Cellulite is a complex, multifactorial process, what are the options?

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Cellulite is a complex multifactorial process what are the options

Before we dive into all the ins and outs about how those pesky dimples work and how to get rid of them, please keep in mind that cellulite is absolutely normal and incredibly common. So common that an estimated 80% to 90% of postpubertal women deal with it, meaning that more often than not, especially in women, cellulite is present on one or the other part of our bodies. This can come from a variety of factors, and while there is a huge common misconception that cellulite is a sign of being overweight or having too much fat in a given region of the body, this is certainly not always the case. In fact, most cases of cellulite are caused by more uncontrollable factors such as genetics, hormones, medical reasons, and yes, sometimes weight gain. Regardless of how common it is, and how severe your cellulite is, it is still a major cause of insecurity for many of us, which is why there has been countless trial and error in terms of effective cellulite treatment. Below are the most common causes behind cellulite, along with a description of various successful and unsuccessful treatment attempts for the classic dimpling seen in oh so many of us!

Cellulite symptoms causesLet’s start with the basics: What is cellulite and why do I have it?

Cellulite is generally classified by its dimpled orange peel like appearance and is most commonly observed in the buttocks and thighs of females, particularly after puberty. While cellulite can be present anywhere on the body and isn’t only a problem faced by women, it is less common in other regions of the body and men.

There is a common misconception that cellulite is strictly fat related, however this couldn’t be farther from the truth. While fat tissue is involved in the appearance of cellulite, the primary contributing factor to the classic dimpling seen in cellulite is fibrous septae. Fibrous septae are fibrous connective bands which connect the skin to the underlying muscle fascia. Because fibrous septae are irregular and have gaps in between each other so there is space for other surrounding tissue, this surrounding tissue, which is primarily made up of shallow subcutaneous fat, often bulges outward, causing the appearance of cellulite on the surface of the skin. So, while the fat in the area of concern does contribute to the appearance of cellulite, the dimpling in particular is caused by the fibrous septae pulling the skin down (1).

Now that we know what the physical background of cellulite is, what is it that actually causes this to happen? Why do some people have more cellulite than others? The answer is that there is no one main reason behind the formation of cellulite. Cellulite can occur due to increase in fat in a particular area of the body, hormonal factors, disease, and genetics. Cellulite is also more common in women than in men, mostly because it is most commonly seen in the thighs and buttocks, a region of the body that has the strongest muscles, in which women are more likely to carry some extra fat. In addition, due to hormonal changes in adult women, even those that are on the leaner side may develop cellulite, as female fat cells often grow larger than those of men. While there is no way to stop the formation of cellulite, there are quite a few tools that have been developed and tested to eliminate already existing cellulite dimples, some of which turned out to be successful, while others did not. Keep reading to learn about all the dos and don’ts when it comes to cellulite and how you can get rid of yours once and for all.

There are numerous creams and DIY home treatments to help mask the appearance of cellulite dimples. While some of them do have some great consumer reviews, having users swear by their cellulite creams and scrubbers, do keep in mind that even though these products can be effective in hiding your cellulite, they will not eliminate the fibrous septae which is the root cause of the dimpling.

Cellulite is classified based on a Nurnberger methodology with a severity scale, including grade 0, grade I, grade II, and grade III.

Cellulite classified dimpling gradeCREAMS

There are endless creams on the market that claim to reduce and sometimes even eliminate the appearance of cellulite through regular use, leaving you with smooth, dimple free skin. These creams typically contain one or more of three key ingredients: caffeine, retinol, and dimethylaminoethanol (DMAE), an antioxidant that is said to help reduce the appearance of cellulite. While some scientific studies testing the efficacy of such creams have results that suggest that they are capable of reducing the size of participant’s thighs with regular use, they do not eliminate cellulite or the fibrous septae causing the dimples seen in cellulite.

While none of these creams will physically eliminate the actual underlying cellulite or its root cause, they can result in temporarily smoother skin and less visible cellulite dimples.

Caffeine works by essentially drying out your skin, as it is a diuretic, meaning that it dehydrates you. Dry skin automatically results in slightly tighter skin, making your cellulite less visible. One of the most popular anti cellulite creams on the market is Sol de Janeiro Brazilian Bum Bum Cream, which contains caffeine and various oils to moisturize your booty along with the reduction of the visibility of cellulite dimples.

