Cellulite: Why Does It Occur and Which Treatments Can Improve the Appearance of the Skin?

To understand why treatments differ, it is important to know that cellulite has a multifactorial origin.

Fibrous septa and the architecture of subcutaneous tissue

Fibrous septa are bands of connective tissue that cross the fatty tissue and connect the skin to deeper structures. When they pull on the skin and the adjacent fatty tissue protrudes between them, the characteristic cellulite dimples appear. This mechanism explains why certain procedures aim to mechanically release the septa rather than simply reduce fat volume.

Skin elasticity and thickness

Age-related changes, including reduced elasticity and thinning of the dermis, can make uneven areas more visible. Therefore, treatments intended to improve skin firmness may have a role in certain cases, even if they do not remove the fibrous septa responsible for the dimples.

Individual factors

Genetic predisposition, hormonal influences, the distribution of fatty tissue, and weight fluctuations may contribute to the development or worsening of cellulite. Body weight may influence its appearance, but it is not the only determining factor.

In practice, the assessment should distinguish between fixed dimples associated with septal traction, a diffuse uneven skin texture, and skin laxity. These features may require different treatment approaches.

Non-surgical treatments: Radiofrequency, mechanical massage, and acoustic wave therapy

These are commonly chosen by patients who want to improve the appearance of their skin without invasive procedures.

Radiofrequency (RF) uses electromagnetic energy to heat tissues. Depending on the device and the parameters used, heating may promote collagen remodelling and temporarily improve skin firmness and the appearance of uneven areas. Some devices combine radiofrequency with vacuum or mechanical massage. Results vary and are generally moderate, while maintaining them may require repeated sessions.

Acoustic wave therapy uses mechanical waves applied to the tissues. Studies suggest that it may reduce the visibility of cellulite after several sessions, but the extent and duration of the effect differ between patients and treatment protocols.

Mechanical massage and vacuum may temporarily improve the appearance of the skin. However, the evidence regarding their sustained effectiveness is inconsistent, and these methods should not be presented as permanent solutions.

It is important to note that results obtained with one device cannot automatically be extrapolated to all devices in the same category. The technology used, the device’s indication, and the treatment protocol influence both effectiveness and the safety profile.

Subcision and minimally invasive treatments

For well-defined dimples caused predominantly by the traction of fibrous septa, procedures that release these structures may be more appropriate than treatments aimed exclusively at skin firmness.

Subcision involves the controlled cutting of the fibrous septa located beneath the skin using an instrument inserted through a small incision or puncture. Releasing the traction allows the dimple to rise and may provide lasting results in selected cases.

Subcision is not necessary for all forms of cellulite. In cases involving a diffuse appearance, predominantly skin laxity, or other changes in body contour, the doctor may recommend a different approach or a combination of treatments.

Creams, lifestyle, and the limitations of treatments

Anti-cellulite creams may have limited effects, particularly on the temporary appearance of the skin.

Products containing caffeine may temporarily reduce the visibility of uneven areas but require repeated application. Products containing topical retinol may help improve skin thickness and texture after long-term use, but their effect on cellulite is usually modest. Retinol may cause irritation, and skin tolerance should be assessed.

Regular physical activity and strength training may improve body composition and muscle contour, sometimes helping to reduce the visibility of cellulite. If excess weight is present, weight loss may be helpful, but it does not guarantee that the dimples will disappear. In some situations, skin laxity after weight loss may make cellulite more noticeable.

It is important to distinguish between reducing fatty tissue and treating cellulite. For example, liposuction is intended to remove fat and is not a first-line treatment for cellulite; it may sometimes accentuate existing irregularities. Procedures for localised fat reduction should not automatically be considered anti-cellulite treatments either.

Mesotherapy with injectable mixtures, supplements promoted as anti-cellulite solutions, and procedures without strong clinical evidence require caution. Uncertain benefits and the risks of adverse reactions should be discussed before any intervention.

There is no single procedure that is optimal for everyone. The choice depends on the clinical appearance, the severity of the uneven areas, skin elasticity, medical history, and the patient’s tolerance for risks and recovery time.

In general:

• For a diffuse appearance with mild changes in skin texture and firmness, non-surgical procedures such as radiofrequency or acoustic wave therapy may be considered.

• For well-defined dimples associated with traction from the fibrous septa, the indication for a subcision procedure may be assessed.

• When skin laxity or excess fatty tissue predominates, the treatment plan should be adapted to the main concern, without assuming that fat reduction will automatically eliminate cellulite.

Standardised photographs taken under comparable conditions may help assess the result objectively.