Evidence guide
What causes cellulite, which treatments work, and what the evidence shows.
Written by Orr Shauly, MD, plastic surgery resident. Updated .
For information and education only, not medical advice.
The short answer.
Cellulite is the dimpled, uneven skin seen most often on the thighs and buttocks, and it affects an estimated 80% - 90% of women after puberty.1 It is caused mainly by tight fibrous bands under the skin that pull down while fat pushes up.2 No treatment removes cellulite permanently. Treatments that release the fibrous bands, such as subcision, have shown the most consistent results, while creams and most devices produce modest or short-lived changes.2,3
- 24 Trials
- 2,084 patients
- Randomized trials of cellulite treatments included in a 2025 systematic review.4
- 0.46 cm
- thinner thighs with creams
- Pooled extra reduction in thigh circumference with cosmetic creams vs control in 7 controlled trials, a small effect.5
- 67.4%
- shallower dimples
- Average improvement in dimple volume on 3D imaging 3 months after a single vacuum-assisted subcision treatment in 16 women.6
What cellulite is.
Cellulite is a change in the surface of the skin that creates dimples, bumps and an orange-peel texture. It is a normal finding in most adult women and is not a medical disease.1 It is far less common in men, in part because the fibrous bands under the skin are arranged differently.
Beneath the skin, fat sits in compartments separated by bands of connective tissue called fibrous septae. When these bands tighten and pull the skin down while the fat between them bulges up, the surface becomes uneven.2 Female sex, older age and a higher body mass index all contribute.2
How cellulite is graded.
Doctors and researchers use photo-based scales, such as the Cellulite Severity Scale, that score the number and depth of dimples, raised areas and skin laxity. Grading helps match the treatment to the severity.3
| Severity | Usual Approach |
|---|---|
| Mild3 | Lifestyle changes such as healthy diet, hydration and exercise, with topical products as an add-on |
| Moderate3 | Noninvasive devices such as radiofrequency, laser or ultrasound |
| Severe3 | Minimally invasive treatment such as subcision or injectable treatment |
The evidence at a glance.
| Treatment | Study | Main Finding |
|---|---|---|
| Topical Creams5 | Meta-analysis, 7 controlled trials | Thigh circumference 0.46 cm smaller vs control |
| Acoustic Shock Wave Therapy7 | Meta-analysis, 11 trials, 297 women | Improvement after 6 - 8 sessions, with no data beyond 1 year |
| Radiofrequency4 | Systematic review, randomized trials | Thigh circumference about 2.09 cm smaller |
| Collagenase Injection8 | 2 randomized placebo-controlled trials, 843 women | At least 1-level improvement in 37.1% - 41.6% vs 11.2% - 17.8% with placebo |
| Vacuum-Assisted Subcision6 | Prospective registry, 16 women | Dimple volume 67.4% smaller at 3 months |
Older reviews were more skeptical. A 2015 systematic review of 67 studies found that most had serious design flaws, and only 19 were randomized and placebo controlled.1 A 2025 review of 24 randomized trials rated the overall quality as moderate and found the most promising results for shock wave therapy, radiofrequency and injectable treatment.4
Treatment options.
- Lifestyle: Weight management and exercise can improve the appearance of mild cellulite but rarely remove it.3
- Creams: Topical products containing caffeine, retinoids or plant extracts have small and inconsistent effects.5
- Energy Devices: Radiofrequency, laser, ultrasound and shock wave devices usually need several sessions, and results tend to fade without maintenance.4,7
- Subcision: A needle or blade releases the fibrous bands that create dimples, either by hand or with a vacuum-guided device.6
- Injectable Collagenase: An enzyme injected under the skin breaks down fibrous bands, and it was tested in two large placebo-controlled trials.8
Side effects.
Bruising is very common after both subcision and collagenase injection. In a 2024 meta-analysis of 1,254 patients, bruising occurred in 99% after subcision and 89% after collagenase, and skin discoloration in 7% vs 16%.9 Pain needing pain medicine was reported in 60% after subcision and 74% after collagenase.9
Noninvasive devices usually cause only temporary redness, swelling or tenderness. Creams rarely cause problems other than skin irritation.
What we don't know yet.
