Cellulite

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What is cellulite?

Cellulite is the dimpled appearance of the skin that some people have on their hips, thighs, and buttocks. Cellulite is much more common in women than in men because of differences in the way fat cells, muscle, and connective tissue are distributed in men's and women's skin. Fat deposits that push and distort the connective tissues beneath skin cause the appearance of lumpiness, leading to the characteristic "cottage cheese" changes in the appearance of the skin. Physicians refer to cellulite as edematous fibrosclerotic panniculopathy (EFP).

Cellulite is unrelated to the condition known as cellulitis, which is a spreading bacterial infection or inflammation of the skin and tissues beneath.

What causes cellulite?

The dimpled appearance of cellulite is a normal variant -- one way that many perfectly normal human beings look. Heredity, skin thickness, gender, the amount and distribution of body fat, and age can all influence the extent to which cellulite is present or visible. Cellulite occurs due to shrinkage or shortening of the fibrous tissue cords that anchor the skin. While cellulite is more common in women than men, men also can develop cellulite. Cellulite occurs in people of all races living all around the globe. Although female hormones may play a role in contributing to this pattern of fat distribution, cellulite is not treatable by hormone therapy.

What are risk factors for cellulite?

Cellulite is more common in women than in men. Having a family history of cellulite is another risk factor. Pregnancy and an inactive lifestyle may increase the risk of developing cellulite.

Learn about ways to get rid of cellulite.

How do I get rid of the cellulite on my thighs?

Cellulite is caused by irregular patterns of connective tissue beneath the skin, and as the adipose (fatty) tissue, which forms in compartments of little honeycombs, pushes into the skin, it causes the dimpling of cellulite. It has been shown that people who have cellulite have different patterns of connective tissue than people who don't, and men tend to have this pattern much less than women. Cellulite is not directly a function of excess weight, but a genetic difference in the way adipose tissue and connective tissue form. In fact, cellulite affects people whether they are overweight or not. Biochemically, cellulite does not behave any differently than other fat, and there is no health risk from cellulite (some evidence even suggests that lower extremity fat is protective against chronic diseases like diabetes and heart disease).

What are cellulite symptoms and signs?

Cellulite causes dimpling of the skin and a lumpy appearance to the flesh. Cellulite can cause an "orange peel" appearance to the skin. It is most commonly located in the hips, buttocks, and abdomen. Sometimes it occurs in the breasts, upper arms, or belly. With mild cellulite, the dimpling is not apparent unless pinching the skin.

How do doctors diagnose and assess cellulite?

Cellulite is a cosmetic problem. The characteristic appearance of cellulite is sufficient to confirm that the condition is present. There are no diagnostic tests for cellulite.

What specialists treat cellulite?

Since cellulite is a cosmetic problem, aesthetic physicians, including plastic surgeons and some dermatologists, may offer some treatments for cellulite.

What are treatments for cellulite?

Many people dislike the appearance of cellulite and prefer to have skin as smooth as they possibly can. Therefore, there are many articles about cellulite, and many treatments exist, ranging from dietary changes to cellulite creams and mechanical treatments.

Some treatments have an effect on cellulite in medical studies. These include the following:

Acoustic wave therapy (AWT) is a treatment that studies have shown reduces the appearance of cellulite. This technique applies acoustic waves (also called sound, pressure or shockwaves) to the affected areas. Typically, multiple treatments and maintenance treatments are necessary. Lipotripsy is another term for AWT.

Laser, light, or radiofrequency therapy: The U.S. FDA has approved certain light-therapy devices that combine suction or massage with light therapy for the temporary reduction of the appearance of cellulite. TriActive is a treatment that combines a low-level laser treatment with suction and manipulation of the skin. Velasmooth/Velashape is a treatment combining laser and massage therapy. These treatments require multiple treatment sessions and maintenance treatments to sustain the improved appearance. Other systems use radiofrequency therapy in combination with massage and infrared light or radiofrequency at multiple levels simultaneously. One minimally invasive laser treatment, called Cellulaze, involves insertion of a tiny laser fiber beneath the skin.

Subcision is a procedure that involves insertion of a needle beneath the skin to break up bands of fibrous connective tissue that separate the clusters of fat cells. Health care professionals perform subcision with a device known as Cellfina. Results of the technique can last up to two years or more.

Vacuum-assisted precise tissue release is another new procedure that can help break up the tough bands of fibrous tissue that contribute to the appearance of cellulite. The doctor uses a device containing small blades to cut the tough tissue bands. Subsequently, the fat tissue moves upward to fill out and reduce the look of dimpled skin.

Other proposed treatments for cellulite have fewer studies that show their effectiveness than those described above. These include the following:

Methylxanthines: Methylxanthines are a group of chemicals that include aminophylline, caffeine, and theophylline. These chemicals are present in many cellulite creams because of their known ability to break down fat stores. However, skin creams cannot deliver the required concentration of these chemicals for the length of time required for significant fat breakdown. While studies have shown a small reduction in thigh measurements with some of these preparations, they do not promote significant loss of cellulite.

Massage treatments: Several machines are available that massage the areas affected by cellulite. These machines use rolling cylinders to gather areas of skin and massage them inside a chamber. One example of massage treatments is Endermologie, a French technique used for cellulite treatment since the mid-1990s. This technique uses an electrically powered device that suctions, pulls, and squeezes affected areas. Treatments typically last for 30-45 minutes, and 10-12 treatments are typically required before results are noticeable. While a temporary decrease in the appearance of cellulite may occur, the technique appears to redistribute fat rather than permanently alter its configuration under the skin, and studies about the effectiveness of this therapy have shown conflicting results. Individuals need regular maintenance treatments after achieving the initial effect or the cellulite will return.

