Cellulite Treatment

Dr. Johnson discusses what causes cellulite and the treatments that may reduce it.

Cellulite is a mattress like or orange peel appearance that affects the skin in most women and some men. Studies show that over 80% of women have some degree of cellulite.

Cellulite is most prevalent on the thighs and buttocks, but can also be present on the abdomen and arms. For many years, cellulite was considered a normal skin condition. In fact many practitioners today still consider cellulite normal and do not see a reason for treating it. Until around the year 2000, little research was done to understand and treat cellulite. We now have some understanding of the causes of cellulite. Treatments have also been developed that improve the appearance of cellulite in many if not most patients. Some patients respond well to several different treatments. Other patients respond well to some and not others. Unfortunately, no one procedure works for every patient.

Fortunately there is a growing body of research on treatments. This allows us to see what procedures are the most effective for the most patients. It also allows us to combine treatments in a manner that is consistent with what we know about cellulite. Innovations Medical has used this approach to develop its Cellulite Analysis and Treatment System or CATS. This article will discuss cellulite and describe CATS. Feel free to read only the sections that will be helpful to you.

Why do I have cellulite?

This question has been asked many times, and it has many answers. Hormones and genetics play very important roles. If you have family members with cellulite, you are more likely to have problems. Some women see the beginnings of cellulite with puberty. Many others develop cellulite after pregnancy. Weight changes, local injuries, sun exposure, lifestyle and other factors all play a role in the development and severity of cellulite. Recently science has given us some insight into what is occurring in our skin to cause the mattress-like appearance of cellulite. There are two skin changes that are primarily responsible for the appearance of cellulite.

  • Fat cells erupt from the normal fat layer into the lower edge of our skin called the dermis. This tends to push the skin up in local areas.
  • The connective tissue pillars that support the fat become hardened and contract. This tends to dimple the skin in local areas.

These two factors are the primary causes of the dimpling and bulging we associate with cellulite. Decreased lymphatic drainage, blood flow changes, and weight gain can all also have some effect on the appearance of cellulite. We cannot change your genetic tendencies and hormone treatment has no real effect on cellulite. However, when we can impact the fat eruption and contracted pillars, we can improve the appearance of cellulite. Most treatments that impact the fat eruptions and contracted pillars also improve lymphatic drainage and blood flow.

What is the importance of loose skin with cellulite?

Cellulite is typically defined as the orange peel or mattress-like appearance of the skin in areas such as the upper thigh. It is characterized by dimples and bulging. The dimples tend to be round or oval.

Not all patients who have cellulite follow this pattern. Some people have lines or waves of irregular skin without any true dimples. This is more common on the front and back of the thighs than on the buttocks or elsewhere. This line pattern we refer to as linear cellulite. Linear cellulite often has a significant loose skin component. Therefore, we often want to use skin tightening technology with linear cellulite.

Skin Tightening is often the only treatment or procedure necessary in women with predominantly linear cellulite. These treatments are directed at tightening the skin and do not address the fat bulging and contracted pillars of classic cellulite.

Of course, many women do not fall perfectly into either category. These women have areas of classic dimpling and other areas of wavy irregularity. These women respond to cellulite and skin tightening treatments. Many women with combined cellulite will be pleased with either treatment. Others may require both types of treatment.

Combined cellulite â“ shows dimples and wavy irregularities. Results may vary.

How do you evaluate my cellulite?

For many years cellulite has been evaluated using a scoring system. The scoring system rates cellulite in this manner:

  • GRADE 1: There is no cellulite when standing, however, when you pinch the skin on the thighs, you will see the appearance of orange peel or mattress appearance of the skin. This is also a desirable grade.
  • GRADE 2: There is visible cellulite while standing, but it is not visible when lying.
  • GRADE 3: There is visible cellulite while standing and laying down.

This system is fairly easy to apply and obtain consistent results. We use this scale to help guide treatment and evaluate results. In addition, we evaluate the degree of classic cellulite versus linear cellulite. We also look at the location of the cellulite because different areas respond to treatment in different ways. Looking at the pattern and location of your cellulite helps us determine which first step procedure will most likely give you the best results. Persons with classic cellulite on the back of the thighs and buttocks normally begin with SmoothShapes.

Persons with more linear cellulite or on the front of the thigh and knees often do better starting with Thermage Cellulite Treatment. Persons with mixed cellulite or cellulite on other areas most often require a very personal plan to maximize their response to treatment. Our professional consulting staff has evaluated thousands of cellulite patients and can assist you in planning the best treatment regimen for you.

