Radiofrequency for cellulite and skin tightening: 22 things you need to know

RF for cellulite and skin tightening | How many RF treatments do I need? How does RF work? How does RF treatment feel? All you need to know.

• Deep tissue radiofrequency: the best available SAFE treatment for for skin tightening and cellulite reduction today

• What is radio frequency?

• Not to be confused with the so-called ‘high frequency wand’ used for facials

• Deep heat vs superficial heat

• When it comes to RF, both ‘deep tissue’ and ‘high power’ are important

• How does radiofrequency-induced heat removes cellulite / tightens skin?

• What about ultrasound cavitation?

• How does radio frequency treatment feel?

• 99.5% safety, if radio frequency treatment is applied properly

• How many deep tissue radiofrequency sessions are needed for good results with cellulite removal / skin tightening?

• What about those treatments that give “instant” / “amazing” results in 1-4 sessions?

• Will I see any immediate results? when will I see the first long-term results?

• When will I see the final results?

• Does everyone see results?

• Which people tend not to see good results?

• Can specific results be guaranteed?

• Will my cellulite disappear completely and permanently? Will my skin become super-tight?

• How often do I need to have treatment?

• In summary, for the body to change, it needs:

• Do I need maintenance treatments?

• Maintenance/prevention treatments for skin tightening

• Prevention/maintenance treatments for cellulite

• Do you have any more questions?

• Book an advanced skin tightening / cellulite treatment in London, at LipoTherapeia

• Check our professional consultancy in radiofrequency, ultrasound cavitation, cellulite and skin tightening

Deep tissue radiofrequency: the best available SAFE treatment for for skin tightening and cellulite reduction today

At the time of updating this article (December 2023), the best possible technology for cellulite and skin tightening is what we call ‘deep tissue radiofrequency’, i.e. deep-acting, high-power radiofrequency.

The second best technology is low frequency, deep-acting, high-power ultrasound cavitation.

Don’t worry about the long words, we will explain them very simply, yet accurately, below.

Any other technology (such as HIFU, microneedling RF, acoustic wave therapy, infrared/LED treatment etc) is simply either much less effective, much less safe or both.

In general, most technologies are ineffective for cellulite and skin tightening - despite all the wild claims and marketing hype you see on the internet, instagram, tiktok and even aesthetic science journals (most - but not all - papers in aesthetic science journals are not worth the paper they are written on).

What is radio frequency?

Simply put, radiofrequency is very high frequency electricity.

Low frequency electricity can make your muscles contract, even at low intensities. This is used in physiotherapy for musculoskeletal treatment and for pain reduction. A good example of this is EMS, or electrical muscle stimulation / TENS devices/treatments.

On the other hand, very high frequency electricity (>300kHz), when applied on the body, produces just heat.

Not to be confused with the so-called ‘high frequency wand’ used for facials

High frequency wands used for facials operate at a lower frequency (60-200 kHz) and are vastly inferior to radiofrequency, in all aspects.

High frequency wands are of very low power (10 Watts), more superficial and would be very uncomfortable at the higher intensities used for radiofrequency.

Deep heat vs superficial heat

Depending on the equipment used, the products applied and the protocols used, radiofrequency-induced heat can be anything from very deep (i.e. muscles and joints, for physiotherapy purposes) to very superficial (i.e. epidermis, for acne reduction etc) or anything inbetween.

For skin tightening and cellulite reduction the aim is to go deep/medium deep at the hypodermis/dermis level. You definitely don’t want to go:

• Either too superficial, whereby the epidermis will be burned, and the hypodermis/dermis will feel nothing

• Or too deep, whereby the muscles will be warmed up, and the hypodermis/dermis will also feel nothing

When it comes to RF, both ‘deep tissue’ and ‘high power’ are important

Given that most so-called ‘cellulite treatments’ or body ‘skin tightening treatments’ on the market are:

• superficial or medium-deep at best

• and of low power

…it is essential to ensure that you receive both “high-power” AND “deep-tissue” radiofrequency, if you want to have good results - and without pain, superficial burns or irritation.

And it is important for the strong, deep radiofrequency procedures to be applied responsibly and by a well-trained person to ensure comfort, safety and effectiveness.

On the other hand, extreme intensity RF, i.e. radiofrequency applied in a stamp-like, static fashion and with anaesthetic cream/injections to mask the excessive pain, is definitely not a good idea, as the chance of permanent skin damage outweighs any mediocre benefits that such extreme intensity RF offers.

Needless to say that low-power RF machines are useless - especially those sold for home use (total waste of money).

