Got cellulite? So does just about every woman, no matter what size she is. Some men have it, too.
Some people make their peace with it, comfortable knowing that paparazzi aren't vying to take photos of them in a bikini any time soon. Others wage war against it. Half the battle is knowing what cellulite is and what your weapons are.
How Cellulite Is Like Your Couch
In women, the septae pull straight down like a button on a cushion, making dimples. Men's septae come in at an angle, disguising them. Guys also have thicker skin than women, helping to hide their cellulite.
"There's no cure," says Neil Sadick, MD, a Manhattan dermatologist who recently reviewed the science behind some of the most popular treatments. "But there are definitely new things out there that can help."
Gaining weight can add to your cellulite by making your fat cells bigger. More fat under the skin can make your legs look lumpier.
Losing weight can reduce the look of cellulite, especially in women who have a lot of extra pounds to lose.
“If you have less fat, you're going to have less cellulite, potentially," Wanner says.
Weight loss isn't the right approach for everyone, though. For women who are already at a healthy weight, dropping a few pounds can loosen skin, making cellulite even more noticeable.
Caffeine and retinol are two ingredients in creams that aim to reduce cellulite.
In test tubes, caffeine and related ingredients shrink fat cells. Still, there's scant evidence that these treatments work when applied to the skin, according to recent research. Any improvement is likely to be temporary and minor.
The Personal Care Products Council, an industry trade group, declined to comment for this story.
Retinol may help boost the amount of collagen in the skin, making it thicker and more elastic. Thicker skin helps make cellulite less noticeable.
In one small study, a cream with .03% retinol improved cellulite when used for at least 6 months. The study found it increased skin thickness by an average of 2 millimeters on a treated leg compared to the skin on an untreated leg.
A study funded by Johnson & Johnson that tested an unnamed anti-cellulite cream with active ingredients including caffeine and retinol found that the cream reduced the size of the stomach, thighs, and upper arms slightly more than a placebo gel when both were used twice daily for 12 weeks.
A treatment for cellulite called endermologie uses rollers and suction to knead the skin, improving circulation.
Treatments last for 10 to 45 minutes and are typically repeated twice weekly for several months. A package of 10 to 12 sessions runs $1,000 and up.
Despite the hefty price, Wanner and Sadick say there's little evidence that it works against cellulite.
At the Doctor's Office
Wanner says a "dizzying" number of machines are available through doctors' offices that promise to treat cellulite without surgery.
Some cellulite machines, such as VelaSmooth, Venus Freeze, Thermage, and Accent XL, use radio wave energy. Others, including Smooth Shapes and Zerona, use lasers. A newer group of machines, such as the Acoustic Wave Therapy system, uses high intensity sound waves.
Lasers and radio waves work by applying heat. The heat is meant to firm and thicken skin, and it may help melt some of the bulging fat underneath. Acoustic waves aim to break up the septae bands that pull down on the skin, creating dimples.
Most of these technologies require multiple treatments. The cost can range from $1,500 to $5,000, depending on how many times you go and which technology you choose.
How much improvement can you expect?
Wanner says even using the best technologies, "about 25% to 50% of people may see an improvement of 25% to 50%, which may diminish over time."
From a Cosmetic Surgeon
In January 2012, the FDA cleared the surgical treatment for cellulite called Cellulaze.
Cellulaze is a side-firing laser that's inserted under the skin using a few tiny cuts. Working in a grid pattern, a surgeon uses the laser to sizzle away the septae bands that are pulling down on the skin. The laser also cooks pockets of fat, reducing bulges. The company that makes the laser says it also helps thin, sagging skin.
The surgery may take several hours, depending on the size of the area that's treated. The doctor injects a painkiller to numb the area before starting.
Recovery may take 3 to 4 weeks to get over bruising and soreness. Other side effects include temporary swelling, itching, and discoloration, similar to those seen with liposuction. Peak results are achieved 6 months after the surgery, which costs around $7,500.
Despite the initial discomfort, "patients have had a high degree of satisfaction, above the 90% mark," says Barry DiBernardo, MD. He's a board-certified plastic surgeon in Montclair, N.J., and the lead clinical investigator for Cellulaze.
So far, the procedure has only been studied in about 50 patients, DiBernardo says. He says people see about a 65% improvement in their cellulite, on average, and the improvement appears to last as long as 2 years.
DiBernardo says Cellulaze works well for dimpling and for women who have mild to moderate "hills and valleys." But he says it doesn't appear to be the right tool for women with deep depressions and large folds of fat.
“It is a technology that really does attempt to change the three-dimensional structure of the skin, which I think is very interesting," says Wanner, who has no financial interest in Cellulaze.
She cautions that there are still questions that need to be answered, like who the technology may work best for and how long the results may last.
Sadick agrees. "It appears to be probably the most effective single cellulite treatment out there, but just how effective it is and what the long-term results are [are] still not known," he says.