There are 3 injections that can treat cellulite.

Firstly, a new product called QWO has been approved by the FDA. This enzyme releases the fibrous bands under the skin, redistributes fat cells & stimulates new collagen production.

The second type of injection is known as PLLA or Sculptra. This dermal filler stimulates the production of collagen & thickens the dermis.

The third injectable is called calcium hydroxyapatite or Radiesse. It too thickens the collagen bundles to support the dermis-fat junction.

Side firing lasers in the 1440 nm wavelength can treat cellulite. This laser is called Cellulaze. It works by subcision of the fibrous septae, coagulation of fat & stimulation of dermal collagen.

There are no head-to-head studies that suggest lasers are better than other methods. Devices including lasers, RF, ultrasound, shock wave therapy, are all instruments that can be useful as adjunctive treatment that complements dermal fillers & surgical subcision.

Dermal fillers including collagen stimulating fillers can improve some cases of cellulite. This procedure is often combined with subcutaneous subcision of cellulite bands. Collagen stimulating fillers provide strength to the fibro septal network of fat as well as provide volumetric correction of divots.

I prefer the use of hyper diluted PLLA or poly-L-lactic acid. Why? Because it stimulates collagen & is much more cost effective than hyaluronic acid. Most patients will require 2-4 sessions over a period of 2-3 months. Expect bruising for a week (especially if I subcise).  Dermal fillers last 2-4 years in most cases. Costs range from $1900 to $5990 per area.

I often combine RF or radiofrequency with dermal fillers to improve the chances of success.

I was involved in the launch of Cellfina in Europe & the United States by Merz in 2015-2016. This is a FDA approved treatment for cellulite, & is essentially sharp subcision with a modified Nokor under vacuum. It is effective for the treatment of cellulite, with follow up studies spanning over 48 months.

The procedure takes 45 to 90 minutes to perform from start to finish. The first step involves marking of the dimples (easier with angled or tangential lighting). Once marked local anaesthetic & vacuum is applied. The latter is designed to lift the skin from the fibro septal areas. A special blade on the end of a needle transects the bands pulling down on the skin.

Downtime? Over a week. I disagree with the studies that state ‘mild bruising’. Majority of patients will have significant bruising for one week or longer. Nevertheless, this is probably one of the most effective treatments for cellulite as each dimple is manually treated. Once these bands are released, dimpling decreases as the skin is able to bounce back to its original & natural state.

Side effects of any surgical procedure are significant. These include bruising, typically taking 1-3 weeks to settle. Hemosiderin staining is also common. This is due to iron extravasation to the tissue.  It can take up to 6-9 months to resolve, however with pico lasers we can hasten fading.

Venus Legacy is my preferred treatment for cellulite. This is a multi-polar radiofrequency device that combines electromagnetic energy fields with intermittent positive & negative pressure.

Legacy works by increasing dermal thickness through the use of radiofrequency energy. Electromagnetic fields modulate microcirculation. Intermittent pressure improves lymphatic drainage.

Patients undergo a series of 5 to 8 treatments, spaced 2-4 weeks apart. Treatments are painless & typically take 20 to 60 minutes to perform.

VelaShape is a non-invasive body contouring treatment that can be used for cellulite. This treatment is FDA approved for temporary cellulite reduction. The latest model by Candela is known as the Velashape 3. This device uses a combination of four modalities to target cellulite: infrared light, bipolar radiofrequency (RF) energy, suction & massage.

Suction brings fat, cellulite & connective tissue closer to the energy source inside the handheld device. Massage to help relax and stretch the stiff fibrous bands under the skin that cause the dimpling and orange peel texture known as cellulite. Energy delivery via IR & radiofrequency heats the skin, improving collagen production in the fibro septal network, as well as tightening the tissue & reducing the volume of fat cells.

This device may be paired with other modalities including RF microneedling, RF, subcision, Cellfina, shock wave therapy & topicals.

Like any other energy device for cellulite, treatment success is highly variable. Velashape can be used on the thighs, buttocks, upper arms, and stomach.

Disclaimer: as of 2021,I am not using Velashape for cellulite. I did trial this device, & in my experience it has similar results to most energy devices for cellulite. As with all cellulite treatments, the best outcomes are with dimpled isolated bands, using devices as adjunctive treatments to manual revision.

Shock wave therapy or SWT is also known as AWT or Acoustic Wave Therapy & EPAT extracorporeal pulse activation therapy. This is a non-invasive, low yield solution for some cases of cellulite.

These techniques employ the use of sound delivered via high pressure sound waves targeted to the affected areas. Shock wave therapy has medical applications including treatment of sports injury, kidney stones & even after Coolsculpting for fat reduction. High pressure sound causes cavitation & break down of the targeted tissue.

The discovery of SWT for cellulite was a serendipitous event. A clinician demonstrated an improvement in cellulite whilst treating a hamstring injury.  The mechanism of action is unclear, however cavitation, increased blood flow & upregulation of collagen has been proposed.

The level of evidence for shock wave therapy as monotherapy has not been confirmed by reputable studies, however company sponsored white papers exist. I do use show wave therapy for other conditions, but I do not employ this method for cellulite. Shock wave therapy, much like RF devices should be combined with other cellulite treatments.

Caffeine modulates blood flow, & can metabolise fat. This is why it is banned in some countries for long distance cycling & running. The concentration of topical caffeine 3% is about one quarter the amount in a cup of coffee. A simple DIY application is with coffee grounds. You can repurpose this in compost for your garden.

Jojoba seed oil which is a plant wax that is commonly used to moisturize skin. It is claimed that it “reverses the appearance of cellulite on the skin and defend against the formation of more cellulite on the legs, arms, or tummy areas”. This is a very budget friendly option & in the best case acts as a moisturizer.

Centella Asiatica– also called gotu kola or tiger’s herb, this has been shown to increase blood flow and allow for better absorption of nutrients. Another theoretical blood flow modulator for cellulite areas.

Peptides– these are amino acids that serve as the building blocks for collagen and elastin.  Those are the things that make up the connective tissue in your skin that becomes weakened and allows for cellulite to show.  Research is still ongoing when it comes to peptides.

An Italian dermatologist has produced a great paper on the use of HIFU (Ultherapy) combined with Radiesse (Ca OH apatite dermal filler) for the treatment of cellulite. These two treatments complement each other & can stimulate collagen within the fibro septal network of cellulite. This can result in better support.

The biggest drawback with this combined treatment is the cost of consumables- namely the three transducer depths of 4.5, 3.0 & 1.5 mm, in addition to the cost of Radiesse at a 1:1 dilution. This means the average cost per session for the patient ranges between $5,500 to $8,000 depending on the extent of cellulite treatment. On this basis I prefer poly-l-lactic acid over Radiesse. The opposite holds true for facial atrophy as the G Prime for calcium hydroxyapatite is several hundred magnitudes higher than poly-l.

There are no long-term studies past 5 years, though there are ongoing studies that should reach the 5-year mark in 2022. These include studies on subcision, as well as combination collagen stimulation fillers such as Radiesse & poly-l-lactic acid (Sculptra).

To date, studies have shown that physical disruption of fibro septal networks (subcision/Cellfina), have given the longest remission rate.