AVELI

Pros:

• Avéli addresses the fibrous septa bands that are one of the root causes of cellulite.
• Though there are other treatments for cellulite that work by severing the septa, no other procedure allows for the same kind of precision and verification as Avéli.
• Most women need only a single treatment session to see the results they want.
• Targeting the dimples reduces damage to any other tissue, which limits side effects. 
• The procedure is fast (about an hour) and performed under local anesthesia, so you can drive yourself home afterward. 
• Downtime after an Avéli procedure is typically minimal. Most patients return to work and other light activities within 48 hours. 
• The tiny (3 mm) incisions, or even smaller needle holes, are made in inconspicuous spots and create barely visible scars.  
• Results appear to be long-lasting. In the clinical trial submitted to the FDA by the manufacturer, Revelle Aesthetics, the cellulite of 80% of participants was either much or very much improved after 90 days, and those results were sustained out 1 year.
• While Avéli treats only cellulite, it can be combined with body-contouring or skin-tightening procedures, to improve your results.

Cons: 

• Side effects like pain, swelling, and bruising are common and can linger. 
• Some skin smoothing may become apparent after two weeks, but it can take up to three months for the swelling to resolve so you can see the final results. 
• New dimples and depressions can crop up in adjacent areas after treatment, as the skin changes over time. 
• The treatment can be expensive and isn’t covered by insurance.Avéli treats only defined cellulite dimples. It doesn’t address other concerns often seen with cellulite, such as skin laxity (streaks or rippling in the skin) or pockets of excess fat, which typically contribute to moderate to severe cellulite.

RealSelf Tip: Dr. Ron Shelton, a board-certified dermatologic surgeon in New York City, says that he and other providers “are currently devising protocols to combine Avéli with other nonsurgical treatments, like RF microneedling, acoustic energy with the Resonic device, and high-intensity ultrasound with Sofwave, with the goal of addressing skin laxity in addition to dimples.”

• Average Cost:
• $5,541

• Range:
• $3,750 - $9,501

The price you pay will depend on your provider’s credentials and level of experience, their practice location, and the specifics of your treatment plan.  

Most providers offer monthly payment plans or accept third-party financing options, to help make this and other elective cosmetic procedures more affordable.

The best candidates for Avéli are women with discrete dimples on the butt and thigh who have minimal skin laxity and localized fat. 

Clinical trials for Avéli included only nonsmoking patients, or those who had stopped smoking (or having any form of nicotine) for at least six months prior to treatment. That’s because nicotine can increase bleeding and make it more difficult for your body to heal.

If you have skin laxity and excess fat, Avéli can still be performed as a stand-alone treatment, but it will treat only cellulite. Your treatment plan may include complementary skin tightening, fat reduction, or weight loss treatments, to address other issues that may be contributing to this complex concern. 

Your provider should do a thorough exam at your initial consultation to be sure Avéli is the best cellulite treatment for you.

Here’s what to expect during your treatment session.

• First, your doctor will mark the cellulite dimples that are being treated while you’re standing up. “The patient must be carefully marked in the standing position at rest and with muscles contracted, so that the linear, circular, and irregularly shaped depressions that are shallow and deep can be accurately marked,” says Dr. Casas. “Once the patient lies on their stomach, the complex network of septa are no longer tethered, and they disappear.”
• Once you’re on the treatment table, local anesthesia (lidocaine) is injected into the treated area. “In one study, the average pain level on a scale of 1–10 was about a 1, so the treatment is basically painless,” says Dr. Casas. The anesthesia also contains epinephrine, aka adrenaline, which constricts blood vessels to minimize bleeding and bruising.
• When the area is numb, your doctor will insert the device through a tiny incision or needle hole, usually in the buttock crease or at the upper thigh. The lighted tip helps guide them to find the problematic septa just under the surface of the skin. (Staying in the superficial tissue also helps prevent bleeding.) 
• Your provider will gently tug on the septa with the hook until they can see the dimple being pulled down. 
• At that point, they will deploy the blade and release the band. 
• To confirm that all the tethers creating a depression have been completely severed (the fibrous bands can be very stubborn), they’ll repeat the process until no septa are pulling down the skin’s surface. 

