Review of acoustic wave therapy for cellulite: does it work?

My professional acoustic wave therapy review for cellulite

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• Acoustic wave therapy (shockwave therapy) for cellulite doesn’t work, here’s why

• My acoustic wave therapy review and the clinical study

• What is acoustic wave therapy for cellulite and what is the rationale of using it?

• How could acoustic waves possibly reduce cellulite?

• Bones are hard, cellulite is soft

• Cellulite, overpriced miracle treatments and marketing hype go well together

• Focused and unfocused Acoustic wave machines

• Shockwave therapy, cellulite and Madonna

• Unfocused acoustic wave therapy and spider veins

• Focused shockwaves: from kidney stones to cellulite

• My extensive focused acoustic wave therapy trial on fat and cellulite: still not much happened

• Acoustic wave therapy for cellulite and fat reduction: not "statistically significant”

• A randomized, controlled clinical study to investigate the safety and efficacy of acoustic wave therapy in body contouring

• Check our professional consultancy in cellulite, skin tightening, ultrasound and radiofrequency

Acoustic wave therapy (shockwave therapy) for cellulite doesn’t work, here’s why

What is now euphemistically called acoustic wave therapy (AWT) cellulite treatment goes by several other names:

• Pressure wave therapy

• Extracorporeal shockwave therapy (ESWT, the correct name and the original one coined by scientists)

• Shockwave therapy (the shortened version of the correct name)

• And “lipotripsy” (the most ridiculous one I have even heard)

Before shockwaves were ever used for questionable “cellulite removal”, they were initially used to break down kidney and gallbladder stones, hence the medical name lithotripsy, meaning “breaking down stones”.

From that, one crafty marketer coined the pathetically ridiculous term “lipotripsy” (as in lithotripsy in kidney stone removal…) to denote breaking down fat, although shockwaves do NOT physically work on anything soft and therefore do not physically break down fat.

Etymology aside, this article is about a study on the effectiveness of acoustic wave therapy/shockwave therapy on fat reduction and cellulite.

And it is about my own hands-on experience and clinical results with AWT for cellulite reduction, years before some misleading marketing campaign turned acoustic wave therapy cellulite treatments into a huge money spinner, making some clinics millions.

My acoustic wave therapy review and the clinical study

Before reading this long article about my review, based on an extensive research and assessment into AWT for cellulite, let me fast-forward and present you with the verdict of the study, as stated by the researchers:

“However, the results obtained were not statistically significant”.

This is science-talk for “the results could simply be attributed to luck”. In plain English, it means “Based on this study, acoustic wave therapy does not work”.

Now, if you still want to know about the study, the ins and outs of AWT cellulite treatment and my extensive hands-on research into it, way before anyone ever thought of applying AWT for cellulite reduction, please read below.

What is acoustic wave therapy for cellulite and what is the rationale of using it?

Acoustic wave therapy refers to treatments whereby a machine sends loud mechanical shockwaves (hence the name ‘acoustic wave therapy’) into your deeper tissues through your skin.

ESWT, as was originally named and as it is still known in physiotherapy and in medicine, was developed to help tendons recover from chronic injury, heal fractured bones that refuse to heal and break down gallbladder and kidney stones.

A few years ago acoustic wave therapy has become known in the tabloids as an expensive, hyped-up anti-cellulite treatment that, quite predictably for cellulite treatment, doesn't really work.

The rationale is that since AWT can be used to break down HARD kidney stones, HARD bone tissue and HARD tendon scar tissue, it can also be used to break down SOFT fat tissue.

I know, there is no logic, go figure…

Since I have read and heard so much nonsense about the use of AWT for cellulite reduction, and given the fact that I investigated the subject for several months in 2005 (way before the Daily Mail wrote their first hyped up article about it and started a BS revolution on AWT, I feel the need to present the facts as I know them.

So here goes.

How could acoustic waves possibly reduce cellulite?

To begin with, using ESWT on cellulite sounds like a fab idea.

In theory, the shockwaves will disrupt and shock the cellulite fat cells causing them to breakdown and die off. These, and the released fat, can then be removed by the body.

