Cellulite: An Evidence-Based Review
Cellulite is a multifactorial condition that is present in 80–90 % of post-pubertal women. Despite its high prevalence, it remains a major cosmetic concern for women. A wide range of products and treatments for cellulite reduction is available; however, no systematic review has been performed so far to evaluate the efficacy of the available treatment options for cellulite.
The objective of this review is to provide a systematic evaluation of the scientific evidence of the efficacy of treatments for cellulite reduction.
This systematic review followed the PRISMA guidelines for reporting systematic reviews and meta-analyses. Only original articles in English or German reporting data on the efficacy of cellulite treatments from in vivo human studies were considered. In total, 67 articles were analyzed for the following information: therapy, presence of a control group, randomization, blinding, sample size, description of statistical methods, results, and level of evidence.
Most of the evaluated studies, including laser- and light-based modalities, radiofrequency, and others had important methodological flaws; some did not use cellulite severity as an endpoint or did not provide sufficient statistical analyses. Of the 67 studies analyzed in this review, only 19 were placebo-controlled studies with randomization. Some evidence for potential benefit was only seen for acoustic wave therapy (AWT) and the 1440 nm Nd:YAG minimally invasive laser.
This article provides a systematic evaluation of the scientific evidence of the efficacy of treatment for cellulite reduction. No clear evidence of good efficacy could be identified in any of the evaluated cellulite treatments.
No funding was received for the conduct of the study or the preparation of the manuscript. Stefanie Luebberding and Nils Krueger have no conflicts of interest to disclose. Neil S. Sadick received support for travel from Storz Medical AG and owns stock options from Venus Concept.
- 4.Hexsel DM, Abreu M, Rodrigues TC, Soirefmann M, do Prado DZ, Gamboa MML. Side-by-side comparison of areas with and without cellulite depressions using magnetic resonance imaging. Dermatol Surg. 2009;35(10):1471–77.Google Scholar
- 7.Bayrakci Tunay V, Akbayrak T, Bakar Y, Kayihan H, Ergun N. Effects of mechanical massage, manual lymphatic drainage and connective tissue manipulation techniques on fat mass in women with cellulite. J Eur Acad Dermatol Venereol. 2010;24(2):138–42.Google Scholar
- 12.Bertin C, Zunino H, Pittet JC, Beau P, Pineau P, Massonneau M, Robert C, Hopkins J. A double-blind evaluation of the activity of an anti-cellulite product containing retinol, caffeine, and ruscogenine by a combination of several non-invasive methods. J Cosmet Sci. 2001;52(4):199–210.PubMedGoogle Scholar
- 16.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.Google Scholar
- 29.Auxilium Pharmaceuticals, Inc. Mid and high level doses demonstrate statistically significant improvement in cellulite across all endpoints; nearly 70 % of mid and high dose patients satisfied or very satisfied with results. 2014. http://ir.auxilium.com/phoenix.zhtml?c=142125&p=irol-newsArticle&ID=1960062. Accessed 15 Sept 2015.
- 32.De Godoy JMP, de Godoy M de FG. Treatment of cellulite based on the hypothesis of a novel physiopathology. Clin Cosmet Investig Dermatol 2011;4:55–9.Google Scholar
- 35.De Godoy JMP, Groggia MY, Ferro Laks L, Guerreiro de Godoy M de F. Intensive treatment of cellulite based on physiopathological principles. Dermatol Res Pract. 2012. doi: 10.1155/2012/834280.
