Cellulite

Grade I

• Smooth skin without any dimpling upon standing up and lying down

• Mattress-like configuration upon pinching the skin

Grade II

• Mattress-like appearance upon standing but disappears in supine position

Grade III

• Skin dimpling upon standing and supine position

• Skin dimpling is exacerbated by pinching the skin

Endermologie®

• A device used to mechanically massage fat in the affected area

• Treatments repeated twice weekly appear to reduce thigh size

• Treatment is costly with little evidence of long-term efficacy

Liposuction

• Liposuction is effective for removing large areas of deeply placed subcutaneous fat

• Fatty tissue of cellulite is close to the skin surface where liposuction may be risky

• Lipoplasty is not recommended for cellulite because of poor cosmetic outcomes

Subcision

• Surgical procedure using a needle to to cut fibrous bands between fat lobules

• May temporarily improve the skin dimpling, but long-term efficacy is uncertain

Mesotherapy

• Various substances eg, phosphotidylcholine or deoxycholate, may be injected into subcutaneous tissue to dissolve fat

• Precise treatment protocols are lacking

• Outcome is unpredictable, and dimpling may get worse

• May cause abscesses and scarring

Bipolar and unipolar radiofrequency devices, eg, VelaSmooth®, TriActive™, Accent XL, ThermaCool®

• Various devices are under investigation

• Small studies have shown mixed but sometimes impressive results; long-term efficacy is unknown

• VelaSmooth® approved by US Food and Drug Administration (FDA); combines infrared light (700–2000 nm), bipolar radiofrequency, suction and mechanical massage

• Bipolar devices penetrate >3 mm for better control of localised fatty deposits

• Unipolar devices use high frequency electromagnetic radiation with greater depth and breadth of thermal damage but diffuse pattern results in less control

Ultrasound devices, eg, UltraShape®

• Ultrasound can destroy fat cells

• Efficacy in cellulite is unknown

Laser-assisted lipolysis, eg, Smartlipo™

• Certain lasers destroy targeted areas of fat and tighten the skin

• Laser assisted lipoplasty using Nd:YAG laser may be suitable for small areas of fat deposition

• Efficacy for cellulite may not be as good as when liposuction is used for large areas of fat

Topical medications

• Retinoic acid (retinol) used over a period of >6 months has been shown to improve cellulite, probably by increasing dermal collagen thickness and contour of elastic fibres

• Topical aminophylline has not been shown to objectively improve cellulite; however, some patients have reported improvement

• Several herbal creams are marketed for cellulite, containing ingredients such as caffeine and botanicals of unknown efficacy; some components may cause contact allergic dermatitis

• Carboxy therapy is the injection of carbon dioxide into fatty tissue, and is intended to dissolve fat (lipolysis)

• Peroxisome proliferator-activated receptor agonists are newly discovered nuclear transcription factors activated by petroselinic acid and conjugated linoleic acid; they are being investigated as they appear to improve epidermal differentiation, reduce inflammation, increase extracellular matrix components and elicit skin tightening; conjugated linoleic acid can prevent fat accumulation in fat cells

Cryolysis eg, Cryolipolysis™

• Cooling the skin surface is being evaluated for cellulite and body contouring, as freezing destroys fat cells