Cellulite

Published on 19/03/2015 by admin

Filed under Dermatology

Last modified 22/04/2025

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Cellulite

Bruce E. Katz, Doris M. Hexsel and Camile L. Hexsel

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports

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Cellulite consists of surface relief alterations resulting in depressions and raised areas and thus irregular appearance, such as an orange peel, cottage cheese or mattress-like appearance of the skin, located mainly on the thighs and buttocks but also on the arms, abdomen, legs, and other areas. Depressed lesions are due to the presence of fibrous septa that pull the skin surface down; raised areas result from the projection of underlying fat to the skin surface as shown on anatomical and imaging studies. Women are most frequently affected by this condition; this is due to the structure and anatomy of the subcutaneous septa compared to the structure of men. In addition, cellulite is aggravated by progressive skin laxity or flaccidity, localized fat deposition and obesity. Furthermore, other factors have been implicated in the pathogenesis of cellulite, such as hormonal, biochemical, inflammatory and circulatory factors.

Specific investigations

The diagnosis is clinical. No imaging studies are required in clinical practice.

First-line therapies

image Subcision B
image Laser, light sources B
image Radiofrequency devices B

Reduction in thigh circumference and improvement in the appearance of cellulite with dual-wavelength, low-level laser energy and massage.

Gold MH, Khatri KA, Hails K, Weiss RA, Fournier N. J Cosmet Laser Ther 2011; 13: 13–20.

In this controlled, open-label, multicenter study, 83 subjects with mild to moderate cellulite received eight treatments with a device comprising a low-level, dual-wavelength diode laser (650 nm and 915 nm, to target fat), combined with heat induction and mechanical massage by suction (Smoothshapes™), in one leg, with the untreated contralateral thigh serving as a control. The maximum reduction in thigh circumference of the treated areas (−0.82 cm) occurred in the upper thigh at 1 month. There was subjective clinical improvement of the appearance of cellulite when comparing pre- and post-treatment photographs.

A single center, randomized, comparative, prospective clinical study to determine the efficacy of the VelaSmooth system versus the Triactive system for the treatment of cellulite.

Nootheti PK, Magpantay A, Yosowitz G, Calderon S, Goldman MP. Lasers Surg Med 2006; 38: 908–12.

Twenty female patients were treated twice weekly for 6 weeks with randomization to VelaSmooth™ on one side and TriActive™ on the other side. Velasmooth™ combines infrared light (680–1550 nm) with bipolar radiofrequency and mechanical massage by vacuum suction. Triactive™ has six diode lasers (808/810 nm) combined with mechanical massage, suction and localized cooling. In both treatment groups, 25% of the patients had improvement in the appearance of cellulite, with average percentage improvement in roughness for the VelaSmooth™ versus TriActive™ of 7% and 25%, respectively. There was a perceived change grade of cellulite; 75% of subjects showed improvement in the VelaSmooth™ leg while 55% of subjects showed improvement in the TriActive™ leg. There was no statistically significant difference (p > 0.05) in all variables between the two treatment arms.

Unipolar radiofrequency treatment to improve the appearance of cellulite.

Alexiades-Armenakas M, Dover JS, Arndt KA. J Cosmet Laser Ther 2008; 10: 148–53.

In this randomized, blinded, split-design study, 10 individuals with clinically observable excess of subcutaneous fat and cellulite (grades II–IV) on the thighs received up to six unilateral treatments (number of treatments at the investigator’s discretion and resulted in a mean of 4.22 and range of three to six treatments) at 2-week intervals with unipolar RF (Accent™). The untreated side of the thigh served as control. The results were assessed by two blinded investigators by using photographs and the authors’ cellulite grading scale. A novel quantitative four-point cellulite grading system was applied. All participants responded to treatment. The blinded evaluations of photographs using the cellulite grading scale demonstrated the following improvements in mean grading scores for the treated leg versus the control leg: 11.2% in dimple density; 10.7% in dimple distribution; 2.5% in dimple depth; and 8±2.8% mean score improvement.

Second-line therapies

image Oral supplementation with conjugated linoleic acid B
image Topical retinol, caffeine, and ruscogenine B
image Occluded topical caffeine with extracts of green tea, black pepper seed, citrus, ginger, cinnamon B
image Topical retinol C
image Topical caffeine B
image Topical phosphatidylcholine gel and light emitting diode (LED) C

The effectiveness and safety of topical PhotoActif phosphatidylcholine-based anti-cellulite gel and LED (red and near-infrared) light on grade II-III thigh cellulite: a randomized, double-blinded study.

Sasaki GH, Oberg K, Tucker B, Gaston M. J Cosmet Laser Ther 2007; 9: 87–96.

In this placebo controlled, double-blinded study, nine subjects with grade II–III thigh cellulite were randomly treated twice daily with a phosphatidylcholine-based anti-cellulite gel on one thigh. Twice weekly, each thigh was exposed for a 15-minute treatment with LED array (660 nm and 950 nm) for 24 treatments. At the end of 3 months, eight out of nine thighs treated with the combination were downgraded to a lower cellulite grade by clinical examination, digital photography, and pinch test assessment. At the 18-month evaluation period for the eight responsive thighs, five thighs had reverted back to their original cellulite grading.

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