How does radiofrequency-induced heat removes cellulite / tightens skin?

The intense heat produced by high-power, deep-acting radiofrequency on the hypodermis and dermis has three actions:

• It stimulates fat release (lipolysis) and weakens fat cells (adipolysis), leading to less cellulite fat

• It stimulates collagen and elastin synthesis by collagen cells (fibroblasts) and collagen contraction of existing collagen, leading to tighter skin

• It intensely stimulates circulation and lymphatic drainage on the area it is applied, leading to detoxification and better tissue metabolism in the tissues affected

All together, these three actions combined lead to both cellulite removal and skin tightening.

This means that with deep-acting, high-power radiofrequency you don’t need to have a separate treatment for cellulite removal and another one for skin tightening.

What about ultrasound cavitation?

High-power ultrasound cavitation is ideally combined with RF for cellulite reduction and sometimes it can also help with skin tightening - under specific protocols.

Strong ultrasound cavitation stimulates fat release and helps destabilise fat cells, leading to lipolysis (fat release) and adipocyte apoptosis (fat cell death).

Furthermore, ultrasound cavitation can help break down cellulite fibrosis.

If applied at very high intensity (but always within safety parameters) ultrasound can also stimulate skin tightening.

Similarly to radiofrequency, ultrasound has to be of high-power, deep-tissue to be effective. Low-power cavitation machines are useless - especially those sold for home use (total waste of money).

How does radio frequency treatment feel?

What you will feel when you have proper (i.e. high-power, deep-tissue) radiofrequency treatment is mainly deep heat.

If RF is properly applied, the surface of your skin (epidermis) will feel warm, while your deep skin layers (hypodermis and dermis) will feel very hot.

However, you should NEVER feel burning or pain. If you feel burning or pain continuously, ie for more than a split of a second here and there, that means that the treatment is not provided properly.

Within a few minutes of their first treatment, most people get used to the feeling of deep skin heat and usually relax, finding the treatment comfortable or even relaxing/soothing in the following treatments.

In fact, by the second session many clients can even doze off during treatment.

A small minority of clients (5-10%) find the treatment uncomfortable but still acceptable while a very small minority (~1-3%) find it painful, in which case an alternative treatment should be provided.

99.5% safety, if radio frequency treatment is applied properly

There is no such thing as 100% safety with any medical, aesthetic or complementary treatment.

However, if the pain threshold rule is adhered, then properly applied deep-acting, high-power radiofrequency treatment should be ~99% safe or better.

In 1% of the cases, or less, minor / temporary irritation could occur, but nothing major or permanent should happen.

Of course, safety rate can vary widely, depending on equipment used and training levels, but this is the safety rate to expect. At our clinic our safety rate was 99.9% in the last two years (2022 and 2023). Not bad!

So a quality high-power, deep tissue radiofrequency treatment can be deemed extremely safe, if provided by a well-trained, experienced and knowledgable therapist.

(Unfortunately most RF/ultrasound operators only receive one day's basic training - and zero training in the science of cellulite and skin tightening, and this is a problem in our industry.)

How many deep tissue radiofrequency sessions are needed for good results with cellulite removal and/or skin tightening?

Even with the absolute best possible technology available today for skin tightening and cellulite reduction, 6-12 sessions are recommended for good results, with a treatment frequency between twice a week to once in two weeks.

(3x sessions are good for a quick top-up before a holiday or a special event, but for good, long-term results 6-12 sessions are needed.)

The body needs FREQUENT and REPEATED stimulation, as well as TIME, to change.

(The body will NOT change with an one-off session or with sessions taken one month apart or less often OR overnight. Frequent, repeated treatments, as well as time, are all needed. Don’t believe the smooth operators who promise convenient instant miracles. One-off miracle treatments, in particular, typically cause more harm than good, and results are not worth the pain or the extortionate prices)

Very bad cases may need 12-24 sessions, even with the best technology in the world.

If more than 24x sessions are needed, as in very severe cases of skin laxity or cellulite, then surgery should be considered for skin tightening.

On the other hand, cellulite surgery is usually a disaster, for several reasons (this is a matter for another article). So I would never opt for cellulite surgery or suggest it, regardless of cellulite severity. In 99% of cases cellulite surgery is a bad idea - don’t fall victim to the promises.

What about those treatments that give “instant” / “amazing” results in 1-4 sessions?

Those promises of results with “you only need 1-4 sessions”, “instant results overnight” or “amazing body transformations with monthly sessions”, as advertised by cowboys, are simply lies to take advantage of the naive, the gullible and the desperate.

