Cellulite – All You Need To Know About Origin of Cellulite and Treatments

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Unsightly, bumpy, dappled, or warped flesh is something nobody particularly wsihes to deal with. For most of us, however, it’s not much of a choice. Cellulite is an extremely common affliction, affecting as many as 90% of women at some point in their lives. Some of us are frustrated by severe dents and folds; others only experience slight, hardly visible indents that are nonetheless a reminder that nobody’s perfect. We can’t seem to escape its eventual arrival, but there are a few ways to minimize the appearance of cellulite. From topical creams to injectables and incisions, we are going to go over some of the major cellulite treatments in the world today. 

grade 1 cellulite on thighs
Cellulite on Thighs


Cellulite has a few different names. Whether you call it puckering, dimpling, or the more colloquial cottage-cheese or orange-peel skin, these are all names used to refer to little indents or rivets in the flesh. In scientific circles, it can be referred to as gynoid lipodystrophy (GLD), nodular liposclerosis, and panniculosis. More mild forms of cellulite, usually on younger women, only appear when pressure is applied to an area; these small dents appear, for example, when placing your hands against your thigh and squeezing them towards each other. More severe cellulite presents itself as dimples or folds that are visible no matter what position you’re in, without the skin being manipulated in any way.

Cellulite is not dangerous, or a cause for concern. It is merely the result of the way connective tissue in the dermis interacts with fat beneath the skin. But just because it doesn’t have any health effects or indications doesn’t mean that cellulite is looked upon as favorable. Many find it to be a major aesthetic concern. That’s why many cosmetic measures to prevent and treat existing cellulite have spawned over the years.


You may have compared yourself to the airbrushed models on magazine covers or the seemingly poreless actresses in your favorite Hollywood flick and thought: why can’t I look like that? Everywhere you look, it seems like people have perfectly smooth skin. For many of us, that can send us into a spiral of insecurity and wondering what we are doing wrong in terms of skincare. However, that kind of reality really only exists on TV and inside catalogs. Most of us have marks, lines, scars, and dimples on various points in our bodies –– that’s only natural.

Does that mean that everybody has cellulite? Well, not exactly –– but it’s probably a lot more common than you think. It’s also not necessarily an indication of physical health or even obesity, as a lot of people tend to believe. Cellulite tends to appear most frequently after pregnancy, weight fluctuations, or simply going through puberty and getting taller, or accumulating fat where you may not have had it as a child (for example, in the hips or thighs).

Cellulite tends to occur more often on more heavyset or overweight folks, but people who are very toned can also have some cellulite. Often, it just comes down to age and genetics. The texture and structure of your skin is largely determined by your hormones, after all. Skin that is thinner and less elastic tends to crease and dimple more. Apart from genetics, certain lifestyle habits –– like lack of exercise and smoking –– can contribute to the formation of skin puckering.

There is also an uneven distribution of cellulite amongst genders. Women are much more likely to have cellulite than their male counterparts; a whopping 80-90% of women will notice cellulite on their body at some point after puberty. It most commonly pops up in the hips, butt, and thighs, regions in which women store more fat than men. 


While the exact causes of cellulite are still not fully understood, we know to look towards the interaction between skin and fat layers. In the human body, subcutaneous fat sits sandwiched amongst a network of fibrous connective cords between the skin and muscle. This fat is made up of two layers –– the areolar layer, which is closer to the dermis and consists of large fat lobules arranged vertically, and the lamellar layer, which contains smaller fat cells arranged horizontally. The lamellar layer is what grows during weight gain. The areolar layer is thicker in women and children (think of baby fat, for example). More fat cells in the adipose layer means that upward pressure is applied towards the skin, which is counteracted by these tough connective cords, aka the fibrous septae. In women with cellulite, the fibrous septae network tends to be more perpendicular to the skin, as opposed to parallel. The result is a tension between collagen fibers and fat cells that creates textured, dimpled skin. 

In short, cellulite is caused by superficial fat lobules (or papillae adiposae) bulging into the dermis. This means that greater adipogenesis in the body –– that is, the accumulation of fat cells, adipocytes, in subcutaneous tissue –– puts you at higher risk of developing noticeable cellulite; women who experience cellulite have been found to have a subcutaneous adipose layer that is 5 times thicker than those without. This does not mean, however, that people who are slim, muscular, or well-toned can’t also develop cellulite. In fact, post-pubertal women tend to have cellulite because their bodies retain more adipose tissue in order to preserve calories and fat for pregnancy. 