How do I choose a cellulite treatment?

The evaluation is critical in determining the best place to start. Once we know the scale, pattern, and location of your cellulite, we can recommend a first step treatment. Typically, the first step is one of two treatments, SmoothShapes or Thermage Cellulite Treatment. We will give a brief description of both.


SmoothShapes is our first tool of choice for classic cellulite (round or oval dimples) and most cellulite on the back of the thigh or buttocks. SmoothShapes combines three different technologies, a vacuum/massage, a special light at 650 nm wavelength and a laser of 915 nm wavelength. The laser warms the fat, making it want to leave the fat cell. The 650 nm light makes the cells leaky so that more fat leaves the cells and goes into the space between cells (interstitial space). Fat in the interstitial space is collected by the lymphatic and venous systems and taken to the liver for processing. The vacuum/massage helps promote the lymphatic and venous removal of fat. Working together, this system can reduce the fat that has erupted into the dermis, one of the two major changes that cause cellulite. The 915 nm laser has been shown to promote collagen formation. The heat and massage also help release contracted pillars and promote new collagen, the other major skin changes in cellulite. SmoothShapes feels like a warm massage. There is minimal to no discomfort and known significant side effects or downtime. Studies have shown SmoothShapes to result in improvement in the appearance of cellulite in 85-94% of patients. The improvement has been shown to be around 75% and to last for at least 6 months. Most patients do two 15 minute procedures a week for 4 weeks. It appears that 2-4 weeks of procedures should be repeated about every 6 months to retain results. SmoothShapes is Innovations Medical newest addition for cellulite. It was chosen on the strength of scientific studies.

SmoothShapes before and after treatment number seven. Results may vary.

Learn More About SmoothShapes


Thermage Cellulite Treatment is our first tool of choice for linear cellulite (lines or wavy irregularities) or cellulite on the front of the thigh. Thermage uses radio-frequency energy to deep heat the skin. This causes an immediate tightening and smoothing in over half of patients. The body also responds to Thermage by making new collagen that further tightens and smooths the skin. Studies show that around 96% of patients see improvement with Thermage. Thermage is widely regarded as the gold standard for non-surgical skin tightening. This is especially true on the body, including the thighs, arms, and abdomen. Innovations Medical is one of the most experienced Thermage practices in the country. We have done over 1,000 body Thermage procedures. With that experience, we believe that linear cellulite responds better to Thermage as the initial treatment. Thermage also works very well on the front of the thighs. Frequently, it is the best choice for cellulite on the front of the thighs. Thermage is the best choice for crepe paper skin, often seen on the front of the thighs. We normally do not think of Thermage requiring maintenance treatments.

Thermage before and after 6 months on linear cellulite. Results may vary.

However, it may be beneficial to consider repeat treatment in 1-3 years to avoid a complete return of the cellulite.

Patients with a mixed pattern of cellulite are usually started with SmoothShapes. Later, if further improvement is desired, they may also do Thermage. Using these two technologies after proper analysis provides an improvement in the appearance of cellulite in the majority of patients. For those who desire even more improvement, or do not respond well, the Cellulite Analysis and Treatment System (CATS) can provide more answers.

Learn More About Thermage

What other procedures should I consider?

Some patients may desire further improvement after seeing a response to their initial treatment with SmoothShapes or Thermage therapy. This is the area where many cellulite procedures have failed because no treatment works on every patient and many patients desire further improvement even after having a good response to their first treatment. Our Cellulite Analysis and Treatment System (CATS) allows us to address this issue. Once again, we begin by looking at the patient’s pattern of cellulite, but now we also factor in the treatments you have done in the past. The experience of our consulting staff is essential at this point. A detailed description of the decision-making at this point is beyond this article. However, we can discuss general guidelines.

The next step in patients with classic cellulite is usually a technology known as Acoustic Wave Therapy (AWT). AWT is used widely in Europe for this purpose. Innovations Medical was the first to introduce AWT for cellulite in the United States. Here is how AWT works:

Acoustic Wave Therapy

Acoustic Wave Therapy (AWT) is also known as Extracorporeal Shock Wave Therapy (ESWT). The technology is best known for breaking up kidney stones. In that application, ESWT uses highly focused shock waves to break apart the kidney stones so that they can easily pass. AWT uses lower energy, unfocused shock waves to impact the contracted pillars that cause dimpling. This causes the dimples to release and helps to smooth the skin. The body also responds by making new collagen that helps strengthen the barrier at the lower dermis and decreases fat eruption. This combination is effective in improving the appearance of cellulite. At least three studies have shown that AWT is effective and has no significant side effects.