The irony is that these wild claims and fake promises are usually made by those who usually offer low-power, superficial treatments that have no chance in hell of ever creating a “body transformation”, either in 1, in 10 or even in 50 sessions.

Oh well…

There is also another category of treatments utilising painful and/or dangerous “destructive” technologies, such as radiofrequency (RF) microneedling.

Results with those treatments are:

• Neither instant: you need 1-6 months to recover and experience the full “results”

• Nor amazing: you can get the same results or better with deep tissue RF

• Nor worth all the adverse reactions

• Nor worth the extreme rip-off prices

Needless to say we don’t do those treatments and do not intend to do them at any time in the future.

Will I see any immediate results? when will I see the first long-term results?

With proper, deep-acting, high-power radio frequency, clients typically experience some immediate skin contraction, which sometimes is quite impressive.

However, the skin contraction produced by just one session is temporary, so we don’t make much of it. A series of treatments will produce a more permanent skin contraction, and that is what both client and therapist should focus on.

Furthermore, a series of treatments will gradually produce more collagen and reduce cellulite fat, which are also important long-terms goals.

Most people see the first long-term results in 3-4 sessions. Some people we see at the clinic start raving about the treatment after 1 session already, while some may need as many as 4-5 sessions to start seeing the first long-term results.

Everyone is different.

When will I see the final results?

Experience has shown that the results of any given session appear gradually and it takes about one month for 80% of the results of that session to show up, with another 20% improvement gradually occurring for about three more months after any given session.

I have seen hundreds of clients over the years who finished their course of 6x or 12x sessions, went on holiday and commented that they actually kept improving during holiday and even after holiday. This is very, very common.

Does everyone see results?

As mentioned above, the objective is to give everyone the strongest SAFE treatment possible in order to stimulate skin tightening / cellulite reduction and offer the best possible results.

Then it’s up to each individual body to respond to treatment. Some bodies respond faster and some slower, depending on genetics, lifestyle, metabolism and overall individual health/fitness at the time of treatment.

A strong, deep radiofrequency treatment always provides results - the only question is how fast these results occur, i.e. after how many sessions. As we discussed above, with a quality treatment most people need 6-12 sessions for good results

(Note: With lower quality treatments you may need 2x, 3x, 4x times as many, i.e. 12-24, 18-36 or even 24-48 sessions, i.e. practically never.)

Very stubborn cases may need more sessions, while the very severe cases will definitely need more.

So in a nutshell, yes, everyone (with rare exceptions) sees good results with deep-acting, high-power radiofrequency and/or deep acting, high-power ultrasound cavitation within 6-12 sessions, ranging from good to amazing.

Which people tend not to see good results?

As discussed above, with deep-acting, high-power radiofrequency (and high-power ultrasound cavitation) treatment intensity should be just below the pain threshold.

• Going above the pain threshold with the use of anaesthetic creams or injections can cause a lot of adverse reactions.

• Going really easy will result in poor results

And as mentioned above, there is a small minority of people who are too sensitive to have a decent treatment intensity. These are the people who do not respond well to treatment.

This practically means that such sensitive people may need double the amount of sessions that everyone else needs to see good results.

There is no way to predict who is going to be too sensitive so the the job of an honest, well-trained and responsible therapist is to inform the sensitive client that they may need 12-24 sessions for good results, instead of the usual 6-12.

Then the client can make an informed decision of whether to continue or not have any more treatments.

They can perhaps have high-power ultrasound cavitation or perhaps strong cellulite-specific massages for cellulite. We would not recommend any other cellulite treatment of any kind, as they are either ineffective and/or dangerous - and definitely not good for sensitive people either.

And they can also try specially applied high-power ultrasound cavitation for skin tightening or perhaps infrared/red LED treatment. The latter is very slow acting but is great for even the most sensitive people. Again, we would not recommend any other skin tightening treatment of any kind, as they are either ineffective and/or dangerous - and definitely not good for sensitive people either.

Can specific results be guaranteed?

Can specific results after a number of sessions be guaranteed?

Absolutely not.

Nothing in biology can ever be guaranteed and whoever promises guaranteed specific results are lying.

No responsible doctor or healthcare practitioner ever guarantees a specific outcome. The body is not a car to replace a spare part and get it working perfectly again.

Will my cellulite disappear completely and permanently? Will my skin become super-tight forever?

Just to make things clear: you cannot eliminate established cellulite either completely or for ever.

We are talking about long-term (not permanent) cellulite reduction (not elimination). Perhaps a maximum of 60% improvement in most cases and a maximum of 80% improvement in rare cases.

