Effect of cosmetic ingredients as anticellulite agents: synergistic action of actives with in vitro and in vivo efficacy

Marine cosmetics and the blue bioeconomy: From sourcing to success stories

As the global population continues to grow, so does the demand for longer, healthier lives and environmentally responsible choices. Consumers are increasingly drawn to naturally sourced products with proven health and wellbeing benefits. The marine environment presents a promising yet underexplored resource for the cosmetics industry, offering bioactive compounds with the potential for safe and biocompatible ingredients. This manuscript provides a comprehensive overview of the potential of marine organisms for cosmetics production, highlighting marine-derived compounds and their applications in skin/hair/oral-care products, cosmeceuticals and more. It also lays down critical safety considerations and addresses the methodologies for sourcing marine compounds, including harvesting, the biorefinery concept, use of systems biology for enhanced product development, and the relevant regulatory landscape. The review is enriched by three case studies: design of macroalgal skincare products in Iceland, establishment of a microalgal cosmetics spin-off in Italy, and the utilization of marine proteins for cosmeceutical applications.

Algae a Potential Source in Cosmetics: Current Status, Challenges, and Economic Implications

Recently, many studies have revealed the association between environmental stresses and skin disorders. Skin protects the inner body organs as a first line of defence against various environmental detriments. The physical, chemical, biological, and environmental stresses and internal factors, including reactive oxygen species, can lead to skin aging, laxity, wrinkles, dryness, and coarse texture. Therefore, utilizing naturally occurring bioactive phytochemicals has increased in recent years because of advancements in green technology, and new extraction techniques have made their use more compatible, enabling sustainable development. Alga, both macroalgae and microalgae are photosynthetic organisms that are highly exploited in food, feed, pharmaceuticals, nutraceutical, and cosmetic industries. Algae widely synthesize primary and secondary bioactive metabolites such as polysaccharides, vitamins, flavonoids, carotenoids, pigments, phenolic, and mycosporine-like amino acids, etc. Many cosmetic formulations use algal bioactive metabolites or algal cells as a moisturizer, texture-enhancing agents, anti-wrinkle agents, whitening agents, sunscreen, anti-cellulite, thickening agents, and also for hair care. The current review focuses on a better understanding and recent advancements in the application of algal extract and its biomass in a cosmetic formulation. It also briefly describes the current market scenario, challenges, and future prospectus of algae-based cosmetic products.

A pilot study on the efficacy of a seaweed mud application in the treatment of cellulite

BACKGROUND

Cellulite represents a common multi-factorial condition that affects nearly all women and is now recognized as a clinical condition associated with systemic factors and negative psychological effects. Several noninvasive and minimally invasive treatments were developed during the last few years, but limited evidence supports many of them due to lack of evidence, insufficient participants, and potential adverse effects.

METHODS

This study aimed to evaluate the efficacy of a seaweed mud application in improving both the structure and function of tissues affected by cellulite. Sixty women with cellulite underwent 4-week applications of seaweed mud on the buttocks and thighs. The following assessments were performed at baseline and after the last treatment: photographic, clinical, and anthropometric evaluation; tests for elasticity and hydration; ultrasonography of cellulite nodules; and cellulite biopsies in the trochanteric region. Patient satisfaction was assessed using a 5-point Likert-scale questionnaire.

RESULTS

The treatment resulted in a significant improvement in the severity of cellulite severity between the initial assessment and the 4-week follow-up, with enhanced structure, elasticity, and hydration of the affected tissues. Microscopic analysis of the cellulite biopsies revealed a significant restoration of dermal organization with induced collagen synthesis and reduced inflammation, edema, and lipid deposition following the 4-week seaweed mud applications. Additionally, the treatment led to a remarkable improvement in comfort and satisfaction as well as a reduction in body circumferences.

CONCLUSIONS

The cosmetic application of seaweed mud has proven to be a safe, non-invasive treatment for improving the tissue alterations characteristic of cellulite.