The next step in patients with linear cellulite or cellulite on the front of their thighs is usually to do a course of SmoothShapes. Afterward, they may benefit from a course of AWT if further improvement in cellulite appearance is desired.

The next step with mixed cellulite varies somewhat based on the pattern and location of their cellulite. Some patients will do Thermage as the second step. Others may do AWT as their next step. This is something best decided between you and your consultant. In most cases, we will want to use all of these technologies (SmoothShapes, Thermage, and Acoustic Wave Therapy) before proceeding to the next treatment options on the Cellulite Analysis and Treatment System.

Learn More About AWT

What if all else fails?

In a small number of patients, unacceptable cellulite appearance may still be present after all of the non-invasive treatments have failed. In addition, some patients have very deep dimples, depressions, or scars that have to be addressed with minimally invasive procedures. For these special situations, we use two different technologies, SmartLipo with Cellulase and fat shifting/transfer. We will describe them briefly:

SmartLipo with Cellulase

SmartLipo uses a special laser that is inserted under the skin through a small incision. When treating cellulite, a special cannula is used that allows the laser to fire at a 90-degree angle to the skin. This procedure is referred to as Cellulase. The area treated is first anesthetized using a special technique of local anesthesia called Tumescent Liposuction. The laser is then inserted just underneath the skin. When fired, the laser heats the skin and causes skin tightening and smoothing. When firing at an angle to the skin, the laser cut the collagen pillars that are pulling down the skin. This releases the dimples. The laser can also destroy the fat cells that have erupted through the skin helping reduce the cellulite. Using SmartLipo with Cellulase can result in improvement in some of the toughest cellulite cases.

Learn More About SmartLipo

Fat Shifting/Transfer

For very deep dimples including those caused by injuries, fat shifting or Fat Transfer is often the best option. In fat shifting, we move fat from a high area into a nearby depression. Since the fat does not leave the body and is never separated from its support structure, this is a highly effective technique for filling defects and smoothing localized areas. Not all defects have enough surrounding fat or high areas to allow fat shifting. In these areas, fat can be taken from another part of the body and transferred into a dimple or depression. In this case, the fat has been separated from its support structure, so sometimes not all of the fat survives. Fat transfer occasionally takes two and rarely even three procedures to fill some defects. These two related techniques can often help treat severe dimples or depressions when all other treatments have failed.

In some rare cases, liposuction may also be recommended. In most cases, we reserve the invasive techniques such as SmartLipo Laser Liposuction or Fat Transfer until after the noninvasive treatments have failed. An important exception to this rule is when a patient wishes to change the shape of an area as well as get rid of cellulite. In that case, liposuction with SmartLipo may be the first choice. All of these options show the importance of doing proper analysis before choosing a treatment for cellulite.


CATS (Cellulite Analysis and Treatment System) has been developed to help the majority of women improve the appearance of their cellulite. Cellulite is the mattress like or orange peel appearance of the skin of many women and some men. It is most common on the back of the thighs and buttocks but can be present on the front of the thighs, abdomen, and arms. Cellulite has many causes including genetics, hormonal, and weight changes. The most important microscopic skin changes resulting in cellulite are an eruption of fat into the lower dermis and contraction of the microscopic pillars that support the fat. Several treatments have good scientific studies supporting their use. The ones included in the CATS system are:

CATS begins with a careful cellulite analysis performed by a professional counselor. Dr. Johnson is also available when needed.

No one cellulite treatment works for every patient and many patients require more than one treatment. CATS is designed to give you personalized help towards the greatest improvement in cellulite with the least expenditure of time and money.

Contact Innovations Medical for a Consultation

You can upgrade your appearance quickly, with help from Innovations Medical. Our skilled professionals will help you decide which confidence-boosting services are right for you, and walk you through the next steps in the process. We’ve been helping our patients look and feel their best since 2005, and even our most advanced procedures are often minimally invasive.

To find out which enhancing procedures are right for you, and to learn how Innovations Medical can improve your life, call us at (214) 643-8665 or schedule an appointment.