Retinol is common in various skin care products from anti aging creams to face washes and of course, cellulite reduction creams. It is said to penetrate the skin and stimulate collagen production, thickening and firming the skin, which in turn will disguise the dimples seen in cellulite patients. As Retinol creams are often recommended for more mature skin, Paula’s Choice Retinol Skin Smoothing Body Treatment Cream is a very popular Retinol based anti cellulite and anti aging cream.

DMAE is an antioxidant that is supposed to eliminate cellulite by stimulating muscle contractions, causing the muscles to become firmer. Unfortunately, there is no scientific proof of this actually working successfully. Revision Skincare BodiFirm cream is a popular antioxidant based cream that promises firmer and more toned looking skin due to its richness in nourishing ingredients.

Efficacy: DMAE and Creams can bring the appearance of cellulite on the outer skin down by one grade.


There are several scrubs out there that are meant to help reduce and eliminate cellulite with consistent use, almost all of which are coffee scrubs. One simple search for an “anti-cellulite scrub” and you will be bombarded with a variety of boutique or DIY homemade coffee scrubs to cleanse you of all your cellulite related problems. As mentioned above, while caffeine does have some benefits when it comes to skin care and promoting circulation in the treated area, which can result in a reduction in the visibility of cellulite, in order to maintain the results, you will have to be very consistent, meaning that the results will only last a few hours before you need to do another scrub. Most of the anti cellulite scrubs you will find online are coffee based scrubs such as Arabica Coffee Scrub, which is believed to fight cellulite, stretch marks, spider veins, and wrinkles.

Efficacy: Scrubs can bring the appearance of cellulite on the outer skin down by one grade.


Aside from scrubs, some people also swear by massages and dry brushing tools like this one to reduce the appearance of cellulite. These methods are said to work by not only stimulating blood circulation in the treated area, but also promote lymphatic drainage, which may help to eliminate toxins that commonly build up in your fat layer. While this can be effective, keep in mind that if you plan on using this method, you will have to be consistent with it and practice it daily for your results to last.

Aside from the convenience of these non-invasive methods, they are also a lot more affordable than the surgical methods, as a full body lymphatic drainage massage can go anywhere from $50 to $200. Creams, Scrubs, and dry brushes are mostly between $15 and $50, and you can probably go for the cheaper ones as the ingredients are typically the same.

There are various medical treatments that you can get at a medical spa, plastic surgeon, or dermatologist. There has been a lot of trial and error with these medical treatments, as once again, many of them attempted to tackle cellulite by eliminating fat, rather than the fibrous septae, making some treatments less effective than others. The most commonly used medical treatments for cellulite include various lasers, different varieties of microneedling, ultrasound energies, and injectables. Below is a list of the least invasive to most invasive medical grade medical treatments used to treat cellulite.

Efficacy: Massages can bring the appearance of cellulite on the outer skin down by one grade.


Pressotherapy is a treatment designed to help with lymphatic drainage and works through the use of a machine, which massages you using a very specific amount of pressure to improve the efficacy of lymphatic drainage. During your treatment you will be strapped into a sleeve surrounding the treatment area which massages you similar to a mechanical massage chair in sleeve form. Compared to a massage performed by hand, pressotherapy is meant to be more exact and therefore more effective. This can help reduce the size of the area that is being treated, and has been reported to help reduce the appearance of cellulite as well. While the treatment won’t directly eliminate cellulite and its underlying causes, it may temporarily reduce its appearance. In order to keep the results however, you will have to continue with the treatment on a regular basis.

Side effects of pressotherapy are mild and rare and include possible muscle pain, redness, or irritation. Overall you will likely be spending anywhere from $50 – $150 per session on this treatment, though you will likely need more than just one. There are currently no peer reviewed clinical studies that proves the efficacy of this treatment.

Efficacy: Pressotherapy can bring the appearance of cellulite on the outer skin down by one grade.


