Cellulite, also known as orange peel or cottage cheese-like appearance of the skin, is a multifactorial condition characterized by collections of fat pushing against the connective tissue beneath your skin. Cellulite is one of the most common lipodystrophy syndromes (uneven fat distribution), affecting 80%-98% of post-adolescent women. It is commonly seen on the thighs, stomach, and buttocks, and is regarded as one of the most bothersome cosmetic flaws. Cellulite is different from generalized obesity because, with obesity, muscle mass increases throughout the body and results in an overall increase in size. On the other hand, cellulite is characterized by large, metabolically stable fat deposits that are limited to lower body areas (e.g., pelvis, thighs, and abdomen).

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What is Cellulite?

Cellulite, also called orange peel or cottage cheese-like skin, refers to the appearance of dimpled or lumpy skin, often on the thighs, hips, and buttocks. (It is worth mentioning that cellulite must not be confused with cellulitis, a bacterial skin infection affecting the deeper layers of the skin and subcutaneous tissues).

The indication for cellulite is distinct, with the skin appearance changing to a surface that resembles an orange peel. It is caused by the way that fat cells and connective tissue are arranged in these areas, and it is more common in women than in men. This condition is found in 80-90% of postpubertal women. Cellulite is a multifactorial concern caused by age, sex, genes, and/or hormones.

The exact cause of cellulite is not known. However, there is no doubt that an improper lifestyle is an accelerator of the cellulite problem. Excessive intake of food products rich in fats, with a high salt and preservative content, has been associated with the development of various metabolic disorders, which can increase lipodystrophy. A sedentary lifestyle plays a similar role. Lack of physical activity increases the severity of cellulite by weakening the muscle layer of the blood vessels. Alcohol consumption indirectly causes cellulite formation by causing dehydration and excessive and improper fat storage. 

Despite multiple medicinal approaches that attempt to treat cellulite, no procedures have been proven successful in the long term. Topical agents, injectable treatments, and energy-based devices can reduce the appearance of cellulite, sometimes to a great extent, but never uproot the problem because this involves extensive tissue remodeling.

Common Types of Cellulite

Cellulite is a multifactorial ailment characterized by large, metabolically stable fat deposits that are limited to lower body areas, e.g., the pelvis, thighs, and abdomen. There are different types of cellulite depending on their underlying causes and characteristics. Common types of cellulite are:

  • Soft cellulite

    Soft cellulite, sometimes referred to as flaccid or loose cellulite, is common among women aged 30-40 and is characterized by sagging, wavy, or jelly-like skin. Soft cellulite is easier to pinch and has a less firm texture. It is often caused by an excess accumulation of fat beneath the skin, which can be due to various factors such as genetics, hormonal changes, or a sedentary lifestyle. 

    Soft cellulite is most commonly found in areas such as the buttocks, thighs, and hips. Regular exercise and a healthy diet can help to reduce the appearance of soft cellulite. More invasive treatments, such as liposuction or radiofrequency, may be necessary for those who want more significant results.

  • Hard cellulite

    Hard cellulite, also called compact cellulite, is a type of cellulite characterized by a firm, compact texture that is difficult to move or pinch. It is caused by an accumulation of fibrous tissue beneath the skin, which can lead to a dimpled, orange-peel appearance. Hard cellulite is typically found in areas such as the thighs, buttocks, and hips. 

    Hard cellulite can be more challenging to treat than other types of cellulite. Exercise and a healthy diet may reduce the appearance of hard cellulite. However, more aggressive treatments such as massage or laser therapy may be necessary to achieve significant improvements.

  • Edematous cellulite

    Edematous cellulite is a type of cellulite caused by excess fluid retention in the body. It is characterized by a swollen, puffy appearance and a soft texture that is easy to pinch. Edematous cellulite is most commonly found in the legs and ankles. Factors such as poor circulation, hormonal changes, or a sedentary lifestyle can cause it. In addition to causing cosmetic concerns, edematous cellulite can also be associated with discomfort and swelling in the affected areas. Treatment options for edematous cellulite may include massage, lymphatic drainage therapy, compression stockings, and lifestyle modifications such as exercise and a healthy diet.

What Causes Cellulite

It is difficult to pinpoint the exact cause of cellulite. Many factors are involved in and affect it, and many processes occur simultaneously and sequentially.

Cellulite is formed when fibrous bands connecting your skin to the underlying muscle do not tighten regularly. This irregular tightening pulls down on your skin, and the normal layer of fat beneath the skin protrudes upward. It results in a puckering appearance of the skin.

Another theory suggests that higher amounts of the hormone estrogen may cause cellulite. Cellulite often develops when more estrogen is produced in women, typically during adolescence or pregnancy.

