Cellulite

Cellulite is a structural problem, not a fat problem. Bands of fibrous tissue called septae run from the underside of the skin down to the fascia over the muscle, anchoring the skin at fixed points, with fat sitting in the compartments between them. Those bands hold their anchor points down while the fat between them pushes up, and the surface reads as dimples and valleys.

That explains the part people find most frustrating. Losing weight shrinks the fat in the compartments but does nothing to the bands, so the dimples usually stay, and very lean people get cellulite too. It also explains why it is so much more common in women. The septae in women tend to run straight down in parallel, which pockets the fat neatly, while in men they cross in a lattice that holds the surface flatter.

The skin above matters as well. Thin, slack skin sinks into every tether and shows the texture plainly, while firmer skin bridges across it. So treatment goes after one of two things: the bands themselves, or the quality of the skin lying over them.

Start with the limit, because it is the part most brochures leave out. No treatment eliminates cellulite permanently in everyone. Releasing the bands produces the longest-lasting change because it removes the mechanism, but bands can re-form and new dimples can appear over the years, and surface treatments hold their result only as long as they are maintained.

Matching the treatment to the severity is most of the skill, and the options sort into two tiers for exactly that reason. Mild to moderate dimpling, the broad orange-peel texture with no single dimple to point at, is surface territory: VelaShape, Exilis Ultra or Thermage, chosen on how often you want to come in and maintained once you get there. More severe dimpling, a handful of deep, distinct dimples on the buttocks or the back of the thighs, is a tethering problem, and Vaser Smooth or ThermiTight is where the more permanent results come from. Dimpling that shows up alongside obvious laxity is worth treating with a tightening procedure, since slack skin exaggerates how visible the dimples are.

Two things reliably disappoint. Creams and lotions do not reach the septae, which is why people who have tried them end up in a medical office anyway. And liposuction on its own is not a cellulite treatment. Removing fat can sometimes improve how a dimple looks, but it is not a proven treatment for cellulite, which is why band release exists as a separate procedure.

At a consultation we determine the type and grade of your cellulite, look at your skin tone and texture, and build the plan around what we find. We are direct about which pattern responds well and which one we can only soften.