UNDERSTANDING AND TREATING CELLULITE IN TRANSGENDER PATIENTS

Dr Tatiana Mandavia talks through her holistic, inclusive approach

Cellulite is a concern shared by many, but for transgender individuals, especially those undergoing hormone replacement therapy (HRT), it can carry deeper physiological and emotional complexities. Addressing these challenges requires more than just a technical understanding of treatment – it demands a compassionate, inclusive approach that recognises the uniqueness of every patient’s experience.

Transgender patients often undergo dramatic hormonal and physical shifts, which alter fat distribution, connective tissue structure, and skin texture.

Feminising HRT, for instance, increases subcutaneous fat in areas like the hips, thighs, and buttocks- locations that are already prone to cellulite. These hormonal changes can also affect collagen and elastin production, reducing skin elasticity and creating the ideal conditions for cellulite to develop or become more visible. On the other hand, masculinising therapy changes fat distribution and muscle mass differently, which might also influence how and where cellulite appears.

For practitioners, this means rethinking the conventional aesthetic pathways. Transgender patients are not starting with the same skin, fat composition, or emotional relationship to their body as cisgender individuals. Their needs are specific, and a blanket approach won’t deliver safe, ethical, or effective results. Taking the time to understand each patient’s stage in transition, their hormonal background, and their personal body goals is essential.

The significance of cellulite treatment in transgender patients goes beyond skin deep. For someone who has worked hard to feel aligned with their gender identity, small aesthetic concerns – like dimpled skin – can trigger disproportionate distress. The journey to self-confidence for transgender people is often longer and more layered, influenced by past traumas, societal judgement, or gender dysphoria. In this context, a procedure as seemingly simple as cellulite treatment becomes a powerful tool for affirmation.

SAFE SPACES

Creating safe, affirming spaces for transgender patients starts with the consultation. Clinicians should approach every encounter with curiosity rather than assumption. Asking about pronouns, being comfortable discussing body changes from HRT or gender-affirming surgeries and avoiding binary language can significantly impact how comfortable a patient feels. A thorough consultation will include a review of current hormone regimens, discussion around any surgeries (like breast augmentation or facial feminisation), and exploration of what “success” looks like to the patient. This may not be the complete removal of cellulite but rather feeling good in fitted clothing or swimwear – goals that are deeply individual and must be respected.

While the aesthetic industry has made strides in embracing diversity, the transgender community remains underserved in many ways. There are still gaps in clinical training programmes around trans-specific protocols. Few clinics feature transgender representation in marketing. Some intake forms are strictly binary, and post-operative care for gender-confirming surgeries isn’t always considered when recommending aesthetic treatments. Inclusivity must move beyond branding. It needs to be embedded in every aspect of the patient experience, from consultation forms to aftercare protocols.

Another major consideration for aesthetic practitioners is the way HRT affects the skin. Oestrogen tends to make the skin thinner and more sensitive, while testosterone may increase sebum production and result in different skin texture challenges. Transgender patients may also have areas of scar tissue from surgeries, which could affect how certain treatments respond. These nuances need to be part of the treatment planning process- not an afterthought.

When it comes to cellulite specifically, it’s important to understand how and why it forms. Cellulite is caused by fibrous septae beneath the skin pulling downward, while fat cells push upward. This creates a dimpled or uneven appearance, most commonly on the thighs and buttocks. It’s not a reflection of fitness, weight, or health, but rather a structural issue beneath the skin that affects more than 90 percent of women and an increasing number of men and non-binary individuals.

A range of treatments are available to help address cellulite. Some are invasive, such as subcision or laser-based therapies, which physically cut or melt the fibrous bands causing the dimpling. These often deliver long-lasting results and are supported by extensive clinical data. Others, like acoustic wave therapy, use external devices to break up tissue adhesions, stimulate collagen production, and improve blood flow. Radiofrequency microneedling is another option that combines deep tissue stimulation with surface-level rejuvenation. Each of these approaches has merit, but they must be selected with care, especially for transgender patients whose skin or tissue behaviour might differ due to hormone therapy or past surgeries.

TREATMENT SOLUTION

A more recent option in the cellulite treatment space is Cellution by Deleo. This non-invasive platform uses a combination of high-intensity focused diodes (HIFD), vibration therapy, and mechanical massage to stimulate deep circulation, break down fat, and support lymphatic drainage. The treatment is comfortable and requires no downtime, making it especially well-suited for patients who are mid-transition and may be more sensitive to aggressive procedures.

What makes Cellution promising for transgender patients is its adaptability. Whether a patient is experiencing adipose cellulite from increased subcutaneous fat due to oestrogen, or more fibrous, structured cellulite, Cellution can be tailored to different skin types and fat distributions. Because the treatment does not interfere with hormonal pathways, it is safe for those on HRT. Additionally, by supporting collagen and elastin synthesis, Cellution helps restore the skin’s structural integrity – something that’s often compromised during hormonal shifts.

At our clinic, we use Cellution in conjunction with other therapies such as electrical muscle stimulation and massage to achieve an overall improved skin appearance. Holistic therapies such as acupuncture are gaining popularity in aesthetic medicine, particularly for its effects on circulation and collagen stimulation. From a traditional Chinese medicine perspective, cellulite is related to stagnant Qi and dampness, both of which can be improved through targeted acupuncture. Cupping therapy is also being explored for its detoxifying and fascia-releasing properties, while wood therapy, or maderotherapy, is beloved by many patients for its manual breakdown of fat deposits and deep tissue massage effects.

Diet and lifestyle play an important role too. Hydration, consistent movement, a nutrient-rich diet, and regular skin stimulation through dry brushing or massage can enhance and prolong the results of in-clinic treatments. Especially for transgender patients managing fluid retention or hormonal bloating, these habits help optimise lymphatic flow and support a smoother, firmer appearance.

In managing expectations, it’s important to be honest with patients. Cellulite reduction takes time, and while significant improvement is possible, perfection is never the goal. For transgender women, cellulite may appear more pronounced following the increase in fat tissue in typically feminine areas. However, with consistency, a layered treatment plan, and realistic timeframes, many patients see dramatic changes in both the texture of their skin and their overall confidence.

The message for practitioners is clear: to treat cellulite effectively in transgender patients, one must treat the person – not just the symptom. Understanding the hormonal background, listening without judgement, and tailoring treatment to both physiological and emotional needs are what differentiate good care from great care. This isn’t just about smoother thighs, it’s about offering dignity, affirmation, and transformation to a group that has often been overlooked in aesthetic medicine.

With the right tools, language, and mindset, cellulite treatment can be a deeply empowering experience. As clinicians, we have the opportunity, and responsibility, to ensure that every patient, regardless of gender identity, feels safe, seen, and supported. That’s how we move from aesthetics to advocacy. And that’s where true transformation begins.

DR TATIANA MANDAVIA

Dr Tatiana Mandavia is one of the world’s leading aesthetic experts and founded the clinic. Alongside her University of London medical degree, she completed a Bachelor’s degree in Aerospace Physiology and a Master’s degree in Aesthetic Medicine with Distinction.

Dr Mandavia is an international key opinion leader for dermal fillers as well as for laser and radiofrequency devices and has an active interest in research, having published and presented her work extensively.

Dr Mandavia has also featured in television series as well as in numerous magazines and newspaper publications. She has a keen interest in teaching and leads an international fellowship programme as well as an advanced cadaveric aesthetic training course in association with the European Academy of Facial Plastic Surgery (EAFPS). She is a member of the Royal College of General Practitioners and continues to practice in the NHS.