- 37.Hexsel D, Orlandi C, Zechmeister do Prado D. Botanical extracts used in the treatment of cellulite. Dermatol Surg. 2005;31(7 Pt 2):866–72.Google Scholar
- 40.Machinal-Quélin F, Dieudonné MN, Leneveu MC, Pecquery R, Castelli D, Oddos T, Giudicelli Y. Expression studies of key adipogenic transcriptional factors reveal that the anti-adipogenic properties of retinol in primary cultured human preadipocytes are due to retinol per se. Int J Cosmet Sci. 2001;23(5):299–308.PubMedGoogle Scholar
- 41.Dupont E, Journet M, Oula M-L, Gomez J, Léveillé C, Loing E, Bilodeau D. An integral topical gel for cellulite reduction: results from a double-blind, randomized, placebo-controlled evaluation of efficacy. Clin Cosmet Investig Dermatol. 2014;7:73–88.Google Scholar
- 44.Epstein E, Young VL, Schorr M, Young AE, Weisenborn S. Prospective and randomized determination of the efficacy of topical lipolytic agents. Aesthetic Surg J. 1997;17(5):304–7.Google Scholar
- 45.Kligman A, Pagnoni A, Stoudemayer T. Topical retinol improves cellulite. J Dermatol Treat. 1999;10(2):119–25.Google Scholar
- 52.Sasaki GH, Oberg K, Tucker B, Gaston M. The effectiveness and safety of topical PhotoActif phosphatidylcholine-based anti-cellulite gel and LED (red and near-infrared) light on Grade II-III thigh cellulite: a randomized, double-blinded study. J Cosmet Laser Ther. 2007;9(2):87–96.PubMedGoogle Scholar
- 57.Gerdesmeyer L, Maier M, Haake M, Schmitz C. Physical-technical principles of extracorporeal shockwave therapy (ESWT). Orthop. 2002;31(7):610–7.Google Scholar
- 60.Christ C, Brenke R, Sattler G, Siems W, Novak P, Daser A. Improvement in skin elasticity in the treatment of cellulite and connective tissue weakness by means of extracorporeal pulse activation therapy. Aesthetic Surg J. 2008;28(5):538–44.Google Scholar
- 61.Siems W, Grune T, Voss P, Brenke R. Anti-fibrosclerotic effects of shock wave therapy in lipedema and cellulite. Biofactors Oxf Engl. 2005;24(1–4):275–82.Google Scholar
- 63.Russe-Wilflingseder K, Russe-Wilfingsleder K, Russe E, Vester JC, Haller G, Novak P, Krotz A. Placebo controlled, prospectively randomized, double-blinded study for the investigation of the effectiveness and safety of the acoustic wave therapy (AWT®) for cellulite treatment. J Cosmet Laser Ther. 2013;15(3):155–62.PubMedGoogle Scholar
- 64.Knobloch K, Joest B, Krämer R, Vogt PM. Cellulite and focused extracorporeal shockwave therapy for non-invasive body contouring: a randomized trial. Dermatol Ther. 2013;3(2):143–55.Google Scholar
- 65.Schlaudraff K-U, Kiessling MC, Császár NB, Schmitz C. Predictability of the individual clinical outcome of extracorporeal shock wave therapy for cellulite. Clin Cosmet Investig Dermatol. 2014;7:171–83.Google Scholar
- 69.Ioppolo F, Tattoli M, Di Sante L, Venditto T, Tognolo L, Delicata M, Rizzo RS, Di Tanna G, Santilli V. Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months’ follow-up: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2013;94(9):1699–706.PubMedGoogle Scholar
- 76.DiBernardo BE. Treatment of cellulite using a 1440-nm pulsed laser with one-year follow-up. Aesthetic Surg J. 2011;31(3):328–41.Google Scholar
- 77.DiBernardo B, Sasaki G, Katz BE, Hunstad JP, Petti C, Burns AJ. A multicenter study for a single, three-step laser treatment for cellulite using a 1440-nm Nd:YAG laser, a novel side-firing fiber, and a temperature-sensing cannula. Aesthetic Surg J. 2013;33(4):576–84.Google Scholar
- 79.Goldman A, Gotkin RH, Sarnoff DS, Prati C, Rossato F. Cellulite: a new treatment approach combining subdermal Nd: YAG laser lipolysis and autologous fat transplantation. Aesthetic Surg J. 2008;28(6):656–62.Google Scholar
- 80.Nestor MS, Zarraga MB, Park H. Effect of 635 nm low-level laser therapy on upper arm circumference reduction. J Clin Aesthetic Dermatol. 2012;5(2):42–8.Google Scholar
- 81.Houreld NN, Ayuk SM, Abrahamse H. Expression of genes in normal fibroblast cells (WS1) in response to irradiation at 660 nm. J Photochem Photobiol 2014;130:146–152.Google Scholar
- 85.Savoia A, Landi S, Vannini F, Baldi A. Low-level laser therapy and vibration therapy for the treatment of localized adiposity and fibrous cellulite. Dermatol Ther. 2013;3(1):41–52.Google Scholar
- 86.Whelan HT, Smits RL, Buchman EV, Whelan NT, Turner SG, Margolis DA, Cevenini V, Stinson H, Ignatius R, Martin T, Cwiklinski J, Philippi AF, Graf WR, Hodgson B, Gould L, Kane M, Chen G, Caviness J. Effect of NASA light-emitting diode irradiation on wound healing. J Clin Laser Med Surg. 2001;19(6):305–14.PubMedGoogle Scholar