Cellulite is caused by fibrous septae or bands of connective tissue extending from the skin down to deeper structures at the fascia or muscle layer. These irregular undulations and flaccidity (lack of youthful firmness) in the skin are caused by pockets of fat which bulge against the connective tissue and skin layer. The condition worsens with age as the skin becomes lax or sags. This reveals the origin skin attachments as the elastic property of our skin fades with age and sun exposure. Various treatments are available to treat cellulite, but most have only temporary results because they do not target the anatomic structures of cellulite. The newer treatments that appear to have longer lasting results are the Nd:YAG 1440 nm wavelength laser, the subcision techniques, topical creams which improve tissue hydration and radiofrequency treatments. Of course, the best treatments are surgical with tightening of the skin envelope, but often the scars are so noticeable that such an involved intervention is undesirable.
- Treatment improves the appearance of dimpled cellulite tissues.
- Skin thickness and elasticity are increased.
- Results last one year or more.
- Fibrous tissue bands are released.
- Side effects include bruising, swelling, numbness and mild discomfort.
- With Cellulaze there is a possibility of fluid leakage from incision sites.
- This nonsurgical treatment is relatively new to the market and can be costly.
These are the top pros and cons to weigh when considering cellulite reduction treatment. If you wish to focus on what is unique to you, please consult with your aesthetic plastic surgeon.
Are you a good candidate for cellulite treatment?
- If your skin has a puckered appearance near fat deposits that disturbs you.
- If you are at a healthy weight, but have moderate cellulite on your thighs, buttocks and/or hips.
- If you have light-colored skin, on which cellulite tends to be more noticeable.
- If you have tried various cellulite creams, massages or injectables with no improvement.
If you are in good general health, have a positive attitude and realistic expectations, you are most likely a good candidate for this procedure.
Detailed Procedural Info
How is a cellulite treatment procedure performed?
Cellulite treatment procedures are often performed in a physician’s office. Sterile technique is used to cleanse the skin and prevent post-operative infections. The skin is anesthetized with a tumescent fluid to allow for minimal bruising and comfort during the procedure and a small incision approximately 2 mm in size is made in the skin to allow for access of the surgical probe. The cannula probe is Advanced 2 the levels where the fibrous septa are tethering the skin and the laser energy is applied at the fibrous septa. This allows for release of the septa and also provides concomitant skin tightening. There is also a component of fat lipolysis with the heat energy at the same time. Procedure is performed under local anesthesia and can be often performed in less than an hour. Post-procedure treatment often includes massage as well as compression garments.
There are a number of cellulite treatments available.
Cellulaze is a minimally invasive procedure that uses an Nd:YAG 1440 nm pulsed laser. Areas of cellulite to be treated are marked and small incisions to insert the laser cannula (tube) under the skin are made at the area of concern. A local anesthetic is injected into the site to be treated. The laser heats up and is used in a three-step process to: 1) melt excess fat 2) release fibers that connect the dermis to underlying fascia (fibrous connective tissue) that pull down on the skin and create the dimpling effect and 3) stimulate collagen production to tighten and thicken the dermis, increasing skin elasticity. After the laser procedure, the treatment area is squeezed to expel the liquefied fat cells.
VelaShape delivers vacuum, mechanical massage, radiofrequency and infrared light to treat cellulite on the thigh, buttocks, love handles and abdominal areas and to provide circumferential reduction on the thighs. The applicator is placed directly on the treatment area to smooth the skin’s surface and to deliver heat energy safely and efficiently. The treatments are noninvasive and do not require any anesthesia. This device is safe for all skin types. Four to six weekly treatments are recommended for most patients, with additional sessions over one to three months.
VASER Shape uses ultrasound high-frequency sound waves to deliver heat below the surface of the skin to temporarily reduce the appearance of cellulite and to treat unwanted fatty tissue in the abdomen, back, arms, love handles, hips, buttocks and thighs. The treatments are noninvasive and do not require any anesthesia. The physician moves the hand piece over the treatment area to warm connective tissue and redistribute fat. Then zonal lymphatic massage stimulates the body’s lymphatic system by improving local blood circulation to drain the unwanted fat that has been treated by the ultrasound technology. Three to five sessions are usually recommended to produce noticeable results.
