It happens when fat deposits push through the connective tissue beneath the skin.
Common names for cellulite are orange-peel skin, cottage-cheese skin, hail damage, and the mattress phenomenon.
Cellulite can affect both men and women, but it is more common in females, due to the different distributions of fat, muscle, and connective tissue.
Between 80 and 90 percent of women may experience cellulite at some point in their lives.
Fast facts about cellulite
- Between 80 and 90 percent of women will probably experience cellulite.
- Cellulite is also known as orange-peel skin, due to its texture.
- Numerous treatments available, but the effect is mostly temporary.
- A diet low in fat, smoking cessation, and an active lifestyle may help reduce the incidence cellulite.
Causes and risk factors
Cellulite is also known as orange-peel skin due to its appearance and affects 80 to 90 percent of women.
The exact cause of cellulite is unknown, but it appears to result from an interaction between the connective tissue in the dermatological layer that lies below the surface of the skin, and the layer of fat that is just below it.
In women, the fat cells and connective tissue in this layer are arranged vertically.
If the fat cells protrude into the layer of skin, this gives the appearance of cellulite.
In men, the tissue has a criss-cross structure, which may explain why are less likely to have cellulite than women.
Some other factors appear to be linked to the chance of having cellulite.
Hormonal factors and age
One theory is that as estrogen in women decreases in the approach to menopause, blood flow to the connective tissue under the skin also decreases.
These factors combine to makes the fat deposits more visible. As the fat under the skin protrudes through weakening connective tissue, the familiar dimpling effect results.
Age also causes the skin to becomes less elastic, thinner, and more likely to sag. This increases the chance of cellulite developing.
Certain genes are required for cellulite development. Genetic factors can be linked to a person's speed of metabolism, distribution of fat under the skin, ethnicity, and circulatory levels. These can affect the chance of cellulite developing.
Dietary and lifestyle factors
Cellulite is not caused by "toxins," although a healthy lifestyle may help reduce the risk.
Exercise and diet may help reduce the appearance of cellulite.
People who eat too much fat, carbohydrates, and salt and too little fiber are likely to have greater amounts of cellulite.
It may also be more prevalent in smokers, those who do not exercise, and those who sit or stand in one position for long periods of time.
Wearing underwear with tight elastic across the buttocks can limit blood flow, and this may contribute to the formation of cellulite.
Cellulite is more prevalent in people who have excess fat, but slim and fit people can have it too. It is more likely to happen after the age of 25 years, but it can affect younger people as well, including teenagers.
Grades of cellulite
A cellulite severity scale, published in 2009, ranks the condition using three grades:
Grade 1, or mild: There is an "orange-peel" appearance, with between 1 and 4 superficial depressions, and a slightly "draped" or sagging appearance to the skin.
Grade 2, or moderate: There are between five and nine medium-depth depressions, a "cottage cheese" appearance, and the skin appears moderately draped.
Grade 3, or severe: There is a "mattress" appearance, with 10 or more deep depressions, and the skin is severely draped.
Treatment and removal
Several therapies have been suggested for removing cellulite, but none have yet been confirmed by scientific research.
Several sessions of acoustic wave therapy can help to treat cellulite.
The American Academy of Dermatology (AAD) has reviewed a number of techniques that may be successful in reducing the appearance of cellulite by breaking up the bands of connective tissue under the skin's surface.
Acoustic wave therapy uses a hand-held device to transmit sound waves. It may work, but it can take several sessions.
Laser treatment may improve the appearance of cellulite for a year or more. It involves inserting a very small laser probe under the skin.
The laser is then fired, breaking up the tissue. This can also thicken the skin by increasing collagen production. The thickened skin may reduce the appearance of the cellulite below.
Subcision involves a dermatologist putting a needle under the skin to break up the connective tissue bands. Results can last 2 years or more, say the AAD.
Vacuum-assisted precise tissue release cuts the bands using a device containing small blades. As it cuts the connective bands, the tissue underneath moves up to fill the space under the skin, removing the appearance of cellulite. This may last for 3 years, but data on its success is limited.
Carboxytherapy involves inserting carbon dioxide gas under the skin. Side effects include bruising and discomfort after the procedure, but some cellulite might disappear.
Endermologie involves a deep massage with a vacuum-like device that lifts the skin. The United States (U.S.) Food and Drug Administration (FDA) have approved it as safe, but there is little evidence that it works, say the AAD.
Ionithermie cellulite reduction treatment involves covering the affected area with a special mud or clay, then wrapping it in plastic before applying an electric current. It is not proven to be effective.
Radiotherapy aims to reduce cellulite by heating it, but any results are short-term.
Laser-assisted liposuction removes small amounts of fat, but this may make dimpling worse. Research has not yet shown that it works to reduce cellulite.
Ultrasonic liposculpting targets and destroys fat, but again, research is lacking to show that it works.
Techniques that the AAD do not recommend include cryolipolysis, which freezes fat, mesotherapy, which involves injecting a mixture of substances under the skin.
Medications and creams
Some medications and creams have been proposed because they act on fatty tissues.
Caffeine dehydrates cells, making them less visible. This needs to be applied daily.
Retinol may reduce the appearance of cellulite by thickening the skin. At least 6 months' use is needed to see results. It is important to try a patch test first, because some people have experienced adverse effects, such as a racing heart.
Some researchers have proposed using medications that can improve cell metabolism and circulation, but these have not been tested or proven effective.
Alternative or supplemental therapies include caffeine, grape seed extract, or gingko biloba. These agents have been applied topically, orally, and by injection, but none of them have proven effective.
Some people wear compression garments to reduce the appearance of cellulite. These garments try to compress arteries and increase blood and lymph flow to reduce visible cellulite.
Liposuction and dieting do not remove cellulite, because it does not affect the structure of the connective tissue.
However, reducing fat will mean having less fat to push through the tissues. Eating a healthful, balanced diet and exercising may, therefore, reduce the appearance of cellulite.
A 2015 review of a variety of studies into the effectiveness of different techniques indicated that either the procedures did not work, or the research methodology was flawed.
For this reason, any promise to get rid of cellulite should be approached with caution.