Untargeted metabolomics-based molecular networking for chemical characterization of selected Apiaceae fruit extracts in relation to their antioxidant and anti-cellulite potentials

Stress, obesity, hormonal changes, and aging have been connected to cellulite aggravation resulting in skin dimpled appearance, a very common painless skin disorder with a female preponderance. Several Apiaceae plants have been traditionally used for cosmetic applications. However, their screening for anti-cellulite potential has not been deeply investigated. In this work, UPLC-HRMS/MS coupled with molecular networking was employed to glean a holistic overview of the chemodiversity of the metabolome of nine Apiaceae fruits. Additionally, the extracts were screened for in vitro antioxidant and anti-cellulite activities. Apium graveolens and Petroselinum crispum revealed excellent free radical scavenging activity, remarkably increased lipolysis, and decreased adipogenesis. Furthermore, apigenin and its glycosides were identified to be the major components in both extracts, which might be responsible for the antioxidant activity and anti-cellulite potential. Conclusively, these results signify the potent antioxidant and anti-cellulite properties of A. graveolens and P. crispum fruit extracts, holding potential for the development of plant derived products for cellulite management.

Evaluation of a retinol containing topical treatment to improve signs of neck aging

BACKGROUND

The neck region is an area that can be indicative of signs of skin aging. A novel topical product that combines multiple active ingredients including retinol, tripeptide and glaucine was formulated to specifically target neck aging correction and complement post-procedure as part of an integrated skincare regimen.

OBJECTIVES

To evaluate the efficacy of a topical neck treatment through clinical subject evaluation, in addition to ultrasound and biopsy assessment.

METHODS

Evaluation for the efficacy of this novel topical product on improving the aging signs of neck skin was performed in multiple clinical trials. The first trial focused on clinical efficacy and included clinical assessment, subject questionnaires, ultrasound imaging and digital photographs. The second trial focused on biomarker analysis through skin biopsy.

RESULTS

Data from the clinical trials showed that aging signs on the neck were significantly improved after 12 or 16 weeks of product usage. Changes were readily observed by clinical evaluators and participants. They were documented with digital photos, ultrasound images, and biomarker expression in the skin which clearly display the improvements.

CONCLUSIONS

This novel topical product is effective in treating the aging signs on the neck skin and has been shown to provide statistically significant improvement on a myriad of neck aging attributes including fine lines/wrinkles, crepiness, laxity, and texture.

Rhodophyta as Potential Sources of Photoprotectants, Antiphotoaging Compounds, and Hydrogels for Cosmeceutical Application

Seaweeds are macroscopic, multicellular, eukaryotic and photosynthetic organisms, and are a source of chemical diversity with powerful biological activities for diversified industrial applications including cosmeceuticals. Red seaweeds (Rhodophyta) are good sources of Mycosporine-like amino acids (MAA) for photoprotectant and antiphotoaging compounds. In addition, Rhodophyta are also good sources for hydrogel compounds that are used widely in the food, pharmaceutical and cosmeceutical industries as gelling agents, moisturizers or for their antiphotoaging effects. Our survey and ongoing studies revealed that the biodiversity of Indonesian Rhodophyta is rich and is a treasure trove for cosmeceutical agents including MAA and hydrogels. This study delivers valuable information for identifying potential red seaweeds in screening and searching for cosmeceutical agents.

Seaweed-Based Molecules and Their Potential Biological Activities: An Eco-Sustainable Cosmetics

Amongst the countless marine organisms, seaweeds are considered as one of the richest sources of biologically active ingredients having powerful biological activities. Seaweeds or marine macroalgae are macroscopic multicellular eukaryotic photosynthetic organisms and have the potential to produce a large number of valuable compounds, such as proteins, carbohydrates, fatty acids, amino acids, phenolic compounds, pigments, etc. Since it is a prominent source of bioactive constituents, it finds diversified industrial applications viz food and dairy, pharmaceuticals, medicinal, cosmeceutical, nutraceutical, etc. Moreover, seaweed-based cosmetic products are risen up in their demands by the consumers, as they see them as a promising alternative to synthetic cosmetics. Normally it contains purified biologically active compounds or extracts with several compounds. Several seaweed ingredients that are useful in cosmeceuticals are known to be effective alternatives with significant benefits. Many seaweeds' species demonstrated skin beneficial activities, such as antioxidant, anti-melanogenesis, antiaging, photoprotection, anti-wrinkle, moisturizer, antioxidant, anti-inflammatory, anticancer and antioxidant properties, as well as certain antimicrobial activities, such as antibacterial, antifungal and antiviral activities. This review presents applications of bioactive molecules derived from marine algae as a potential substitute for its current applications in the cosmetic industry. The biological activities of carbohydrates, proteins, phenolic compounds and pigments are discussed as safe sources of ingredients for the consumer and cosmetic industry.