Unfortunately, cellulite doesn’t usually just disappear. Even with weight loss and exercise, cellulite is one of those features that just stubbornly sticks around despite your best efforts to get rid of it. Sometimes, losing a lot of weight rapidly can even make cellulite worse by creating loose skin. The good news is, cellulite can’t harm you in any way, so you don’t have to worry too much. However, we all know that it can be a major source of insecurity. As common as cellulite is, many of us plan our wardrobes around hiding it –– especially when sporting revealing clothing, like swimsuits or lingerie.

Rather than spend your time fretting over disguising cellulite, why not pursue some way to minimize it? Because cellulite is such a widespread cosmetic concern, there are plenty of treatments to diminish its appearance. These range from completely non-invasive and topical treatments to more intensive approaches, like surgery. Let’s go over some of the most popular ones so you can get an idea of your options!


At Skinly Aesthetics, we specialize in offering minimally invasive and non-invasive skincare options. These are often lower risk and easier than surgical approaches, while being more effective than the kind of short-term fixes you might get from topical treatments. Some of the most popular cellulite-fighting procedures include QWO, radiofrequency microneedling, and Fraxel lasering. Let’s take a look at how these individual procedures work, and how they target cellulite.


What Is QWO Cellulite Treatment?

Out of all the minimally invasive treatment options for cellulite, QWO might be the most effective. QWO is an FDA-approved, minimally invasive, injectable form of cellulite treatment. A product of the Endo pharmaceutical company, it involves injecting a solution containing collagenase clostridium histolyticum-aaes (CCH) into the region of concern to permanently raise skin dents and dimples for a sleek, uniform thighs and backsides.

How does QWO Cellulite Treatment Get Rid of Cellulite?

The primary way that QWO works is through enzymatic subcision and remodeling (ESR). QWO solution if formulated with collagenase clostridium histolyticum-aaes (CCH), which, when injected into the subcutaneous layer of the affected area, hydrolizes and dissolves the fibrous septae that cause tension that pulls on skin, making dimples appear. AUX-I and AUX-II are enzymes found within CCH that break the bonds holding these vertical collagen bands together. The downward tension between the bands and the skin is severed, adding plumpness to previously depressed areas and smoothing over skin texture. This happens over the course of about three weeks.

What Are Risks and Possible Side Effects of QWO?

In general, QWO is a relatively safe and low-risk treatment. However, those with many known allergies and hypersensitivity should disclose these to their doctor before considering treatment, so any potential bad reactions can be ruled out and tested for. If you have an active skin condition, rash, or infection, make sure it resolves before you come in for treatment. Pregnancy and bleeding disorders may also block you from receiving QWO. As for risks, the most frequently occuring side effect is bruising. You can expect some temporary tenderness and discomfort after your session as well. While very uncommon, some patients have dealt with erythema, pruritus, nodule formation, and discoloration after receiving a QWO treatment.

before and after results on buttocks and thighs using QWO treatment
42 Year Old Woman’s Buttocks 5 Weeks Post Third Treatment with QWO for Cellulite


What Is Radiofrequency Microneedling?

Radiofrequency microneedling combines the technique of traditional microneedling with the additional power of radiofrequency energy to replenish, plumpen, and even out skin. It primarily targets dermal texture –– such as acne scarring, wrinkles, and minor cellulite –– for an aesthetically pleasing, refreshed, and more youthful look. Secret RF and Morpheus8 are two of the most popular and effective forms of radiofrequency microneedling. They are safe, speedy, and FDA-approved cosmetic procedures that deliver wonderful results with only minimal invasiveness and side effects. A radiofrequency microneedling session only takes 30 to 60 minutes; while the results take a few months to come to complete fruition, the final outcome will be well worth it.

How Does Radiofrequency Microneedling Combat Cellulite?

Radiofrequency microneedling uses the body’s natural healing process to bolster its collagen and elastin supply and alter subcutaneous tissue at a cellular level. Here’s how: a handheld device lined with extremely thin needles is injected 0.5 mm to 3.5 mm into the dermis. At the same time, radiofrequency energy surges into the skin, into its deepest layer –– the SMAS. These energy beams deliver precise columns of thermal coagulation and micro-damage at 45-60 degrees Celsius. During this process, other tissue remains undamaged. The thermally damaged areas of skin contract during wound-healing, creating skin that is tighter and smoother.

