest that ultrasound alone can significantly reduce cellulite.
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