What is the best cellulite treatment?

Most cellulite treatments do not work...

As most women know by experience, most cellulite treatments simply do not work. And when I say they don't work, I mean that they either do not work at all or that they offer so poor results that you would need 20, 30 or 50 sessions to be happy with the results.

The reason for this is that cellulite is a multi-faceted aesthetic condition with several different aspects: superficial fat accumulation, poor circulation / lymphatic drainage, skin and connective tissue looseness, inflammation, skin and connective tissue deformity, glycation and oxidative damage. It is evident that no single treatment can tackle all those aspects at the same time, hence the failure of most treatments to work. A holistic, more comprehensive approach is needed, ideally one that combines two or more complementary techniques / technologies / approaches.

Here we will review the best single treatments, according to effectiveness (more effective treatments are presented first, ineffective treatments are presented last). A combination of two or more of the most effective treatments is recommended for good results with cellulite reduction or prevention.

 

The best cellulite treatments, in order of effectiveness

This review is the result of our 14 years of specialisation and research in cellulite reduction and we hope it can be of help to you - you should definitely not have to spend 14 years to know what treatment is the best!

Please note that this is only a list of the best technologies or techniques. The application of those technologies varies from clinic to clinic. Your therapist's knowledge and experience, the therapeutic protocols she/he uses for the treatment, the products used and the quality of the equipment are equally as important, so do your research and don't be afraid to ask questions!

And of course, don't expect everything from the treatment. Follow a healthy diet regime (loads of vegetables, fruits and lean protein, restricted carbs, and no fried or sugary food), exercise a lot and try not to indulge too much on alcohol or smoking if you want good / long-term results!

 

Resistive, monopolar radiofrequency

This treatment involves the use of high frequency electrical currents. These currents can create and focus heat on specific tissues of the body, depending on the technology and protocols used for the treatment.

This intense heat contracts your existing collagen fibres and stimulates the secretion of more collagen and elastin by fibroblasts (collagen cells), thereby making your skin and connective tissue tighter.

The intense, focused heat also stimulates release of fat from adipocytes (fat cells) and the adipocyte apoptosis (early fat cell death), thereby making your fat deposits and cellulite smaller.

A huge increase in circulation on the treated area is also the result of intense, focused heat, caused by RF currents.

All in all, resistive monopolar radiofrequency is the best technology to use for cellulite reduction, acting on fat, firmness and circulation all at the same time. And if combined with other technologies, the results can be amazing - always of course in combination with diet and exercise (miracles do not exist).

Please note that the similar-sounding, but very different, "capacitive monopolar radiofrequency" and "bipolar radiofrequency" varieties do not work - the reason being is that they are too superficial to do anything for cellulite, which is seated deep inside the skin. So before you commit to any treatment, do your research! On this website we have several articles with more detailed analysis on RF treatments - for a full list just check the keyword / tag list on the sidebar.

 

Ultrasound cavitation

Ultrasound cavitation treatments utilise high frequency sound to create cavities (bubbles) inside fat cells, in particular. As the cavities grow in size with continuous application of the ultrasound head on the same area, they burst the fat cell. However, with the intensities used, not all fat cells are burst (the maximum intensity of those machines is capped to prevent damage to other tissues), but still this mechanical disruption caused by the sound waves encourages adipocyte apoptosis (early fat cell death), thereby helping reduce the severity of cellulite and the thickness of deeper fat layers.

Unlike radiofrequency, cavitation does not help much with circulation or skin firming, so for best results other treatments may need to be used in conjunction with it, such as massage or pressotherapy.

You can read more about cavitation on this website by clicking on the ultrasound cavitation tag on the sidebar.

 

Electro-mesotherapy (mesotherapy without needles)

Electro-mesotherapy, also known as no-needle mesotherapy or needle-free mesotherapy, refers to the increased absorption of anti-cellulite active ingredients into the skin. If after applying an anti-cellulite cream your skin absorbs X amount of actives, with the application of electro-mesotherapy it will absorb 2X, 5X or even more.