Endermologie is a massage-like treatment that is said to reduce and eliminate the appearance of cellulite by regenerating the skin, promoting lymphatic flow and drainage, and ultimately smoothing out the treatment area, namely, the buttocks and thighs. The treatment is carried out using a handheld vacuum tool that is carefully dragged across the body, similar to a deep massage. The suction and gentle massaging actions regenerate skin-thickening fibroblasts, induces what is called lipolysis, the elimination of fat cells, releases tight bundles of fat and skin tissue – to soften the appearance of cellulite – and boosts lymphatic flow. A 2016 study suggested visible results in just three sessions, and a 67 percent reduction in cellulite. While this treatment does have mixed results, with some satisfied patients, and others less enthusiastic about their results, those that did see results also seemed to have lost overall weight and a reduction in the circumference of the treatment areas, based on a study conducted to determine the safety and efficacy of the treatment. Results should be seen within 3 – 6 sessions total, with regular weekly treatments. The side effects that are associated with this treatment are mild, the main possible side effect being bruising, which only occurs in individuals with very sensitive skin. You can expect to spend $95 – $150 per treatment, depending on the size of the treatment area.

Efficacy: Endermologie can bring the appearance of cellulite on the outer skin down by one to two grades.


Velashape is a non-invasive treatment that uses infrared light, bi-polar radio frequency energy, and vacuum, causing controlled heat damage to the underlying fat and connective tissue in the treatment area, namely, the buttocks and thighs. Once again, while this treatment has proven to be effective in some cases, particularly to tighten the skin and reduce the size of the treatment area, it will not actually fully eliminate the cellulite itself as it does not address the fibrous septae underneath the skin. Studies demonstrated significant results in circumference reduction of the abdomen, flanks, buttocks, and thighs, as well as a reduction of the appearance of cellulite. Based on patient reviews, 46% felt that the treatment was worth it for cellulite reduction, meaning that Velashape isn’t the most popular treatment for cellulite alone. Due to the heat involved in the treatment, some possible side effects include tingling, a localized warm sensation, redness, and bruising. For optimal results, doctors recommend four to six weekly treatments, and you can expect to spend $200 to $600 for each. Keep in mind that Velashape is a treatment primarily designed to reduce the treatment area in size for a more weight reduction geared result, rather than for cellulite treatment. However, due to reported residual side effects of simultaneous reduction in the appearance of cellulite, Velashape is now also considered a treatment to help reduce cellulite in certain regions of the body.

Efficacy: Velashape can bring the appearance of cellulite on the outer skin down by one grade.


CoolSculpting is a non-invasive treatment that can be found at medical offices which is used to eliminate subcutaneous layers of fat. This works through the use of a vacuum applicator that freezes areas of the body in which fat is to be treated. This treatment is very common and has been consistently successful in eliminating unwanted fat through cryolipolysis. While the process is not instant and may require several sessions, CoolSculpting is great for a non-invasive alternative to liposuction. That said, CoolSculpting actually is not ideal to treat cellulite. In fact, the reduction in fat may even cause an increase in dimpling, as the fibrous septae protrude outward and the areas where the fat once was are sunken in, which once again confirms that fat reduction alone does not necessarily mean cellulite reduction. CoolSculpting prices vary and can range from $500 – $1600 per session.

Efficacy: CoolSculpting does not reduce cellulite.


Originally used under the name XIAFLEX to treat adults suffering from Dupuytren’s contracture, QWO is an injectable solution made up of collagenase clostridium histolyticum, which works to reduce and eliminate cellulite by breaking down the fibrous septae pulling down the skin which causes the classic dimpling seen in cellulite patients. The treatment was FDA approved for the treatment of moderate to severe cellulite on the female buttocks and is currently becoming increasingly popular. No anesthesia is necessary as the treatment itself involves little to no pain due to the small size of the needle used, which is 31-32 gauge. As a minimally invasive procedure, QWO is offered by highly sought after board certified cosmetic physician Dr. Schwarzburg, at his boutique NYC medical spa, Skinly Aesthetics.

One of the main downsides that comes with this treatment is that it results in severe bruising after each treatment, which, however, lessens with every subsequent treatment. The bruising occurs because multiple small blood vessels are trapped inside the fibrous bands and as they are getting lysed by the enzyme the vessels are lysed along with them because their walls contain collagen too. You can expect the bruising to last up to three weeks, which has been reported by several patients, though the bruising itself is completely painless.

You may also feel a certain degree of soreness for one to two days following your treatment, as the treatment causes the destruction of the fibrous tissue, as well as blood vessels (causing the bruising), which can result in some tenderness post procedure. This can be alleviated using over the counter painkillers, but you will still be able to resume normal activities right after your treatment.