If cellulite is very little or very recent it can indeed be eliminated in some cases - but again not for ever. There is nothing permanent in biology - or in this universe for that matter.

Anyone who promises cellulite elimination, especially permanent cellulite elimination, are simply lying. Stop believing the internet hype.

The exact same things apply to skin tightening.

Nobody can have the skin they used to have when they were 18 again and no treatment (even surgical ones) can transform someone’s skin to that of a top model, in the same way that no amount of training and/or anabolic steroids can turn a couch potato - or even a normal person - into an olympic athlete. Again, stop believing the internet hype.

Once I saw a client who came for a consultation and who literally grabbed her bottom, lifted it up by four inches with her hand and asked me “Can you do this? Can you lift my bum that much? I want this kind of lift”.

Obviously my answer was an immediate and resounding “No”, adding politely that even if I could, I wouldn’t do it. In fact, what she was asking was not even possible with surgery. Moreover, no surgeon would ever agree to creating such deformity, even if that was possible.

I know that’s an extreme anecdote, but there are limits and we should all be down to earth and realistic with what is possible and what we want from our body and our aesthetic practitioner.

How often do I need to have treatment?

Clinical practice has shown that the best treatment frequency is anything between twice a week to once in two weeks.

Treatment three times a week is OK for up to a couple of weeks and provided there is at least one day gap between treatments.

Treatment once a month is only suited to maintenance/prevention - never for improvement/reduction.

In summary, for the body to change, it needs:

• Strong, deep but balanced stimulation for a certain amount of time

• Frequent repetition of that stimulation (neither too frequent and nor too infrequent). If you are short of time or live far away from the clinic that provides a treatment, it won’t help if you have treatments once a month. All you will achieve is maintenance, but not improvement.

• A minimum number of sessions. As we mentioned above, 6-12x sessions are needed for most women, with occasionally 3x sessions being enough for satisfactory results, and 12-24x needed for more severe cases of cellulite / loose skin or for perfectionists. Regardless of how much money you are prepared to throw at a super-expensive, overhyped, gimmicky treatment, you will not get satisfactory results in 1-4 sessions.

• The passage of time after treatment, for tissue changes to occur, i.e. lipolysis, adipocyte apoptosis, collagen synthesis, collagen contraction. Again regardless of how much money you are prepared to throw at a super-expensive, overhyped, gimmicky treatment, you will not see overnight results. Best advice: start early, don’t leave it for last minute before the holidays.

Do I need maintenance treatments?

After you achieve a nice result from your course of treatments you may consider maintenance treatments.

Maintenance/prevention treatments for skin tightening

As long as you keep active and you don’t follow any crash/yoyo diets, you don’t need much or any maintenance treatments - collagen stays in your body for a very long time.

Of course due to the natural ageing process at some point you will need to have some more treatments, but not for a couple of years or even longer.

On the other hand, if you have a very sedentary life (working/studying hard on your desk for 12 hours a day and for months on end with little exercise) then you need maintenance treatments.

The more sedentary you are, the more treatments are needed to prevent skin laxity from taking hold again. For the body, things are simple: if you don’t use it, you lose it.

Most very sedentary people have maintenance treatments every 2 months or they have a course of 3-6 top-up sessions every year.

Prevention/maintenance treatments for cellulite

As long as you keep active, eat healthily, avoid sugar, fried food and alcohol, do not take hormonal contraception and do not smoke, you don’t need much or any maintenance treatments.

However, experience shows that most women do not do all the above (blame modern life, the cause of cellulite), so maintenance treatments are more important for cellulite prevention than for skin looseness prevention.

Again, the more you abuse your body, the more treatments you need to prevent cellulite from taking hold again.

Most people have maintenance treatments every 1-2 months or they have a course of 3-6 top-up sessions every year.

Do you have any more questions?

So there you have it, answers to most questions asked about radiofrequency and ultrasound treatments for cellulite / skin tightening.

If you have any more pertinent questions about treatments, please feel free to suggest it here for inclusion in this article (please note we do not answer questions unrelated to our clinic and our treatments by email, but we can post your answer here).

Check our professional consultancy in radiofrequency, ultrasound cavitation, cellulite and skin tightening

Do you want to deeply understand radiofrequency, ultrasound cavitation, cellulite and skin tightening? Attend a half-day, 1-day or 2-day or 3-day professional consultancy / one-to-one masterclass and confidently offer your clients the safest, strongest and most effective treatment possible. Service available via Zoom or at our central London practice.