Cellulite treatments are not always as effective as patients may expect, according to Elizabeth Tanzi, MD, FAAD.
“We're better at treating cellulite, but we're still not there where I really enjoy talking to patients and treating them [for cellulite],” began Elizabeth Tanzi, MD, FAAD, a board-certified dermatologist and founder of Capital Laser & Skin Care, at SCALE 2023.1 Tanzi’s session covered available cellulite treatments for patients and current treatment limitations. Tanzi noted that 2019 used to seem like the golden age of treating cellulite, but now in 2023, it’s not her favorite cosmetic concern to address. Some of the main struggles of cellulite management include patient expectations and time to results. As Tanzi previewed in her session, some cellulite treatments can take up to 1 year to see noticeable improvement.
Current cellulite treatment options include breaking the septae (using mechanical, chemical, or acoustic methods), using biostimulants and injectables, and using heat-based technology to improve overall skin quality. For breaking the fibrous septae, a since-discontinued treatment was collagenase clostridium histolyticum. While effective, this treatment option caused significant bruising that lasted for months. Other septae treatments include rapid acoustic pulse technology (RAP) and minimally invasive devices.
Cellulite acoustic subcision emits a rapid acoustic shockwave that can shear fiber bands and quickly break them apart. Similarly, acoustic shearing breaks apart septae within 3 minutes, but the best results are seen after 1 year compared to 3 months. Tanzi noted that patients often struggle with this result time, as they hope to see an immediate reduction in their cellulite.
According to Tanzi, the reality of RAP is that the device itself is unreliable, it often breaks down, requires longer treatment times, both the patient and provider experience fatigue due to the heavy device and long treatment times, and the emitted sound itself is very loud.
Moving on to biostimulants, Tanzi referenced a recent study that examined the use of biostimulants in 20 patients and found that the greatest improvement in depressions and global skin scores was seen at almost 1 year.
“I think there are longer-term changes that are taking place in the skin that we have to wait for when we’re using some of these cellulite technologies. That's an important message to get out to our patients - that it's not right away and you want to follow them up with photos,” said Tanzi.
Tanzi concluded her session by noting that she believes cellulite treatments will continue to get better, but that providers have to have candid conversations with their patients about the expectations.