One other very rare longer term side effect reported in the clinical studies of QWO is post-inflammatory hyperpigmentation, which typically can be treated with depigmentation creams as well as lasers. Based on patient reviews, 53% of patients felt that the treatment was worth it. However, do keep in mind that this treatment is a newer one on the market, meaning that it has significantly less ratings than other treatments. The prices of QWO range $800 – $1500 per session, with a recommended three sessions over the course of nine weeks for optimal results.

Efficacy: QWO can bring the appearance of cellulite on the outer skin down by three grades.


Similar to fractional microneedling in a sense that it can be administered in the form of a microneedling device, mesotherapy is another treatment used to nourish the skin and sometimes cause a tightening effect. It involves the injection of a custom solution made up of vitamins, peptides, and hyaluronic acids, which is also said to potentially reduce the appearance of cellulite, especially due to the collagen peptides which boost dermal density and therefore may help smooth out the outer layer of the skin. While this treatment isn’t always effective, it has been noted to reduce the severity of cellulite in women. Mesotherapy reviews state that 48% of patients found it effective and would recommend it, though this is not specifically geared towards its treatment for cellulite alone. The average cost of mesotherapy may range $400 – $1000 per session, and possible side effects include redness, swelling, bruising, and discomfort.

Efficacy: Mesotherapy can bring the appearance of cellulite on the outer skin down by one grade.

Fractional radiofrequency microneedling

Fractional radiofrequency microneedling is a skin tightening treatment used primarily in the face and neck for lifting and tightening effects. It works through the use of a hand held microneedling device that emits radio frequency waves into deep layers of the skin, causing controlled heat damage and a heavy boost in collagen. It can also be used to eliminate fine lines, wrinkles, and scars, but is sometimes also used to treat stretch marks and of course, cellulite. Due to its tightening effect, it does have the ability to reduce the appearance of cellulite by tightening and smoothing out superficial and even deeper layers of the skin. That said, it is not necessarily a treatment designed to eliminate cellulite, meaning that it does not target the fibrous septae at all, which also confirms that it will by no means fully eliminate the cellulite. It was also found to help improve skin laxity due to weight loss in recent studies. Fractional microneedling side effects include pain, discomfort, swelling, and bruising, though these side effects are only temporary. You can expect to spend up to $2500 for this treatment, depending on the treatment area and the number of sessions purchased.

Efficacy: Fractional radiofrequency microneedling can bring the appearance of cellulite on the outer skin down by one to two grades.


Cellulaze is a laser treatment that works through the use of a small laser fiber surgically inserted under the skin to cause controlled heat damage to melt fat cells, cut through fibrous septae, as well as stimulate collagen production for tighter skin. The laser used for this treatment is the ND:YAG 1440-nm Wavelength Laser with side-firing fiber, It was approved by the FDA in 2012 for the treatment of cellulite and while the treatment does involve a surgical approach, it has shown to cause improvement in the reduction in cellulite, though the results are not permanent. Based on average patient reviews, cellulaze is 64% worth using. Because cellulaze is a surgical procedure, you will experience some bruising, swelling, and minor aches and pains after your treatment with an average recovery time of one week. During your treatment you will be under general anesthesia or receive local anesthesia to make the process more comfortable, as it would not be tolerable without any kind of numbing agent. Keep in mind that once you have finished your treatment, your results will not be permanent, but will last up to one full year. The average cost for the treatment is $5800 which can vary depending on where you go and how many treatments you decide to purchase.

Efficacy: Cellulaze can bring the appearance of cellulite on the outer skin down by two grades.


Liposuction is a well known treatment used to eliminate unwanted fat in various regions of the body using a cannula to suck out the fat. A cannula is an often larger hollow needle. While it is specifically designed to eliminate unwanted fat, is sometimes also used to help treat cellulite, and has mixed results in this regard. While it is effective in removing unwanted fat, and sometimes breaks down fibrous septae in the process, it doesn’t specifically target it, making liposuction a hit or miss when it comes to cellulite reduction. Liposuction is more commonly used for the sole purpose of eliminating fat, though the cannula used to remove the fat may cut through this fibrous tissue pulling the skin in and creating the dimples seen in cellulite. However, do keep in mind that the cannula used for liposuction is not a cutting instrument, meaning that it will not necessarily have this effect on your cellulite dimples. In addition, cellulite is typically found in the thighs and buttocks, and liposuction is almost never administered on the buttocks, making it less than ideal for cellulite elimination in that section of the body. Each session of liposuction can cost you anywhere from $2000 to $8000 depending on the treatment area and general pricing of your chosen clinic, but is usually a one and done procedure for fat elimination, meaning that it won’t require multiple follow up treatments. Because this is a painful surgical procedure, you will be put under general anesthesia to complete the entire treatment. The risks and side effects associated with liposuction including lumps, numbness, infection, internal puncture, fat embolism, and contour irregularities, which are risks that should be taken into consideration before going through with the treatment.

