Q: Are there any effective treatments for cellulite? I’m not talking about the creams that were targeted to women in the ’90s — I realize those don’t work — but instead laser therapy or something similar that might have been developed over the last few years. I’m a proud Gen-Xer who turned 50 last year. I’m active, lift heavy weights, run a half-marathon and if I don’t get injured, a marathon once a year; I eat well and overall am in fantastic shape. But my thighs! I just can’t get past the dimples I see on the front of my quads. They’re the first thing I notice when I look at a picture of myself or see my reflection in a mirror when I’m wearing shorts. I realize that this clearly falls into the category of first-world problems and I do have a ton of self-confidence otherwise. I just don’t want to feel bad about my legs.
A: Cellulite! I have such mixed feelings about it. You probably know already that it’s a common condition, affecting, by some accounts, around 90 percent of women. (Those 10 percenters? They must like their privacy; I’ve never met one.) Sadly, a Harris poll revealed that around 60 percent of women believed cellulite was their fault (their cellulite, not yours). I want to remind you, before we get to your options, that once, by which I mean back in the mid-1900s when I was a girl, cellulite did not exist. Not because women were in fighting shape, but because it hadn’t yet been invented. If our thighs were large, they were called heavy, but they weren’t saddled with a full-blown medical disorder (as Howard Murad, M.D., identified it in his book The Cellulite Solution). Once, full hips suggested a woman’s strength, her powerful, awe-inspiring ability to procreate; the soft slice of thigh exposed between a panty girdle and the dark welt of a stocking held fast by a garter was delectable, not diseased; the natural padding on a woman’s thighs was considered plush, luxurious, suggestive of a velvety capaciousness altogether female.
But in our ferocious quest for physical perfection, often so fetishized as to be inhuman, women have learned to revile that padding, which now seems to represent our body’s recalcitrance to submit to our will, a weighty reminder that we will never achieve the physical ideal.
That said, I can understand why the dimples on your quads annoy you. You feel almost perfect; why shouldn’t you look almost perfect? Though I don’t personally subscribe to that kind of thinking — some of the tastiest stews I’ve eaten appeared on my plate looking like the dog had already enjoyed them — I get it that you’d like to see a bigger reward for your workout. So I asked HNTFUYF DermDiva Heidi Waldorf for her best advice.
“The first thing to understand about cellulite is that all cellulite is not the same,” she said. There are dimples caused by the pulling of vertical fibrous bands (like the indentations on a traditional mattress) and rolling waves from skin laxity (more like your duvet). They require different treatments.
Improving dimples requires releasing the underlying bands (called septa) by dissolving, cutting, or softening them. And how can this can be achieved? By subcision, said Waldorf, which means sweeping under each dimple with a sharp instrument. You can use a device (Cellfina) designed to stabilize the depth and the angle of the subcision instrument; or one guided by light visualization (Aveli); or one that disrupts the bands with acoustic pulses (Resonic); or inject an enzyme to dissolve the fibrous collagen (Qwo, which is no longer available because of persistent post-injection hyperpigmentation).
Skin laxity, on the other hand (or thigh) may be improved with procedures that improve skin density through the regeneration of collagen, said Waldorf. These treatments include injectable biostimulators (such as the fillers Radiesse or Sculptra); tightening devices (like radiofrequency with Thermage or Emtone); radiofrequency plus microneedling (as with Morpheus 8 or Fractora); focused ultrasound (as with Ultherapy or Sofwave); or potentially certain lasers (like the Nd:YAG). Improving support by helping to build muscle under lax skin may also improve appearance (with devices like Emsculpt, TruSculpt Flex, or Cooltone), depending upon the degree of laxity.
That’s a lotta devices, which means a lotta options — unsurprising, as there’s a lotta money to be made from this naturally occurring condition seen in a lotta women. According to one research company, the U.S. market size value for cellulite treatment in 2022 estimates $1.4 billion.
So you think you have cellulite? How can you tell what type you’ve been blessed with? If, when you pull your skin taut, a dent doesn’t diminish but becomes a deeper divot, it’s likely a dimple (a common sign of cellulite), said Waldorf. If it diminishes, it’s likely laxity. It’s important to get a thorough evaluation by a physician to find out if you have one, the other, or — lucky you! — both. Obviously, for a satisfactory result, you need the right tool for the job; the tightening procedures won’t have a big effect on the dimples and going after the bands won’t help diminish the effect of laxity, said Waldorf.
Some treatments, like subcision, may require only one or two sessions if the fibrous bands are destroyed successfully. Most current treatments for laxity take several treatments and often a combination of treatments such as an injectable biostimulator (filler) plus a tightening device to get a worthwhile result.
Are you still reconciled to finding a solution to your cellulite? The key before throwing your money at it is to have a discussion with your treating physician about realistic expectations, Waldorf said. A young person with dense skin, firm underlying musculature, and some dimpling will likely be happier with an outcome than an older person with laxity and minimal underlying support. Which brings me back to the line I seem to keep repeating week after week: The less a device (or skin-care product) has to do, the better it works.
Valerie Monroe was beauty director at O, The Oprah Magazine, where she wrote the monthly “Ask Val” column for nearly 16 years. Now she writes the weekly newsletter How Not to F*ck Up Your Face. Her goal continues to be to shift our thinking in the beauty arena from self-criticism to self-compassion and to learn how to be loving witnesses to ourselves and one another as we age.
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