Development, Characterization, and Stability Evaluation of the Anti-Cellulite Emgel Containing Herbal Extracts and Essential Oils

Recently, the herbal compress was successfully developed and applied for cellulite treatment. The aim of this study was to formulate a more convenient dosage form of herbal application from the original formula. In addition, we aimed to characterize and evaluate the stability of the developed dosage form. A gelled emulsion, or an “emgel,” incorporated with 0.1 wt% tea and coffee extracts (1:1 ratio) plus 5 wt% essential oils (mixed oil) was prepared. The caffeine content in the finished product obtained from tea and coffee extracts analyzed by HPLC was 48.1 ± 2.3 µg/g. The bio-active marker monoterpenes of mixed oil characterized by headspace GCMS were camphene 50.8 ± 1.8 µg/mg, camphor 251.0 ± 3.2 µg/mg, 3-carene 46.7 ± 1.8 µg/mg, α-citral 75.0 ± 2.1 µg/mg, β-citral 65.6 ± 1.3 µg/mg, limonene 36.8 ± 6.7 µg/mg, myrcene 53.3 ± 4.5 µg/mg, α-pinene 85.2 ± 0.6 µg/mg, β-pinene 88.4 ± 1.1 µg/mg, and terpinene-4-ol 104.3 ± 2.6 µg/mg. The stability study was carried out over a period of 3 months at 4, 25, and 50 °C. The caffeine content showed no significant changes and passed the acceptance criteria of ≥80% at all tested temperatures. However, monoterpenes showed their stability for only 2 months at 50 °C. Therefore, the shelf-life of the emgel was, consequently, calculated to be 31 months using the Q10 method. Thus, the anti-cellulite emgel was successfully formulated. The characterization methods and stability evaluation for caffeine and monoterpenes in an emgel matrix were also successfully developed and validated.

Efficacy of an Anti-Cellulite Herbal Emgel: A Randomized Clinical Trial

Cellulite describes unsightly skin overlying subcutaneous fat around thighs and buttocks of post-pubescent females. A herbal ‘emgel’ containing volatile oils and extracts of A traditional Thai herbal compress was tested in a double-blind, placebo-controlled trial with 18 women aged 20–50 year with severe cellulite. Appearance of cellulite (primary outcome), thigh circumferences, skin firmness, and cutaneous blood flow (secondary outcomes) were assessed at baseline, 2, 4, 8 and 12 weeks with a 2-week follow-up. Herbal emgel applied onto the thigh skin twice daily reduced cellulite severity scores in every time point. The score was reduced from 13.4 ± 0.3 (baseline) to 12.1 ± 0.3 (week 2) and 9.9 ± 0.6 (week 12). All secondary outcomes improved with both placebo and herbal emgels suggesting that ingredients in the base-formulation might be responsible. Querying of participants, analysis of their diaries, and physical monthly inspections found no adverse events. The herbal emgel safely improved the appearance of cellulite, while the base emgel may play a role for other endpoints. Further studies on the active constituents and their mechanism of action are needed to further explore these factors.

Dermal white adipose tissue: Much more than a metabolic, lipid-storage organ?

The role of dermal white adipose tissue (dWAT) has emerged in the biomedical science as an ancillary fat district in the derma without a defined and distinct function respect to the subcutaneous adipose tissue (sWAT). Despite some evidence describing dWAT as an immune-competent compartment, particularly engaged in wound repair, very few reports dealing with dWAT has elucidated its major modulatory role within the skin biology. Whereas an increasing bulk of evidence allows researcher to describe the main activity of sWAT, in humans dWAT is not properly a separated fat compartment and therefore scarcely considered in the scientific debate. Due to its strategic position between epidermis and sWAT, dermal fat might play a much more intriguing role than expected. This review tries to shed light on this issue, by expanding the debate about a possible role of dWAT in skin physiology.

Insights Into the Pathophysiology of Cellulite: A Review

BACKGROUND

The etiology of cellulite is unclear. Treatment of cellulite has targeted adipose tissue, dermis, and fibrous septae with varying degrees of success and durability of response.

OBJECTIVE

Results from clinical trials that target different anatomical aspects of cellulite can provide insights into the underlying pathophysiology of cellulite.