Efficacy: Liposuction can bring the appearance of cellulite on the outer skin down by one to two grades.


Cellfina is a surgically administered treatment involving the use of a hand held semi-automatic tool that employs multiple rotating blades that cut through fibrous septae underneath the skin, releasing them from the skin and in turn eliminating the dimples that come with cellulite. During the treatment you will be under local anesthesia and a mild sedative to eliminate any pain during the surgery, as the doctor uses a stabilize-guided subcision to cut through the fibrous septae under your skin in a horizontal manner. The results are said to last up to three years, though some patients do warn to look out for scars, lumps, and discoloration after the treatment. The process used during the treatment is called subcision and has clinically been proven to effectively eliminate cellulite affecting the majority of female patients.

Do keep in mind that this is a minor surgical procedure that requires insertion of specialized surgical tools under your skin, which will result in possible risks and definite side effects including bruising, swelling, soreness, and microscarring along the needle insertion points, with an average recovery time of up to two weeks and results that will last up to three years. With any surgical procedure you can expect at least a few of the possible side effects as it requires a more invasive approach.

Based on patient reviews, 61% of them feel that the treatment was worth it. The average cost for one treatment is around $4000 depending on the number of sessions purchased, as well as the clinic in which you are receiving your treatment.

Efficacy: Cellfina can bring the appearance of cellulite on the outer skin down by one to three grades.

Let’s sum it up

In conclusion, there are actually quite a few tools that can be used to help you get rid of, or at the very least reduce the appearance of those pesky cellulite dimples. While some methods are more effective than others, the treatments that seem to have the best effects on cellulite elimination are those that eliminate the actual cause behind cellulite: fibrous septae.

Based on treatments that specifically target fibrous septae, the best treatments to battle cellulite include QWO, Cellulaze, and Cellfina – QWO being the least invasive of the three options. Do keep in mind that while these treatments break down the fibrous septae, they do not stop new ones from forming, meaning that they will not stop you from developing new cellulite dimples in the future. A downside to all three of these treatments, is that they are all on the spectrum of minimally to fully invasive procedures, requiring at the very least an injection (QWO), or a small surgical intervention (Cellulaze, Cellfina). This means that they do come with risks and side effects, as mentioned in the treatment descriptions above.

That said, for those who are looking to avoid any kind of invasive treatment, there are many creams, massages, and scrubs that can be used to help smooth out the skin and make any given problem area look a little less dimply. While they do require consistent treatments and will not permanently eliminate your cellulite, they do offer a non-invasive alternative to help mask the cellulite that is bothering you, especially if you don’t want to have to schedule an appointment with your doctor or undergo a surgical procedure. The downside here is that you will have to plan on receiving several treatments for lasting effects, otherwise the results will begin to diminish. However, a major benefit of these minimally invasive cellulite treatments is that you won’t be dealing with any downtime or pain. Creams, scrubs, and DIY massages such as dry brushing tools, will gently help reduce the appearance, while simultaneously serving as a moisturizing lotion or an exfoliating skin smoothing result, without the downside of requiring any kind of anesthetic, sedative, or surgery.

Velashape, Edermologie, and Pressotherapy all require professional administration of treatment and work to reduce the appearance of cellulite through lymphatic drainage. These treatments do not involve any side effects other than potential redness and tenderness due to the pressure from the massage. Once again, while these treatments are effective in reducing the visibility of cellulite dimples, you will have to get regular treatments in order to maintain these results. A huge plus with these treatments, is that aside from a reduction in the appearance of your cellulite, the treatment itself can actually be quite relaxing, as it essentially is nothing more than a deep tissue massage.

If you are still unsure of where to start with your cellulite treatment, you can always schedule a consultation with your physician at Skinly Aesthetics to see what your options are, or start with the smaller DIY options and work your way up to a more permanent medical solution.

Methods of cellulite reduction Methods of cellulite reduction

A comparison of cellulite reducing techniques