Electro-mesotherapy can be based on ultrasound (sonophoresis), electrical currents (electrophoresis, electroporation etc.) or on a combination of both. Both ultrasound and high frequency electrical currents are known to enhance skin absorption of active ingredients.

If a quality anti-cellulite gel / cream / serum is used for the treatment (one that contains several actives and in high concentration), the results can be impressive, especially if the treatment is combined with radiofrequency or ultrasound.

Unfortunately, however, many such electro-mesotherapy treatment products are actually highly diluted instead of highly concentrated and contain irrelevant or two few active ingredients and that's where most such treatments fail. So before you commit to such a treatment, make sure you ask what ingredients are included in the treatment and if the treatment is combined with other technologies, for maximum results.

 

The "hit and miss" ones

The treatments below can be helpful or they can be a waste of time and money - it all depends on the detail: therapist experience, equipment used, products used etc. So read on and do your research before committing to anything.

 

Cellulite creams

It is true that most cellulite creams do not work. This is because, for profit maximisation reasons, most creams contain only one, two or three active ingredients and at low concentrations.

As we mentioned above, cellulite is a multi-faceted esthetic problem and unfortunately some caffeine here or some retinol there are not enough. Clearly a more comprehensive approach is needed, with multiple actives that act on multiple aspects of cellulite (fat, circulation, inflammation, firmness, tissue repair etc.) and in high concentrations.

In summary, a highly concentrated, multi-ingredient cream can be effective in the fight against cellulite. However, a cheap, single-ingredient, low-concentration one would probably be a waste of time and money...

 

Injection-based mesotherapy

Mesotherapy involves the use of a "gun" with multiple needles which inject anti-cellulite actives into the skin. This intrusive procedure, which is painful and leaves the skin with bruises, can be effective in some cases and pretty ineffective in most.

If homeopathic or irrelevant actives (such as "artichoke extract that cleanses the liver" - really? the liver?) are used, don't expect much results. If things like caffeine, vitamin C etc are used, you should expect some results, but don't hold your breath: it has been found that most of the benefit of mesotherapy is due to the injury caused by the needles and subsequent healing of tissues, rather than the actives themselves.

In some countries the combination of lecithin with bile acids (yes, the ones you use to digest your food in your gut), such as deoxycholic acid, is allowed for use in mesotherapy injections (banned in the UK). This combination does help reduce cellulite and fat, but be prepared for the bruises, pain and the occasional fainting (if lecithin escapes into the blood stream it can get converted into choline and then to acetylcholine, which stimulates the parasympathetic nervous system, hence the fainting)...

In some other countries stronger chemical cocktails, banned in the "civilised world", are used. I once had a client that had painful weekly injections (she could not sit properly for a couple of days after the injections) for two months every six months, every year - and to be honest she did not have much to show for all that pain. In my opinion the results do not justify all the cost, effort and anguish and she would be way better off with one of the non-intrusive techniques referenced above.

In conclusion, if the right chemicals are used, mesotherapy can reduce fat and therefore cellulite, but it will not do much for the loose skin that accompanies most cases of cellulite, so it has to be combined with a skin firming treatment, such as radiofrequency for overall good results.

 

Skin needling

Skin needling, typically provided via "rollers" with needles or "stamps" with needles, has become very popular in the last few years. 

The main benefit of "derma rollers" with needles is their stimulation of collagen production on the surface of the skin. As such they can be very helpful for skin firming / anti-ageing on the face, where the skin is very thin, and to a lesser extent on the body.

However, cellulite is located at least 5mm deep inside the skin, and as such cannot be reached by the device needles, which have a length of 0.5mm (very mild, very superficial) to 2.5mm (deeper but not deep enough for cellulite, very painful and causes bleeding).