According to another theory, the cavitation produced by the acoustic waves is the one that damages fat cells (cavitation is volatile gas bubbles produced in tissues by things like shockwaves, ultrasound waves or radiofrequency waves).

In either case it sounds great: “Blast those stubborn fat cells and kill them off with them sound waves", I can hear people saying.

Not so easy tiger, things are not so simple…

Bones are hard, cellulite is soft

Unfortunately reality is often quite different to theory.

In actual fact, shockwaves work very well on HARD, rigid structures, such as tendons, ligaments and especially bones.

These HARD tissues cannot effectively absorb the shockwave vibrations, so the shockwaves cause micro-damage to the HARD tissues. This in turn stimulates new tissue growth, the tendon/ligament/bone heals, and everybody is happy.

In contrast to hard tissues, however, fat is really soft and elastic.

The word "cushy" immediately springs to mind, when it comes to fat. And what are cushions renowned for? Well done, you guessed it: softness. Cushions are great in absorbing vibrations and impact, including shockwaves.

Therefore, using shockwaves is evidently not the smartest way to to break down fat tissue, including cellulite tissue, which is specifically made by nature to be, well, "cushiony".

Cellulite, overpriced miracle treatments and marketing hype: all three go well together

Still, one could theorise that even the little energy that does make an impact on cellulite could have some beneficial effects.

Perhaps acoustic waves will help break down the irregular collagen fibres (fibrosis) that characterise cellulite. Sounds like a good idea, right?

Maybe even this little impact can cause fat cells to break down.

Most probably not but, wooh, who knows, maybe...

The truth is that one can never know for sure unless one tries. And this is what I tried to do back in 2005: to investigate if shockwaves really work as a cellulite reduction method.

That was loooong before this technology became famous due a misleading PR marketing campaign by a leading “medispa" here in London, which specialises in selling the latests overhyped, overpriced miracle treatments to its over-wealthy customers.

The truth is that I was one of the first ever therapists to try this technology for this purpose, but I was not the first one to think of the idea.

Before me trying AWT, a research paper titled "Anti-fibrosclerotic effects of shock wave therapy in lipoedema and cellulite" described how ESWT could help the body remove lipid peroxidation (LPO) products from the cellulite tissues, but did not mention any significant effect on cellulite.

As with all trials, however, the results of the trial depend largely on the exact method used: different ways of applying the same technology can have different results.

So I ventured on to try it for myself.

Focused and unfocused Acoustic wave machines

Now shockwave machines come in two versions: focused and unfocused:

• The unfocused is quite crude and sends the shockwaves to the epidermis, which is then transferred to the dermis, hypodermis, muscles etc. This cheaper, crude method is what ALL cellulite AWT machines on the market use. Oh well…

• The focused version bypasses the epidermis and focuses the shockwaves into a focal point straight into the dermis, hypodermis, subcutaneous fat, muscles, kindeys, gall bladders or wherever else you want to focus it. This is smarter and more expensive, and sure enough no cellulite AWT machines use this technology.

Shockwave therapy, cellulite and Madonna

After an initial research and comparison of the different machines on the market, which in those days were exclusively used by a very small number of doctors and advanced physiotherapists for tendon and bone injuries, I first went on to try an unfocused ESWT system.

As I mentioned above, unfocused shockwave therapy is inferior to focused shockwave therapy. However, this is the system that became known worldwide that year through the tabloid media hype.

[BTW these systems only cost about £12,000, and not £50,000 as was erroneously stated in that hyped-up Daily Mail article, but hey, that’s Daily Mail. On the same article it was also mentioned that Madonna bought(?) this system for her (non-existent those days) cellulite. However, I would argue that the primary intention (if she ever bought the machine) was to treat her known tendon injuries caused by hours of exertion every day and that cellulite was a secondary consideration. Anyway, Madonna is old news these days (2023), so let’s move on with the article.]

At that point I had the pleasure to meet an extremely helpful physiotherapy equipment salesperson who volunteered to offer me a machine for a free month's trial at my premises. Sure enough, a few days later the machine was at my clinic and I started trialling it on my clients, who were very excited to try this the new technique.