  • Genetics

    Research has found that cellulite runs in the family. It shows that genetics might be the most significant factor in causing cellulite. Certain genes may be associated with an increased risk of developing cellulite. For example, genes involved in regulating collagen, the protein that gives skin its structure, may be linked to cellulite development. Other genes that influence fat distribution and metabolism may also be involved. There is a genetic test that can detect a specific gene variant that causes the development of moderate to severe cellulite. However, the cost of this test is excessively high. Nonetheless, it confirms what most women are already aware of - if their mothers and grandmothers had cellulite, then it's probable that they will have it as well.

  • Hormonal changes

    In some cases, hormonal imbalance can contribute to weight gain, water retention, and the development of cellulite. Mostly estrogens are the hormones responsible for developing cellulite, as they are responsible for arranging the fatty tissue. In women, fatty tissue production is independent of the amount of food eaten.

  • Lifestyle factors

    Lifestyle factors, such as a sedentary lifestyle, unhealthy diet, smoking, and stress, may contribute to the development of cellulite. A diet consisting of too much fat, salt, and carbohydrates and a fiber-deficient diet can increase the chances of cellulite production. An inactive lifestyle with no exercising or not frequently moving around can increase the risk of cellulite. Gaining weight due to malnutrition or inactivity can worsen cellulite development.

  • Structural changes in the skin

    Structural changes in the skin are considered a critical factor in the development of cellulite. Specifically, changes in the connective tissue that lies beneath the skin and alterations in the fat cells themselves can lead to the characteristic dimpled appearance of cellulite.

Procedures That Remedy Cellulite

Understanding the causes of cellulite is crucial in developing targeted approaches. A plethora of options is available to dermatologists to offer to their patients with cellulite. Topical agents, energy-based devices, subcision, injectable biologic medications, and, more recently, dermal fillers have all been used to treat cellulite safely and effectively.

  • Laser treatment

    Depending on their wavelength, laser and light devices emit energy to the dermis/subcutaneous plane; by heating the local tissue, they can stimulate collagen remodeling, improving cellulite's appearance. The impact of these devices is not very substantial in fat destruction. However, they can improve the appearance of the skin and smooth the surface.

    Typically, more than one treatment is required followed by multiple sessions to sustain the results. In addition to the clinical improvement of cellulite, there is a high satisfaction rate and minimal adverse effects.

    Find doctors who offer Laser Skin Resurfacing
  • Subcision

    Subcision is a minimally invasive surgical technique used to treat the appearance of cellulite and other types of scars. It involves the insertion of a small, specialized needle beneath the skin, which is used to cut through fibrous bands or connective tissue that are pulling the skin downwards and causing the appearance of dimples or depressions. Although efficacious, the main disadvantages of this treatment are the side effects, including edema, discomfort, pain, and bruising.

  • Carboxytherapy

    Carboxytherapy is a treatment that involves the injection of carbon dioxide gas into the skin or subcutaneous tissue. This technique improves the appearance of various skin conditions, including cellulite. 

    During the procedure, a small needle injects a controlled amount of carbon dioxide into the affected area. The gas is thought to increase blood flow to the area, stimulate collagen production, and increase fat cell breakdown.

    Find doctors who offer Carboxytherapy

Frequently Asked Questions

How long cellulite treatments take to show results depends on multiple factors, such as the severity of the problem, the patient's health record, and the treatment method employed. For example, the results of subcision for cellulite may take several weeks to become noticeable. Some individuals may see improvements in the cellulite immediately after the procedure, while others may experience gradual improvements over time as the skin heals. Similarly, cellulite laser treatment is not a one-time "quick fix" and requires ongoing maintenance to sustain the results.

Various cellulite treatment options are available, and each treatment may have its own risks and side effects. The followings are some standard cellulite treatment options and their associated risk factors and side effects:

Topical creams: Topical creams, such as those containing caffeine or retinol, may cause skin irritation, redness, and itching.

Laser treatment: Laser treatment may cause skin irritation, redness, and bruising. In rare cases, it may cause skin burns or scarring.

Radiofrequency therapy: Radiofrequency therapy may cause temporary redness, swelling, and itching.

... Show more.

Cellulite is more common in women than men due to differences in skin structure and underlying fat. Women tend to have thinner skin than men, and the connective tissue between the skin and muscle is arranged in a way that allows fat to push through and create a dimpled appearance. In addition, women tend to have more body fat than men, often distributed in areas where cellulite is most likely to occur, such as the thighs and buttocks.

Hormones may also play a role in the development of cellulite. Estrogen, for example, can contribute to the weakening of connective tissue and the enlargement of fat cells, making cellulite more visible.

Cellulite can affect different areas of the body. However, it is most commonly found in areas with a higher concentration of body fat, such as the thighs, buttocks, hips, and abdomen. These areas tend to be more prone to developing cellulite due to the structure of the skin and underlying fat.

In women, cellulite is most commonly found in the thighs and buttocks. However, it can also occur in other areas, such as the arms, breasts, and abdomen. In men, cellulite is less common, but it is typically found in the abdominal region and around the waist when it develops.

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