Tuesday, 24 October 2017 06:19

Treating Cellulite: What Really Works?

Written by   Lyn Ross, L.M.E.

Consumers want effective, non-invasive treatments that help contour and slim the body along with healthy lifestyle practices. Modern aesthetic technology and treatments are viable alternatives to surgical procedures, which often necessitate significant downtime. With the right marketing direction and client education, skin care professionals can make body contouring one of the most in-demand services on the treatment menu.


Women of all ages seek non-invasive methods to shape their bodies. Cellulite is a common concern for the majority of post-pubescent women, with 85 percent having some form of it. Many women assume that their cellulite is reflective of their fitness level, although it is not necessarily the case. While regular exercise can help reduce the appearance of cellulite, estrogen is the main culprit of its formation. Estrogen causes subcutaneous fat cells to swell, cutting off circulation and producing an inflammatory response within the skin that causes cellulite to assume its classic orange-peel appearance. Along with genetic disposition, estrogen also contributes to the development of stubborn pockets of fat that are resistant to diet and exercise, even if women are at their ideal weight. Paradoxically, weight loss can actually make cellulite appear worse in a client whose skin is thinner and is less elastic due to aging or hormones. Pregnancy and menopause can also trigger hormonal changes in the body, which aggravate the appearance of cellulite. When clients go to the spa for a body contouring treatment, the best methods to address their concerns are to use technology and products that build skin-strengthening collagen to improve tone and texture, since firmer skin will appear smoother.




Endermologie is a popular body contouring machine that has revolutionized the field of cellulite reduction and anti-aging. Designed by LPG, endermologie is a completely non-invasive way to firm the areas of concern and improve cellulite through the process of mechanical lipomassage. The FDA-approved machine uses patented motorized rollers, which gently yet intensively utilize targeted motion and suction to eliminate fat deposits and tighten sagging skin.

A Vanderbilt University Medical Center study published in the Aesthetic Surgery Journal (the first study of its kind to find evidence supporting endermologie as a cellulite reduction device) found that endermologie treatments appeared to create collagen bands that ran parallel to the surface of the skin, which, in turn, created a smoothing effect on the surface of the skin. Changes were more significant the more treatments a client had, leading to the current recommendation that best results are achieved with a series of treatments.

Clients wear a nylon body stocking for treatments to avoid friction on the skin as it is vacuumed and kneaded. It is an enjoyable treatment and has the same feeling as a deep tissue massage. Blood and lymphatic circulation improves, helping to flush away accumulated toxins and excess water; the treatment reactivates the breakdown of fat (lipolysis), which aids in sculpting problem areas. Endermologie also benefits clients who have issues with fibrosis, inflammation, edema, lymphedema, and circulatory problems.

Endermologie treatments range from 20-to-40 minutes and areas that can be treated are the hips, thighs, legs, buttocks, stomach, and upper arms. There are few contraindications of endermologie, including pregnancy, circulatory or vascular disease, cancer, blood clots, varicose veins, wounds, infectious diseases, AIDS, and clients taking anti-coagulant medication.


Radiofrequency is the latest non-invasive skin technology that is gaining popularity for tightening skin on the face and body. Radiofrequency uniquely uses light energy that bypasses the epidermis to heat the dermal layer and stimulate collagen production, triggering lipolysis. Radiofrequency current is defined as a high-frequency electric current in the 0.3 to 100 megahertz range. These radio frequency waves affect the primary layers of the skin, causing them to react to the energy that the waves create. This is a kinetic influence and because the heat is introduced in low frequency waves, there is no damage to the outer layer of the skin. It is these vibrations of a certain wavelength that cause the skin to react by tightening.

As a cellulite intervention, radiofrequency works by applying the thermal energy to the treatment area to denaturalize the proteins in the connective tissue. This effect creates a tightening in the connective tissue as these proteins regain their structure, helping to prevent the underlying fat cells from protruding outward and causing a dimpled effect. This treatment is perfect for clients who want optimal results with absolutely no downtime, since the epidermis is undisturbed. Most clients will likely see an immediate tissue tightening effect and an improvement of skin laxity, but full clinical results may not be seen for the first few months. Optimal results are typically seen after six-to-10 treatments, with a maintenance treatment every six months thereafter.

A treatment gel is applied to act as a barrier between the client’s skin and the device handpiece that is delivering the energy. Once the treatment is completed, a soothing lotion is applied to the skin. Clients may experience mild redness immediately following the treatment, which dissipates quickly. Radiofrequency is virtually pain-free and gives instant results; normal activities may be resumed immediately after treatment.

Contraindications of radiofrequency are minimal when performed correctly. People with pacemakers or metal implants cannot be treated because radiofrequency current flowing through the body may interfere with these devices or heat up metal implants, which could be dangerous.