Venus Freeze uses multipolar radio frequency and magnetic pulsed fields to generate heat below the skin’s surface to reduce wrinkles and cellulite, to tighten skin and for circumferential reduction on the thighs. The device is designed for use on both the face and the body and for all skin types. Treatment gel is applied to the treatment area, which helps the hand piece glide more smoothly over the skin. The physician moves the applicator in gentle circular and sweeping motions over the treatment area. A hot-stone massage sensation is felt in the treated area. Eight to ten weekly sessions are generally recommended for visible results in the body; six to eight sessions are recommended for the face and neck.
This technique utilizes subcisions just underneath the skin layer combined with vacuum-assisted tethering to allow for fibrous septum release by sweeping a needle underneath the skin while it is being immobilized from the suction device. While this technique is more optimal for the buttock region, it can be also applied to the thigh region. Early results have been encouraging with the mechanical disruption of the fibrous septa, however long term results are still pending. This technique can be performed in an office setting under local anesthesia.
Topical Skin Creams
Retinols have been very successful at improving the dermal thickness and minimizing noticeable skin undulation with fiber septa. Concentrations of 0.3% have the maximal effect. Alastin has released their tri-hex technology product to improve dermal thickness and improve tissue hydration. Early results suggest this may also improve skin tone and elasticity. Overall tissue hydration is essential and can dramatically improve cellulite appearance. While this is not addressing the underlying cause, it may make the condition appear less noticeable.
What are my options?
You need to consider what level of frustration you have with your cellulite and what you’re willing to commit in terms of resources, time and money.
What are the brand names for cellulite treatment?
- Cellulaze by Cynosure, Inc.
- VelaShape by Syneron, Inc.
- VASER Shape by Solta Medical, Inc.
- Venus Freeze by Venus Concept
- Cellfina by Merz
What will my cellulite treatment incisions and scars be like?
When Cellulaze treatment is used, small incisions are made at the treatment site; for example, on the outer thigh. VelaShape, VASER Shape and Venus Freeze do not require incisions. Cellfina subcision will result in small needle sized holes which will close without the need for sutures.
After finding a board-certified plastic surgeon in your area who is experienced in performing cellulite treatment, you will need to make an office appointment for your consultation. Generally, because of the in-depth nature of the consultation, there is a cost associated with the initial visit.
Your initial consultation appointment
During your initial consultation, you will have the opportunity to discuss your cosmetic goals. Your surgeon will evaluate you as a cellulite treatment candidate and clarify what cellulite treatment can do for you. Understanding your goals and medical condition, both alternative and additional treatments may be considered (see related procedures
You should come to the consultation prepared to discuss your complete medical history. This will include information about:
- Previous surgeries
- Past and present medical conditions
- Allergies and current medications
Your treatment plan
Based on your goals, physical characteristics and the surgeon’s training and experience, your surgeon will share recommendations and information with you, including:
- An approach to your treatment, including the type of procedure or combination of procedures.
- The outcomes that you can anticipate.
- Your financial investment for the procedure.
- Associated risks and complications.
- Options for anesthesia and surgery location.
- What you need to prepare for your procedure.
- What you can expect to experience after cellulite treatment.
- Before-and-after photos of cases similar to yours and answer any questions.
Questions to ask your aesthetic plastic surgeon
It is important for you to take an active role in your treatment, so please use this list of questions as a starting point for your initial consultation.
- Am I a good candidate for cellulite treatment?
- Are the results I am seeking reasonable and realistic?
- Do you have before-and-after photos I can look at for the procedure I am undergoing?
- Will my scars be visible? Where will my scars be located?
- What kind of anesthesia do you recommend for me?
- What will be the costs associated with my treatment?
