Table 4.

Imaging Techniques Used to Assess Cellulite Severity

Technique	Measurement of cellulite severity	Used in clinical practice?	Used in research?	Comments
2D/3D photography20-23,25,28,30,49	Measures: • Waviness of skin surface • Dimple depression and elevation	2D photography is primarily used to document cellulite severity 3D photography is used where available	Yes	• Photographic assessment is the only validated method of measuring cellulite severity, and the use of photonumeric scales is recommended by the FDA for the evaluation of new treatments • Standardized camera settings, lighting conditions, and patient positioning are important for reproducibility • In research studies, evaluators should ideally be blinded and independent
Ultrasonography12,13,34,35	Provides direct visualization of the epidermis and dermal thickness	Very little clinical use Used in research to show fat herniation into the dermis	Yes	• Operator technique is important for image quality • Dermis–hypodermis and dermis– subcutaneous length correlate with cellulite severity
Thermographic techniques6,39,53	Uses measurements of skin temperature to grade cellulite severity	No	Yes	• Considered subjective because skin temperature can be affected by multiple factors, including sun exposure, fever, smoking, and menstrual cycle phase in women • Can be combined with less subjective and more quantitative techniques (eg, photonumeric scales) • Cellulite must be accompanied by edema for adequate assessment
MRI10,11,13	Used to visualize skin architecture of the dermis and hypodermis	No	Yes	• Primarily used in research setting
Computed axial tomography41,54	Used to assess adipose tissue thickness	No	Yes	• Primarily used in research setting • Good correlation with MRI results

2D, 2-dimensional; 3D, 3-dimensional; FDA, US Food and Drug Administration; MRI, magnetic resonance imaging.