The Tricky Problem With Cellulite Treatments

If you type "cellulite" into your Google search bar, the first phrase that populates is, "cellulite treatments that actually work." It's not surprising when you consider all the products on the market claiming to reduce or help dimpled thighs and butts — but do any of them "actually work"? The answer, if Google was being honest, is not really. That's why, for years, the most effective way to treat cellulite has been with in-office options, ranging from noninvasive to minimally invasive.

Still, even if you're willing to invest time and money into in-office treatments, the reality is not all methods are met with great success; in fact, it can be the opposite. This December, after a few years on the market, the first injectable treatment for cellulite, Qwo, ceased production due to concerns of severe bruising and the potential for long-term skin discoloration. A few months before, the popular fat-freezing treatment CoolSculpting was in the news for dramatic and mixed side effects.

At the end of the day, this could be because cellulite is notoriously difficult to treat. Here, we're breaking down the controversy and exactly why these treatments have such mixed results.

Let's start with a hard truth: cellulite is not fat. "Cellulite is a condition of the skin, not of the fat," says dermatologist Azadeh Shirazi, MD. "Even if you lose weight or remove the fat, it's primarily the firm fibrous bands under the skin's surface that cause the dimple. They act like buttons in tufted furniture and stick to the fat that gets pushed up in between the bands. The bands pull on the surface of the skin with fat stuck in between them, creating a dimple."

This is why fat-reducing treatments are not typically effective at addressing cellulite.

Board-certified nurse practitioner Maylen Cadenas, ARNP, explains that because these treatments are designed to target fat cells to reduce fat volume, they do nothing to treat the fibrous tissue that causes cellulite. "Fat is simply a type of tissue that accumulates in the body," says Cadenas. "Cellulite is a complex condition caused by multiple factors and is challenging to treat."

These factors include genetics, age, hormones, and lifestyle. "The location of the fibrous connective tissue also makes it challenging to treat cellulite effectively. This tissue is located deep within the skin and is surrounded by fat." This placement makes it difficult to target with treatments such as creams, massages, and topical products.

While losing fat may help, board-certified dermatologist Deanne Robinson, MD, says it does not impact the structure of the connective-tissue bands, so the pulling that leads to dimpling can not only still occur — it can even look worse. "If you lose a significant amount of weight, you may actually notice that your cellulite appears more visible," she says. "With large amounts of weight loss there is increased skin laxity, and cellulite may be more visible on looser skin."

Oh, and let's not forget anatomy. "Anatomically, the fat cells and connective tissue are arranged differently in women versus men," says Robinson. "Which may explain why males are less likely to have cellulite than females."

As the only FDA-approved injectable for reducing the appearance of cellulite, Qwo was groundbreaking, and it left a hole in the market for an effective, noninvasive procedure to treat cellulite.

"Most topical and laser therapies are aimed at improving the skin texture and tone to kind of camouflage its appearance," says Robinson. "Unfortunately, many patients don't really grasp that, so they spend big bucks and find themselves disappointed that they still have cellulite." Shirazi adds: "Cellulite is emotionally distressing for many women, negatively impacting their self-confidence. I often reiterate cellulite is normal and it's seen in over 95 percent of women, so they are not alone."

For an issue that, according to Cleveland Clinic, affects at least 80 to 90 percent of women who have gone through puberty, it's amazing that there aren't more concrete options available on the market. In fact, doctors still recommend lifestyle changes and to focus on diet and exercise as the first line of defense against cellulite. "Cellulite isn't an indicator of being 'fat,' however the more muscle tone you have beneath the surface of the skin, the smoother your dimples may appear," Robinson explains. "So keeping muscles strong and toned may help minimize the appearance."

Because of how psychologically and emotionally triggering cellulite can be, it's not uncommon for people to be especially desperate and eager to try a variety of treatments, no matter the time or price. But "despite the variety of options available, patients need to understand that there is no cure for cellulite, and what works for one person may not work for another," Robinson says.

In instances where skin laxity is contributing to the appearance of cellulite, Robinson recommends a nonablative treatment or microneedling to rejuvenate the skin texture and stimulate collagen production. "Topicals aren't going to treat the cellulite, but they may support the skin overall and improve the appearance at the surface."

The same goes for dry-brushing or massaging: they won't effectively cure your cellulite long-term, but with consistency, these daily habits might show a reduction in the appearance of dimples.

You can, however, see significant results with in-office treatments such as Avéli, subcision, Cellfina, and Cellulaze, all of which use different methods and technologies to cut or break up the bands beneath the skin, allowing them to lift, release from the fat, and lie more smoothly. But Dr. Shirazi warns that it can take several sessions to see improvements and they require some maintenance since bands can come back or thicken as you age.

That's why if you want to see real results, invest in in-office treatments that may actually make a difference. Just be aware that, for now, even those procedures will be long-term, recurring investments until the next thing comes along.