What to Know About Cellulite

The term "cellulite" describes pockets of fat deposits that collect just below the surface of the skin. This can cause the skin to have a dimpled or lumpy appearance.

Approximately 80% to 90% of women develop cellulite at some point after puberty, primarily around the hips, thighs, and buttocks, while less than 10% of men have cellulite.

Cellulite is not harmful to your health, but some people may find its appearance distressing. Most factors contributing to cellulite are not preventable. However, there are treatments that can improve its appearance.

This article explains what cellulite is, what causes it, and the available treatment options.

What Is Cellulite?

Cellulite consists of deposits of fat surrounded by fibrous connective tissue. It gives the skin's surface a puckered, dimpled appearance and is most common in these areas:

• Thighs
• Hips
• Buttocks
• Abdomen

There are layers of fat that store energy below the surface of the skin. Strong collagen fibers and septae (membranes) connect them to the skin. Over time, the fibers and septae stretch or break down, and the fat cells grow. The "compartments" holding the fat cells get crowded, and the fibers pull down on the skin, creating the uneven surface of cellulite.

Grades of Cellulite

Cellulite's appearance can be classified into the following groups, or grades:

• Grade 0: No dimpling when pressure is applied
• Grade 1: Dimpling when pressure is applied
• Grade 2: Visible dimpling when standing, but not when lying down
• Grade 3: Visible dimpling when standing and lying down

What Are the Causes of Cellulite?

While cellulite tends to increase with weight gain, it can also affect those who are thin. This is because the fat itself is not the primary cause. The main contributing factors of cellulite are things you can't control, including skin structure, hormones, genetics, and age.

Skin Structure

The compartments formed by those tough fibers under the skin are part of the connective tissue. These fibers are the actual cause of cellulite. The way the connective tissue is arranged varies, mainly by sex assigned at birth.

In most males, the fibers are arranged beneath the skin in a cross-hatched or diagonal manner, in a smooth and continuous pattern.

In females, they tend to run vertically and perpendicular to the skin. Because of this, they tether the skin to the underlying tissue at certain points. This creates chambers of fat cells that push up on the skin while the fibers pull it downward. It's a lot like tufted upholstery.

Males also generally have a thicker skin layer than females, which reduces the appearance of cellulite.

Hormones

Hormones are another cause of cellulite that varies by assigned gender.

Estrogen, the primary female hormone, plays a role in regulating fat. It causes fat to naturally build up in the breasts, thighs, and buttocks, especially during the reproductive years. This fat is intended as an energy source for childbearing.

You're more likely to develop cellulite when you're in a high-estrogen state, such as:

• During pregnancy
• While breastfeeding
• When using birth control pills long-term

Not only does estrogen influence fat stores, but it also helps you maintain consistent fat levels. When estrogen declines in menopause, it can lead to weight gain, which increases the likelihood of cellulite.

In addition, lower estrogen can lead to impaired circulation (blood flow) and decreased activity in the walls of some blood vessels. It also causes the skin to lose elasticity. All of these factors are believed to contribute to cellulite.

Testosterone, the primary male hormone, has the opposite effect—it burns fat. The majority of males who have cellulite have abnormally low levels of testosterone or high levels of estrogen due to medical conditions, including:

• Castration (removal of testicles)
• Hypogonadism (inadequate hormone secretion by the testicles)
• Klinefelter's syndrome (two or more X chromosomes in males)
• Estrogen therapy for prostate cancer

Genetics

Cellulite is believed to have a genetic component, and it does run in families. In fact, one of the major risk factors for cellulite is having family members who have it.

A few studies have identified genes that appear to play roles in the likelihood a person will develop cellulite. Some of these genes may influence inflammation, blood-flow regulation, estrogen receptors, and the biology of fat cells, which all are known to play roles in cellulite development.

The increased risk of cellulite posed by one of the genes appears to be heightened in smokers.

Dietary and Lifestyle Factors

Several factors can increase your risk of and exacerbate (worsen) cellulite. However, unlike the causes, you may be able to control some or all of them.

Things that can increase the appearance of cellulite include:

• Weight changes
• Poor nutrition
• Dehydration
• Lack of muscle tone
• Smoking
• Poor skin health

How Is Cellulite Treated?

Several products and procedures are touted as treatments for cellulite. Some of them work well for some people, while others are not as effective, or not effective at all.

Lotions and Creams

Topical products (applied to the skin) like creams and lotions may have some value when it comes to smoothing out the appearance of your skin, depending on their ingredients.

Ingredients believed to work include:

• Caffeine: While oral intake of caffeine isn't considered beneficial when it comes to cellulite, in topical applications caffeine can dehydrate cells and make dimpling less obvious when used regularly.
• Retinol: Products containing 0.3% retinol may help thicken skin and smooth the appearance of cellulite. However, you're not likely to see noticeable results until after at least six months of use.

When you start using a new topical product, test it on a small patch of skin first to make sure you are not allergic to any of the ingredients.

Medical Procedures

Medical procedures for cellulite are considered cosmetic, not medically necessary, which means they're often not covered by insurance.

According to the American Academy of Dermatology, the following minimally invasive procedures generally have good results that last for at least several months after a single treatment.

Massage

Vacuum-assisted mechanical massage with lymphatic drainage is a technique that may promote circulation and remove fluid build-up to temporarily improve the appearance of cellulite.

Subcision

Subcision involves a needle inserted under the skin to break up tough septae and give fat cells more space to spread out, which reduces dimpling.