Infrared LED

Combining LED treatments with radiofrequency treatments is a relatively new combination treatment for skin tightening and appears to be producing superior results. LED light therapy delivers energy through light emitting diodes. LED light has the ability to stimulate ATP (adenosine triphosphate) within the body. ATP is the chemical messenger that signals the skin’s fibroblast to produce collagen. The red and infrared LED light promotes collagen production and improves skin firmness. Optimal LED wavelengths for tissue regeneration are 880 nanometers. Visible red light activates skin cells and promotes blood circulation. Near-infrared light (720 nanometers and above) is absorbed by the skin and is used as energy to stimulate fibroblast cell activity, increase collagen, and stabilize elastin proteins. Cumulative benefits are achieved over time with regular treatments. Visible results should occur within four-to-eight weeks.

LED applications are non-invasive, painless, and have absolutely no downtime for clients. Handheld LED devices can be recommended to the client for at-home use. These devices are non-invasive, low-level, non-thermal light energy that activates skin cells. It is also safe for all skin types, skin colors, and ages. Contraindications are pregnancy, epilepsy, thyroid conditions, open wounds or lesions, and clients susceptible to migraines.


The principle of skin needling is to stimulate the body’s own production of collagen. Dermal microneedling involves the use of a sterile roller comprised of a series of fine, sharp needles that create many microscopic channels, stimulating the body to produce new collagen. At a microscopic level, proliferated skin cells, such as fibroblasts, migrate to the point of injury and transform into collagen fibers, resulting in increased fiber strength and elasticity.

This treatment improves the skin by inducing the increased production of collagen, facilitating natural repair and growth, and making the skin stronger and thicker. This process takes approximately two-to-three months to produce smoother, firmer, and younger-looking skin.

As the therapeutic use of microneedling has grown, various modifications have occurred since the roller was originally introduced. Needling procedures for body skin tightening are performed in a precise manner in order to achieve a uniform depth of penetration of topical products and the needle cylinder is rolled on the skin in multiple directions (hence the name ‘dermal roller’). The procedure is normally completed within 30-to-60 minutes, depending on the required treatment and anatomical site. Topical ingredients applied during this treatment more deeply penetrate into the skin cells and can vastly improve the appearance of skin laxity and cellulite. After the procedure, the skin will be red and flushed in appearance in a similar way to a moderate sunburn. Clients may also experience skin tightness and mild sensitivity to the touch on the area being treated. The skin’s redness will diminish greatly after a few hours following the treatment and, within the next 24 hours, the skin will be generally calm. After three days, the skin will return to a normal or near normal appearance.

Age and skin condition will determine the number of treatments required to achieve the maximum effect. Although results are evident from both the skin texture and its appearance after the very first session, between three-to-eight treatments with a three- or four-week interval between visits is recommended for optimal results. It is also recommended that the client use a roller at home up to three times a week between treatments. Homecare rollers, with needles less than 0.1 millimeters in length, increase the transdermal delivery of topical ingredients, helping clients maintain results between professional treatments.

Microneedle roller body treatments are an affordable treatment option for most clients with minimal discomfort and downtime and can be safely performed on all skin types and ethnicities. There is little-to-no risk of post-inflammatory hyperpigmentation as the melanocytes remain, like the dermis, intact during skin needling. This is the major distinguishing safety feature.

Contraindications for microneedle rolling are keloid scars; eczema, psoriasis, and other chronic skin conditions; actinic (solar) keratosis; herpes simplex infections; diabetes; raised moles or warts on targeted area; scleroderma; collagen vascular diseases or cardiac abnormalities; blood-clotting problems; active bacterial or fungal infection; and pregnancy.


Microcurrent has been around since the 1980s in the United States and has been used to treat a wide variety of medical conditions. The ‘tens’ system for pain management utilizes microcurrent. Microcurrent mimics the electrical current in the body and has the ability to speed up the metabolism of the tissue and cellular activity. This is also useful for re-educating muscles to lift (toning) and stimulating collagen and elastin production and ATP, which plays a critical role in the body for signaling and energy metabolism. In the cosmetic arena, microcurrent is used to deliver a unique electrical waveform that, in combination with the naturally occurring biological current of the body, works on the nerve and muscle cells.

This technology works internally on the muscle fiber and tissue for visible, external results, such as increased tone and muscle tightening.

Using specific microcurrent frequencies has targeted beneficial actions for lifting and toning the body. Microcurrent is measured in hertz, which is the frequency or speed of the current.