At the same time, the healing process triggers neocollagenesis –– the production of collagen –– in the skin. Collagen lends the skin its primary structure, strength, and flexibility. Skin that is rich in collagen heals faster and looks younger. 

What Are Possible Side Effects and Contraindications of Radiofrequency Microneedling?

Radiofrequency microneedling is a wonderful, safe cosmetic opportunity for most healthy individuals. When it comes to side effects, these are mostly minimal. The most common side effects include initial swelling, redness, bruising, and mild discomfort. More rare complications are marginal mandibular neuropraxia or hardening of the targeted region.

Not everybody is well-suited for this treatment. If you are prone to cystic acne, you may want to avoid radiofrequency microneedling as the heat can create breakouts. Certain health conditions –– like collagen vascular disorder, dysfunctional wound healing, or certain autoimmune diseases –– may bar you from this procedure. Pregnancy or active infections will also make you ineligible. 

before and after results of radiofrequency microneedling for cellulite on legs
Before and After Results of Secret RF Microneedling on Legs Cellulite After 6 Months


What Is Fraxel Dual Laser Treatment?

This non-ablative skin resurfacing treatment is one of the most popular ways to slough off uneven, pigmented skin to reveal a more flattering and even complexion. Laser treatments are often used to target textural concerns in the skin, whether that be acne scars, wrinkles, stretch marks, or cellulite. Unwanted lines and dimples can be airbrushed using top-of-the-line Fraxel laser technology. Much like radiofrequency microneedling treatments, Fraxel stimulates the growth of collagen for improved skin structure; in contrast to microneedling, however, lasers work mainly on the superficial layer of skin, rather than penetrating into subcutaneous layers.

How Does a Fraxel Laser Treatment Get Rid of Cellulite?

Fraxel lasers have the ability to create highly specific points of microscopic thermal damage. During a Fraxel laser treatment session, the tip of the lasering device shoots a small laser beam into the area of concern. This, in turn, causes an inflammatory response in the body that boosts collagen production and encourages rapid cellular turnover. The skin cells surrounding the zone of damage are left intact, which allows them to aid in the ensuing healing process. The targeted, fractional nature of this procedure that leaves the epidermis undamaged is what gives it its name.

Fractional laser treatment devices can be set to different wavelengths for optimal results. For cellulite, your provider may recommend a 1550 nm wavelength, aka the Erbium component. At this wavelength, photons are able to focus on deep, underlying textural issues. They can add volume to the skin, counteracting the dents and dimpling of cellulite by synthesizing structural proteins like collagen and elastin.

What Are Possible Side Effects and Contraindications of Fraxel Lasers?

Fraxel lasering is an overall safe, FDA-approved treatment for fighting aging and other skin concerns. Some patients may run into certain issues when it comes to Fraxel lasering. For example, darker skin types may be at a risk of hyperpigmentation when it comes to laser procedures. Those with acne should also avoid the thermal damage induced by lasering, as it can further irritate their skin.

before and after results of Fraxel lasers on butt cellulite
34 Year Old Woman’s Before and After Results from Fraxel Laser Treatment on Buttocks Cellulite

Acoustic Wave Therapy

What Is Acoustic Wave Therapy?

Acoustic wave therapy (also referred to as shockwave therapy or pressure wave therapy) is still a relatively new method of treating cellulite, but it’s beginning to garner traction and attention after showing early success. By generating acoustic pressure waves, AWT puts pressure on fibrous septae beneath the skin, breaking it up for an improved dermal aesthetic. This is done over the course of several treatments and may need regular follow-up visits for maintenance.

How Does Acoustic Wave Therapy Treat Cellulite?

Like many other cellulite treatments, the primary approach with AWT involves disturbing the tough cords of collagen fibers that run perpendicularly down from the skin. Pressure waves sent out by the AWT device penetrate the skin, release it from the clutches of these bands by relaxing them, and dissolve the dimpling caused by the bands and the upwards protrusion of fat.

What Are the Possible Side Effects and Contraindications of AWT?

