The fact that almost daily a new cellulite treatment comes out shows that nobody has yet come up with a permanent solution. Endermologie seems to help on a temporary basis and if you don't mind the expense and repeat treatments. Many patients are reasonably happy with the temporary results.
We have seen large surface irreguarities, permanent pigmentary changes, and permanently increased cellulite from aggressive superficial liposuction techniques, lasers and radiotherapy devices, so I would avoid them.
There are three primary causes for cellulite:
1. Irregularities in the superficial fat just under the skin. In my opinion you can't treat these yet. The problem is the subdermal plexus, the blood supply to the skin. Techniques which have attempted to eradicate this layer have resulted in ischemic changes of the skin, permanent hyperpigmentation, non-fixable "moguls" in the skin resembling terrible cellulite. I have seem patients literally spend tens of thousands of dollars and look worse than before they had treatments.
2. Irreguarities in the deep fat septae that translate to irregularities in the skin. Here there is room for improvement if deep fat can be sculpted away, reducing the cellulite appearance by breaking deep septae. This is the single biggest area that can be improved surgically.
3. Looseness. If there are loose areas of the skin that can be treated with clever, minimal lifts within anatomic creases, for example a posterior buttock lift, subtle, medial thighlift originating in the groin crease, etc. this helps.
What you can do about cellulite:
1. Be as fit and trim as possible.
2. Avoid yo yo weight gain/loss. Have a healthy lifestyle and stick to it. Exercise regularly and stick to it. You may not have quite the body you want, but if you are an American woman above the age of 18 chances are you will have some cellulite. Yo yo weight gains/losses result in stretching and contraction of the skin, loss of elastic fibers, etc.
3. Avoid the sun. Sun causes destruction of the elastic fibers of the skin and worsening or cellulite.
4. Don't smoke. Causes changes in the skin, reduction in elastic fibers, diminshed blood supply to skin.
Sorry I did not present a cure-all, but we try to be honest. There is some empowerment in knowing what can and can't be done, and with living with those things we can't really change.