• Some studies report up to 99% satisfaction.
• Results may last two years or longer.
• It's only recommended for those with grades III and IV cellulite (visible when skin is at rest).

Acoustic wave therapy

Shock wave or pulse activation therapy may smooth the appearance of cellulite by improving circulation, collagen production, and fluid drainage. Positive results have been reported after at least six weekly sessions.

Acoustic wave therapy works by administering focused shock waves and radial shock waves to the areas containing cellulite. A handheld device is applied to skin and emits these waves, which enter the subcutaneous tissue.

The waves prompt the body to promote lipolysis (the natural process of breaking down fat), increase blood flow, create new collagen, and allow for lymphatic drainage. This treatment may require seven appointments to complete.

Radiofrequency

With radiofrequency treatment, cellulite is heated with radio waves. This has a superficial and temporary effect of smoothing out bumps. The technique may also involve lasers, suction, infrared energy, and/or massage to improve results.

Laser Therapy

With a device called Cellulaze, a tiny laser fiber inserted under the skin breaks up tough septae and can thicken skin, both of which help with a smoother appearance. Results may last a year or longer.

With other brands of laser devices, results may last six months or more.

Vacuum-Assisted Precise Tissue Release

With vacuum-assisted precise tissue release, small blades are inserted to cut the septae, allowing tissues to move upward and fill out dimpled areas. A small study showed results that lasted up to three years.

Cryolipolysis: Cryolipolysis, also known by the product name CoolSculpting, is a procedure in which fat is cooled by an applicator placed on the skin to break down fat cells. One data analysis looked at more than 1,000 people who underwent cryolipolysis and found that fat in the treated areas was reduced by about 25%, on average.

Carboxytherapy: Carboxytherapy involves the injection of carbon dioxide gas underneath the skin. Carbon dioxide brings additional oxygen into the area and dilates the blood vessels where it is injected to improve the overall appearance of your skin. A small study of healthy women age 29 and older found that cellulite removal using carboxytherapy resulted in a noticeable improvement in the areas of the buttocks and thighs.

Procedures Unlikely to Work

Several other procedures have been found ineffective or are too new to be thoroughly evaluated, including:

• Laser-assisted liposuction
• Ultrasonic liposculpting
  
• Mesotherapy
  

Home Remedies for Treating Cellulite

Certain lifestyle modifications may be useful in helping improve the appearance of cellulite.

Weight Loss, Weight Gain

Neither losing nor gaining weight is a foolproof way of minimizing cellulite.

For many people, weight gain makes cellulite stand out more. It goes back to the growth of those fat cells and the possibility that they could start to bulge.

However, for some people, weight loss causes looser skin. This is especially true of rapid or extreme weight loss. Loose skin may make cellulite stand out even more, just as it does with loose skin from aging.

Since cellulite isn't harmful (unless it causes emotional distress because of how it looks), it shouldn't be the deciding factor as to whether you should lose or gain weight. However, there are a few studies that show a possible correlation between high levels of cellulite and a risk for some chronic diseases. The decision about weight should be made with your healthcare provider while considering your overall health.

Proper Nutrition

A healthy diet isn't just about weight—it can also keep your skin and connective tissues stronger and more supple.

A healthy diet focuses on:

• Vegetables
• Fruit
• Whole grains
• Healthy fats
• Lean protein

Eating this way can also lower inflammation and prevent water retention, which could also lessen cellulite's appearance. Staying hydrated can also help.

Exercise

Some studies show that aerobic exercise and endurance training such as cycling can reduce the appearance of cellulite.

Exercise helps with cellulite in a multitude of ways:

• For some people, it may help keep body fat levels lower.
• It improves circulation, which keeps skin and connective tissues healthier.
• It improves muscle tone in cellulite-prone areas, smoothing out the appearance.
  

Quitting Smoking

Smoking is harmful to connective tissue, collagen, and fibers of the skin, causing the normal aging process of stiffening and contracting to go into hyperdrive. It also prematurely ages your skin.

The best way to protect your tissues (and the rest of you) from the harmful effects of tobacco is to never start smoking. If you do, kicking the habit is the best choice for your health.

Collagen Supplementation

Healthy, supple septae (membranes) don't draw your skin and muscles together so hard that they cause the fat cells to bulge out and cause a lumpy appearance. Healthier, more youthful skin holds fatty areas tighter so cellulite doesn't show as much.

A crucial part of healthy tissues is collagen. It's one of two proteins that make up connective tissues and accounts for 75% of your skin's dry weight. Research suggests that collagen supplements can improve the appearance of skin and cellulite.

Over time, your body produces less collagen. Effects of reduced collagen include:

• Stiffer connective tissues
• Wrinkly skin
• Smaller, weaker muscles
• Joint pain from cartilage loss

To make collagen, your body uses amino acids from protein. It also needs vitamin C, zinc, and copper.

However, as you get older, or if you don't get enough of these nutrients, you may benefit from adding collagen-boosting foods or supplements to your diet. Bone broth and pork skin are two of the best dietary sources of collagen.

Other supplements on the market that claim to reduce cellulite contain ingredients like caffeine, grape seed extract, ginkgo biloba, and gotu kola. Thus far, none of these supplements has been proven to reduce the appearance of cellulite.

Summary

Cellulite is the fat deposits that give the skin's surface a puckered, dimpled appearance. It most commonly occurs around the hips, thighs, and buttocks.

Most of the contributing factors for cellulite are things you can't control, including skin structure, hormones, genetics, and age. Things you can control that may improve cellulite include eating well, exercising, maintaining a healthy weight, and avoiding smoking.