Laser-assisted liposuction adds a laser treatment to the typical liposuction fat removal procedure. Studies have not yet shown whether this can be an effective cellulite treatment. Pure liposuction involves extracting fat by vacuuming it from under the skin and is not effective for cellulite. In fact, liposuction may worsen the appearance of the skin by sucking out the cushion of fat that resides just under the skin. The result is additional dimpling of the skin.

Ultrasonic liposculpting uses sounds waves to try to reduce cellulite. There is no definitive evidence to prove that this technique is effective.

Retinol creams or topical products containing 0.3% retinol may also have some effect on cellulite. Some people claim that this reduces the appearance of cellulite. Retinol can help thicken the skin, which may explain the diminished appearance of cellulite. It is necessary to apply the product for six months or longer to see an effect.

Carboxytherapy is a medical procedure in which health care professionals inject carbon dioxide (CO2) gas just beneath the skin. A small study showed this may be beneficial in treating cellulite.

Physicians do not recommend the following treatments due to lack of medical evidence for their effectiveness:

Mesotherapy: Mesotherapy is a controversial treatment for cellulite that involves injecting drugs or other substances directly into affected tissue. Often, FDA-approved medications are used off-label (meaning that the FDA approved the drugs for other conditions but not for treatment of this particular condition) in the injections. The injection cocktails often contain herbs and vitamins. Health care professionals administer many injections over multiple (typically 10 or more) sessions. Most experts feel that this treatment is unproven and risky.

Dietary supplements: Several of these products have been marketed and contain a variety of ingredients such as ginkgo biloba, sweet clover, grape-seed bioflavinoids, bladder wrack extract, oil of evening primrose, fish oil, and soy lecithin. These preparations claim to have positive effects on the body such as boosting metabolism, improving circulation, protecting against cell damage, and breaking down fats. Such claims are difficult to evaluate, as is the case with similar assertions made on behalf of many supplements and alternative therapies. Concepts such as "metabolism," "circulation," or "cell damage" cannot be easily measured on an objective basis to determine whether or not any improvement has been achieved. Additionally, because merchants sell these products as dietary supplements and not as drugs, they are not subject to the jurisdiction or regulation of the U.S. Food and Drug Administration (FDA). They are therefore exempt from meeting the scientific standards for both safety and effectiveness that apply to drugs. Furthermore, there are no valid clinical studies to support the use of these dietary supplements for the treatment of cellulite. Some dietary supplements for cellulite treatment may also pose health risks or may interact with certain prescription drugs. For example, the formulation known as Cellasene contains iodine, which many doctors warn may be harmful for those with thyroid and other conditions.

Cryolipolysis is a procedure that freezes small areas of unwanted fat. While it may reduce fat deposits, it does not reduce the appearance of cellulite.

Cellulite diets: Special "cellulite diets" claim to be effective in treating cellulite. Proponents of these diets claim that the combination of foods in the diet can reduce inflammation and improve circulation in affected areas and diminish cellulite. However, no studies published in the medical literature have supported these claims. Experts have conclude that eating a healthy diet can decrease fluid retention and improve the overall health and appearance of skin, but specific diets designed to target cellulite are of no value.

Wraps: Many salons offer herbal or other types of body wraps as treatments for cellulite. As is the case with cellulite diets, controlled studies in the medical literature have not proven the effects of wraps. While wraps may decrease fluid retention and improve the overall appearance of skin, these effects are temporary. It is also not possible to "detoxify" the body by the use of herbal or other wraps.

Tips for cellulite removal and prevention

  • Eating a healthy diet and keeping muscles toned by regular exercise are reasonable approaches to keeping the body as taut and smooth as it can be.
  • Patients should be very cautious before trying out surgical procedures, dietary supplements, or elaborate techniques of unproven value.
  • It is important to remember that the FDA has approved only certain therapies for the temporary decrease in the appearance of cellulite. To maintain any effect, it is necessary for patients to get these costly and time-consuming treatments on a regular basis.

What is the prognosis for cellulite?

Cellulite is not a medical problem and does not have adverse health consequences. Most treatments, even those that are FDA-approved, only offer a partial and temporary solution. The prognosis boils down to cosmetic opinion and treatment results.

Is it possible to prevent cellulite?

It is not always possible to prevent cellulite, but maintaining a healthy weight and getting regular exercise may help diminish the appearance of cellulite. Maintaining hydration (drinking plenty of fluids) and smoking cessation may also make cellulite less noticeable.

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Medically Reviewed on 5/16/2018
References
REFERENCES:

American Academy of Dermatology. "Cellulite treatments: What really works?" <https://www.aad.org/public/diseases/cosmetic-treatments/cellulite-treatments>.

Luebberding, S., N. Krueger, and N.S. Sadick. "Cellulite: an evidence-based review." Am J Clin Dermatol 16.4 Aug. 2015: 243-256.

Tuck, Miriam E. "Cord-Cutting Technique Smooths Cellulite for 3 Years." Medscape.com. Mar. 11, 2016. <https://www.medscape.com/viewarticle/860285>.
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