Cellulite: Current Understanding and Treatment

Abstract

Cellulite is an aesthetically distressing skin condition that manifests as dimples and depressions, producing an uneven surface to the skin. Occurring in 80% to 90% of females, mostly on the thighs, buttocks, and hips, it is associated with profound negative psychosocial and quality of life issues. Its ethiopathogenesis and pathophysiology are likely to be multifactorial and complex and not fully understood. There is no effective treatment for cellulite, although a number of different treatment modalities are available, from noninvasive to minimally invasive. The efficacy of most treatments is unpredictable and improvements in cellulite appearance are short lived, although significant progress has been made with newer treatments. This review provides an update on the current state of knowledge about cellulite, with an emphasis on patient assessment and an individualized treatment approach for optimal results.

Figure 1.

Subcutaneous gluteal architecture in females. Structure and arrangement of skin and subcutaneous tissue in individuals with (A) low-to-normal BMI or (B) high BMI. The arrows demonstrate the interplay of biomechanical forces (red arrows: outward force of fat lobules; lavender arrows: inward tethering force of the septal network, with illustrated dimorphism between the numerous short and thin septa [small lavender arrows] vs the fewer long and thick septa, which have greater stability [large lavender arrows]; yellow arrows: inward containment force of the dermis). BMI, body mass index. Artwork created by and published with permission from Dr Levent Efe, CMI.

Figure 2.

Subcutaneous gluteal architecture in males. Structure and arrangement of skin and subcutaneous tissue in individuals with low-to-normal BMI (upper panel) or high BMI (lower panel). The arrows demonstrate the interplay of biomechanical forces (red arrows: outward force of fat lobules; lavender arrows: inward tethering force of the septal network, with illustrated dimorphism between the numerous short and thin septa vs the fewer long and thick septa, which have greater stability [lavender arrows]; yellow arrows: inward containment force of the dermis). BMI, body mass index. Artwork created by and published with permission from Dr Levent Efe, CMI.

Figure 3.

Septal dimorphism. (A) Vertical septa in females and (B) crisscrossed septa oriented at 45° angle in males. Artwork created by and published with permission from Dr Levent Efe, CMI.

Figure 4.

Cellulite treatment algorithm. Treatment is based on the underlying structural alteration of the fibrous septa and/or the exacerbating factors that worsen cellulite appearance–volume loss, excess fat, and skin laxity.

Figure 5.

A 46-year-old female patient (A) prior to and (B) 9 months after cellulite treatment by manual subcision using the new FDA-approved device (Avéli; Revelle Aesthetics, Inc.). Note, no prior procedures had been performed on the buttocks.

Figure 6.

Illustration of the new FDA-approved device (Avéli; Revelle Aesthetics, Inc.) used to treat the patient shown in Figure 5. Artwork created by and published with permission from Dr Levent Efe, CMI.