Cellulite: What It Is, Why It’s Normal, and How to Treat It

Cellulite is a common cosmetic issue affecting 90% of women and 10% of men in most industrial countries.1 And yet, so many people are desperate to get rid of it that the global cellulite treatment market is expected to rise dramatically in the next decade. The 2018 Plastic Surgery Statistics reported 5.8 million reconstructive procedures worldwide, while non-invasive treatments have taken over to fuel the market.2

What has led to our disdain for cellulite? Much of it is the aesthetic of the times and unrealistic societal perceptions of beauty. We rarely, if ever, see a model or celebrity on the front page of a magazine showing off cellulite — and when we do, it's often at the hands of critical tabloid photographers and snarky entertainment journalists.

If you lament your cellulite, rest assured that it is normal. It’s also erasable with several therapeutic options, from non-invasive therapies to surgery to laser treatment and beyond. We will detail these options below, but first, let's look at what cellulite is and what causes it.

Cellulite is a harmless condition marked by dimpled, lumpy flesh in various body areas. It forms when fatty tissue pushes through the fibers connecting the skin to the muscles. These adipose tissues give the skin its signature "cottage cheese" appearance.

Cellulite is most common in the thighs and buttocks but can also appear in the upper arms and lower abdomen. Cellulite (as well as stretch marks) in the abdominal areas are more common in women who have given birth.

Cellulite is not limited to individuals who are overweight. It can affect thin individuals as well as young girls and teenagers. However, it is most common in women beginning between the ages of 25 and 35, increasing as estrogen decreases nearing menopause.2

While the exact pathophysiology of cellulite's development is not fully understood, in a 2019 study featured in the International Journal of Women's Dermatology, Dr. Nick Sadick describes several theories on the physiological processes involved in the creation of cellulite and factors that contribute to its development, including:3

• Gender
• Genetics
• Lifestyle
• Vascular changes
• Hormonal changes
• Body structure
• Inflammatory factors

The gender disparity in cellulite distribution is because women and men store fat differently. The fat in women's thighs is stored in columns that begin to pucker out through the septae (connecting bands) as we age, creating the rippled effect of cellulite. On the other hand, men have a zig-zag septae pattern to hold this connective tissue in place, making the fatty fibers unable to push through.

In a 2019 study on women's and men's cellulite, researchers concluded that men have stronger connective tissues than women and lower overall body fat levels.4 These differences in fat storage are heavily influenced by hormones. Men with lower levels of testosterone or those undergoing hormone-suppression therapy are more likely to develop cellulite.

Women are far more likely to develop cellulite than men. This is true regardless of your muscle tone or body mass index (BMI). Cellulite is equally distributed across races and ages, but you are more likely to develop it as you age and your connective tissues get weaker.

Cellulite is also more noticeable in different skin types and color ranges, with some being imperceptible and others overt. In the 2019 study from Aesthetic Medicine, researchers determined that cellulite develops with age as our middle skin layers become thinner, making the lumps more noticeable.4

Individuals seeking to rid themselves of cellulite often do so from a perspective of gaining self-esteem. And while having a beach-perfect body feels great, there's also nothing wrong with embracing your cellulite and yourself.

Exercises aimed at firming and toning the gluteal muscles tighten the skin, reducing the appearance of cellulite, but even rigorous training won't make it go away. The cause of cellulite is partly genetic, so even thin athletes can develop it. You may reinforce the muscle structure in the body, but cellulite will often appear with age, no matter how fit you are.

However, exercise is always a healthy lifestyle choice and will contribute to your overall health, wellbeing, and self-esteem. It may not burn away cellulite, but it can reduce fat.

Topical creams with combined massage are the oldest treatments for cellulite, but it can be difficult for its ingredients to reach their target. The most evaluated topical agents are methylxanthines, including:

• Caffeine
• Theophylline
• Aminophylline

Methylxanthines hypothetically stimulate lipolysis by inhibiting an enzyme called phosphodiesterase, which allows fat cells to grow. Retinoids work by increasing dermal thickness and angiogenesis, which minimizes the appearance of cellulite.3

While some topical products can improve collagen production and tighten the skin, they are rarely effective in eliminating cellulite because the entire collagen, fat, and connective tissues need remodeling.3

You have a few effective options if you're determined to eliminate cellulite. According to doctors, the most effective method is to attack and separate the fibrous bands within the dermal plane. However, this is not a permanent solution because your body will continue to create new bands.

The solution to your cellulite issue will largely depend on the following factors, which vary significantly among treatments:

• Cost
• Expected results
• Side effects
• Complications
• Recovery time
• Size of the area being treated
• Length and number of procedure(s) involved

If problems arise, you may also want to consider factors like age, location, and access to emergency medical care. Some of the following procedures and treatments may be unavailable in your immediate area, while others are widely accessible.

Surgery

In manual subcision, your surgeon will numb the area with a topical anesthetic. A needle is inserted under the skin and fanned back and forth to release the fibrous cords. This method is effective but comes with several side effects, including:3

• Discomfort
• Pain
• Edema
• Bruising

The results of this procedure can last up to two years, but has a high cost.

Mechanical subcision

Mechanical subscision is another surgical option for cellulite removal. The Cellfina System features more precision than the traditional manual subscision as it employs a device that vacuums each dimple, making room for a thin blade to release the band. This is the only treatment the FDA has cleared, demonstrating up to five-year improvements in the appearance of cellulite in the gluteal area. However, its costs are significant. Side effects from the therapy include:3

• Bruising
• Swelling
• Pain

Laser and light treatments

In these procedures, laser and light devices emit energy to the subcutaneous plane. These devices heat the local tissue and can effectively:

• Stimulate collagen remodeling
• Increase microcirculation
• Improve the appearance of cellulite

Laser treatment is minimally invasive and does not require multiple treatments. It is also well-tolerated by patients.

Non-invasive energy therapies

Several non-invasive therapies involving radio and acoustic wave frequencies boost collagen production while tightening and thickening the skin. These procedures may also relax the fibrous bands in the dermal layer and decrease fatty tissue. The devices used may include the following:3

• VelaShape
• ZWave
• Exilis Elite
• Venus Legacy
• Endymed Body Shaper
• ThermiRF

These therapies require several sessions before you'll notice significant improvement.5

Injectable treatments

The most common injectable cellulite treatments are collagenase clostridium histolyticum and dermal implants.

Ultimately, all cellulite treatments are non-permanent and will fade over time, requiring additional work on the areas of concern. The least expensive option by far is embracing your body, dimples and all.