Cellulite affects 80% to 90% of all women and results in dimpling of the skin around the thighs and buttocks. It is the result of structural changes to fat that lies below the skin and its interactions between itself and the skin above. These structural changes result in the characteristic orange peel and cottage cheese effects. The main factors influencing the formation and development of cellulite include oestrogen levels, microvascular (small arteries and veins) changes in the skin and fat over the thighs and buttocks, as well as, to date unidentified, genetic and hormonal changes. Ultimately these all result in fibrosis (scarring) in and around adipose tissue (fat cells).

Cellulite grading was established by Dr Nurnberger and Dr Muller in 1978. The grading scale consists of 4 grades ranging from grade 0 to grade 4. An important aspect of grading cellulite is the pinch test. The pinch test is a simple way to visually grade cellulite. Pinch the skin on your outer thigh between your index finger and your thumb, and look for dimpling. This approach can be used on any part of the body susceptible to cellulite. The table below summarises the Nurnberger-Muller Cellulite Scoring System.

Numerous clinics offer a wide range of treatment options for cellulite. Each of these clinics claim their treatments work to reduce and in many cases eliminate cellulite. These treatments usually cost a large amount of money and often the results are not as promised. At Rejuvence Clinic we believe in practising evidence based medicine. Evidence based treatments are treatments that have been the subject of intense research and have a wealth of published data demonstrating their effectiveness. So what actually works for cellulite?

The truth is there is no treatment that performs above and beyond any other. However, some work better than others. Dr Irene Zerini is a plastic surgeon based at the University of Sienna, Italy. Dr Zerini and colleagues published a review of all research that has been published regarding the treatment of cellulite. They assessed the results of all major studies published up until 2015 and summarised their efficacy in the treatment of cellulite. Zerini et al. identified 73 studies that described a total of 9 different treatment options for cellulite. Patients treated in these studies range between 20 and 48 years of age. The table below summarises the treatments reviewed.

Aside from individuals treatments, many researchers published data on a combination of treatment modalities for cellulite. Combination treatments included IPL and retinol-based creams, dual wavelength laser and massage, topical creams with low calorie diets, exercise and lower body pressure interventions as well as cryolipolysis and shock wave therapy.

Endermologic is a combination of firm massaging, rolling and sucking at the surface of the skin. This treatment aims to alter the architecture of the skin to improve the appearance of cellulite. The results of this treatment were shown to be relatively poor.

Velasmooth and Velashape are well known technologies that combine infra-red light and radio-frequency energy with suction and massage. Velasmooth and Velashape achieve moderate improvement in cellulite.

Tri-active treatment consists of a combination of suction, massage and low-level diode lasers. This form of treatment has also been shown to yield significant improvements in the appearance of cellulite. When compared with Velashape no difference in final results were identified.


Radio-frequency technology is different to laser. It involves the use of electric currents as opposed to a light source (as in laser) and has been shown to be very effective in a large variety of conditions. In addition to cellulite reduction, radio-frequency has been used to treat acne scars, hypertrophic and keloid scars, rosacea and inflammatory acne. In the context of cellulite, radio-frequency has been shown to result in tightening of tissue improving skin laxity and reducing wrinkles. It also results in fat reduction.

Extra-corporeal shock wave therapy demonstrated significant reduction in subcutaneous fat layers alongside a reduction in the thickness and circumference of thighs. However, it is associated with significant pain, redness and minor bruising.

Many authors have published the results of treatment of cellulite with topical products in the form of creams. A common ingredient in many of these products was caffeine. Caffeine has been shown to prevent excessive accumulation of fat in cells. In addition caffeine has potent anti-oxidant properties. Retinol has also been used in many topical products.

Dr Zerini and colleagues made the following conclusion from their study: ‘No treatment is completely successful as none is more than mildly and temporarily effective.’

Despite this conclusion, encouraging results have been demonstrated by numerous physicians. Before embarking on any treatment for cellulite, as long as expectations are realistic, excellent results are possible, but maintenance treatment is often necessary and effects can last for longer if a healthy diet and regular exercise regime are followed.

At Rejuvence Clinic we propose the use of PDO threads in combination with platelet rich plasma (PRP) and micro needling for the treatment of cellulite. At Rejuvence, we have a great passion for the use of platelet rich plasma in modern aesthetic medicine. Platelet Rich Plasma (PRP) provides a source of the patient’s own platelets that can provide a concentrated doseof growth factorsthat work together to aid in the growth and regeneration of new cells as well as the development of new blood vessels. As a result, depending on how it is used, platelet rich plasma has positive effects in a number of applications in aesthetic medicine.

PDO threads are often used for facial rejuvenation and specifically in the context of non-surgical facelifts. When inserted under the skin they have been shown, over a period of 3 months, to result in the production of new collagen as well as the activation of fibroblasts and myofibroblasts. Together this results in the tightening of skin as well as an improvement in the overall appearance. Microscopic examination of changes in skin treated with PDO threads have also demonstrated they have a lipolytic effect i.e. they have been shown to reduce underlying fat. Hence if inserted into specific areas with excessive superficial fat, as in the case of cellulite, they can result in reduction of this fat and smoothening of skin.

In combination with PRP and micro needling, PDO threads yield reduction in fat in regions of cellulite as well as an increase in collagen and help to significantly tighten overlying skin. At Rejuvence Clinic we specialise in the treatment of cellulite with a combination of these three treatment modalities. We believe that an initial session of PDO threads specifically targeting areas of cellulite in tandem with PRP and micro needling followed by three further sessions of PRP and microneedling over the subsequent 3 months can have dramatic effects on the appearance of cellulite. There will be a reduction in fat as well significant tightening of overlying skin, improvement in the appearance of the overlying skin as well as smoothening out the contour. For further information please call 0203 131 7024 to book a free consultation.