What Causes Cellulite? Treatment and Prevention

Cellulite, contrary to popular belief, is not caused by fat. It's a harmless skin condition that can affect anyone, regardless of weight. About 90% of women will have cellulite at some point in their lives (usually after age 25), compared to just 10% of men.

Cellulite is a condition that affects the appearance of the skin in areas with underlying fat deposits (most noticeably on the buttocks and thighs), giving the skin a dimpled, lumpy appearance.

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.

Woman holding her leg kneeling
 Datacraft Co Ltd / Getty Images

What is Cellulite?

Below your skin—regardless of weight, body fat percentage, and fitness level—you have fat cells that store energy. Women have more than men. Over time, they grow as a result of several factors, including hormones, diet, and lifestyle.

The fat cells are inside compartments made up by strong, fibrous cords that connect your skin to your muscles. These cords are called septae. When fat cells are small, earlier in life, they generally fit well inside these compartments.

However, as the cells grow, the compartments get crowded. The septae pull down on the skin as the expanding fat cells push upward. That's what creates the uneven surface of cellulite.

Cellulite is not a medical problem, and having it doesn't mean you're unhealthy. It can cause emotional distress over how it looks, however, because of society's unrealistic standard of beauty.

Even so, many people turn to their doctors for ways to get rid of or minimize their cellulite, and many medical products and procedures have been created as a result.

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

The 4 Grades of Cellulite

Doctors categorize the severity of cellulite via several grading systems. One system uses grades one through four.

  • Grade I: No cellulite is visible but early changes have begun.
  • Grade II: No cellulite is visible when skin is at rest, but it becomes apparent when skin is compressed or muscles are contracted.
  • Grade III: Cellulite is visible when skin is at rest.
  • Grade IV: More severe cellulite is visible when skin is at rest.

Another system looks at five aspects of cellulite:

  • Number of depressions
  • Depth of depressions
  • Clinical morphology (shape and arrangement)
  • Looseness or sagginess of skin
  • Nürnberger-Müller classification grade

The Nürnberger-Müller classification grade has to do with how your skin looks at rest—either smooth, with an "orange-peel" appearance, or having nodules, bumps, and depressions in addition to an orange-peel appearance.

Each of the five aspects is given a grade between zero and three, with three being most severe, and then the total is added up.

  • 0–5 = Mild
  • 6–10 = Moderate
  • 11–15 = Severe

Doctors sometimes use imaging tests, such as ultrasound or MRI, to evaluate cellulite. However, whether the results are useful is a matter of debate in the medical community.

What Causes Cellulite?

While the appearance of cellulite tends to worsen as you gain weight, it can affect even the thinnest people. The reason for this is that while fat deposits do exacerbate the condition, fat itself is not the primary cause.

You may be able to control some exacerbating factors, but the basic causes of cellulite are things you can't control, including:

  • Skin structure
  • Hormones
  • Genetics
  • Age

Skin Structure

As mentioned above, compartments formed by those tough, fibrous septae are the actual cause of cellulite. However, the way that connective tissue is arranged varies, mainly by sex.

In most males, the septae 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, creating the chambers in which fat cells push up on the skin while the bands 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 in the rare instance that men do have it.

Hormones

Hormones are another cause of cellulite that varies by sex.

Estrogen, the primary female hormone, plays a role in regulating fat. It causes fat to naturally build up in the breasts, thighs, and buttocks (right 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

Estrogen doesn't just influence fat stores, though. It also helps you maintain consistent levels of fat. When estrogen declines in menopause, it becomes easier for women to gain weight, which then exacerbates cellulite.

In addition, lower estrogen concentrations lead to impaired circulation and decreased activity in the walls of some blood vessels. It also causes 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. Many of the 10% of men 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 with the skin so everything remains smooth.

Then puberty hits, and hormones wreak havoc on the connective tissue. It becomes stiffer and less elastic, which makes the fibrous cords pull down on 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 septae continue to get tighter and stiffer. Blood vessels in your skin become more fragile. All of this makes cellulite more and more apparent.

The True Cause of Cellulite

Cellulite is caused by the relationship between your skin, connective tissues, and the normal fat cells everyone has, plus the effects of hormones, age, genetics, and lifestyle on those structures.

Exacerbating Factors

Several factors can increase your risk of and exacerbate cellulite, and 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
  • 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 out of their container.

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. That decision should be made with your doctor 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, as well.

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

Not a lot of research has been done in this area, but some studies do 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, 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 (but, of course, that doesn't help you if you're already addicted.) 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 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 every year. Effects of reduced collagen include:

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

In order 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.

Cellulite Treatment Options

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 only effective at taking your money.

It's important to note that procedures that just remove fat often have no impact on cellulite. It takes specialized procedures to have the effect you're looking for.

The following treatment information comes from the American Academy of Dermatology and a 2017 review of medical studies on cellulite published in the journal Clinical, Cosmetic and Investigational Dermatology.

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.

Creams and Lotions

Topical 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 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.

Ingredient Warning: Aminophylline

Some people have reported anxiety or a racing heart while using topical products that contain aminophylline. Testing on small areas is recommended with these products.

If you have asthma and use an inhaler, don't use products containing this ingredient, as the combination could result in breathing problems.

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 three minimally invasive procedures, which are performed by dermatologists, are shown to have generally good results that last for at least several months after a single treatment.

Subcision

  • A needle is 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.)

Laser Treatment

  • 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.

Less Certain, Many Sessions Needed

A couple of other treatments have had some positive results in studies, but they require multiple sessions to achieve the desired results and may not be as long-lasting as the above treatments.

  • 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.
  • Carboxytherapy: Carbon dioxide gas is infused beneath the skin. Early studies suggest positive results after eight treatments, with researchers reporting improvement in the arrangement of septae and fatty tissues.

Procedures That Might Not Be Worth It

Two other treatments that might be effective but take more treatments and have shorter-lived results are:

  • Vacuum-assisted mechanical massage with lymphatic drainage: This technique may promote circulation and move out fluids to temporarily improve the appearance of cellulite.
  • 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.

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

Spa Treatments

Some spa treatments, such as endermologie and ionithermie cellulite reduction treatments, claim to reduce the appearance of cellulite. Thus far, none have had enough adequate or consistent study results to be recommended.

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 doctor and figure out the safest, most likely methods to work for you given your overall health, budget, lifestyle, and treatment goals.

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