The only application of skin needling that is suited to cellulite is that of stimulating skin penetration of anti-cellulite actives - something like "mesotherapy-light" - and only when combined with a quality anti-cellulite skin product. But then it all depends on the number of actives in the cream and their concentration: a diluted product won't do much, while a concentrated one may be worth the pain (mild to significant, depending on needle length) and the bruising (typically light) that skin needling causes.

 

Strong, cellulite-specific massage

Massage can be a relatively effective cellulite reduction method or a complete waste of time - it all depends on the skill and knowledge of the practitioner.

A strong massage that acts on cellulite itself can help boost circulation / lymphatic drainage, mechanically break down fat cells (limited effect), mechanically break down scar tissue (very good effect) and (if applied very regularly for several weeks) stimulate collagen production.

Unfortunately, such a strong massage is very tiring and unhealthy for the practitioner's hands and joints, painful for the recipient and also causes bruises, so it is not one of our first choices. Furthermore, if the therapist does not exactly knows what she/he is doing, you will end up with lots of bruises and not much else. On the other hand, with a good therapist you will have some good results (albeit accompanied by bruises and pain in the first few treatments until your body gets used to it).

Massage does not significantly affect fat tissue, which is the number one factor in cellulite, and as such it has limitations. However, in combination with a good anti-cellulite product, one with multiple active ingredients in high concentrations, results can be better.

In conclusion, as this technique depends 100% on therapist skill, it is hit and miss, so again, do your research before committing to a course of treatments.

 

Pressotherapy

Pressotherapy helps boost circulation and lymphatic drainage and as such can help reduce cellulite, but as it does not act on the fat tissue it has limitations. If pressotherapy is combined with a cling film wrap. after a quality anti-cellulite cream / gel is applied on the legs, results can be better. It all depends on the active ingredients contained in the cream and their concentration.

Wrap or no wrap, the effectiveness of pressotherapy also depends on the equipment used. One with high speed of inflation / deflation and with high pressure capabilities will offer better and faster results, in comparison to a cheap machine with slow inflation / deflation cycles and low maximum pressure.

Some women also use pressotherapy to boost the effects of cavitation or electro-mesotherapy, which is helpful. As radiofrequency significantly boosts circulation, pressotherapy is not necessary for that treatment.

 

Acoustic wave therapy (AWT)

About 7 years ago, when acoustic wave therapy used to be known as shockwave therapy and only confined to breaking down kidney stones, healing bones and treating tendon and ligament injuries, I have decided to research this technology for the treatment of cellulite. That was well before the PR hype by a well-known London cosmetic clinic about Madonna buying a machine and using it for her cellulite (yeah, right)...

There was some research published on the use of EST, i.e. extracorporeal shockwave therapy (not the euphemistic "AWT" name, which was invented later for PR reasons) which was quite promising and the whole idea "made sense" - well at least theoretically.

This prompted me to thoroughly research the subject: I looked at all the research, found the major manufacturers, read about the different equipment specifications, features and limitations, talked to a consultant doctor specialising in EST about the application I had in mind, travelled all the way to Germany to talk to experts in the field of EST and finally rented, tried and tested the two best machines from the two leading shockwave equipment manufacturers for a month at my clinic: one machine offering radial shockwaves (more crude form) and one offering focused (superior, more refined form).

For several weeks I used at my clinic on volunteering clients the two best and strongest machines on the market at maximum or near maximum intensity for about 8-12 sessions each. The result? Well, not much...

The problem with acoustic wave therapy / extracorporeal shockwave therapy, is that it is great for hard tissues or structures (such as kidney stones, bones, ligaments, tendons and more fibrous muscles) and not that great for soft tissues (such as less fibrous muscles and fat). This is because softer tissues absorb the majority of the shockwave in the same way a safety net absorbs the impact of someone falling from height, so no significant therapeutic stimulation is achieved.

I suppose with enough sessions some women will see some results, some of the times. But this is not what I call an effective cellulite treatment. Research can be manipulated to prove or disprove anything and I have seen this happening with many treatments where theory says something works and reality says otherwise...