Three-hundred hertz stimulates lymphatic drainage, 20 hertz stimulates circulation, 10 hertz lifts superficial muscles, and 0.8 hertz gives a lift to deep muscles. The frequency variation in the current can be concentrated on specific tissues and adapted to the individual needs of each client. The microcurrent frequency utilized produces different effects on the muscle and the tissue of the skin. Microcurrent is corrective, as well as a preventative treatment, producing a proliferation of cells by the fibroblasts secretion of proteins. Applying a specific current to specific muscular areas encourages the re-education of sagging muscles and assists in the correction of atrophy. In addition, because the muscle and tissue is then in a better state of repair to receive the body’s own natural bioelectrical impulses, the aging process is delayed.

Best results are achieved with a series of treatments performed twice a week consecutively for the first 10 weeks, with maintenance treatments every four-to-six weeks thereafter. Clients can continue the effectiveness of the professional treatment by using a complementary skin care routine at home that contains clinically-proven ingredients for skin tightening and toning, such as glycolic acid and shea butter.

Contraindications are physical or mental limitations, implants, pacemakers, hearing aids, a history of seizures, epilepsy, pregnancy, or active cancer.


Galvanic current is a constant electrical current with low voltage, which can be used on the body to penetrate beneficial topical solution into the skin. It is especially useful for cellulite treatments on the body, helping to penetrate gels into the skin and to stimulate lymphatic drainage. The client forms a circuit by holding a covered electrode in the hand, which is linked to the machine. Rollers are also linked to the machine and placed on the body to form a circuit for the current to flow through. Penetration of products into the skin is performed by iontophoresis (same poles repel each other, opposite poles attract). The ions are forced into action by the electrical current. When the polarity of the machines rollers is the same as the polarity of the product, they will not attract one another. In this way, the ions in the cream will be attracted to the electrode in the hand, therefore going through the skin to get there.

There are many creams and gels with electrolytes (or ions) available to work with, so always check which polarity to use. As long as the rollers and the topical product are the same polarity, they will not be attracted to each other, but to the opposite electrode in the hand.

Achieving maximum penetration for active ingredients that promote collagen and elastin will promote the natural regenerative process of the skin and give added tone and elasticity to the tissue and the skin.

Contraindications include broken skin, cuts, abrasions or acne pustules, pregnancy, epilepsy, implants, heart conditions, pace makers, migraine sufferers, high or low blood pressure, and nervous clients.


Always consult with clients on their expectations and what can realistically be achieved based on their skin condition, body type, and lifestyle. For example, subcutaneous fat lays on top of muscle, so if the muscles are weak or slack, this can contribute to an uneven appearance of the skin's surface. In such cases, an exercise plan combined with aesthetic body rejuvenation treatments may be necessary to help clients achieve their contouring goals or a recommendation for a combination of treatments, such as radio frequency and microcurrent, to address both the superficial and the underlying issues.

Topical homecare product recommendations with active ingredients that can have a stimulatory effect on lipolysis may also be a necessary component for achieving results in the appearance of cellulite. Wild yam extract is a phytonutrient that blocks the formation of new adipocytes caused by estrogen in the subcutaneous fat layer of the skin. Niacin is a powerful vasodilator that increases circulation and detoxification where applied and Regu-Slim® is a patented formulation of guarana seed extract, caffeine, carnitine, and maltodextrin that has been clinically proven to drastically reduce adipose tissue.

Outlining a homecare regimen to clients with topical products containing active ingredients for skin tightening, along with a microneedling roller or a handheld LED device for use at home, will help them achieve better penetration of these products and aid in long-term skin toning and tightening results. Clients need to understand that connective tissue naturally begins to get looser due to the aging process of the collagen and elastic fibers. Advising clients on a product regimen containing collagen-building ingredients, such as glycolic and lactic acids, retinol, and vitamin C, is a good idea. Retinol is probably one of the most important nutrients to topically apply to because it works as a powerful antioxidant for the skin, as well as really revs up the rate of cell renewal for aging skin. This stimulation also affects the fibroblasts and helps to prevent the disorganization of collagen and elastin support networks with long-term use.  

Stock retail items in the spa, such as natural dry body brushes, loofahs, handheld massagers, LEDs, and cosmetic microneedle rollers. These items are low-cost inventory and a logical sell through to body-contouring clients who want to maintain results.

Lyn Ross is a licensed master aesthetics instructor, accredited through the Georgia Board of Cosmetology with over 30 years of experience in the field of professional aesthetics. A true medical spa pioneer, Ross has written numerous articles, co-authored textbooks, and appeared on radio and television shows, highlighting professional aesthetics. She is dedicated to sharing her passion, knowledge, and years of clinical aesthetic experience. Ross provides skin care professionals with clinical and medical treatment protocols, products, and the education that guarantees client results and spa business success.

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