MATERIALS AND METHODS

A search of the PubMed database and ClinicalTrials.gov website was conducted to identify clinical trials that have investigated treatments for cellulite.

RESULTS

A lack of trial protocol standardization, objective means for quantification of improvement and reported cellulite severity, and short-term follow-up, as well as variation in assessment methods have made comparisons among efficacy studies challenging. However, the lack of durable efficacy and inconsistency seen in clinical results suggest that dermal or adipose tissue changes are not the primary etiologies of cellulite. Clinical studies targeting the collagen-rich fibrous septae in cellulite dimples through mechanical, surgical, or enzymatic approaches suggest that targeting fibrous septae is the strategy most likely to provide durable improvement of skin topography and the appearance of cellulite.

CONCLUSION

The etiology of cellulite has not been completely elucidated. However, there is compelling clinical evidence that fibrous septae play a central role in the pathophysiology of cellulite.

New trends for macroalgal natural products applications

There is a significant interest in the usage of algae in everyday diet because of their positive influence on the gastrointestinal system due to the presence of high amounts of dietary fibres, while the presence of ω-3 fatty acids contributes to the protection of cardiovascular system. Algal derived polysaccharides are found in the food products as stabilisers, thickening agents and emulsifiers. In the cosmetic industry, algae are used in sunscreen, anti-age, anti-cellulite, moisturising and skin whitening products. These products can be used for the development of cosmeceuticals which contain algal derived bioactive compounds and they can exert a pharmaceutical therapeutic benefit. However, these compounds also have potential for being isolated and used for development of novel drugs against diseases, such as cancer, neurodegenerative disorders, and diabetes. Present review provides information about algal compounds incorporated into various food, cosmetic or medicinal products, as well as their potential for health improvement was evaluated.

Seaweeds as Source of Bioactive Substances and Skin Care Therapy—Cosmeceuticals, Algotheraphy, and Thalassotherapy

Riverine, estuarine, and coastal populations have always used algae in the development of home remedies that were then used to treat diverse health problems. The empirical knowledge of various generations originated these applications, and their mechanism of action is, in most cases, unknown, that is, few more scientific studies would have been described beyond simple collection and ethnographic recording. Nevertheless, recent investigations, carried out with the purpose of analyzing the components and causes that alter the functioning and the balance of our organism, are already giving their first results. Water, and especially sea water is considered as essential to life on our planet. It sings all the substances necessary and conducive to the development of the living being (minerals, catalysts, vitamins, amino acids, etc.). Oceans cover over 70% of Earth, being home to up to 90% of the organisms in the planet. Many rich resources and unique environments are provided by the ocean. Additionally, bioactive compounds that multiple marine organisms have a great potential to produce can be used as nutraceuticals, pharmaceuticals, and cosmeceuticals. Both primary and secondary metabolites are produced by algae. The first ones are directly implicated in development, normal growth, or reproduction conditions to perform physiological functions. Stress conditions, like temperature changes, salinity, environmental pollutants, or UV radiation exposure cause the performance of secondary metabolites. In algae, proteins, polysaccharides, fatty acids, and amino acids are primary metabolites and phenolic compounds, pigments, vitamins, sterols, and other bioactive agents, all produced in algae tissues, are secondary metabolites. These algal active constituents have direct relevance in cosmetics.

Beneficial Effects of Marine Algae-Derived Carbohydrates for Skin Health

Marine algae are considered to be an abundant sources of bioactive compounds with cosmeceutical potential. Recently, a great deal of interest has focused on the health-promoting effects of marine bioactive compounds. Carbohydrates are the major and abundant constituent of marine algae and have been utilized in cosmetic formulations, as moisturizing and thickening agents for example. In addition, marine carbohydrates have been suggested as promising bioactive biomaterials for their various properties beneficial to skin, including antioxidant, anti-melanogenic and skin anti-aging properties. Therefore, marine algae carbohydrates have potential skin health benefits for value-added cosmeceutical applications. The present review focuses on the various biological capacities and potential skin health benefits of bioactive marine carbohydrates.

