First things first: cellulite is extremely common, affecting 85 to 90 percent of women (and 10 percent of men–they're connective tissue is stronger and they generally have less subcutaneous fat). Even very thin women can have cellulite because it has very little to do with weight—the key players are genetics, hormones, and age, but before we get into that, let's start with a quick anatomy lesson.
Cellulite occurs when fibrous bands under the skin (technical term: septae) pull down, causing the subcutaneous fat (AKA the fat just under the skin) to bunch up, creating a distinct dimpled appearance. The rippled effect is most likely to occur on your butt, hips, and thighs because this is where we naturally have the most of that subcutaneous fat, as well as reduced circulation and lymphatic drainage, neither of which help matters.
While genetics are largely to blame, estrogen is involved, too. More estrogen equals more fat, which is why cellulite often first appears post-puberty, when estrogen levels spike. But as estrogen levels decrease with age, cellulite can also get worse. Less estrogen leads to inhibited circulation and decreased collagen production, both of which exacerbate the appearance of dimples.
At the end of the day, there's no magical cream or treatment that will completely eliminate every last nook and cranny for good, so it's important to adjust your expectations, first and foremost. That being said, there are now more options than ever that are undoubtedly effective for at least diminishing the appearance of cellulite. Ahead, Dr. Manish Shah, a board-certified plastic surgeon in Denver, Colorado, Dr. Deanne Mraz Robinson, a dermatologist in Westport, Connecticut, and Dr. Paul Jarrod Frank, cosmetic dermatologist, chief medical officer, and founder of the PFRANKMD brand explain exactly what these are and how they work.
Keep reading to learn more about five cellulite treatments.
Apply Topical Creams
Our experts unanimously agreed that topical products are the least effective treatment for cellulite. "There are no at-home creams that will do anything therapeutic for cellulite, other than work temporarily, almost like makeup," warns Frank. Still, they're also the least expensive, least invasive, most accessible option, so it's understandable that many women want to try them. (And, if nothing else, they won't make matters worse.) If creams are the way you want to go, seek out formulas that contain retinoids, which help thicken the skin to help make it appear smoother, and/or caffeine, which constricts blood vessels to help reduce swelling, says Shah. The big caveat? It will take weeks or even months of dedicated, regular slathering in order to see any effects, which will disappear if and when you stop using the product.
Try an Endermologie Session
"Tissue massage techniques, such as endermologie, can temporarily improve the appearance of cellulite by draining excess lymphatic fluid, redistributing and reducing fat cell mass, and improving skin microcirculation," says Shah. Key word? Temporarily. Endermologie won't yield any long-term improvement, warns Robinson. Shah underscores this fact, pointing out that cellulite has been shown to reappear as early as three months after treatment. In positive news, even though the results won't last, you will notice an improvement quickly, often after just one session (though Shah advises multiple treatments for best results). And, as compared to other in-office options, it's fairly cost-effective, typically a few hundred dollars per session.
Consider Radiofrequency Treatments
Frank cites the Emtone device, which he says, "is like exercise for the skin." It uses both thermal and mechanical energy, using acoustic shockwave energy to break those fibrous bands that cause the puckering of the skin, he explains, adding that no treatment like this has existed previously. In the pros column: It's not painful, there's no downtime, and the treatments are fast, generally 20 to 30 minutes. The best results are usually seen after four of these sessions over a two-week period, at a cost of $1000 each. After that, patients usually come back for a maintenance treatment after three to six months, says Frank.
Opt for an Injectable
On the slightly more invasive end of the treatment spectrum are injections for cellulite. Frank often uses biostimulatory fillers such as Radiesse and Sculptra. Unlike their hyaluronic acid filler counterparts, these contain calcium hydroxylapatite and poly-lactic acid, respectively, both of which boost collagen and elastin production longterm. "The results are both immediate and semi-permanent, lasting up to a year. You get a smoothing and tightening of the skin anywhere on the body, without producing bulk or a 'filled look' associated with other techniques," he says. Depending on the area being treated, it should take only 20 to 40 minutes, though typically patients do one to four treatments over the course of a month, says Frank. The cost? Around $2500-$5000 per session.
There's also a new injectable making waves. QWO was recently approved by the FDA as the first and only injectable for treating cellulite (moderate to severe cellulite, in the buttocks of adult women, to be precise). "This is an exciting new option for the treatment of cellulite because it targets the septae," says Robinson. More specifically, it targets two types of collagen in these fibrous bands that they release, she explains. In studies, results were seen after three treatments, spaced 21 days apart; there's currently a five-year extension study in the works to see how long these results will last. Look for the injectable hitting doctors' offices starting Spring 2021, pricing is still TBD.
Consider an Invasive Procedure
While QWO is the first injectable to address cellulite by targeting the septae, there are two other treatments on the market that also do so, both of which are surgical procedures. Cellfina uses special cutting needles to detach the fibrous bands that attach to the undersides of the skin and form dimples, explains Shah. While it can be good to spot treat smaller areas, it's less effective for more generalized cellulite management, he says.
Similarly, Cellulaze also works on those bands, but using a fiber-optic laser to melt fat and cut through them. Both are considered invasive surgical procedures, so there will definitely be some downtime; it will also take about six months to see results from either, notes Shah. A long-term study of Cellfina showed lasting results after five years, says Robinson, though Cellulaze didn't have the same type of efficacy data, she adds. Either way, they're both quite pricey. According to Shah, Cellfina typically costs several thousands of dollars, depending on the area being treated, while at most practices the cost for using Cellulaze to treat the backside and thighs can run well over $10,000.