Let’s be real. Cellulite is basically a universal experience for women. Research from the Cleveland Clinic suggests that between 80% and 90% of women who have gone through puberty have it. It doesn’t care if you’re a marathon runner or a couch potato. It’s there. And honestly, the "body positive" movement has done a great job telling us it’s normal, which it is, but that doesn’t stop people from wanting it gone.
If you’ve spent hundreds of dollars on coffee scrubs, dry brushes, or those vibrating foam rollers, you already know the truth. They don't work. Not really. They might plump the skin for an hour by causing minor inflammation, but the structural issue remains. That’s why people eventually start looking into surgery to get rid of cellulite.
But here’s the kicker: "surgery" is a broad term in the world of aesthetics. Some of it is invasive, some of it is "minimally invasive," and some of it is just fancy marketing for a laser. If you're going to let someone poke around under your skin, you need to know exactly what is happening to those fibrous bands.
Why is cellulite so stubborn?
To understand why a surgeon needs to get involved, you have to understand the anatomy. It’s not just fat. If it were just fat, weight loss would cure it. It doesn’t.
Cellulite happens because of the way your skin is tethered to the underlying muscle. Think of your skin like a mattress. You have these tough, fibrous bands called septa that run from the skin down through the fat layer. These bands are like the buttons on a tufted sofa. They pull down. Meanwhile, the fat cells are pushing up. When those bands get tight or lose elasticity, they pull the skin into those deep divots we call dimples.
Most creams try to fix the "stuffing" (the fat) or the "fabric" (the skin). Surgery actually goes after the "buttons" (the septa).
Subcision: The OG surgery to get rid of cellulite
The most direct way to fix a dimple is to cut the thing pulling it down. This is called subcision.
Dr. Doris Hexsel, a renowned dermatologist, pioneered much of the research on this. In a traditional subcision, a doctor uses a specialized needle or a tiny blade called a norkor needle. They numbed the area, stick the needle in horizontally, and move it back and forth to physically "snap" those fibrous bands.
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It sounds aggressive. It kinda is.
You’ll see bruising. Significant bruising. We’re talking "looks like you fell down a flight of stairs" bruising for two weeks. But the results are often permanent for the specific dimples treated. Once that band is cut, the skin bounces back up.
Cellfina: The tech-heavy version of subcision
If the idea of a doctor "manually" sawing at your leg sounds terrifying, Cellfina is the FDA-cleared alternative. It’s still subcision, but it’s automated.
The device uses a vacuum to pull the skin taut and then deploys a tiny, motorized blade to snip the bands at a precise depth. It’s very controlled. The Journal of Drugs in Dermatology published studies showing that patient satisfaction with Cellfina remains high even five years after a single treatment.
It’s great for deep, "cottage cheese" dimples. However, it’s not a fix for skin laxity. If your "cellulite" is actually just saggy skin from aging or weight loss, Cellfina might actually make it look worse by removing the internal support. This is where a lot of people get frustrated—they get the wrong procedure for their specific skin type.
The Laser Approach: Cellulaze
Then there’s Cellulaze. This is often marketed as a "one-and-done" surgery to get rid of cellulite.
Unlike Cellfina, which is a mechanical snip, Cellulaze uses a side-firing laser fiber inserted under the skin through a tiny incision. The laser does three things:
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- It melts some of the fat.
- It thermally severs the fibrous bands.
- It heats the dermis to stimulate collagen production.
That third point is the big selling point. By stimulating collagen, it supposedly thickens the skin. Thicker skin hides the lumps better.
But be warned. It’s expensive. It’s more invasive than a quick subcision. And the recovery involves wearing a compression garment for weeks. Does it work? Yes, for many. But the "thickening" of the skin takes six months to really show up. It’s a long game.
Liposuction: The big misconception
Let’s clear something up right now. Liposuction is not a surgery to get rid of cellulite. This is the biggest mistake patients make. They think, "I have lumps on my thighs, I’ll get lipo."
Actually, traditional liposuction can make cellulite look significantly worse. When you vacuum out the fat but leave the fibrous bands intact, the "mattress" has less stuffing, making the "tufting" even more prominent.
There are newer forms of liposuction, like VASER (ultrasound-assisted) or SmartLipo (laser-assisted), that surgeons use to try and smooth the area, but they are still primarily fat-reduction tools. If your main concern is the dimples, don’t expect lipo to be your silver bullet.
What about "Injectable" Surgery?
In 2021, the FDA approved Qwo (collagenase clostridium histolyticum-aaes). It was the first injectable for cellulite. While not technically "surgery" in the sense of a scalpel, it was a medical procedure that chemically dissolved the bands.
However, as of late 2023, the manufacturer (Endo) stopped producing it. Why? Because the bruising was astronomical. Patients were getting "black-and-blue" marks that lasted for months, and some experienced permanent skin staining.
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It's a cautionary tale in the world of cellulite treatments. Just because it’s "non-surgical" doesn't mean it’s easy or risk-free.
Reality Check: The Costs and Risks
This isn't cheap. You’re looking at anywhere from $3,000 to $8,000 depending on the size of the area and the city you live in. Insurance won’t touch it because it’s "cosmetic."
And there are real risks:
- Hemosiderin staining: This is when the iron from a bruise gets trapped in the skin, leaving a brownish smudge that can last for years.
- Seromas: Pockets of fluid that might need to be drained with a needle.
- Indents: If a surgeon over-treats an area, you can end up with a "divot" that looks like a new kind of cellulite.
You have to weigh that against the potential for smoother skin. Honestly, for most people, the results are "better," not "perfect." You’ll go from a 10 on the "dimple scale" to maybe a 3.
How to choose the right path
If you’re serious about a surgical fix, you need to look at your skin in the mirror under overhead lighting.
If you see deep, distinct "craters," you’re a candidate for subcision or Cellfina. Those are structural band issues.
If your skin looks like "ripples" or "waves," especially when you pinch it, you probably have skin laxity. In that case, surgery to cut bands won't help. You’d be better off with something like Profhilo, Radiesse (diluted), or Sculptra—injectables that build volume and skin thickness—or even radiofrequency treatments like Morpheus8.
Actionable Next Steps
If you are tired of the DIY approach and want to pursue a medical solution, here is how to handle it properly:
- Consult a Board-Certified Plastic Surgeon or Dermatologist: Specifically ask how many Cellfina or Cellulaze procedures they perform monthly. If they only do one or two a year, go elsewhere.
- The "Pinch Test": Before your consultation, pinch your skin. If the dimples disappear when you lift the skin upward, your issue is laxity. If they stay, it’s fibrous bands. Tell your doctor what you found.
- Check for "The Voids": Ask the doctor to show you "after" photos of patients with your specific skin tone. This is crucial for avoiding doctors who ignore the risk of post-inflammatory hyperpigmentation (skin staining).
- Manage the Timeline: Do not get surgery to get rid of cellulite three weeks before a beach vacation. You will be bruised. You will be swollen. Give yourself a three-month buffer.
- Stabilize Your Weight: These surgeries are most effective when your weight is stable. Drastic weight changes after the procedure can shift fat cells and create new dimpling in untreated areas.
Ultimately, medical intervention is the only thing that actually changes the architecture of the skin. It’s a big decision, but for those who are genuinely self-conscious about deep dimples, the mechanical "snap" of subcision is usually the only way to finally see a smooth surface.