Unfortunately, our enthusiasm did not last long. Although I used the machine at the highest power level and for three sessions per week for a few weeks, and despite the deafening noise produced as each loud shockwave left the probe to be absorbed by the cushy cellulite fat, not much happened to my clients' cellulite.

Predictably, cellulite and fat proved to be too soft and shock absorbing for the acoustic wave vibrations to have any discernible effect. This is no surprise, as in fact this is one of the reasons fat and cellulite exist: to absorb vibrations.

I could easily reproduce the exact same results with the cellulite specific-massage I was practising those days, at a fraction of the cost and time it took to cover the same area and without all the deafening noise.

Unfocused acoustic wave therapy and spider veins

Finally, applying raw acoustic waves on bare skin also seem to cause an undesirable side effect: the development of spider veins (also known as thread veins).

Not all women develop thread veins with such vigorous treatments, but even the thought of causing thread veins to some of my clients did not make sense to me. The use of acoustic wave therapy, it seems, is only appropriate for use on tendons, ligaments and bones.

So, since I did not want to potentially cause spider veins on their thighs and at the same time subject them to the annoying very high decibel noise, I gave up on using unfocused shockwave therapy as a method of cellulite reduction - an otherwise great technology for tennis elbow, achilles tendinitis and patellar tendinitis.

Focused shockwaves: from kidney stones to cellulite

Although I became disillusioned about the potential of unfocused acoustic wave therapy for the treatment of cellulite, there was still in my mind the potential that focused shockwave therapy presented.

After all, energy focused directly on the cellulite tissues sounds much better than energy crudely applied to the surface of the skin and then allowed to dissipate and disperse before having any chance to properly reach the cellulite tissues.

Consequently, I made enquiries about a focused shockwave machine which cost a whopping £30,000 those days (probably 100% more expensive today). That was in contrast to the celebrated in the media cheap, unfocused variety that only cost £12,000.

"If I can provide your clients with amazing results, cost is not an issue", has always been my motto. So hoping that I could make a breakthrough in the fight against cellulite, I proceeded to make an appointment for a demonstration.

Again I had the luck to meet an extremely helpful doctor, consultant at a major university London hospital, who practised shockwave therapy for rather more serious applications.

n the day I went to see him at the hospital he has worked on a patients' kidney (lithotripsy, the original application of focused shockwave therapy), on another patient's broken humerus (the upper arm bone) and then on a patient’s Peyronie's disease (fibrosis on the penis).

I explained my ideas to the doctor, who in turn kindly volunteered to demonstrate the machine on my stomach's fat tissue and a friend’s cellulite.

My first focused acoustic wave therapy trial on fat and cellulite: nothing happened

Initially we started at a very low level and predictably nothing happened. We then gradually increased the intensity until we used the machine at full power. After half an hour of application on a tiny area of each of our fat tissues, we ended the treatment with little more to remind us of it than some very temporary redness and mild skin sensitivity.

Focused acoustic waves, it seemed, were pretty similar to the unfocused variety, at least in regard to cellulite: treatment times were extremely long and to just cover a small A4-sized area you would need to spend at least half an hour. And cellulite fat also seemed to absorb the shockwaves pretty efficiently, due to its inherent elasticity.

However, even after this second disappointment, I still did not want to give up. After all I should try the focused ESWT/extracorporeal shockwave therapy machine for a month, as I did with the unfocused one. But I wanted to save that trial for an even more advanced - and even more expensive - machine.

That specific state-of-the-art focused shockwave therapy machine had a higher power output than the one I tried at the hospital. This would have more chances of affecting cellulite than any other machine on the market.

At this point I would like to mention that for the traditional ESWT applications, power output is not very important. For work on bones you only need to use the machine at 1/10 of total power or less, as bone does not absorb shockwaves very well, so a little energy goes a long way. Working on cellulite fat, in contrast, requires very large amounts of power as it is highly elastic.

My extensive focused acoustic wave therapy trial on fat and cellulite: still not much happened

So after a lot of research to find the absolute best, state-of-the-art focused shockwave machine, I made a trip to Switzerland to meet the distributor of the equipment (it was not available in the UK) and then we together passed the border to southern Germany to meet an orthopaedic doctor who practised focused shockwave therapy there.