And this is the reason why I never buy machines for my practice based just on research or on technical characteristics any more (and of course I will never buy a machine based on marketing hype or because "Madonna uses it"). Research and technical data are there to guide me to shortlist a specific machine, but the final decision comes only after trying the machine at the clinic on several patients for a month or more.

In summary, AWT does not live to it's expectations. At low intensities it does not do much and at high intensities it does way too little - except perhaps from causing hearing impairment on the therapist using it (at high intensities AWT is deafening loud)...

 

The pointless ones

The treatments below are, in my experience, a waste of time and money, despite some of them being hyped up by the so called "experts" in the media.

 

Deep tissue massage

Deep tissue massage refers to massage that acts mainly on the muscles, tendons, ligaments and deep fascia, and as such it misses the point (cellulite is located above those tissues), so it is quite useless for cellulite reduction or prevention.

Keep your deep tissue massage for your sore back muscles and for cellulite find a therapist who specialises in and can do a strong cellulite-specific massage (see above), or better still go to a clinic that offers one of the three top techniques (cavitation, electro-mesotherapy, radiofrequency) mentioned above.

 

Lymphatic drainage massage

This must be the biggest hype in the history of cellulite reduction (if such a thing as history of cellulite exists...).

Manual lymphatic drainage massage (MLD) helps shift excess water from the legs, thereby improving the appearance of cellulite VERY temporarily, but does not do anything else: it is way too gentle to stimulate skin firmness and for the same reason it does not help repair the skin and connective tissue deformity caused by the expansion of fat cells. But most importantly, it does not do anything to reduce fat - the number one issue with cellulite. Inflammation reduction, due to better circulation and lymphatic drainage, would be helpful though.

On the other hand, circulation and lymphatic drainage can be improved equally well - or even more so - by strong cellulite-specific massage, which offers several other benefits, as described above.  Furthermore, cellulite-specific massage can be used with a good anti-cellulite product, whose absorption it boosts - while MLD can only be applied with talcum powder or a minute amount of oil, thereby preventing such synergy. Contrary to the popular myth, even good old deep tissue massage can boost circulation equally well or more than MLD, with the added benefits of muscle relaxation and muscle tissue micro-stretching.

All in all, lymph massage should be confined in the care of people with compromised lymphatic glands (typically due to chemotherapy) or people who for a variety of reasons are fragile and with very poor lymphatic system. In those cases, MLD is valuable and quite often the only manual treatment that can help. For the rest of us, the stronger massage techniques - or the technologies mentioned above - are preferred, as they are more effective and offer multiple benefits.

 

Skin brushing

If cellulite reduction with lymphatic massage is hype then what can I say about body brushing? That it's an urban myth, a hoax, a fraud?

It really is beyond me how can exfoliation of the most superficial layer of the skin can break down fat in the deepest layers of the skin. How can you affect cellulite by brushing the epidermis for ten minutes when even the strongest, deepest, cellulite-specific massages of one hour duration take several sessions and several weeks to give good results? (Unlike massage, you cannot really body brush your skin for one hour without it starting to bleed)...

People who advocate body brushing insist that it helps boost circulation, but so does a plain massage with your hands and some oil or cream - and it is several times more effective.

The only application of body brushing for cellulite reduction would be to exfoliate the skin after a shower and prior to the use of a good anti-cellulite cream. Nothing else.

 

Palper-rouler (vacuum suction with skin rolling)

This is another hyped up treatment whose effectiveness is inversely proportional to the hype that surrounds it.

Palper-rouler refers to a machine rolling the skin while the skin is literally sucked up in a vacuum between the rolling cylinders or rolling balls.

The strong massage in combination with the vacuum do boost circulation and do stimulate collagen production, but at the same time they break the small blood vessels, causing spider veins (thread veins) and also stretch the skin (what's the point of firming the skin when at the same time you stretch it)? 

