Cellulite treatment is a crowded market, and much of what's sold works for a few hours, a few weeks, or not at all. The few treatments with stronger evidence share one feature: they address the structure under the skin that causes dimpling, not just the fat.
This guide walks through the American Academy of Dermatology's (AAD's) review of cellulite treatments, explains why fat-removal procedures often disappoint, covers the FDA-cleared device Avéli, and explains what happened to Qwo, the injectable that was once billed as a cellulite breakthrough.
Cellulite isn't the same as fat
The AAD's guide Cellulite treatments: What really works? notes that most women, "even very fit women," have cellulite. The dimpling comes from what the AAD calls "the tough bands beneath the skin that cause us to see cellulite," The AAD also notes that skin often thins where cellulite forms.
That's why this AAD line is worth remembering: "Treatment that can effectively remove fat often has no effect on cellulite."
Two examples from the same page:
•Cryolipolysis (fat freezing, the technology behind CoolSculpting). The AAD says it "can be very effective for getting rid of small pockets of unwanted fat," but "it currently cannot get rid of cellulite." It lists cryolipolysis under "Not recommended for treating cellulite."
•Liposuction. The AAD says liposuction "works well for removing small amounts of fat" but is "not recommended for getting rid of cellulite," and that "it can make the dimpling more obvious."
If you're weighing fat reduction for a different reason, our guides to CoolSculpting costs and CoolSculpting vs. liposuction cover those procedures. Just don't expect either to smooth cellulite.
What the AAD says, treatment by treatment
The AAD sorts cellulite treatments into four groups based on research, from treatments with research-backed results down to those it does not recommend for cellulite. The page doesn't show an update date, and its reference list runs from 2010 to 2016, so it predates Avéli and Qwo. It's still a useful society-level summary, and its durations are worth knowing before you buy anything.
First tier: results backed by research
•Acoustic wave therapy. A handheld device uses sound waves on the area. The AAD says studies show it can reduce the appearance of cellulite and that "several treatment sessions are needed."
•Laser treatment. For Cellulaze, a minimally invasive laser treatment that uses a fiber inserted under the skin, the AAD says patients are "seeing results that last a year or longer" but that "more research is needed." For other laser treatments, results "can last 6 months or longer; however, a bit of dimpling usually returns."
•Subcision (Cellfina). A needle is inserted just under the skin to break up the bands. The AAD cites a study of 232 patients in which "99% of them said they were satisfied with the results," and says results "can last 2 years and possibly longer." That's patient satisfaction from one study, not a measure of how much the cellulite changed.
•Vacuum-assisted precise tissue release. A device with small blades cuts the bands. The AAD says "a small study shows that many patients who received this treatment had less cellulite for up to 3 years."
•Weight loss and exercise. For some people, losing weight reduces visible cellulite, though the AAD warns that loose skin after weight loss can make it more noticeable. Building muscle can make skin look smoother and firmer.
Second tier: some evidence it may work
•Carboxytherapy (carbon dioxide gas placed just under the skin). In the one study the AAD describes, 10 women received 8 treatments and had "a little less cellulite."
•Creams and lotions. Caffeine products may make cellulite less obvious but must be applied every day to keep the effect. A 0.3% retinol product may help some, but it takes 6 months or longer to tell. The AAD advises a patch test first and warns that products containing aminophylline have been linked to anxiety and a racing heart, and that people who use asthma inhalers should avoid them.
•Endermologie (deep massage with a vacuum-like device). Study results vary, any improvement is temporary, and cellulite "tends to return within 1 month of stopping treatment."
•Ionithermie (a spa wrap with algae or clay and a mild electric current). The AAD says there are no independent published studies and that any results last "about 12 to 18 hours."
•Radiofrequency. Some patients see "a little less cellulite," but the result "is short lived and several treatments are needed to see this minor change."
Third tier: too early to tell
•Laser-assisted liposuction. Adding a laser to liposuction may help, but "it's too soon to tell."
•Ultrasound. The AAD says there's no evidence ultrasound alone reduces cellulite.
Fourth tier: not recommended for cellulite
•Cryolipolysis, covered above.
•Mesotherapy (a series of injections of mixed ingredients). Few studies show it works, and side effects are common, including redness, swelling, tender lumps, infection, and allergic reactions.
•Supplements. "There is no evidence that any supplement can reduce cellulite."
The pattern is clear. Treatments that release the bands under the skin have the longest-lasting results on the AAD's list. Treatments that heat, massage, or wrap the surface tend to fade within hours to months.
Avéli: a band-release device, cleared in 2021, 2022, and 2023
Avéli, made by Revelle Aesthetics, works on the same principle as subcision. According to the company's 510(k) summary filed with FDA, it's "a sterile, single-use manual instrument that releases fibrous tissue (septa) beneath cellulite." The provider inserts it through a small entry point under the skin, feels for the bands under each dimple, and releases them.