The machine was reassuringly expensive but that did not deter me. I asked to hire the machine for an one month trial with my clients and the nice Swiss distributor kindly obliged. A month - and more than a thousand pounds - later in rental and insurance fees I had the machine at my premises to try on my clients.

For a whole month I tried the machine extensively. I used the highest power settings and focused the acoustic waves on different depths: dermis, hypodermis/cellulite and subcutaneous adipose tissue (in comparison, all the acoustic wave machines on the market for “cellulite reduction” are low energy, crude and superficial - you can’t focus anything).

And after 8-10 sessions for each client, not much happened. Not enough to justify the eighty grand (GBP) in today’s money that this machine cost.

So after all my trials, efforts and expenses I gave up on the idea of using acoustic waves or pressure waves or shockwaves or lipotripsy (🙄) for cellulite.

And about a year later, someone filled the world with hype and BS about Madonna being on that machine all day long and made millions out of “acoustic wave therapy for cellulite removal”.

Ah well, that’s life, BS sells…

And within two years everyone copied them and made some more money.

And then, a few years later, the whole thing gradually died down, because it was obviously not that amazing after all.

So clinics started doing bundles to muddy the waters, recommending a bit of AWT, a bit of low-end radiofrequency a bit of something else, charging £5,000 for the smoke and mirrors…

So that was my research into AWT, the results of which are in fact corroborated by the study presented below. So let’s go back to the study.

Acoustic wave therapy for cellulite and fat reduction: not "statistically significant”

A recently published study on the effectiveness of acoustic wave therapy (AWT) concluded that the application of either the radial (superficial) and planar (deep and focused) form of this technology reduced fat but the change was not statistically significant, i.e. it was so small and it could be a statistical error. Non-statistical changes usually refer to small changes of 1-2%, which basically mean that the treatment practically does not work. And eve if it did work, who cares about a 2% difference?

Now most studies are deemed successful if there is the tiniest hint of statistical significance, usually put in numbers by the statistical unit known as “p value”. The p value shows the probability of the results being down to luck, with a p value of 0.01 referring to 1% chance of the results being down to luck, a p value of 0.05 to a 5% chance of random results etc.

A p value of 0.05 is the lowest acceptable standard, with 0.01 being decently acceptable and 0.001 being the gold standard.

In this study the p value was, wait for it, p=0.37.

Let me repeat that: a p-value of 0.37!

If you mentioned a result with a p-value of 0.37 to any scientist, they would laugh out loud at it.

This means that the chance of the result being attributed to luck is 37%, i.e. completely unacceptable.

Indeed, this result confirm the results of my own personal, hands-on research into AWT on multiple clients.

Unfortunately, uninformed therapists still try today to use a technology designed to treat hard tissues (bones, tendons and ligaments), in order to treat the softest tissues of all, fat and cellulite.

It beggars belief...

A Randomized, Controlled Clinical Study to Investigate the Safety and Efficacy of Acoustic Wave Therapy in Body Contouring

• Research paper link: https://pubmed.ncbi.nlm.nih.gov/25742559/

• Abstract: Background: There is an increased demand for the reduction of localized adipose tissue by noninvasive methods. Objective: The objective of this study was to determine the safety and efficacy of noninvasive lipolysis of excess adiposities overlying the lateral thigh region using acoustic wave therapy (AWT). This study incorporates 2 mechanical waves with varying properties in the same session: radial and planar AWT. Methods and materials: The treatment was performed using AWT on the lateral thigh areas of 15 female patients. The study was performed using the planar and radial pulse handpieces, with 8 sessions performed within 4 weeks. Follow-up visits were performed 1, 4, and 12 weeks after the last treatment. Results: Reduction in both thigh circumference and subcutaneous fat layer thickness, measured through ultrasound, was observed. Conclusion: This study demonstrates that AWT is safe and efficacious for the treatment of localized adiposities in the saddlebag area. However, the results obtained were not statistically significant. Larger studies will be needed to further access the effects of AWT on thigh circumference reduction. Furthermore, the authors also found an improvement in the appearance of both cellulite and skin firmness after the treatments.

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