A special enzyme injection breaks up the tough bands under the skin that cause dimples, making the skin look smoother in the butt and thighs.
Scientific Claim
Collagenase Clostridium histolyticum (CCH-aaes) injected subcutaneously into cellulite dimples of the buttocks and thighs disrupts fibrous septae, leading to visible improvement in skin topography, based on expert clinical experience with over 350 patients.
Original Statement
“CCH-aaes is composed of a 1:1 ratio of 2 collagenases... which cleave type I and III collagen in a specific fashion. When injected into a cellulite dimple, CCH-aaes disrupts the fibrous septae tethered to the underside of the dermis, thereby alleviating the local tension thought to cause the skin topography characteristic of cellulite.”
Evidence Quality Assessment
Claim Status
overstated
Study Design Support
Design cannot support claim
Appropriate Language Strength
association
Can only show association/correlation
Assessment Explanation
The study is an expert opinion with no controlled data; it cannot prove causation or mechanism in humans. The claim implies direct causal disruption of septae as the sole cause of improvement, which is not empirically demonstrated.
More Accurate Statement
“Expert clinical experience suggests that collagenase Clostridium histolyticum (CCH-aaes) injection into cellulite dimples of the buttocks and thighs is associated with visible improvement in skin topography, potentially through disruption of fibrous septae.”
Gold Standard Evidence Needed
According to GRADE and EBM methodology, here is what ideal scientific evidence would look like to definitively prove or disprove this specific claim, ordered from strongest to weakest evidence.
Randomized Controlled TrialLevel 1aIn EvidenceThat CCH-aaes injection causes statistically significant and clinically meaningful reduction in cellulite dimpling compared to placebo in adult women, with objective imaging confirmation of septae disruption.
That CCH-aaes injection causes statistically significant and clinically meaningful reduction in cellulite dimpling compared to placebo in adult women, with objective imaging confirmation of septae disruption.
What This Would Prove
That CCH-aaes injection causes statistically significant and clinically meaningful reduction in cellulite dimpling compared to placebo in adult women, with objective imaging confirmation of septae disruption.
Ideal Study Design
A double-blind, placebo-controlled RCT of 200 adult women (BMI 18–30) with moderate-to-severe cellulite on buttocks and thighs, randomized to receive 3 sessions of 0.23 mg/mL CCH-aaes (buttocks) or 0.046 mg/mL (thighs) vs. saline placebo, with primary outcome measured by CR-PCSS and PR-PCSS at 12 weeks and secondary outcome via high-resolution ultrasound confirmation of septae thinning.
Limitation: Cannot prove long-term durability beyond 1 year or mechanism of action in vivo without invasive biopsy.
Prospective Cohort StudyLevel 2bIn EvidenceThe real-world association between CCH-aaes injection and sustained improvement in cellulite appearance over 12–24 months in diverse patient populations.
The real-world association between CCH-aaes injection and sustained improvement in cellulite appearance over 12–24 months in diverse patient populations.
What This Would Prove
The real-world association between CCH-aaes injection and sustained improvement in cellulite appearance over 12–24 months in diverse patient populations.
Ideal Study Design
A prospective multicenter cohort study of 500 adult women receiving CCH-aaes for cellulite (buttocks and/or thighs) with standardized photography, CR-PCSS/PR-PCSS, and ultrasound assessments at baseline, 12, 24, and 36 weeks, tracking outcomes by BMI, skin quality, and prior treatments.
Limitation: Cannot rule out confounding from concurrent treatments or natural aging.
Animal Model StudyLevel 4Direct histological evidence that CCH-aaes enzymatically cleaves dermal fibrous septae in human-relevant tissue architecture.
Direct histological evidence that CCH-aaes enzymatically cleaves dermal fibrous septae in human-relevant tissue architecture.
What This Would Prove
Direct histological evidence that CCH-aaes enzymatically cleaves dermal fibrous septae in human-relevant tissue architecture.
Ideal Study Design
A study using humanized skin grafts in immunodeficient mice injected with CCH-aaes, followed by histological analysis at 24, 72, and 168 hours to quantify collagen I/III degradation and septae disruption via immunohistochemistry and electron microscopy.
Limitation: Does not reflect human immune response, pain, or aesthetic outcomes.
Evidence from Studies
Supporting (1)
This study is about using a special injection called CCH-aaes to break up the tough fibers under the skin that cause cellulite dimples, and doctors say it works well based on what they’ve seen in practice.