Home / News / Which form of cellulite requires which treatment? The future lies in the combination of treatments
Which form of cellulite requires which treatment? The future lies in the combination of treatments

Which form of cellulite requires which treatment? The future lies in the combination of treatments

Written on 20th November 2019
by Dr. Rolf Bartsch


Bartsch Rolf

Plastic Surgeon



Worldwide, 1.7 billion women have cellulite. That’s 85 percent of women between the age of 25 and 60.
Cellulite has always been treated to the best of everyone’s knowledge and belief. However, existing treatment options have not been successful in the long term – and there are reasons for that which we know.
Now there are major medical developments in the field of Cellulite 4.0, because there are new combination therapies leading to success for the first time. Not every appearance of cellulite has the same causes and only those who can identify these causes can treat them successfully and sustainably. This will require a self-test on and an expert analysis to find the individual cause.

There are three causes that lead to the appearance of cellulite:
1. Soft connective tissue – SHELL
2. Not enough or too much volume – FILL
3. Connective Tissue Strands – STRUCTURE

The causes of cellulite and possible combination therapies:
Every form of cellulite needs the right treatment. Cellulite can only be significantly improved and also disappear permanently with the right treatment approach, which often consists of the combination of different treatment methods such as ultrasound, filler, liposuction, cryolipolysis and tissue stabilized-guided subcision (TS-GS).

SHELL: The tissue is soft due to genetics or has become soft over time
Depending on genetic predisposition and exercise, the connective tissue is tighter or softer. In the course of the natural aging process, the connective tissue loses elasticity as the skin thickness decreases with age and the honeycomb-like structure of collagen fibres becomes thinner. For example, cellulite caused by soft connective tissue can be treated with micro-focused ultrasound or a collagen-forming dermal filler. The combination of both methods leads to collagen growth and the skin becomes smoother. Both are outpatient, non-invasive (for ultrasound) and minimally-invasive (for filler) treatments without any downtime and without having surgery.

FILL: There is too much / not enough fat
Adipose tissue also has an impact on the appearance of cellulite. If there is a little more subcutaneous fatty tissue present, many small dimples appear on the surface of the skin. This appearance of cellulite is also called “Cottage cheese” or “Rippling “. In this case, the reduction of fatty tissue is advisable: on the one hand by a regular and healthy diet in combination with exercise, on the other hand by non-invasive treatments such as cryolipolysis – freezing fat without surgery. This type of cellulite usually occurs at a BMI of more than 27. If the BMI is well below 20 and cellulite occurs, a “too empty” skin shell can be the cause. These dimples are not or only very difficult to treat because volume replacement would be necessary below the skin shell. So basically you would have to “inflate the balloon”.

STRUCTURE: Structural cellulite is the cause
The longitudinal collagen bands in the connective tissue are responsible for structural support within the skin. Especially after puberty the influence of female hormones leads to an increase of the size of the fat cells. The structural fibrous septae keep the skin on the “old” level while next to them the skin is being pushed upwards by the growing fat cells. The structural bands are connected down to the deeper tissue layers and are not as elastic as the skin surface so this push/pull effects in the appearance of dimples on the surface. If these bands are released by a new treatment method, they do not grow together anymore – we get a long-term, long lasting result. Here, the minimally-invasive treatment “tissue stabilized-guided subcision” can promise lasting improvement.

However, not every appearance of cellulite is the same and it can have different causes. In addition to the causes shell, fill and structure, the severity is also decisive whether one can achieve a lasting improvement with tissue stabilized-guided subcision, ultrasound and dermal filler.

Classification of the severity level of cellulite:
Grade 0: no treatment recommended
Grade 1-2: significant improvement expected
Grade 3: Improvement to be expected only in the triple combination
Grade 4: Treatments rarely recommended

The future of the treatment of cellulite is in combination therapies. Long lasting results can be achieved with a single, minimally invasive intervention in local anaesthesia with minimal downtime and for the first time, cellulite can be conquered with the right combination of treatments.