Cellulite Reduction by Modified Thai Herbal Compresses; A Randomized Double-Blind Trial

Cellulite remains an obstinate clinical and cosmetic problem. In this study, we adapted the Thai traditional noninvasive treatment formulated with 5 additional herbals to improve blood flow, edema, and lipolysis, thereby augmenting cellulite treatment. This was a double-blind, randomized placebo-controlled paired trial. Twenty-one women (20-55 years) having cellulite (grade ≥2) were treated with steamed placebo or herbal compresses randomly assigned to one or other thigh twice weekly for 8 weeks with 2 weeks washout. Cellulite reduction was assessed from standardized photographs by 3 blinded evaluators at baseline and every 2 weeks; also assessed were thigh circumferences and cutaneous skin-fold thicknesses, trial diaries, and participant feedback. After 8 weeks, herbal compress treatment reduced Nürnberger-Müller cellulite scores from 12.6 ± 2.0 to 9.9 ± 2.4 compared with 12.5 ± 2.1 to 12.1 ± 2.0 (means ± SEM) for contralateral placebo-treated thighs (P < .0001; effect size [ES] = 1.16, confidence interval [CI] = 0.48-1.83). Thigh circumferences diminished by 2.2 ± 0.9 cm (herbal) and 1.4 ± 0.7 cm (placebo) (ES = 0.96, CI = 0.30-1.61) and correspondingly skin-folds by 5.6 ± 2.2 and 2.4 ± 1.3 mm (ES = 1.72, CI = 0.99-2.45). No adverse actions were reported, and there were no dropouts, no missing data, and 100% adherence. Herbal compresses were efficacious against cellulite and thigh sizes. The herbal formula might be adapted to other delivery options, and rationally added herbals may increase effectiveness of traditional therapies and more sustainable actions.

Botanicals With Dermatologic Properties Derived From First Nations Healing: Part 2-Plants and Algae

INTRODUCTION

Plants and algae have played a central role in the treatment of skin conditions in both traditional First Nations healing and in modern dermatology. The objective of this study was to examine the evidence supporting the dermatological use of seaweed, witch hazel, bearberry, and mayapple.

METHODS

Four plants and algae used in traditional First Nations treatments of skin disease were selected based on expert recommendations. Several databases were searched to identify relevant citations without language restrictions.

RESULTS

Seaweed has potential clinical use in the treatment of acne and wrinkles and may be incorporated into biofunctional textiles. Witch hazel is an effective and well-tolerated treatment of inflammation and diaper dermatitis. Bearberry leaves contain arbutin, a skin-lightening agent that is an alternative for the treatment of hyperpigmentation. Mayapple contains podophyllotoxin, a treatment for condyloma accuminata, molluscum contagiosum, and recalcitrant palmoplantar warts.

DISCUSSION

Common plants and algae are replete with bioactive agents that may have beneficial effects on the skin. Further research will open the door to new and innovative products in the future. Limitations of this study include that the scope of our study is limited to 4 plants and algae, a small sample of the breadth of plants used by First Nations for dermatological treatments.

Cellulite: an evidence-based review

BACKGROUND

Cellulite is a multifactorial condition that is present in 80-90 % of post-pubertal women. Despite its high prevalence, it remains a major cosmetic concern for women. A wide range of products and treatments for cellulite reduction is available; however, no systematic review has been performed so far to evaluate the efficacy of the available treatment options for cellulite.

OBJECTIVE

The objective of this review is to provide a systematic evaluation of the scientific evidence of the efficacy of treatments for cellulite reduction.

METHODS

This systematic review followed the PRISMA guidelines for reporting systematic reviews and meta-analyses. Only original articles in English or German reporting data on the efficacy of cellulite treatments from in vivo human studies were considered. In total, 67 articles were analyzed for the following information: therapy, presence of a control group, randomization, blinding, sample size, description of statistical methods, results, and level of evidence.

RESULTS

Most of the evaluated studies, including laser- and light-based modalities, radiofrequency, and others had important methodological flaws; some did not use cellulite severity as an endpoint or did not provide sufficient statistical analyses. Of the 67 studies analyzed in this review, only 19 were placebo-controlled studies with randomization. Some evidence for potential benefit was only seen for acoustic wave therapy (AWT) and the 1440 nm Nd:YAG minimally invasive laser.

CONCLUSION

This article provides a systematic evaluation of the scientific evidence of the efficacy of treatment for cellulite reduction. No clear evidence of good efficacy could be identified in any of the evaluated cellulite treatments.