Since there are no incisions or injections involved, risks and side effects with AWT are minimal. Some patients report slight pain, bruising, redness, or swelling on the treated area. Patients who have blood clotting disorders, nerve disorders, are pregnant, or take blood thinning medications should not pursue this treatment.

before and after results of acoustic wave therapy for cellulite on bottom
Acoustic Wave Therapy Before and After Results Following 5 Treatments of Acoustic Wave Therapy on 32 Year Old


What Is Subcision?

A lot of people might assume that the surgical approach to cellulite elimination involves liposuction, but this is not actually the case. Subcision is a method in which a trained physician uses a needle to break up the network of tough, fibrous bands that cause cellulite. This procedure costs a few thousand dollars per session (3 to 6 sessions are often required) and is often recommended for moderate to severe cellulite, in which it can have great success. When compared to other types of cosmetic surgery, subcision is on the less invasive side, and leads to improved skin texture.

How Does Subcision Get Rid of Cellulite?

Beneath the surface of the skin, dense cords of tissue and fiber tug the skin downwards to create the appearance of cellulite. The tension of these bands results in that pesky puckering and dimpling; to break up the tension, subcision essentially severs those cords using a needle or cannula. Over time, they are replaced by new, stronger tissue. The whole procedure is done using anesthesia. Occasionally, subcision is performed in conjunction with fat transfer to fill in depressed pockets of flesh and create an overall smoother look.

What Are Possible Side Effects and Contraindications for Cellulite Subcision?

There are a few side effects and risks that tend to crop up with subcision, as with most any cosmetic procedure. Many patients experience bruising, redness, and tenderness or discomfort directly following the procedure. It’s also common to see a bit of bleeding at the injection site right after this treatment. A more severe risk this procedure poses is the possibility of infection. If you suffer from an acute skin disease, active infection, allergies to anesthetics, an autoimmune disease, or or superficial venous diseases, you may not be a good candidate for this procedure. There are a few other conditions that may bar you from treatment, so be sure to talk to your healthcare provider and give them a thorough overview of your medical history. If you are pregnant or breastfeeding, you are also not a viable candidate.

before and after results of subcision procedure for cellulite on legs and buttocks
33 Year Old Woman’s Before and After Results 1 Month Post-Celluerase Subcision Procedure for Cellulite on Legs and Buttocks


Not everyone wants to deal with the price points or hassle of getting a skincare treatment in a clinic; sometimes, it can also take a while to get an appointment, a period of time in which you may start looking towards other solutions to tide you over. In that case, there are several topical ointments, creams, gels, and lotions for you to try. When compared to minimally or moderately invasive procedures, these may not be quite as effective or long-lasting, but they are often cheaper and can have surprisingly beneficial results. Here are some common ingredients that help deal with cellulite, and a few product examples that utilize them.

Retinol (Vitamin A, Retinoic Acid)

What Is Retinol?

You may have heard retinol being referred to as Vitamin A or retinoic acid; in case you were wondering, they are all the same thing. Retinol has long been used as a skincare ingredient that provides benefits from acne-fighting power to anti-ageing. In lower doses, this ingredient can be found in many over-the-counter products, but can also be prescribed for more intense effects. 

How Does Retinol Fight Cellulite?

A 0.3% or 0.5% retinol cream is often suggested to help minimize cellulite. The effects of retinol are multi-layered –– it is an exfoliating ingredient, getting rid of dead skin cells and encouraging the production of fresh ones. It also aids in promoting collagen production, giving your skin strength and support. In only a few weeks, the consistent use of retinol can improve skin texture and pigmentation. Long Term use of retinoic acid treatment can bring about angiogenesis (the formation of capillaries in the body which aids in wound-healing) and an abundance of active fibroblasts, which help create new connective tissue as well as fresh collagen and other fibers. 

This proliferation of fibroblasts and building up of collagen can give skin a smoother and more rejuvenated appearance; it won’t have a severe effect on cellulite, but it can help decrease the look of it. By thickening the

What Are Side Effects or Contraindications of Retinol?

While retinol can have fantastic rejuvenating effects on the skin, it’s known to be somewhat irritating, especially at the beginning of use. For those with sensitive skin, it’s important to introduce retinol into your skin care routine slowly, not all at once –– meaning you should start by using it only every two or three days –– to give it a chance to acclimate. You should also wear plenty of sunscreen to protect the outer layer of your skin while using a retinol. Because your skin might be especially dry while using a retinoid, be sure to stay moisturized.

