D&PS – D&PS December 2025 Column

Dr. Chang-hwan Cho of Dong-An Joongsim Clinic contributed a column to the December 2025 issue of D&PS Magazine, titled “Aesthetic Medicine Trends 2017–2025:
Device-Based Approaches to Cellulite.” In this article, Dr. Cho redefines cellulite not as a simple fat-related problem but as a multifactorial structural condition
involving the subcutaneous fascia, adipose layers, microvascular system, and lymphatic circulation. He explains that when lymphatic flow declines, interstitial
fluid and metabolic waste accumulate between tissues, creating localized edema and worsening the metabolic environment of adipocytes. This process accelerates the
formation and progression of cellulite. The subcutaneous fascia, a key structure separating the superficial(SAT) and deep adipose layers(DAT), undergoes fibrosis
and stiffening over time due to aging and mechanical stress. As these septal structures lose elasticity, superficial fat begins to herniate upward, resulting
in the characteristic uneven and dimpled surface. Dr. Cho notes that women are particularly prone to cellulite due to the vertical orientation of their fibrous
septa, making structural intervention especially important.

In outlining the therapeutic strategy, he identifies three essential components :

1. Reducing fascial inflammation,
2. Releasing fibrotic, stiffened septa,
3. Enhancing blood flow and lymphatic circulation.

He stresses that approaches focusing solely on fat reduction often fail to prevent recurrence. Effective improvement requires simultaneously restoring fascia function,
lymphatic drainage, and microcirculatory balance, integrating all three into a single treatment framework. Discussing device-based therapies, Dr. Cho highlights
that the most consistent and reproducible outcomes arise from combination treatments. Radiofrequency (RF) delivers controlled thermal energy to “activate"
microcirculation, acoustic shockwave therapy helps realign and remodel fascial structures, and vacuum or roller-assisted devices promote lymphatic drainage by
mechanically guiding fluid movement. According to Dr. Cho, this sequential approach—“turning on” microcirculation with heat and “flushing out” lymph congestion
through mechanical massage—represents the core principle of modern cellulite management. He concludes that contemporary cellulite treatment must evolve beyond
traditional fat-destruction paradigms and advance toward a comprehensive structural therapy that addresses fascia, lymphatics, and microvascular health as a unified system.