The Surgeon Minute

Cellulite: Causes & Cures

Cellulite: Causes & Cures

If you are over the age of 30 and a woman, there is a good chance that you will or already have cellulite. The statistics are astounding. Women in this country spend about $6 billion dollars a year trying to banish cellulite.

Until recently, most of these treatment options were not very effective. Dr. Brad Calobrace of Louisville discusses cellulite and how a couple of procedures are giving plastic surgeons a real, viable option for improving its appearance.

Liposuction Does Not Address Cellulite

Cellulite is a problem for so many patients; it is estimated that over 90% of the women past the age of 30 will develop some form of cellulite in their lifetime. It can hit anywhere, but the most common problem areas are the hips, buttocks and around the knees. Everyday in his practice, Dr. Calobrace has patients come into his office asking for liposuction to treat their cellulite. He then reminds them, “liposuction is no treatment for cellulite.”

Liposuction does not address cellulite.

Cellulite makes the skin appear as if there are underlying fat deposits. Patients think that this is what is causing the dimpled or lumpy appearance of their skin. The truth is that while cellulite is caused by lots of things, extra fat is not one of them. In fact, oftentimes, if you remove that underlying fat with liposuction, it can actually make the cellulite look worse.

What is Cellulite?

Cellulite can be a looseness to the skin or a dimpling of the skin. Both create a textural abnormality in which the skin looks bumpy or rough, dimpled or pitted. “It’s lots of different characteristics that we all lump into cellulite,” explains Dr. Calobrace. Plastic surgeons use the terms primary and secondary cellulite to describe different characteristics.

Primary cellulite refers to skin that has dents or dimples. These occur when the connective bands that are woven throughout our fat tighten, pulling the skin down which causes the underlying fat to bulge up. It’s often described as appearing like:

  • orange peel
  • collage cheese
  • hail damage


Secondary cellulite is due to skin looseness. When a patient comes in and lifts the skin on her thigh, for example, and it removes all the irregularities, this is secondary cellulite. Since it’s not caused by deep fat and liposuction isn’t a cure, what are the treatment options?

Treating Cellulite Is Multi-Factorial

There is no one single fix for cellulite; the treatments have to be multi-factorial. As with any cosmetic improvement goal, it always starts with diet and exercise. WIth this in place, your plastic surgeon has to figure out the underling cause of your cellulite. Once you know if it’s primary or secondary, you can come up with the right treatment plan.

The Cellfina treatment process.

For the dimpling caused by primary cellulite, particularly in the buttocks and lateral thigh, there is a new minimally invasive treatment called Cellfina. It’s a small procedure done under local anesthesia that cuts the connective bands that are creating the dimples. If you think of your thighs as a tufted sofa, Cellfina releases the tufts so that your skin looks smoother. The advantages of this procedure are:

  • it only takes about 1 hour
  • is FDA approved
  • requires minimal to no downtime
  • is extremely effective with results in as little as 3 days

The looseness associated with secondary cellulite has to do with the kind of fat that’s underneath the skin, the thickness of the skin and how the skin is constructed over that fat. Female skin has some variations to that of men, which is one of the reasons that cellulite is rarely seen in that population. Woman with thin skin are particularly vulnerable to this type of cellulite.

Secondary cellulite is really tough to treat. The most common surgical technique for addressing it is a thigh lift. However, for those patients who don’t have that much cellulite or who maybe don’t want the scar of a thigh lift, there is a non-surgical procedure called ThermiSmooth that uses temperature controlled radio frequency to heat the skin, stimulating collagen remodeling. The result is tighter, smoother skin.

Cellulite has lots of causes, aging being one of them, making it hard to know whether or not your treatment plan will be permanent. In general, Cellfina requires only one treatment while ThermiSmooth requires 3-5 treatments depending on your desired result.

Patient Expectations

When it comes to cellulite, no patient is expecting eradication. They just want to see an improvement. Patients understand that cellulite is complicated and difficult to treat so, “if you give them a 50% improvement, they’re very, very happy,” explains Calobrace. Oftentimes, he finds that Cellfina and ThermiSmooth treatments get the patient motivated to really get serious about a diet and exercise regime.

Cellfina’s early results are showing a potential game changer for plastic surgeons who deal with cellulite. Finally there is something to offer patients that works for cellulite, a condition that is incredibly common and so disheartening to so many.

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