What works for cellulite (and what does not)?

First of all, let's be clear: cellulite is fat.  Cellulite is not a medical term, but a term that was coined in European salons and spas to describe deposits of dimpled fat found on the thighs and buttocks of up to 90% of women.  Cellulite occurs primarily in women, rather than in men, because of the configuration of fibrous bands that separates fat cells into compartments.  In women, this connective tissue has a honeycomb configuration, rather than the crisscross pattern in men, which allows fat to protrude, creating the characteristic "cottage-cheese" pattern. Cellulite development also appears to be under the influence of hormonal factors, with most cellulite developing in the post-adolescent period.

A recent internet search for "cellulite treatment" revealed thousands of entries.  Special washcloths, loofah sponges, creams and gels to "dissolve" cellulite, vitamin and herbal supplements,  massagers,  rollers,  body wraps,  toning lotions,  electrical muscle stimulation, vibrating machines, "enzyme" injections, liposuction, and massage are just a few of the treatments that are touted at these sites.  Despite a prolific number of treatments, there has been scant research performed to evaluate most of these and only a tiny number have received approval from the U.S. Food and Drug Administration (FDA). Let's look at some of the treatments that work and some that don't.

Weight Loss.  Reduction in body fat can have a beneficial effect on the appearance of cellulite. This makes sense when you consider that having less surplus fat makes it less likely to protrude through the connective tissue.  Of course, this is best done through healthy means such as a sensible c
alorie restricted diet and exercise.  Weight loss is not always successful, however, as genetics also has a major bearing on whether or not cellulite develops.  Even women of ideal weight can have cellulite.

Cardiovascular exercise and weight training.  There is some evidence that along with weight loss, a program that includes cardiovascular exercise (walking, jogging, cycling, etc.) and strength training can help improve the appearance of cellulite.  The cardio portion is best done for 30-40 minutes, 3-4 times per week. The strength training program should include calisthenics-type exercises involving the use of small dumbbells, ankle weights or resistance bands.

Liposuction is falling out of favor as a treatment for cellulite. While this surgical treatment does remove fat, it does not remove cellulite specifically.  In fact liposuction can worsen the appearance of cellulite in cases in which large amounts of fat are removed.

Endermologie is a FDA-approved treatment for cellulite which allows for deep   tissue mobilization with the use of a hand-held machine to knead the skin between rollers.  Up to 14 sessions, at significant expense, may be required to see results.  Unfortunately, these results are usually short-lived and follow-up treatments are usually required.

What's new?  Two of the more recently FDA-approved treatments for cellulite involve a "miminally invasive" technique to sever the fibrous bands beneath the skin that cause the characteristic appearance of cellulite.  The first, marketed under the name, Cellulaze, involves the use of a small laser that is inserted under the patient's skin. Laser energy is used to "melt" fat under the skin and release the fibrous bands that pull down on the skin.  A second system called Cellfina uses a needle-like instrument to "cut" the fibrous bands.  Both procedures require the use of a local anesthetic since small incisions have to be made to introduce instruments beneath the skin.  These procedure can be performed on an outpatient basis and generally only require a single treatment. The results are reported to last a year or more.  Both of these forms of treatment are expensive and are most appropriately used after trying less invasive measures, such as weight loss and exercise.

Buyer Beware.   Body wraps, electric muscle stimulators, bowel cleansers, herbal extracts, mesotherapy (a technique in which substances are injected into layers of fat and connective tissue under the skin), creams or gels to "dissolve" cellulite, most massaging devices, and any "anti-cellulite pills" are ineffective and a huge waste of money.

Genetics and statistics indicate that most women will develop cellulite.  Its appearance, however, can be improved by avoiding excess weight and exercising regularly.  If more than this is needed, by all means stick with a method that has proven results.
   
Sources for article:
Cellulite, Causes and Treatment from WebMD
Cellulite from Mayo Foundation for Medical Education and Research