Avéli's FDA history spans three clearances. None of it is new:
•October 22, 2021. The original clearance, listed as the predicate device in the 2022 summary, covered "temporary reduction in the appearance of cellulite" through three months.
•August 5, 2022 (K221336). FDA cleared an expanded indication. The K221336 clearance letter and summary list Avéli as a Class II prescription device, product code OUP, under 21 CFR 878.4790 ("powered surgical instrument for improvement in the appearance of cellulite"). It is indicated for "long-term reduction in the appearance of cellulite in the buttocks and thigh areas of adult females as supported by clinical data demonstrating treatment benefits through one year of observation."
•August 18, 2023 (K232153). The K232153 clearance kept the cellulite indication and added "soft tissue dissection during general and plastic surgical procedures."
A 510(k) clearance means FDA found the device substantially equivalent to one already on the market for the stated use. It covers buttocks and thighs in adult women. Use anywhere else, or in men, is outside the cleared indication.
What the Avéli study showed
The figures below come from the 2022 summary, which the company prepared for FDA. They describe one study, not a guarantee of results.
•Design. A prospective, non-randomized study of 74 participants at nine sites in the United States and Australia. Each participant had one treatment and served as their own control. There was no separate control group.
•Who was in it. Women aged 26 to 54 with moderate to severe cellulite and a body mass index between 19 and 29.8. Smokers and recent quitters were excluded.
•Effectiveness. Three blinded, independent physicians compared before-and-after photos. The summary reports that the primary goal, an average improvement of more than one point on a cellulite severity scale at three months, was met, and that results held at six and twelve months.
•Side effects. The most common were bruising (86.8% of participants, median duration 27 days), tenderness (51.5%), pain (38.2%), firmness under the skin (36.8%, median 172 days), and numbness (17.6%, median 58 days). About 73.5% returned to normal activities within a week. Some effects (6.0% of reported events) were still present at one year, including firmness, numbness, darkening of the skin, and two cases of skin indentation.
If you're considering Avéli, the study population matters. If your body mass index is above 30, you smoke, or your cellulite is mild, you're outside the group studied.
Qwo: approved by FDA, then discontinued by its maker
Qwo (collagenase clostridium histolyticum-aaes) was an injectable designed to break down the collagen bands behind cellulite. FDA approved it on July 6, 2020, under biologics license application 761146, and Drugs@FDA still lists that approval. Its FDA-approved label covered moderate to severe cellulite in the buttocks of adult women.
On December 6, 2022, its maker, Endo, announced it would stop producing and selling Qwo. Endo cited "market concerns about the extent and variability of bruising following initial treatment as well as the potential for prolonged skin discoloration." Endo said it had launched a study in June 2022 to test ways to reduce bruising, and that while some approaches produced "a modest reduction," none "achieved a consistent level of reduced bruising." Endo also said it had determined that Qwo "does not represent a viable commercial opportunity." Dermatology Times covered the decision the next day.
Two points are often garbled:
•Qwo was discontinued by its maker. FDA did not withdraw it. In the same announcement, Endo said Qwo "remains an FDA-approved product" and that practices could use unexpired stock or return it for a refund.
•Bruising was known from the start. Endo's safety information stated that "in clinical trials, 84% of subjects treated with QWO experienced injection site bruising."
Because production stopped in late 2022, be cautious if anyone offers you Qwo or a "cellulite injection" today. Ask exactly what product it is, where it came from, and its expiration date.
Who should perform cellulite procedures
Avéli is cleared for prescription use, and subcision and tissue-release procedures involve cutting under the skin. These are medical procedures, not spa services. Who may perform them, and under what supervision, is set by state law and varies. Ask who will do the procedure, what license they hold, and who supervises them. Our guide to checking a provider's credentials explains how to look up a license.
Questions to ask at a consultation
•Is this treatment aimed at the bands under the skin, the fat, or the skin surface?
•Where does the AAD place this treatment, and how long do results usually last?
•If it's a device, what is it FDA-cleared for, and does my body area and situation fit that clearance?
•How many sessions will I need, and what happens to my results when I stop?
•What side effects should I expect, and how long did they last in the studies?
•Do I resemble the people in the studies, by age, body mass index, and severity?
•Who performs the procedure, and what is their license?
Be wary of anyone who promises to "eliminate" cellulite, sells fat removal as a cellulite fix, or pushes a large prepaid package of surface treatments. Based on the AAD's summary, a realistic goal is less visible dimpling for a period of time, not smooth skin forever.
This article is educational and does not constitute medical advice. Always consult a licensed medical professional for personalized recommendations.
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