It's estimated that 80 to 90% of the female population who has gone through puberty has this “condition” caused by fat cells pushing up against the skin while bands of connective tissue, called septa, are pulling down. As a journalist who quite often writes about developments in the aesthetics industry, I have come to the conclusion that we shame women too much in general, but especially in this area. We get flack both for having cellulite and for wanting to do something about it. If there’s no winning, I might as well be honest with myself: I’d love to be cellulite-free. Yes, I want to fight the patriarchy; I also want smoother legs.
In pursuit of smoother legs, I’ve tailored my workouts and tried various creams and even lymphatic massage - especially on the side of my right thigh, which had taken on a similar look to the surface of the moon - only to give up in frustration at the underwhelming results. And that makes sense as cellulite treatments in general have historically been underwhelming.
Expert Insights on Cellulite Treatments
To understand the landscape of cellulite treatments, it's important to hear from experts in the field:
- David Shafer, MD: Double board-certified plastic surgeon in New York City.
- Grant Stevens, MD, FACS: Board-certified plastic surgeon in Marina Del Rey, California.
- Steven Williams, MD: Board-certified plastic surgeon in Dublin, California.
- Laurie A Casas, MD, FACS: Board-certified plastic surgeon in Chicago.
- Melissa Doft, MD: Board-certified plastic surgeon in New York City.
Introducing Avéli: A Minimally Invasive Approach
After years of seeking effective solutions, I can now say I have less visible cellulite than I’ve had in years, after a one-hour treatment called Avéli. This recently FDA-cleared, minimally invasive device gets at the root of dimpling under the skin by severing the septa around the divots.
Quick refresher on what “FDA-cleared” means: A device has undergone a 510(k) submission that’s been accepted with the conclusion that it won’t cause harm and is as safe and effective as another legally marketed device. Only FDA-approved products and treatments have been rigorously tested for safety and effectiveness.
My decision to try Avéli might have been influenced by the various beauty treatments I had earlier in the year for my May wedding, or perhaps my upcoming honeymoon/one-year anniversary trip to the Greek islands had swimsuits on my mind. Or maybe my journalist's heart just wanted to see Avéli in action. Likely because of all three, I decided to give it a try. Never one to gatekeep, I’m here to tell you all about it two months post-treatment.
What is Avéli?
Avéli is a cellulite treatment performed at a dermatologist’s or plastic surgeon’s office. It utilizes a long, thin instrument equipped with a light and a retractable blade. The blade extends into a hook shape and then retracts inward, cutting the septa as it pulls back. The procedure is performed under local anesthesia, takes approximately one hour, and requires only a single treatment session.
Avéli joins a category of technologies that target septa to reduce the number of bands under the skin. Other methods in this category include:
- Microneedles: Such as Cellfina.
- Energy from lasers: Such as Cellulaze.
- High-frequency sound waves: Such as Resonic.
- Radiofrequency: Such as VelaShape.
It also succeeds the now-defunct Qwo, which used injected bacterial enzymes to dissolve the bands under the skin. Qwo was taken off the market after less than two years due to severe bruising and the potential for long-lingering skin discoloration from hemosiderin staining (iron-containing pigment left over from ruptured red blood cells).
Unlike other cellulite treatments that may attempt to disrupt septa without breaking the skin, Avéli's strength lies in its precision. As David Shafer, MD, explains, "[It] allows a minimal-access incision and lighted precision to minimize tissue trauma and confirm the band has been cut." This precision theoretically leads to better results with less bruising compared to previous options. (Dr. Shafer also offers NuEra, a radiofrequency device, in his practice for cellulite treatment.)
How Long Do Avéli Results Last?
Since Avéli is relatively new, having received FDA clearance in October 2021, the long-term duration of its results is still being studied. Initial studies published in the Aesthetic Surgery Journal assessed effects at 90 days and then at 12 months, showing a clinically significant reduction in cellulite lasting for a year. However, data beyond 12 months is limited.
Grant Stevens, MD, FACS, who was involved in the development of the device and has been using it on patients since late 2019, reports, "I have yet to run into a single recurrence." (He has a financial interest in the maker, Revelle Aesthetics.)
Expert Opinions on Avéli's Efficacy
Cellulite treatment remains a challenging area in plastic surgery, with many past offerings falling short of patient and physician expectations. Steven Williams, MD, president of the American Society of Plastic Surgeons (ASPS), notes, "Cellulite treatment remains one of the most challenging areas of plastic surgery in terms of successful treatments."
However, some practitioners consider Avéli to be a significant advancement. Laurie A Casas, MD, FACS, who has been performing the procedure since February 2021, now regards it as the "gold standard" for cellulite dimpling treatment, having previously offered Cellfina and Qwo. She highlights Qwo's imprecision and unpredictable skin response, often leading to prolonged bruising. In contrast, Dr. Casas finds Avéli "very satisfying because I can precisely treat the cause of the cellulite dimple - the multiple septa pulling the skin down - and verify it’s been completely treated." Dr. Stevens echoes this enthusiasm, calling the results "spectacular."
