Extracorporeal shock wave therapy (ESWT) for the treatment of cellulite - A current metaanalysis
TL;DR
This meta-analysis provides moderate-quality evidence supporting shockwave therapy as a non-invasive treatment option for cellulite. With 297 patients across 11 studies and 5 randomized controlled trials, there is growing scientific support that both focused and radial ESWT can meaningfully improve cellulite appearance, reduce subcutaneous fat, and improve skin elasticity. The typical protocol of 6-8 sessions performed 1-2 times weekly is well-established, though optimal device settings and long-term maintenance protocols still need further research.
Key Numbers
297 women treated across 11 clinical trials
5 randomized controlled trials confirm ESWT effectiveness for cellulite
24% improvement in Cellulite Severity Scale (P=0.001)
105% improvement in skin elasticity at 6 months
Mean cellulite grade improved from 2.5 to 1.57 (37% reduction)
Subcutaneous fat reduced from 1.4 cm to 1.0 cm (29% reduction)
Circumference reduction of 1.7-4.5 cm depending on protocol
Key Findings
Both focused and radial ESWT devices effectively improve cellulite
Whether your clinic uses focused or radial shockwave devices, both types have been shown to reduce the appearance of cellulite in clinical trials.
5 RCTs with 123 patients showed statistically significant improvements across multiple outcome measures
ESWT significantly improves cellulite severity scores
In a high-quality study where neither patients nor researchers knew who got treatment, cellulite severity improved by nearly a quarter after shockwave therapy.
One double-blinded RCT showed Cellulite Severity Scale improved from 10.9 to 8.3 (24% improvement, P=0.001)
ESWT reduces subcutaneous fat layer thickness
Shockwave therapy can reduce the fat layer under your skin and decrease your measurements by about 1.7 cm in treated areas.
Subcutaneous fat layer reduced from 1.4±0.4 cm to 1.0±0.3 cm in one RCT; circumference reduction of 1.7 cm
ESWT improves skin elasticity
Skin elasticity more than doubled six months after completing shockwave treatment, meaning firmer, more youthful-looking skin.
One cohort study showed skin elasticity improvement of 105% at 6 months follow-up
Typical protocol is 6-8 sessions over several weeks
Most successful studies used a treatment plan of about 6-8 sessions, coming in once or twice a week for a few weeks.
All 11 studies used protocols of 6-8 sessions administered 1-2 times per week
Our Take
This 2015 meta-analysis represents solid evidence that shockwave therapy works for cellulite reduction. While not as extensive as the research for other conditions like erectile dysfunction or plantar fasciitis, having 5 randomized controlled trials all showing positive results is meaningful. The 24% improvement in cellulite severity scores and the dramatic 105% improvement in skin elasticity at 6 months are particularly compelling findings. What's especially valuable for patients is that the treatment protocol is straightforward and convenient—typically 6-8 sessions over a few weeks, with each session lasting about 20-30 minutes. Both focused and radial shockwave devices appear effective, which means most clinics offering shockwave therapy can provide this treatment. The main limitation to keep in mind is that we don't have strong data on how long results last beyond one year, so maintenance treatments may be needed. For women looking for a non-invasive alternative to more aggressive cellulite treatments, shockwave therapy offers a scientifically-supported option with minimal downtime.
Treatment Protocol
- Device
- Multiple devices including Storz D-Actor 200, Storz Duolith, EMS Swiss DolorClast, Storz CellActor SC1, ActiVitor-Derma
- Frequency
- 1-2x/week
Study Limitations
- • Substantial heterogeneity in study designs, devices, parameters, and outcome measures
- • Long-term follow-up data beyond one year is lacking
- • Most studies had small sample sizes with large confidence intervals
- • Only one RCT used a patient questionnaire to assess satisfaction
- • Potential publication bias favoring positive results
- • Study quality scores ranged widely from 22 to 82 points (mean 57)
- • Three of five RCTs used intra-individual (cross-leg) design rather than separate control groups