The Skinny on Cellulite

Why is it so hard to get rid of Cellulite? Over the years I have seen many treatments that claim to reduce or even eliminate cellulite. However, I’ve never seen a treatment that actually works well. There are some treatments that can give a temporary improvement, and if you look at those before and after pictures, it can be very convincing. But the results are fleeting. In this article I’ll explain what Cellulite is and why it is so tough, what we can do for body sculpting and what the limitations are.

What is cellulite?

Cellulite is mostly seen around the thighs but can happen elsewhere in the body. It consists of fatty areas that have dimpling of the skin surface. The result is a wavy, dimpled fatty appearance. The dimples happen because the fat around the thighs is permeated with fibrous bands of connective tissue, like a honeycomb. The thighs have this structure that is very different from other parts of your body, like your belly. Imagine the belly fat as a tub of butter. You could take a spoon and scoop it all out. Now imagine that the thigh fat is like a honeycomb with fat in each little pocket. If you tried to scoop that out, you wouldn’t get much-- you would be blocked by a band of tissue. Now imagine you add butter to each space. The belly just expands and fills up. But the thighs-- those fibrous bands are attached to the skin. As you add fat, the skin bulges out but the attachments to the skin are tugged in, resulting in a dimple. This is why cellulite looks like it does.

Treatments for Cellulite

Thigh creams: no matter what is in a cream, there is no way it is going to penetrate through your skin and release those bands or kill fat. Save your money.

Shock wave: there are several devices that send shock waves into the tissue in attempt to loosen the bands. We have one of them at Glow called Cellutone. We use this device for a very different purpose (breaking up fat that has been treated with Vanquish ME to help it resolve faster and prevent tender lumps as it goes away). Experiments using shock wave to loosen and smooth out cellulite can show minimal temporary improvement, but this is short lived and not enough to throw money at it. There are many devices out there that purport to do this-- don’t waste your money.

Cellfina: This is a semi-invasive procedure that uses a device to target individual dimples in the skin and the physician slices through the band through the skin surface. Cellfina can really produce some nice results. But they are temporary. Why? If you are going in there and literally cutting the band, why would the results be temporary? Because (unfortunately) the bands re-tether over time. That’s right-- your body rebuilds those bands as it heals. The dimples return. Plus it is fairly invasive and expensive. This procedure was exciting when it first came out, but you’ll find few places offering it now. Not worth the money!

Surgery and liposuction: Believe it or not, surgery doesn’t work any better than Cellfina for the same reasons. If you take a scalpel and slice through one of those cellulite bands-- it just re-tethers! As a matter of fact, those fibrous bands are really difficult to deal with during liposuction as well. Let’s go back to that tub of butter. With liposuction, you are using a vacuum to suck out the fat. The belly (and some other areas) are ideal for this, and results can be beautiful. But the thighs-- they bump into those bands and can’t get through them-- or lyse through some but not others. The results of liposuction on the thighs are often weirdly lumpy and wavy. The bands make it so that you have to cut into each tiny pocket of fat to vacuum it out-- and this is really challenging.

Injectables: There is a new injectable medication called Qwo that is being sold for cellulite. There have only been 2 studies of Qwo with only a few patients in each. They showed a 6% and 9% significant improvement that both patient and doctor could agree upon. They showed a 50% minimal improvement that either the doctor or patient felt was present, but the other disagreed. The 1 year follow-up showed a 34% persistence of correction. Meanwhile the treatment causes massive bruising. By massive, these are the worst images of bruising I have ever seen. Long term with that much bruising, the body is often left with hemosiderin deposits that can permanently stain the skin.

Qwo is new, but my prediction-- it will come and go. 

Body Sculpting-- what can we really do for Cellulite? 

We have 3 big things we CAN do with our machines. We can kill fat, we can build muscle and we can tighten skin. We cannot lyse those bands! At least not very effectively with long-lasting results, and that is what I’m looking for. Our treatment for thighs can result in a significant improvement in the appearance of fat and cellulite. If you reduce the fat and build muscle, the cellulite will look better since there is less fat bulging out, thus less tugging in of the skin. We do have a protocol for thighs using primarily Emsculpt Neo, but occasionally adding other fat dissolving and skin-tightening treatments. The thighs are large areas, and have 4 muscle groups (the Quads in front, buttocks and hamstrings in back, and the adductors on the inner thigh and abductors on the outer thighs). That’s a lot of treatments. It is definitely not a one-and-done magical cellulite vanishing cream. I wish I could invent that! Here is an example where we really felt our thigh treatments made a big difference:

In summary, Cellulite is one of the most challenging issues we try to address in aesthetic medicine. The fibrous bands that cause the dimpling appearance are really strong, resistant to any kind of treatment and have a very strong tendency to recur. The best treatments focus on the realistic goals of reducing fat, toning muscle and improving skin.

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