- What will you expect of me to get the best results?
- What kind of recovery period can I expect and when can I resume normal activities?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if the cosmetic outcome of my surgery does not meet the goals we agreed on?
Preparing for Your Procedure
How do I prepare for a cellulite treatment procedure?
Your surgeon will provide thorough pretreatment instructions, answer any questions you may have, take a detailed medical history and perform a physical exam to determine your fitness for treatment.
In advance of your procedure, your surgeon will ask you to:
- Stop smoking at least 6 weeks before undergoing treatment to promote better healing.
- Avoid taking aspirin, certain nonsteroidal anti-inflammatory drugs (NSAIDs: Advil, Motrin, Aleve) and vitamins/homeopathic regimens that can increase bleeding.
- Regardless of the type of surgery to be performed, hydration is very important before and after surgery for safe recovery.
Cellulite treatment is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.
What can I expect on the day of cellulite treatment?
Your cellulite treatment may be performed in an accredited hospital, a freestanding ambulatory facility or an office-based surgical suite. Most cellulite treatment procedures take at least one to one and a half hours to complete but may take longer.
- Medications are administered for your comfort during the procedure.
- For your safety during the treatment, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
- Your surgeon will follow the treatment plan discussed with you before surgery.
- After your procedure is completed, you will be taken into a recovery area where you will continue to be closely monitored.
- You will probably be permitted to go home after a short observation period unless you and your plastic surgeon have made other plans for your immediate post-treatment recovery.
Aftercare and Recovery
Your surgeon will discuss how long it will be before you can return to your normal level of activity and work. After treatment, you and your caregiver will receive detailed instructions about your care, including information about:
How will I look and feel immediately after cellulite treatment?
- Drains, if they have been placed
- Normal symptoms you will experience
- Potential signs of complications
You’ll probably have some bruising, swelling, numbness and mild discomfort and small amounts of fluid may leak from your incision sites. You should be able to return to normal activities within a day or two.
Recovery time frame after cellulite treatment
It is vitally important that you follow all patient care instructions provided by your surgeon. This will include information about wearing compression garments, taking an antibiotic if prescribed and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
The first two weeks
Weeks two to eight
- You might be instructed to wear compression garments for two to three weeks after treatment.
- More strenuous activity and exercise may be resumed after one to two weeks.
- By this time, you should be fully able to return to your normal activities, including your regular physical exercise.
How Long Will the Results Last?
Results continue to improve in the three to twelve months after a single treatment and appear to last one year or more.
Maintain a relationship with your aesthetic plastic surgeon
For safety, as well as the most beautiful and healthy outcome, it’s important to return to your plastic surgeon’s office for follow-up evaluation at prescribed times and whenever you notice any changes in the treated area. Do not hesitate to contact your surgeon when you have any questions or concerns.
The cost of cellulite treatment varies from doctor to doctor and from one geographic area to another.
These numbers only reflect the physician/surgeon fees last year and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or other miscellaneous costs related to surgery.
Because cellulite treatment is an elective procedure, insurance does not cover these costs. Many surgeons offer patient financing plans to make the procedure more affordable.
Choose your surgeon based on quality, training and experience—not cost.
See why ASAPS members are widely recognized for upholding the highest standards in the area of aesthetic plastic surgery by viewing their basic credentials, training and certifications.
Limitations and Risks
Fortunately, significant complications from cellulite treatment are infrequent. Your specific risks for cellulite treatment will be discussed during your consultation.
All procedures have some degree of risk. Some of the potential complications of all are:
- Adverse reaction to anesthesia
- Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
- Infection and bleeding
- Changes in sensation
- Allergic reactions
- Damage to underlying structures
- Unsatisfactory results that may necessitate additional procedures
Other risks specific to cellulite treatment are outlined below:
- Bruising and swelling in treatment areas.
- Small amounts of fluid leaking from incision sites.
You can help minimize certain risks by following the advice and instructions of your board-certified plastic surgeon, both before and after your cellulite treatment surgery.
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