Cellulite: why it happens and what actually helps

Cellulite is the dimpled or lumpy look of skin on the thighs, buttocks and belly. It is extremely common in women, it happens at every size and fitness level, and it is harmless. It is not a sign of poor health or of anything "building up" in your body.

Quick answer: Cellulite happens when fat pushes up toward the skin between fibrous bands under it. Creams with retinol or caffeine may give a small, slow improvement at best. Exercise that builds muscle and a stable weight can make it look smoother. Procedures that release the bands have the best evidence, but they are done by trained professionals.

What is cellulite?

Skin sits on top of a layer of fat. In that fat layer, thin bands of connective tissue (the "fibrous septae") run from the deeper tissue up toward the skin. Where fat bulges upward between these bands while the bands pull down, the surface looks dimpled. Dermatology references describe cellulite as fatty protrusions pushing into the skin's middle layer, the dermis.

In many women these bands run mostly up and down, while in men they tend to criss-cross. That is one explanation for why men get cellulite much less often. Cellulite usually shows up on the thighs, buttocks and lower belly.

Doctors sometimes describe cellulite in three grades, from smooth skin that looks "mattress-like" only when pinched, to visible dimples when standing and lying down. None of the grades is dangerous.

Why do some people have more of it?

Researchers do not fully understand the cause. Things linked to cellulite include:

• Being female. It is much more common in women.
• Genetics. If your mother or sisters have it, you are more likely to.
• Hormones. Hormone changes, including those linked to pregnancy, may play a role.
• Weight changes and body fat. Gaining or losing weight can change how visible it is, although slim and athletic women have it too.
• Age. Skin becomes thinner and looser with time, which can make dimples more visible.
• Sitting or standing for long periods. This has also been suggested as a factor.

What helps? An honest look

Creams and lotions

No cream removes cellulite. Some products may make a small difference, and a body lotion that keeps skin soft and well hydrated always makes skin look better.

Retinol. A retinoid is a vitamin A ingredient. Dermatology sources say retinol body creams may help after around 6 months of regular use, possibly by thickening skin. Retinoids can make skin more sensitive, so use sunscreen every day on treated areas (see retinoids + daily sunscreen). If you are pregnant or breastfeeding, ask your doctor before using one. Test on a small patch of skin first, because allergic reactions can happen.

Caffeine. Caffeine is a popular ingredient in "firming" body products. Its effect, if any, is small and only lasts while you keep using it every day.

Products with aminophylline. The AAD warns that aminophylline-containing cellulite creams can cause anxiety, a racing heart or breathing problems. People who use asthma inhalers should avoid them. DermNet notes there is no objective evidence that aminophylline reduces cellulite.

Herbal and "anti-cellulite" oils. Their effects are unknown, and plant ingredients can cause contact allergy. A body oil can make skin feel soft, but nothing you rub on the surface can change the bands underneath.

Procedures done by professionals

Several procedures aim to reduce cellulite more lastingly. Results and safety depend on the training and experience of the person doing them, and the AAD advises talking to a dermatologist before any cosmetic treatment. Costs vary widely and are usually not covered by insurance, because the treatments are cosmetic.

• Subcision. A doctor uses a small needle to cut the bands that pull the skin down. In one study of 232 people, almost all were satisfied, and results can last around 2 years or longer. DermNet adds that long-term results are uncertain.
• Vacuum-assisted release. A device cuts the bands. One small study found less cellulite for up to 3 years.
• Laser to release the bands. A thin laser fiber under the skin breaks the bands and may thicken skin. Results have been reported to last a year or longer, but more research is needed.
• Acoustic wave therapy. Studies show it can reduce how cellulite looks, but several sessions are needed.
• Radiofrequency. Heat-based devices give a small improvement for some people. The effect is short-lived and needs several treatments. Bruising is common.

Possible risks of any procedure include bruising, pain, swelling, infection and uneven results. Ask who will perform it, what training they have, and what happens if something goes wrong.

Popular treatments to skip or approach with caution

• Mesotherapy (injections of mixtures into the skin). The AAD does not recommend it, and DermNet notes unpredictable results, abscesses and scarring.
• Liposuction alone. It removes fat, not the bands, and is not recommended for cellulite.
• Fat-freezing. It can reduce small pockets of fat but does not remove cellulite.
• Supplements and "cleansing" teas. The AAD says there is no evidence that any supplement reduces cellulite. Cellulite is not stored waste, so diets that promise to flush it out do not work.

Everyday habits that can make it look better

• Move regularly. Include some strength work for the legs and buttocks.
• Aim for a steady weight rather than frequent large swings.
• Keep skin hydrated with a good moisturizer; dry skin makes texture look rougher.
• Use sunscreen on legs and body. Sun damage thins skin over time. See everyday sun protection.
• Consider self-tanner if you want to even out the look. It is a cosmetic effect and does not protect you from the sun.

When to see a doctor

Cellulite itself needs no medical care. See a doctor if:

• One leg becomes swollen, red, warm or painful, especially with fever. This is not cellulite. It can be an infection of the skin called cellulitis, or a blood clot, and it needs urgent care.
• The skin of your legs has sudden changes, sores that do not heal, or hard, painful lumps.
• You are thinking about a procedure and want to know whether it suits your skin and health.
• Dimpling or lumps appear in unusual places, or are limited to one side of your body.

FAQ

Does losing weight get rid of cellulite?

Not always. Weight loss helps some people, but for others, looser skin makes cellulite more visible. Building muscle can help skin look firmer.

Does drinking water reduce cellulite?

Being well hydrated is good for your health, but it does not change the structure behind cellulite.

Is cellulite a sign of being unhealthy?

No. It is a common and harmless skin feature that affects people of all sizes and fitness levels.

Does massage or dry brushing remove cellulite?

Massage may make skin look smoother for a short time, but benefits fade soon after you stop, and it cannot change the bands under the skin.

Can I treat cellulite while pregnant?

Pregnancy can change how cellulite looks. Skip retinol and ask your doctor before using other active products or procedures.

Sources

• Cellulite treatments: What really works? (American Academy of Dermatology)
• Cellulite (DermNet)
• Cellulite: Patient Selection and Combination Treatments for Optimal Results, a review (PubMed, NIH)