What Causes Cellulite? Treatment and Prevention

Cellulite is pockets off fat deposits that collect just below the surface of the skin. This can cause the skin to have a dimpled or lumpy appearance. The most common areas are around the hips, thighs, and buttocks.

About 90% of those assigned female at birth will have cellulite at some point in their lives, but it is rare for those assigned male at birth. Cellulite is a cosmetic or aesthetic concern for some, but it is not harmful to your health. However, there are a few studies that show a possible correlation between high levels of cellulite and a risk for some chronic diseases.

The structure of your overlying skin and the underlying connective tissue determines whether a given area is smooth or has the rippled appearance of cellulite. Even so, you do have options for preventing and treating it. Cellulite cannot be prevented, but it can be minimized.

This article reviews what cellulite is, its causes, how to improve it with treatment.- cannot removed it 100%.

What Is Cellulite?

Cellulite is deposits of fat surrounded by fibrous connective tissue that gives the skin's surface a puckered, dimpled appearance. It's most common in the thighs, hips, and buttocks.

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. That's what creates the uneven surface of cellulite.

Grades of Cellulite

Depending on the severity, cellulite 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.

Causes

While the appearance of cellulite tends to worsen as you gain weight, it can also affect those who are thin. This is because the fat itself is not the primary cause. The basic 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 that 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 (where cellulite is most common), 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:

• Pregnancy
• Nursing
• 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 becomes easier to gain weight, which worsens 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 your susceptibility to cellulite. At least some of them deal with substances that 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.

Age

When you're young, your connective tissue is supple and elastic, stretching and giving way to the skin, so everything remains smooth.

Then puberty hits, and hormones wreak havoc on the connective tissue. It becomes stiffer and less elastic, making the fibrous cords pull down your skin even more. At the same time, your fat cells tend to expand in certain areas (especially if you're female), pushing out against the skin.

Throughout adulthood, your outer layer of skin weakens, thins, and loses elasticity. Gravity takes its toll, and the skin begins to sag. The fibers continue to get tighter and stiffer. Blood vessels in your skin become more fragile. All of this makes cellulite more and more apparent.

Exacerbating 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 to Get Rid of Cellulite

Because you have some control over the factors that exacerbate cellulite, it stands to reason that the opposites of those factors can reduce cellulite's appearance.

Many of the causes and exacerbating factors have to do with four things:

• Fat stores
• Circulation
• Inflammation
• Skin and connective tissue health

Not only can lifestyle modifications help you improve those things, some modifications target a few of them at once.

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. That loose skin may make cellulite stand out even more, just as it does with loose skin from aging.

Cellulite isn't harmful (unless it causes emotional distress because of how it looks), so it shouldn't be the deciding factor as to whether you should lose or gain weight. There are a few studies that show a possible correlation between high levels of cellulite and a risk for some chronic diseases. The decision 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 your cellulite's appearance. Staying hydrated can also help alleviate water retention.

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.

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.

Not ever starting is the best way to protect your tissues (and the rest of you) from the harmful effects of tobacco. However, that doesn't help you if you already smoke. As hard as it may be, kicking the habit is always the best choice for your health.

Skin and Connective Tissue Health

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.

Your body makes collagen, but it naturally makes about 1% less yearly. 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. (The diet suggested above should contain plenty of these nutrients.)

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.

Treatment

If you're not satisfied with lifestyle modifications for getting rid of your cellulite, you do have some medical options to explore.

A lot of products and treatments are touted for cellulite. Some of them work well for some people, while others are not as effective.

Lotions and Creams

Topical (on the skin) products 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. You have to use them every day to maintain the effect.
• Retinol: Products containing 0.3% retinol may help thicken skin and smooth the appearance of cellulite. However, you're not likely to have noticeable results until after at least six months of use.

Studies indicate that these ingredients may work by stimulating circulation in the skin, promoting the breakdown of fat, and increasing collagen production.

When you start using a new topical product, be sure to test it on a small patch of skin in case you're allergic to any of the ingredients.

Supplements

Several supplements are on the market claiming to reduce cellulite. Many contain ingredients like caffeine, grape seed extract, gingko biloba, and gotu kola.

Very little research has been done in this area, and thus far, none of these supplements has been proven to reduce the appearance of cellulite.

As discussed earlier, collagen supplements do have some scientific backing as cellulite reducers.

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 is when a needle is inserted under the skin to break up tough septae and give fat cells more space to spread out, which reduces dimpling. Facts about subcision include:

• 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

Cellulite is heated with radio waves, which has the 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

• 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.

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
• Cryolipolysis
• Mesotherapy

Summary

Cellulite is fat deposits that give the skin's surface a puckered, dimpled appearance. The most common areas are around the hips, thighs, and buttocks.

Most of the contributing factors of cellulite are things you can't control, including skin structure, hormones, genetics, and age. However, weight changes, poor nutrition, dehydration, lack of muscle tone, smoking, and poor skin health are factors you have some control over and may worsen cellulite.

Exercise and eating well help you maintain a healthy weight and muscle tone. Stay hydrated by drinking plenty of water and consider collagen supplements for good skin health. One of the best lifestyle modifications you can make for skin health is to quit smoking (if you are a smoker).

If you want to reduce cellulite's appearance, you can try caffeine or retinol creams. Talk to your dermatologist or plastic surgeon about prescription creams or medical procedures such as laser therapy, massage, subcision, acoustic wave therapy, radiofrequency, and vacuum-assisted tissue release.

A Word From Verywell

Because cellulite is caused by uncontrollable factors and is so common in women, you shouldn't feel guilty about having it or consider it an indictment of your health or fitness.

At the same time, if you believe minimizing it would make you look or feel better, you should talk to your healthcare provider and figure out the safest, most likely methods to work for you given your overall health, budget, lifestyle, and treatment goals.