- Durability: Most studies follow patients for weeks to months, so long-term results are uncertain.4,7
- Standard Measures: Studies use different grading scales and measurements, which makes treatments hard to compare.1
- Best Combination: Combining treatments that target fibrous bands, fat and skin quality is common, but the best combination has not been established.3
Common questions.
Is cellulite a sign of being overweight?
No. Cellulite is common in women of every body size and is mainly caused by the structure of the fibrous bands under the skin. Weight gain can make it more visible.
Can cellulite be removed permanently?
No treatment has been shown to remove cellulite permanently. Some treatments reduce its appearance for months to years, and maintenance is often needed.
Do cellulite creams work?
The effect of creams is small and inconsistent. They may slightly improve skin texture while they are used, but they do not change the fibrous bands that cause dimples.
What is subcision for cellulite?
Subcision uses a needle or small blade under the skin to release the fibrous bands that pull the skin down. It targets individual dimples and is usually done under local anesthesia.
Does liposuction get rid of cellulite?
No. Liposuction removes fat but does not release the fibrous bands, and it can sometimes make the surface of the skin more uneven.
Does exercise help cellulite?
Exercise and a healthy weight can improve the look of mild cellulite. They do not usually remove it, because the fibrous bands remain.
Is cellulite treatment right for me?
Only an in-person evaluation can answer that. This guide is educational and cannot assess an individual case. A qualified plastic surgeon or dermatologist can review your goals, skin and options with you.
Key terms.
- Fibrous Septae
- Bands of connective tissue under the skin that divide fat into compartments and can pull the skin down.
- Subcision
- A procedure that releases fibrous bands under the skin with a needle or small blade.
- Cellulite Severity Scale
- A photo-based scale used to grade the number and depth of dimples and related skin changes.
- Collagenase
- An enzyme that breaks down collagen, studied as an injection to release fibrous bands.
- Acoustic Shock Wave Therapy
- A device treatment that delivers pressure waves to the skin and tissue under it.
Research by Dr. Shauly on this topic.
References.
- 1.Luebberding S, Krueger N, Sadick NS. Cellulite: an evidence-based review. Am J Clin Dermatol. 2015;16(4):243-56. PubMed
- 2.Bass LS, Hibler BP, Khalifian S, Shridharani SM, Klibanov OM, Moradi A. Cellulite Pathophysiology and Psychosocial Implications. Dermatol Surg. 2023;49(4S):S2-S7. PubMed
- 3.Menon A, Shauly O, Marxen T, Losken A, Faulkner HR. A Clinical Guide to the Treatment of Cellulite and Comprehensive Review of the Etiology, Pathophysiology, and Utility of Intervention. Aesthetic Plast Surg. 2024;48(10):1985-92. PubMed
- 4.Lim SK, Gultekin G, Suresan S, Jacob A, Zou Y, Liyanage DD, et al. Comparative Analysis of Cellulite Treatment Modalities: A Systematic Review. Aesthetic Plast Surg. 2025;49(7):2051-75. PubMed
- 5.Turati F, Pelucchi C, Marzatico F, Ferraroni M, Decarli A, Gallus S, et al. Efficacy of cosmetic products in cellulite reduction: systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2014;28(1):1-15. PubMed
- 6.Day D, Burgess CM, Kircik LH. Three-Dimensional Analysis of Minimally Invasive Vacuum-Assisted Subcision Treatment of Cellulite. J Drugs Dermatol. 2018;17(9):960-5. PubMed
- 7.Knobloch K, Kraemer R. Extracorporeal shock wave therapy (ESWT) for the treatment of cellulite--A current metaanalysis. Int J Surg. 2015;24(Pt B):210-7. PubMed
- 8.Kaufman-Janette J, Joseph JH, Kaminer MS, Clark J, Fabi SG, Gold MH, et al. Collagenase Clostridium Histolyticum-aaes for the Treatment of Cellulite in Women: Results From Two Phase 3 Randomized, Placebo-Controlled Trials. Dermatol Surg. 2021;47(5):649-56. PubMed
- 9.Foppiani JA, Raska O, Galinaud C, Stearns S, Hernandez Alvarez A, Taritsa IC, et al. Comparing Collagenase and Tissue Subcision for Cellulite Treatment of the Buttock and Thigh Regions: A Systematic Review and Meta-analysis. Plast Reconstr Surg Glob Open. 2024;12(6):e5857. PubMed