Other doctors, like Dr. Williams, prefer a "wait-and-see" approach, especially concerning the long-term effects of scar tissue formation from cut septa. Melissa Doft, MD, who currently offers microneedling with radiofrequency for cellulite, shares similar reservations, pointing out the limited sample size (74 patients across nine areas) in the three-month study and expressing interest in understanding long-term benefits and the need for secondary treatments.
Who is a Good Candidate for Avéli?
Avéli is best suited for individuals with dimpled cellulite, rather than rolling or wavy fat, which is caused by fat pockets rather than septa bands interacting with fat. Dr. Stevens recommends it for patients who are not obese and have tight skin, as skin laxity can sometimes be mistaken for cellulite.
While there's no official age cut-off, candidates are determined on a case-by-case basis. Avéli was tested on women aged 21 to 55. Patients with mild to moderate laxity may find Avéli less effective for their specific concerns.
The author was deemed a good candidate by Dr. Shafer due to having moderate cellulite with dimpling on her buttocks and the backs and sides of her thighs. It was also noted that she wasn't going to achieve completely flawless legs due to the presence of some fat pockets, which managed expectations.
What Results Can You Expect from Avéli?
According to the company's published study, approximately 80% of the 74 subjects experienced significant improvement three months post-treatment. It's worth noting that Merz (the maker of Cellfina) reports noticeable results for 37 patients five years after their treatment.
The pain rating for Avéli was a self-reported mean of 3.8 out of 10 for the 24 hours following the procedure, with mild side effects like bruising and swelling. There is a risk of scarring around the incision sites, but Dr. Williams notes that these scars are typically minimal due to the small incision size.
It's important to understand that for mild or shallow dimples, Avéli may cause them to disappear. However, with deeper, more pockmark-like divots, you may see a lessening rather than complete elimination. Dr. Shafer likens this to the memory in the skin; even after the band is divided, the surface may not become completely smooth.
How Much Does Avéli Cost?
The price of Avéli can vary depending on the provider and the size of the treated area(s), but you can expect to pay between $4,000 to $6,000.
What Does the Avéli Procedure Feel Like?
The procedure began with the patient standing while Dr. Shafer marked specific areas. Then, lying on her stomach, local anesthetic was injected into the buttocks and backs of the thighs. The Avéli device was inserted through a small 2mm incision to locate and cut the septa bands. This process, involving a slicing motion with a snapping sound, was repeated at different spots, totaling six small incisions (three per leg). The entire procedure took about an hour.
During most of the procedure, the patient felt only tugging. However, on the edges of the anesthesia, occasional sharp pain was felt, ranging from a mild "zing" to a more intense sensation. The patient was able to chat with the medical team throughout the procedure.
Avéli Mechanism of Action Animation
What’s Recovery Like After Avéli?
For the first three days post-procedure, the patient experienced tenderness, with lying on the back being uncomfortable. Sitting was manageable, and sleeping on the stomach was possible. Walking was permitted immediately after treatment, but high-impact workouts were restricted for a couple of weeks.
Over-the-counter pain medication was taken, followed by sleep. The day after the procedure, the patient was able to work from home without significant discomfort. The incisions healed within days.
Bruising and swelling were generally light and resolved within the first couple of weeks, except for the right side, which experienced more significant bruising and swelling, described as looking like "sliding into home base." Dr. Shafer confirmed this was normal, as bruising is unpredictable.
The discoloration lingered longer than the tenderness, which subsided after about 14 days. The patient took arnica pills, and Dr. Shafer recommended a Vbeam laser treatment to address hyperpigmentation, which typically costs $800. It took a total of nine weeks for the bruises to lighten completely, aligning with the 90-day study findings.
The author noted that the discoloration around the incision sites, now resembling marks from healed pimples, is expected to lighten over time, hopefully before swimsuit season. This highlights the importance of scheduling the procedure to allow ample time for healing and fading of any residual marks.
Other Cellulite Treatment Options
Beyond Avéli, a variety of other tools and treatments aim to address cellulite, ranging from at-home devices to professional procedures.
At-Home Devices and Tools
Several devices are available for at-home use, targeting cellulite through various mechanisms:
1. NuBody Skin Toning Device
This is a body version of the popular facial toning tool, designed for areas like arms, abs, legs, and buttocks. It promises a firmer, more toned appearance with consistent use (five days a week for 60 days). Clinical studies show high user satisfaction with firmer-looking skin and improved tone.
- Best for: Full body
- Pros: Adjustable intensity levels, includes conductive gel.
- Cons: Requires consistent use.
2. Manual Lymphatic Drainage Massager (e.g., Beechwood Massager)
This affordable manual massager, often made from beechwood, is designed to aid lymphatic drainage and minimize the appearance of cellulite. It requires a body oil for smooth gliding and can help relieve bloating and sculpt the skin.
- Best for: Entire body
- Pros: Affordable, helps with bloating.
- Cons: Can be slightly painful at first.
3. Therabody Thigh & Glute Tool
This massage tool is specifically designed for the thighs, glutes, and legs. It features a unique system of converging rollers that lift and squeeze the skin to improve firmness, smoothness, and elasticity with daily treatments.