It should also be noted that you should be careful what other skincare you combine retinol with. For example, AHAs are commonly used to treat texture as well; however, AHAs and retinoids should not be used at the same time as they will likely cause an irritating reaction. Vitamin C and benzoyl peroxide can also be extra harsh when used with retinol.


Paula’s Choice Skin Smoothing Retinol Body Treatment

Paula’s Choice is a major player in the skincare realm, and it’s easy to see why. Lots of people love their moisturizers and acne fighting products, and they are one of the number one go-tos when it comes to retinoids. Their Retinol Body Treatment is intended specifically for use on the body –– in contrast to other retinoids targeting the face –– smoothing tone and combatting dull, dry, saggy skin. It features a myriad of moisture-boosting ingredients that will soothe your skin while battling cellulite. Shea butter and evening primrose oil add a rich texture to this moisturizer, ensuring that the active retinol ingredient doesn’t dry you out. Vitamin C and Vitamin E provide more oomph to the product by acting as powerful antioxidants. Paula’s Choice is also great for sensitive skin, as their products are formulated without parabens and fragrances. As an added bonus, you can rest assured that this product is cruelty free, meaning it has not been tested on animals.

Josie Maran Whipped Argan Pro-Retinol Body Butter

This is another retinoid that goes out of its way to prevent excess dryness. The pro-retinol in this product comes from pink algae, aka dunaliella salina extract, which contains beta cartone, a type of Vitamin A. 100% pure argan oil adds to the strength of your skin’s protective barrier, preventing moisture loss and damage from environmental factors. Argan oil has a lot of skincare benefits, including wound healing and soothing properties. Quercetin, an antioxidant found in argan oil, is known to prevent fine lines, pigmentation, and skin inflammation. When used in conjunction with sunscreen, it can further help protect you from sun damage.

Caffeine-based Creams

What Is Caffeine?

We usually associate caffeine with coffee or soda, in which it acts as a stimulant to our nervous system and mind. However, it can also be a stimulating agent in skin. When it comes to its role in skincare, you may be surprised to find out that caffeine is an antioxidant; that means it fights off free radicals that can accelerate the aging process by deteriorating collagen in the skin. It’s also a vasoconstrictor, which allows it to tighten blood vessels, creating a brighter complexion. Caffeine has a variety of properties that make it a mighty ally in the realm of aesthetic care, including cellulite treatments.

How Does Caffeine Fight Cellulite?

Caffeine has several benefits when it comes to reducing the appearance of cellulite. For one, it has a de-puffing effect when applied topically. By constricting blood vessels, caffeine affects microcirculation in such a way that temporarily reduces swelling, minimizing the look of puckering skin that creates cellulite. As a stimulant, it also triggers the function of certain enzymes that break down and briefly dehydrate adipocytes, aka fat cells. This temporarily makes the surface of skin look smoother and less dimpled.  

What Are Side Effects or Contraindications of Caffeine in Topical Creams?

There aren’t many side effects or risks when it comes to caffeine as a skincare ingredient. If you have particularly sensitive skin, there is always the possibility that it might be irritating to you, causing redness or even stinging. To prevent this, try a small spot test before applying it to a larger area to ensure that you don’t exhibit any allergic reaction. There is one major downside to the use of caffeine to treat cellulite: it’s only temporary. Just like drinking coffee only gives you a boost for a few hours, applying caffeine works the same way. It can be a quick fix, but doesn’t offer a long-lasting solution.


Biossance Squalene + Caffeine Toning Body Cream

The caffeine in this product is derived from green coffee beans and will give your skin a refreshed, smooth appearance, all while being supported by other beneficial ingredients that can lend your skin longer lasting moisture. Sugarcane-based squalene, for example, strengthens your skin’s barrier and allows for greater moisture retention. Niacinamide is another ingredient that is often used to combat texture in the case of acne scars, fine lines, or cellulite, especially when used over time. We love that this cream by Biossance has an unscented and citrus scented option, providing an easy choice for those who are easily irritated by fragrances. This nontoxic, paraben- and PEG-free formula is totally vegan and cruelty free for your peace of mind while firming and refining your skin.

