Not loving that cellulite on your thighs but don’t know what to do about it? Dr A Bolin runs through the treatment options to see which ones really work.

Have you ever looked in the mirror and noticed dimpling of the skin on your buttocks or thighs? You are not alone. Most women, even very fit thin women, have cellulite and it can be a major concern, affecting self-esteem.

Not surprisingly there are a host of products and treatments ranging from massages to invasive procedures which claim to banish cellulite. Although no treatment at present is a permanent solution, the good news is that some treatments do better than others in decreasing the appearance of cellulite.

Who is affected by cellulite?

Between 80-90% of post-pubertal women have it. Men are also affected, but have a slightly different architecture to their skin,fat and connective tissue which makes them less likely to develop cellulite.

What is cellulite or ‘peau d’orange’ (orange skin)?

Cellulite is dimpling on the surface of the skin, accentuated by raised areas in between.

Structurally, there are fibrous bands of connective tissue that go from the skin surface down to dermal and the hypodermal fat, connecting to muscles underneath.

When these bands of tissue harden and become less flexible, it tethers down the skin at the points of attachment which results in bulges or pockets or fat in between.

It tends to form on thighs, hips, buttocks, arms and abdomen.

Factors that determine who gets cellulite include:

1. Being a woman – women tend to develop more cellulite than men.
2. Aging – it contributes to a loss of skin suppleness.
3. Weight gain – this can exacerbate the appearance of cellulite (including pregnancy).
4. Genetics – this plays a role too.

How can I get rid of cellulite?

Is there one single treatment that gets rid of cellulite forever? Unfortunately, no.  There are many treatments that can help improve the appearance of cellulite, but it can recur in future as aging and genetics determine your skin’s future.

So, let’s see what does and doesn’t work.

Acoustic wave therapy – YES

Acoustic wave therapy, also called extracorporeal pulse activation therapy (EPAT) uses a handheld transducer which emits low-intensity sound waves and pulses.  These acoustic waves break down the fat beneath the skin and promote microcirculation leading to increased collagen and elastin synthesis, making the skin denser/firmer and visibly improve appearance. It usually take several repeated treatments in order to achieve the desired effect. The skin elasticity improves and certain studies show it lasting up to 6 months.

Laser treatment – YES

Lasers are useful as they are less invasive than many other techniques. In this case, the laser is used to target tough connective tissue bands responsible for the dimpling effect. The skin is also stimulated to become a bit thicker, which is desirable (since thinning of the skin tends to accentuate tugging of the bands).

After local anaesthetic is injected into the area, a small cannula is inserted into the skin and the laser helps to break down the bands. The pulses of laser promotes collagen production. As fat is liquified from the heat, it can be removed. Cellulaze™ – one of the treatment brands claims it can reduce the appearance of cellulite for a year or longer.  More research is needed in future to determine how effective these treatments are.

Subcision – YES

Yes it works. It is a surgical technique which is more invasive than the above technique. The fibrous strands are manually cut which means that your treatment is very much dependent on the experience of the practitioner. Some studies have shown it to be effective but it may work best when combined with other therapies to tighten the skin.

Vacuum-assisted precise tissue release – YES

Similar to the Subcision, this treatment was developed in order to give better control over the tissue release or bands being cut. It uses a microblade which is vacuum-assisted and the blade oscillates to provide more precision. Cellfina is an example of this type of procedure.

Carboxytherapy: MAYBE

Carbon dioxide is infused into the affected areas of cellulite, just beneath the skin. One small study seemed to demonstrated a slight improvement.  More research is needed.

Endermologie® : MAYBE

Hoover your thighs?  The technique was developed in the 1980’s in France by Louis Guy Pitay (who founded the LGP company). An enthusiastic massage with vacuum, it is a mechanical method to help to smooth out the skin and somewhat disrupt some of those tethers or bands that the fat bulges on either side of. Some studies have shown no effect at all, others have demonstrated improvement although the cellulite tends to return within 1 month of stopping treatment.

Creams and lotions: Retinol YES, the others NO

Many lotions and potions claim to be the cure. According to the Mayo clinic, no studies have sufficiently demonstrated that creams including vitamins, herbs, antioxidants, minerals or any other combinations eliminate cellulite.  Additionally, many can lead to allergic reactions and rashes. The only topical cream that has really shown any evidence of having an effect on cellulite is 0.3% retinol applied two times a day (some results are seen after 6 months). Retinol naturally stimulates collagen and elastin production and even has an inhibitory effect on fat cell production (lipogenesis).

Ionithermie cellulite reduction treatments: NO

A spa-like treatment where you are having a type of body mud mask and then attached to some electrodes with low voltage current, there is no current evidence that it works.

Cryolipolysis : NO

Cryolipolysis (sometimes referred to as cool sculpting) tends to be very effective in sculpting as opposed to breaking down those fibrous bands. While it may be good for fat loss, it is not recommended as a treatment for cellulite.

Mesotherapy : NO

Injections into the cellulite area may include caffeine, aminophylline, vitamins, minerals, enzymes, hormones or herbal extracts.  There is no clear evidence to show that it works. Allergic reactions, rashes, lumps under the skin and infection may occur.

Supplements: NO

There is no evidence that supplements reduce cellulite.

Massage: NO

Although your skin may look and feel improved, the results will not be lasting.

Weight loss and Exercise: Good for your health, variable effects on cellulite

If you gain weight, your cellulite might be more visible. If your muscles are toned and lean, they can make the skin look smoother and draw less attention to the dimpling. Eating well and exercise might help with the appearance of your skin, but neither will completely eliminate cellulite.

More options in the future:

More studies are needed to determine the efficacy of laser-assisted liposuction and ultrasonic liposculpting. They may provide newer options to consider alone or in combination with other cellulite treatments. Remember to discuss your skin type with your dermatologist or plastic surgeon for tailored treatments to your needs.