In a small minority of women, who have very firm skin and very strong veins, palper-rouler can give good results, but nothing amazing. This is due to the fact that this technique does not do anything to fight the fat - the most important aspect of cellulite - it mainly addresses the circulation / lymphatic drainage aspect.

In fact, the only reason I would use palper-rouler would be to break down scar tissue (connective tissue deformity), but the problem is that if you set the machine at low suction settings it does not do much, while if you set it at high suction settings the possibility of skin loosening and thread veins disproportionately increases.

I used to offer palper-rouler treatments when I started treating cellulite 14 years ago, when it was the only anti-cellulite treatment you would care to take seriously.

As soon as I realised the limitations of the treatment I adapted the machine so that I could create the same effect on the skin with minimal suction. And later, I got rid of the suction altogether, working with my hands, special tools and special creams that I developed (cellulite-specific massage) and the results were much better and without the side effects of skin looseness and thread veins. For the record, I stopped offering cellulite-specific massages when the cavitation, electro-mesotherapy and - especially - radiofrequency technologies became more powerful, effective and affordable.

Fourteen years later I am amazed by how popular this treatment still is, despite it's problems and low effectiveness. The last few years I have seen at my practice several clients who previously had palper-rouler treatments and none of them was happy...

 

Infrared radiation (LED, cold laser, plain infrared lamps)

Infrared light is electromagnetic radiation beyond the visible spectrum. it penetrates the skin a little bit more than normal light or red light, but it is still very superficial to have any significant effect on fat tissue.

In high intensities, infrared light can tighten up the surface of the skin (epidermis and, to a lesser extent, dermis) and boost circulation, but it won't do anything for the fat and connective tissues comprising cellulite which is located deep inside the skin (hypodermis): the epidermis will literally burn well before the fat tissue notices anything.

Low intensities (as in cold laser treatment, a.k.a. low level laser therapy, LLLT) are even less effective. I have actually rented and tried hands-on for a month the strongest and best cold laser system at my clinic and the results were absolutely nil - waste of time and money. I would wholeheartedly recommend LLLT for musculoskeletal and vascular problems, because of it's proven ability to effect tissue repair and healing, but unless you want to have healthy cellulite tissues (who cares?) I really don't see the point of cold laser treatment for cellulite.

 

Bipolar radiofrequency

By definition, bipolar radiofrequency is way too superficial to affect the deep-lying cellulite tissues and mainly affects the epidermis and dermis. Like intense infrared treatment (see above), the surface of the skin will burn well before cellulite notices anything...

Bipolar radiofrequency is great for superficial skin tightening and to boost circulation, but since there exists a real radiofrequency treatment that focuses on the cellulite tissue with surgical accuracy (resistive monopolar radiofrequency), I do not see why one should use bipolar RF for cellulite.

Tripolar, tetrapolar, octapolar radiofrequency are basically gimmicky forms of bipolar RF (there are only two poles in electricity, negative and positive, not 3, 4 or 8 as the names suggest). These do not offer much more, if anything, than normal bipolar RF.

 

The rest...

There are probably hundreds of other cellulite treatments on the market. For example, there is one that blows air on the skin; there are all sorts of body wraps; water absorbing clays; honey applied on the skin and then a hand pulled from the skin and then "slapped" again on it.

There even exists what I jokingly call "happy slapping", i.e. slapping an area for several minutes with the hands. This does increase circulation and stimulates collagen production, but it is also painful for the recipient's bum and thighs and especially for the provider's hands. Human ingenuity is endless...

There are all sorts of other ideas that don't really work or that only offer a very temporary benefit.  I am not interested in very temporary results - and I am sure you are not either - so i am not going to list all of them here.

I hope this article was informative, interesting and helpful. As an end note, I would advise that if the best treatments listed above are not available in your area, the alternative option is to combine two or three of the secondary treatments for a more holistic approach. With a good anti-cellulite cream, healthy diet and some exercise you should be able to achieve your goal of smoother, healthier, firmer legs!