Cellulite   Introduction   What affects 95% of all women (over puberty) and 10% of all men? Cellulite.   Nonsurgical treatment options today I review here.   Disclaimer   Nonsurgical yes. But at the same time, not you - should be guiding his care. Do not try to simulate any of this care with any Brookstone gadgets from your local mall.   Yes, you should consider it. In a team wise approach with a physician you can trust.   Having said that, the physician you team up with should be able to accept a strong working partnership with you that allows both you and him to guide your care.   Discussion   And here’s your pneumonic, right up front. “The three F’s“ - Fat, Fiber, Fitness. Or fit’nass, like my more vulgar Beverly Hills counterparts like to say. Because it’s all about the derrière “in the end”? (sorry I couldn’t resist). But I’ll save that for... The end. Okay, okay... Enough. I’m a get myself in trouble.      1. Fat. For the fat component… There’s always liposuction. That has complications. Not just the classic fat embolus concern, but other surgical complications. Edema? Yeah. And it hurts more. And it’s more expensive. And the results aren’t always that great, not that even, there can be dimpling, there’s wound care, and there is a variability in the surgical teams you have across the land.   So, what has taken off for the past 10 years in the world of body sculpting are various nonsurgical modalities that produce lipolysis, death of the fat cells. These range from injecting chemicals into fatty areas that destroy fat (needles); to completely noninvasive nonsurgical options like laser, heat, and cold therapy.   And the brand new kid on the block, electromagnetic, high impulse, therapy that not only kills fat cells, but also increases muscle cells in size AND NUMBER. Very exciting. Olympic athletes train 30% of their muscle most the time. This fat killing, first ever muscle augmenting nonsurgical body sculpting modality works out muscle 100%! Crazy. But it’s new. And that in my mind is about the only thing working against it. Let’s see what the next year or two shows...   So. Non-surgical, fat killing modalities. Too good to be true? No. And clearly cheaper. Arguably safer, no doubt. And nicely effective. And you don’t have to miss any work. No downtime at all really. You don’t even have to stop working out, which will help one of the “F’s” below.     2. Fiber. There are these nasty, tenacious fibers that occur around dimpling areas of fat from some prior trauma and what not that must be broken up. Unfortunately, often require surgery, or at least needling techniques that take some time and training to master. Probably little if any ways of getting around that.   Fibrous bands from some long ago forgotten injury that must be dealt with... Versus skin laxity... Which should be dealt with differently. Versus some important blood vessel you don’t want to damage! The world of the plastic surgeon! Gentle retraction on the skin by the hand of a trained surgeon produces difference effects, allowing them to distinguish between these important different things. Hence on to the right kind of surgery...   But wait! There IS a non-surgical modality doctors can use to break up fibrous bands in dimpling cellulite. Shockwave therapy (SWT) provided by acoustic ultrasound machines can indeed break up some banding underneath the tissue of the skin if done aggressively enough. So, no needles. No surgery. And you can get rid of those fibrous bands over time — with a little persistence. And ultrasound SWT.   And another nice advantage to shockwave, ultrasound, acoustic therapy like this is that it increases new blood vessels in that area! Bonus! So, whatever fat has been destroyed by the non-invasive fat killing modalities mentioned above can have a faster, smoother exit from the subcutaneous tissue because of new increased vasculature. Rather than just wait for the body to rid the fat that has been killed by one of the nonsurgical modalities above by it’s regular pokey, slow rate (something the body doesn’t ever seem to want to do; am I right ladies?), ultrasound therapy increases vascularity in whatever tissue it is aimed at so the fat loss is faster. Faster fat elimination. That always sounds good.     3. Fitness. The doctor does his part with the other two “F’s”. Here’s where the patient has to do her part. Here, I have to sell the cellulite patient on eating better than they ever have done before, exercising, non-impact of course (biking, not motorbiking —swimming, yeah you have to get wet, or kayaking, just kidding, but an option). Okay, okay, I’ll be nice. Anyway... I’m not sure why, if it’s the increased teamwork the genuinely interested physician fosters with his or her fat conscious patient, or maybe it’s increased investment the patient has finally made into their temple… But, bit by bit, the body sculpting patient tends to start doing the right thing! Really going to that gym they joined months ago, genuinely eating less because they are actually following calorie counts finally...   (That’s right. The only way to genuinely eat less is to do calorie counts. I’ve spent time with people who swear they don’t eat much at all. They have no clue. To eat less, or less enough to make a difference anyway, you must do your calorie counts! Then... Stick to what you discover for 1 to 3 months, make a change downwards 10% if you are not losing weight. Etc. Easy.)   Conclusion   So, now it’s time to do your Internet search for the modality of your choice! Aesthetics are important! And if you don’t think so, think about self-esteem. And don’t forget about eating less and exercising more.   Stay well, David Allingham, MD