- Best for: Legs, butt
- Pros: Ergonomically designed, effective for specific areas.
- Cons: Can only be used on certain parts of the body.
4. L(A)BR Body Massage Tool
Developed by a massage therapist, this tool is intended for use in the shower to support lymphatic drainage and skin firmness. It has a learning curve for applying the right pressure but is an accessible way to achieve spa-like results at home.
- Best for: Full body
- Pros: Supports lymphatic drainage, accessible spa experience.
- Cons: Takes some practice to master.
5. TriPollar STOP Vx
This device combines radiofrequency with smart temperature control and vibrating massage to target cellulite and boost circulation. It is clinically proven and FDA-cleared, requiring weekly 20-minute treatments per area.
- Best for: Full body
- Pros: Low maintenance, easy to use, clinically proven.
- Cons: Time-consuming since each area requires a full 20-minute session.
6. Foreo Bear 2 Body
This device uses microcurrent technology combined with transdermal vibration signals to stimulate microcirculation and improve oxygen delivery, supporting skin renewal. It also includes a body-sculpting massager with various modes for lymphatic drainage, deep tissue, and more.
- Best for: Full body
- Pros: Easy to use, chic design, multiuse modes.
- Cons: Some users dislike the gel.
7. HigherDOSE Infrared Body Mask
This device uses low-level electrical currents, red light (650nm), and near-infrared light (850nm) to stimulate muscles, improve circulation, and support fascia health. It's designed for use with a magnesium spray for added hydration and tension relief.
- Best for: Full body
- Pros: Stimulates muscles, improves circulation, spa-like experience.
- Cons: Doesn’t include a body oil.
8. Nurse Jamie UpLift Body Tool
A luxury upgrade to body gua sha, this stainless-steel tool is designed for manual massage to minimize cellulite, release trigger points, and depuff. Its shape and weight make it effective for various bodywork techniques.
- Best for: Full body
- Pros: Ultra-luxe stainless steel, ergonomic, versatile.
- Cons: Requires manual effort.
Professional Cellulite Treatments
In addition to Avéli, several professional treatments are available:
1. Laser Treatments (e.g., Cellulaze®)
Minimally invasive, Cellulaze® uses a laser fiber under the skin to break down fibrous bands, release trapped fat, and stimulate collagen. It offers noticeable improvement after one session, with results lasting 1-2 years.
2. Acoustic Wave Therapy (AWT)
AWT uses sound waves to break up fibrous bands and improve blood flow, enhancing skin texture. It's non-invasive and requires multiple sessions for optimal results, with visible reduction seen after 4-6 sessions.
3. Cellfina®
This FDA-cleared procedure offers long-lasting results with a high patient satisfaction rate, lasting up to 3 years or more. It targets deep, persistent dimples.
4. Vacuum-Assisted Precise Tissue Release
This technique uses small blades to release fibrous bands, allowing the skin to bounce back. It provides long-term results with minimal downtime, lasting 2-3 years.
5. Radiofrequency Treatments (e.g., Secret RF)
Secret RF microneedling uses heat energy to stimulate collagen, tighten skin, and reduce cellulite appearance. It's non-invasive and offers gradual, natural-looking results after 4-6 sessions.
6. Cryolipolysis (CoolSculpting®)
Primarily for fat reduction, CoolSculpting® can also improve cellulite by reducing the fat layer beneath the skin. It's non-invasive and results appear gradually over 2-3 months.
7. Topical Creams and Lotions
While many over-the-counter creams offer temporary improvement through ingredients like caffeine and retinol, they provide a temporary smoothing effect and require daily application.
8. Massage and Lymphatic Drainage
Techniques like lymphatic drainage massage can temporarily reduce fluid retention and improve blood flow, diminishing cellulite's appearance. Regular sessions are needed for sustained results.
9. Diet and Exercise
A healthy diet and consistent exercise routine are fundamental for reducing overall body fat and toning muscles, which can minimize cellulite's appearance.
How to Use Cellulite Massagers
Technique Matters: Start with clean skin and apply a body oil or lotion to ensure the device glides smoothly and prevents irritation. Use gentle to moderate pressure with upward movements to support circulation and lymphatic flow without bruising the skin.
Frequency: While specific instructions vary by device, generally, using cellulite massagers three to four times per week is recommended. Remember that results with non-invasive tools are gradual, so consistency is key.
What to Look For in a Cellulite Tool
Manual vs. Electric: Manual massagers are typically more affordable but require more physical effort. Electric massagers are more expensive but often offer customizable settings and additional features.
Ease of Use: Choose a tool that feels sturdy, comfortable in your hand, and is easy to clean. The most effective device is ultimately the one you will use regularly.
Products That Work Well with Cellulite Tools
Body Oils and Lotions: A lightweight body oil or serum is ideal for reducing friction and preventing irritation. Look for products that allow the tool to glide smoothly across the skin.
Skincare Products: Pairing a massager with skincare products that support collagen production (e.g., retinol-based treatments) or contain caffeine can enhance visible results by temporarily smoothing the look of cellulite.