Systematic review. – Extracorporeal Shockwave Therapy – ESWT has had a wide use in rehabilitation, and has presented positive effects in the treatment of unaesthetic affections. The objective of the present study was to search, in the literature, the mechanisms of action and the physiological aspects of shockwaves acting on the biological tissue to improve the condition of cellulite and localized fat. A systematic review of the literature was carried out in the period from September 2016 to February 2017 based on the bibliographic databases Lilacs, MedLine, PubMed and Scielo. Fifteen articles were identified in that systematic review, three of which were excluded because they did not make the complete access to the article available or the theme investigated did not encompass the objective of the study. The revision demonstrated that extracorporeal shockwaves present relevant effects on the biological tissue, which leads to the restructuring of skin properties and subcutaneous tissue, clinically improving the aspects of cellulite and localized fat.