What Is Cellulite, Actually?

Cellulite is a condition that causes your skin to have a dimpled, lumpy, or puckered appearance. It occurs when pockets of fat push through your connective tissue and sit beneath your skin’s surface. Some people say it resembles an orange peel, or cottage cheese.

Experts don’t know the exact cause of cellulite. But, they know that the relationship between your skin, connective tissue, and fat creates the conditions for cellulite to occur. Factors such as genetics, age, and lifestyle can make it worse.

Although cellulite can worsen with weight gain, having cellulite does not mean that you are overweight.  People of all sizes and body shapes can have it. In fact, about 80-98% of people assigned female at birth have cellulite. It typically appears around the thighs, hips, and buttocks.

Cellulite is harmless, but it remains a cosmetic concern for some people. You can’t remove cellulite completely, but there are a variety of products and treatments that help reduce it. 

What Causes Cellulite? 

The exact cause for cellulite is still unknown, but researchers say it stems from the relationship between your skin, fat cells, and connective tissue.

Your skin has three layers:

• Epidermis (outer layer of skin)
• Dermis (middle layer of skin)
• Subcutaneous tissue (innermost layer of skin)

The subcutaneous layer contains fat cells held in place by a collagen fiber matrix or connective tissue. Muscle and skin are held together by the subcutaneous layer. 

Cellulite happens when fat cells break out of the collagen fiber matrix and move closer to the top layer of the skin. This gives the skin a lumpy, puckered, or dimpled look. 

The reason this happens has to do with alterations in the normal function of the subcutaneous layer and connective tissue, including:

• Fat cell overcrowding 
• Poor circulation or oxygenation 
• Fluid retention within the connective tissue
• Inflammation 
• Alteration of fat cells
• Connective tissue stiffening 

The following factors can make you more susceptible to getting cellulite or worsening it. 

Gender

Cellulite primarily affects people assigned female at birth. One theory attributes this to males having stronger connective tissue with less subcutaneous fat. Another theory associates female hormones (estrogen and progesterone) with cellulite development. 

While cellulite is rare for those assigned male at birth, it can occur. However, research shows that it occurs much more frequently in males with a condition that exposes them to female hormones. This includes Klinefelter’s syndrome, androgen deficiency, hypogonadism, and estrogen therapy for prostate cancer.

Female hormones can affect blood flow and oxygenation in the subcutaneous layer. Puberty often accelerates cellulite as these female hormones rise. 

Genetics

Having family members with cellulite increases your risk of developing cellulite too. Genes affect cellulite because they influence cells and structures that affect inflammation, hormone receptors, blood flow, and fat cell growth. 

Age

As you age, your body makes less collagen, a protein your body makes to keep your skin healthy and supple. Hormones also change with age. Both factors can cause your connective tissue to stiffen.

Aging also causes the skin to weaken, lose elasticity, sag, and become more fragile. Combined with more rigid connective tissue, these factors make it easier for fat cells to get shoved out of their compartment and push toward the skin. 

Lifestyle

Studies show that improper lifestyle habits can make cellulite worse. Examples include:

• Lack of physical activity: This weakens muscle tone and decreases the oxygenation of fat tissue. 
• Excessive alcohol intake: Alcohol can cause dehydration and improper storage of fat. 
• Smoking: Smoking exposes you to more free radicals, affecting circulation. 
• Poor nutrition: Eating excessive amounts of fats, salts, and preservatives leads to metabolic disorders that worsen cellulite.

Grades of Cellulite 

The following grades classify the severity of cellulite: 

• Grade 0: There is no change in skin or dimpling when pressure is applied to the skin
• Grade 1: You can’t see changes when lying or standing, but dimpling is present when pressure is applied to the skin
• Grade 2: The skin is smooth when lying down, but there is visible dimpling when standing
• Grade 3: Visible dimpling of the skin occurs when standing and lying down, and may involve soreness

How to Get Rid of Cellulite

Dermatology healthcare providers offer multiple treatment options to their patients with cellulite. Permanent solutions require extensive fat, collagen, and connective tissue remodeling. The most permanent and effective solutions involve combining multiple types of therapies. 

Massage

The first attempts to treat cellulite involved vigorous massage combined with a topical agent. There is now a mechanical massage treatment that uses a combination of positive and negative pressure from two rollers. 

Data shows this massaging device significantly improves the appearance of cellulite. But it’s unclear how long the results last.

Creams

Some topical formulas improve collagen production and tighten skin, but rarely actually work on cellulite. The problem with using topical treatments alone is that it’s difficult for the active ingredients to reach down to the level they need to go to have an effect. 

The most active ingredients in these topical treatments include:

• Caffeine
• Theophylline 
• Aminophylline
• Retinoids

Energy-based Devices

Energy-based devices use power from radiofrequency, acoustic waves, lasers, and light to temporarily treat cellulite. These include:

• Radiofrequency: This involves electrodes that use thermal energy and heat to remodel collagen and break down fat. The newest devices have promising results. They combine light, bipolar radiofrequency, skin suction, and massage. 
• Laser and light therapy: Laser and light devices use wavelengths to emit energy. This energy heats the surrounding tissue, stimulating collagen remodeling and increasing skin circulation. This technique is effective at improving the appearance and smoothness of the skin.
• Acoustic wave therapy: This involves pressure waves that break down fat cells, improve blood flow, assist with lymphatic drainage, and stimulate new collagen growth. It involves multiple sessions over several weeks. 

Injectables

Injectables are substances placed under the skin through a small needle. Example injectables used to treat cellulite include:

• Clostridium histolyticum (Xiaflex): This enzyme releases stiffening fibers, redistributes fat cells, and stimulates new collagen growth. This injectable can cause bad bruising.
• Calcium hydroxyapatite (CaHa): This dermal filler plumps and smooths the skin. 
• Poly-l-lactic acid microspheres: This is another type of dermal filler that can help correct scars, wrinkles, and cellulite. 

Subcision

Subcision loosens or releases fibers in the subcutaneous tissue. This gives the fat cells more room to sit in their usual pocket rather than under the outer layer of skin. There are two types of subcision, manual and vacuum-assisted. 

• Manual subcision is when a healthcare provider numbs the skin and inserts a needle under the skin. They use a fanning technique to release fiber cords. Sometimes this subcision is performed by a laser that emits heat and breaks down collagen bands under the skin. It can cause swelling, bruising, or discomfort. Some popular treatments are Cellulaze and Cellfina.
• Vacuum-assisted subcision allows more precise control. Studies show it can improve cellulite appearance for up to three years.

How to Prevent Cellulite

While you can’t entirely prevent cellulite, it helps to address lifestyle factors that worsen cellulite. These involve:

• Eating a healthy diet (decrease inflammation, prevent water retention, keep skin and connective tissues healthy)
• Exercising (improves circulation, increases muscle tone)
• Stop smoking (smoking ages your skin)
• Decreasing alcohol intake (alcohol dehydrates the skin)
• Hydration (drinking plenty of water reduces water retention)