First Aid Beauty Sculpting Body Lotion

First Aid Beauty is praised by many for its facial moisturizers, but thai sculpting body lotion deserves its own heaps of praise. Naturally, it contains caffeine to decrease the puffy, uneven texture associated with cellulite –– but it doesn’t stop there. Hydrolyzed wheat protein –– aka dermapeptide –– lends the skin added elasticity and firmness. Glycerin adds moisture to this formula; in case you don’t know, glycerin is a humectant, meaning that it will draw moisture from the environment to enrich the deeper layers of your skin. Finally, colloidal oatmeal acts as a calming ingredient that will add the ultimate polish to this smoothing product.

Alpha Hydroxy Acids

What Are Alpha Hydroxy Acids?

Alpha Hydroxy Acids, or AHAs, are a group of acids commonly used nowadays to target a large variety of skincare concerns, mainly those relating to aging and texture. They serve primarily as exfoliators that heighten the evenness of the skin, working to prevent and minimize wrinkles, scarring, and dimpling over time. The most AHAs are glycolic acid derived from sugar cane lactic acid. Citric acid, hydroxycaproic acid, and mandelic acid are other frequently encountered examples.

How Do Alpha Hydroxy Acids Fight Cellulite?

AHAs act as exfoliators to the skin –– that means they essentially shed the outermost layer of the skin to reveal a fresher, smoother surface underneath. The most popular AHAs, like glycolic acid, consist of extremely small molecules that are ideal when it comes to penetrating the skin; these can also aid in collagen production, accelerating the healing process of the skin and overall making it more durable and elastic. By peeling off the dead, superficial layer of skin, AHAs encourage it to rejuvenate itself and leave behind a smoother texture than before, making cellulite less noticeable.

What Are Side Effects or Contraindications of Alpha Hydroxy Acids?

AHAs can cause irritation in some people, especially when they are used in combination with other commonly drying or irritating products (like BHAs or retinols). Using AHAs too frequently can cause your skin to become over-exfoliated, making it dry, thin, and easily damaged. Make sure not to overdo it and use AHAs sparingly, as they are intended. Because of likely increased sensitivity, don’t forget to wear UV protection when using an AHA.


Paula’s Choice 8% AHA Gel Exfoliant

Once again, we turn to Paula’s Choice for its 8% AHA Gel Exfoliant product. The main ingredient here is glycolic acid, which, as mentioned before, is able to penetrate deep into the skin to stir up collagen growth all while shedding that superficial layer of dead skin. While this is unlikely to get rid of cellulite, it can make it less obvious and create an overall flattering skin effect. A variety of plant extracts and antioxidants add a soothing element that allows for an overall glowing, healthy skin appearance.

First Aid KP Smoothing Body Lotion with 10% AHA

This lotion from First Aid features an impressive 10% of AHA, the highest concentration you can use without having to consult a doctor beforehand. Unlike the Paula’s Choice option, this formula features lactic acid, which is a slightly milder AHA that is often recommended for those with drier or more sensitive skin. The rest of this formula also keeps gentleness in mind, avoiding fragrances, alcohols, oils, sulfates, and parabens –– on top of all that, it’s also vegan and cruelty-free. This product aims to create silky bump-free skin through the additional use of ceramides and colloidal oatmeal, which relieve and strengthen the skin.

The Takeaway

Cellulite isn’t a big deal –– a lot of people have no problem sporting their cellulite year-round, especially considering that it’s something so many people deal with. However, it’s no secret that many of us would much rather wave a magic wand and have our cellulite disappear forever. While nothing is quite so simple, there is a huge variety of invasive, non-invasive, and minimally invasive treatments that can help make that annoying dimpling and indenting in the skin a thing of the past –– or, at least, much less of a worry.

If you are interested in checking out one of the non-invasive or minimally invasive cellulite treatment options, your go-to destination should be Skinly Aesthetics on Manhattan’s Upper East Side. Owned and operated by Dr. Schwarzburg, this charming and accommodating clinic will make sure that you meet your body goals in the safest and best possible way. Dr. Schwarzburg is a board-certified cosmetic physician who has an impressive backlog of knowledge and experience to help you achieve an optimal outcome. Don’t hesitate to call us at (212) 774-4264, or e-mail us at info@skinlyasethetics.com.