This verification is critical to a successful outcome. “Have I gone back after treating an area and found more septa in the verification step? Yes!” says Dr. Casas, who has released as many as 20 septa that were causing a single dimple.

The average number of septa releases per dimple is eight, per one study. The blade on the single-use device is sharp enough to release 500 septa in one treatment session.

“When performed correctly, the complication rate is very low,” says Dr. Casas. The clinical study found no unanticipated, serious adverse events.

The most common side effects are bruising, tenderness, pain, induration (small areas of skin firmness), localized swelling, and numbness. Everyone heals differently, but the clinical study found these median durations:

• tenderness for 21 days
• bruising for 27 days
• areas of localized numbness was 58 days
• induration (small areas of skin firmness) for 172 days

Most of these side effects didn’t require any medical attention, aside from over-the-counter pain medication or at-home after-care, including compression garments, massage, or icing (more on that below).  

Technique is very important with Avéli, so it’s important to see an experienced provider, ideally a board-certified dermatologist or plastic surgeon. 

When the instrument is wielded incorrectly—for instance, used in a fanning motion that cuts everything under the skin—there can be trauma to surrounding tissue, and complications like seromas (a collection of fluid) or hematomas (a collection of blood) may develop.

There’s little to no recovery time needed post-procedure: most people return to normal activities within 48 hours. 

You may be asked to wait a few days before exercising to allow the skin to heal. Dr. Casas asks women not to do any lower body aerobic exercise for 7–14 days, depending on the number of releases. “I just don’t want the buttock and thigh skin to be moving a lot until there’s a little bit of healing.”

You can also expect soreness in the treatment area. “By day three or four, it’s okay, but sitting the first three days rates a 4 on a pain scale of 1–10,” says Dr. Casas. Over-the-counter pain medications can help reduce discomfort.

During the first 24 to 48 hours after the treatment, you may also notice some clear or pink fluid leak from where the device pierced the skin.

Dr. Casas mitigates swelling and bruising with compression (wearing either a compression garment or something like Spanx for a week or two) and a thin layer of foam padding. She has also found that patients who apply topical Alastin Reform and Repair twice a day during recovery see the bruises resolve more quickly. 

You can expect to start seeing smoother skin within two weeks to one month after your treatment session.

Full results will be apparent after three months, once the swelling has completely resolved.

Avéli and Cellfina are both forms of subcision, a treatment that releases the fibrous connective tissue bands that play a major role in the appearance of cellulite. Cellfina uses suction to elevate the skin over the dimpled area while cutting the septa with a tiny blade. Cellfina, which has been available since 2014, is clinically proven to be effective for cellulite reduction on the thighs and butt for up to three years.

While both treatments work similarly to smooth cellulite, Avéli is a more precise process. “Cellfina is subcision, but it’s blind subcision—you deploy your knife and go back and forth blindly through the area that you marked,” Dr. Casas says. Dr. Shelton agrees, saying this blind technique is “similar to a windshield wiper motion.” There’s no tactile or visual feedback, so you can’t identify the bands or verify their release.

With Avéli, you identify the septa by tugging on it, and you verify its efficacy by passing through the same area after you’ve released all the septa. 

“Failures” aren’t unusual with Cellfina, which has a far lower Worth It Rating from reviewers on RealSelf. “You do what you were supposed to do and then four weeks later, when the swelling is gone, the patient still has the depression. You’re like, what did I do wrong?” says Dr. Casas. “Turns out that these little dimples can have 4-20 little septa oriented in different directions that you have to cut. It’s crazy!”

RealSelf Tip: A new noninvasive acoustic subcision cellulite treatment, Resonic, is currently being evaluated for efficacy at select practices in the U.S. Dr. Shelton has had a couple of patients treated by Resonic who had “outstanding results with zero downtime, but the minimally invasive Avéli produces better reduction of cellulite after one treatment. Most patients treated with Resonic need more than one treatment, and not all see great results.”