Cellulite treatment: a comprehensive literature review

An effective and long-term treatment of cellulite has not been well established. To our knowledge, no review has analyzed the whole range of treatments for this condition. We conducted a review of in vivo studies on humans adopting the key words "cellulite" and "treatment." The studies were included according to eligibility criteria. We performed an analysis to estimate the overall effect of cellulite treatments from clinical studies. Medline library was screened up to December 2014 to identify eligible studies. We included 73 original studies in the present review. All of them were clinical studies, in most of them, only women were recruited. Above the studies searched up, 66 tested the effectiveness of an exclusive treatment performed without the association to other procedures: 11 topical agents, 10 shock-wave therapy, 10 radio frequency, eight laser therapy, five oral therapy, four manual massage therapy, three carbon dioxide therapy, two compressive therapy, two infrared therapy, one dermabrasion, and 11 devices that use an association of multiple treatments. Seven papers tested a combination of two or more treatments. The mean difference of clinical morphologic features and ultrastructural changes between the treated group and the controlled showed significant heterogeneity between studies. It is still difficult to indicate an exclusive and effective single treatment for this condition. Our analysis purposed to obtain a complete overview of the available treatments in cellulite reduction.

An integral topical gel for cellulite reduction: results from a double-blind, randomized, placebo-controlled evaluation of efficacy

BACKGROUND

Cellulite is a serious cosmetic concern for most of the 90% of women affected by it.

OBJECTIVE

To assess the clinical efficacy of a complex integral anti-cellulite gel.

METHODS

This double-blind, randomized, placebo-controlled study involved 44 healthy women, aged 25-55 years. Subjects had a normal to slightly overweight body mass index and presented slight to moderate cellulite on their thighs, buttocks, and/or hips at baseline. Subjects were randomly assigned to either the treated or placebo group and accordingly applied the active product or placebo on their hips, stomach, buttocks, and thighs, twice daily for 3 months. Skin tonicity, orange-peel aspect, and stubborn cellulite were assessed at day 0, 28, 56, and 84. A self-evaluation questionnaire was completed by all volunteers.

RESULTS

At the end of the study, an average of 81% of the subjects applying the active product presented improvement in their cellulite condition versus 32% for the placebo group (all descriptors and sites combined). At day 84, skin tonicity, orange-peel appearance, and stubborn cellulite were improved in a significant manner (P<0.05) over placebo, on all studied areas. Skin tonicity improved on average by +41% for buttocks, +35% for hips, and +31% for thighs. Orange peel appearance was reduced on average by -25% for buttocks, -22% for hips, and -22% for thighs. Stubborn cellulite was reduced on average by -19% for buttocks, -24% for hips, and -22% for thighs. Circumference measurements decreased in a significant manner (P<0.05) over placebo, for the abdomen (average value of -1.1 cm) and thighs (average value of -0.8 cm). The product was well tolerated and perceived by the volunteers themselves as better performing than placebo on all criteria.

CONCLUSION

All results validate the efficacy of the present integral formulation to significantly reduce signs of cellulite and reshape the silhouette.

Efficacy of cosmetic products in cellulite reduction: systematic review and meta-analysis

BACKGROUND

The number of original articles investigating the efficacy of cosmetic products in cellulite reduction increased rapidly in the last decade; however, to our knowledge, no systematic review and meta-analysis has been performed so far.

OBJECTIVE

We conducted a systematic review of in vivo studies on humans adopting the PRISMA guidelines. Moreover, we used a meta-analytic approach to estimate the overall effect of cosmetic creams in cellulite treatment from controlled trials with more than 10 patients per arm, using thigh circumference reduction as the outcome measure.

METHODS

Medline and Embase were searched up to August 2012 to identify eligible studies.

RESULTS

Twenty-one original studies were included in the present systematic review. All studies were clinical trials, most of them recruited women only and 67% had an intra-patient study design. About half of the active cosmetic creams tested only contained one active ingredient among xanthenes, herbals or retinoids. The other studies tested cosmetic creams with more complex formulations and most of them included xanthenes. A total of seven controlled trials satisfied the inclusion criteria for the meta-analysis. The pooled mean difference of thigh circumference reduction between the treated and the controlled group was -0.46 cm (95% confidence intervals, CI: -0.85, -0.08), with significant heterogeneity between studies (P < 0.001).

CONCLUSION

This article provides a systematic evaluation of the scientific evidence of the efficacy of cosmetic products in cellulite reduction and supports a moderate efficacy in thigh circumference reduction.