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Cellulite (gynoid lipodystrophy) is the non-inflammatory pathology of subcutaneous cells affecting over 80% of post-pubertal females. Deposition of excessive fat is the ingestion of foods which are not utilized by the body. Put simply, cellulite is a topographic change that occurs in females that are past post-puberty stage.

It comes in form of a dimple which is mostly found in the women’s pelvic region, abdomen, and lower limbs.1

Cellulite clinical research has shown that treatments for localized adiposities range from topical creams to liposuction. Most treatments lack a substantial proof of efficacy. The unpredictable treatment outcome can be related to the fact that cellulite adipose tissue is physiologically and biochemically different from subcutaneous tissue found elsewhere in the body. 2

There is some evidence that thigh reduction can be achieved by Endermologie after repeated treatments over a period. Thigh reduction seen after Endermologie treatments may be influenced by weight loss. The basis for various massage/suction techniques used for cellulite treatment rests on the premise that the condition is caused by impaired circulation.

Endermologie ESI (LPG Systems, Valence, France) or skin kneading is a nonpharmacologic method that employs mechanical means to mobilize the subcutaneous fat in affected areas. Despite the high cost of Endermologie treatment, little evidence exists to support its efficacy. Proponents of this process claim that massage/suction improves the disorganization of subcutaneous tissue structures and improves lymphatic flow.

The procedure is performed twice weekly, with each session lasting 10 to 45 minutes. A 12-week study by Collis et al4 compared healthy individuals with cellulite treated with Endermologie and/or aminophylline cream (a phosphodiesterase inhibitor) and found no statistical difference in thigh measurements between patients.3

While liposuction can diminish fat deposits deep in the subcutaneous fat, its effect on the superficial components of fat as seen in cellulite is often disappointing. Although lipoplasty has been purported by some to be an excellent method to improve body contouring, others have reported increased skin dimpling after liposuction. Ultrasonic liposculpture may be a superior, potentially safer, less destructive technique for cellulite reduction than traditional liposuction. Liposuction is still not a recommended treatment for cellulite. In part, that may be because cellulite adipose tissue is very close to the surface of the skin, with only a thin layer of dermis overlying it. 4

Mesotherapy, a technique that uses the injection of various substances into the subcutaneous fat to dissolve the fat, is another highly popular treatment for cellulite. However, few studies substantiate the benefit of this approach. The technique involves a series of injections delivered into the subcutis.

The solutions have included compounds like methylxanthines, such as caffeine, aminophylline, and theophylline, etc, which cause lipolysis via phosphodiesterase inhibition and elevation of cyclic adenosine monophosphate (c-AMP) levels, as well as hormones, enzymes, herbal extracts, vitamins, and minerals.

The one ingredient most consistently used is phosphatidylcholine (soybean lecithin extract), which is responsible for lipolysis via the activation of b-ARs. The lack of a precise treatment protocol, the unpredictable outcome, and the risk of localized adverse events— including edema, ecchymosis, tender subcutaneous nodules, infection, urticarial reactions, and irregular skin contours—have discouraged many clinicians from attempting this technique. 5

The herbal product Cellasene (Medestea Internazionale, Torino, Italy) contains Gingko biloba, sweet clover, seaweed, grape seed oil, lecithin, and evening primrose oil has been marketed internationally as a ‘‘miracle cure’’ for cellulite. A parallel, placebo-controlled clinical study comparing the effects of Cellasene with those of a control cream on the appearance of cellulite in 24 women between 25 and 45 years of age failed to record significant changes after 2-month of treatment.

Of note, seven of the 11 women using the study cream gained weight. It is important to note that many of the ingredients in purported topical treatments for cellulite are not known, and therefore the risk of adverse effects may be increased. In one study, there were 232 ingredients in the 32 different cellulite creams examined—these ingredients were predominantly botanicals, emollients, and caffeine. One-fourth of these materials were noted to cause allergic reactions. 6


Despite many treatments available—all of which claim to work somehow—few actually do work, and many work with unpredictable results. Recently introduced noninvasive cryolysis might have promising results in the reduction of subcutaneous fat, at least temporarily. Its role in the treatment of cellulite adipose tissue as a noninvasive modality remains to be explored.7

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  1. Misbah H. Khan, MD, Frank Victor, MD, Babar Rao, MD, and Neil S. Sadick, MD, ‘Treatment of cellulite: Part II. Advances and Controversies’, 2009, 10, 373- 382.
  2. Ryan TJ, Curri SB. Blood vessels and Lymphatics. Clin Dermatol. 1989; 7:25-36.
  3. Collis N, Elliot LA, Sharpe C, Sharpe DT. Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream. Plastic Reconstruction Surgery 1999; 104:1110-4.
  4. Hexsel DM, Mazzuco R. ‘Phosphatidylcholine in the Treatment of Localized Fat’. J Drugs Dermatol 2003; 2:511-8
  5. Rose PT, Morgan M. ‘Histologic Changes Associated with Mesotherapy. J. Cosmet Laser Therapy’, 2005; 7:17-9
  6. Lis-Balchin M. ‘Parallel Placebo-controlled Clinical Study of a Mixture of Herbs Sold as a Remedy for Cellulite. Phytother Res 1999; 13:627-9.
  7. Wanner M, Avram M. ‘An Evidence-based Assessment of Treatments for Cellulite’. J Drugs Dermatol 2008; 7:341-5