Cellulite: What Works, What Doesn't, and What's New

Cellulite is common and has no definitive cure. Treatments fall into four categories: lifestyle measures, mechanical therapies, procedures targeting fibrous septae (including subcision and injectable collagenase), and energy or topical treatments. Subcision and collagenase have the strongest evidence for targeted improvement. Liposuction does not reliably treat cellulite and can sometimes worsen skin irregularities.

Overview

Cellulite (gynoid lipodystrophy) is a common change in the appearance of skin - dimpling or "orange-peel" texture - most often on the thighs and buttocks. Despite decades of treatments, there is no single cure. Many therapies produce modest, temporary improvement for some people, while others have limited or inconsistent evidence.

How treatments are evaluated

Clinical trials for cellulite are challenging. Outcomes often rely on photography and patient-reported satisfaction, both subjective. Research groups increasingly use objective measures (high-resolution ultrasound, MRI) to study changes in subcutaneous tissue and fat, but standardized, long-term outcome measures remain limited.

Four practical approaches to treatment

1) Reduce aggravating factors

Clinicians recommend healthy lifestyle habits: maintain stable weight, balanced diet, and regular exercise. These steps can improve overall appearance and skin tone but do not reliably eliminate cellulite. Hormones, genetics, and skin structure also play major roles, so lifestyle changes alone are rarely curative.

2) Physical and mechanical therapies

Vacuum massage systems (often called endermologie) and acoustic wave therapy aim to improve lymphatic flow and soften fibrous bands. Studies report temporary cosmetic improvement for some patients, typically requiring repeated sessions to maintain results.

3) Procedural interventions targeting fibrous septae

Subcision techniques mechanically release the fibrous bands that tether skin downward. Minimally invasive subcision devices (for example, those cleared for cellulite treatment) have shown clinically meaningful improvements that can last months to years in some studies. Injectable collagenase (approved in 2020 for certain patients) enzymatically disrupts these septae and offers another option, though it can cause bruising, nodules, and requires post-procedure care.

4) Energy-based and topical treatments

Lasers, radiofrequency, and combined energy devices can thicken skin or remodel tissue and produce modest, variable improvement. Topical creams - ingredients like retinoids, caffeine, and herbal extracts - may temporarily improve texture but usually do not provide durable change.

What about liposuction?

Liposuction removes deeper fat but does not specifically treat the fibrous bands that cause cellulite. In some cases liposuction can worsen surface irregularities. It is not considered a reliable cellulite cure and is used primarily for contouring rather than treating cellulite.

Bottom line

No single, universally effective cure exists. Some procedures (subcision, injectable collagenase) have the most robust evidence for targeted improvement, while other approaches offer temporary or modest benefits. Treatment choice should be individualized based on goals, risk tolerance, and guidance from a board-certified dermatologist or plastic surgeon.