What Really Causes Cellulite? A Doctor Explains

Cellulite is a complex structural condition of the skin, not simply an issue of excess fat. 

It occurs when fat deposits push through the web of connective tissue beneath the skin, creating a characteristic dimpled or lumpy appearance.

This common and harmless condition affects an estimated 80% to 90% of women at some point after puberty, regardless of their body weight or fitness level.

While many factors contribute to its development, the root cause lies in the unique architecture of female skin and subcutaneous tissue.

In this comprehensive guide, we will delve into the deep science behind what causes cellulite, separate pervasive myths from medical facts, and explore the full spectrum of available treatments, from lifestyle changes to the latest medical procedures.

Read on to gain a definitive understanding of your skin.

What is Cellulite, Medically Speaking?

While commonly known by descriptive names like “orange-peel skin” or “cottage-cheese skin”, the medical community understands cellulite as a multifactorial condition involving the skin’s structure.

It is not a disease and poses no health risks, but its appearance can be a source of significant cosmetic concern for many.

Beyond “Orange Peel Skin”: A Clinical Definition

Clinically, cellulite is sometimes referred to by terms like gynoid lipodystrophy, edematofibrosclerotic panniculopathy, or dermopanniculosis deformans.

These names reflect the complex interplay of factors involved: fat (lipo), fluid retention (edema) and changes in connective tissue (fibrosclerotic).

At its core, cellulite is an architectural disruption. It involves fibrous connective cords, known as septae, that tether the skin to the underlying muscle.

The fat lies in pockets between these cords. When fat cells enlarge or the septae become rigid and pull down, the fat bulges upward, creating the visible dimples and bumps on the skin’s surface.

As fat cells increase, they push up against the skin. Tough, long connective cords pull down, creating an uneven surface.

How is Cellulite Graded? The Cellulite Severity Scale

To provide a more objective assessment, dermatologists often use a validated grading system like the Cellulite Severity Scale.

This scale evaluates several key features, with each scored from 0 (none) to 3 (severe). The total score determines the overall severity.

Feature	Grade 0 (None)	Grade 1 (Mild)	Grade 2 (Moderate)	Grade 3 (Severe)
Number of Depressions	0	1-4 superficial depressions	5-9 medium-depth depressions	10+ deep depressions
Depth of Depressions	Smooth surface	Slightly visible	Medium-depth “draped” look	Deep “mattress” look
Morphological Appearance	Smooth skin	“Orange-peel” appearance	“Cottage cheese” appearance	“Mattress” appearance
Skin Laxity / Sagging	No sagging	Slightly draped/sagging	Moderately draped/sagging	Severely draped/sagging

The sum of these scores classifies cellulite into three main grades:

• Grade 1 (Mild): Total score of 1-5.
• Grade 2 (Moderate): Total score of 6-10.
• Grade 3 (Severe): Total score of 11-15.

Why Do Women Get Cellulite More Than Men? The Anatomical Truth

The overwhelming prevalence of cellulite in women is not a coincidence, it is rooted in fundamental biological differences in skin structure, fat storage and hormonal profiles between the sexes.

While men can develop cellulite, it is far less common, affecting only about 10% of the male population, often linked to hormonal imbalances or significant weight fluctuations.

The Role of Connective Tissue (Septae): Vertical vs. Criss-Cross

The primary structural reason lies in the arrangement of the fibrous septae in the subcutaneous fat layer.

In women, these connective tissue bands are arranged vertically, like columns in a picket fence.

This structure creates chamber-like compartments that allow fat cells to bulge upwards towards the dermis when they expand, much like stuffing pushing through the buttons of a tufted mattress.

In contrast, men have a stronger, more robust network of septae arranged in a criss-cross or diagonal pattern.

This mesh-like structure provides better support, holding fat deposits more securely and preventing them from protruding to the surface, even with weight gain.

Fat Distribution and Lobule Structure

Beyond the septae, the fat lobules themselves are different.

Women tend to have larger fat lobules that are more prone to pushing into the dermis. Hormones also dictate where the body stores fat.

In women, fat is typically distributed in the thighs, hips and buttocks—the most common areas for cellulite.

This is a biological predisposition designed to support pregnancy and childbirth. Men, on the other hand, tend to accumulate fat more in the abdominal area.

The Hormonal Factor: Estrogen’s Influence

Hormones, particularly estrogen, play a pivotal role. Estrogen influences fat storage, circulation and the integrity of connective tissue.

It is believed to contribute to the breakdown of collagen, the protein that gives skin its strength and structure.

As estrogen levels fluctuate during puberty, pregnancy, and perimenopause, changes in circulation and collagen production can weaken the connective tissue framework, making the appearance of cellulite more pronounced.

Conversely, the male hormone testosterone helps burn fat and build thicker skin, providing a natural defense against cellulite formation.

What are the Underlying Causes and Risk Factors for Cellulite?

The development of cellulite is multifactorial, meaning it’s not caused by a single factor but rather a combination of predisposing and contributing elements.

Understanding these can help manage expectations and guide lifestyle choices.

Genetic Predisposition: Is Cellulite in Your DNA?

Genetics play a significant role. If your mother and grandmother had cellulite, you are more likely to develop it.

Research has begun to identify specific genes that may increase susceptibility.

For example, a study published in the Journal of the European Academy of Dermatology and Venereology identified polymorphisms in the Angiotensin I-converting enzyme (ACE) and Hypoxia-inducible factor 1A (HIF1A) genes as being associated with a higher risk of developing cellulite.

These genes are linked to factors like circulation, inflammation and how tissues respond to low oxygen levels—all of which are implicated in cellulite pathophysiology.

Hormonal Fluctuations: Beyond Just Estrogen

While estrogen is a primary player, other hormones are also involved in the cellulite production process. These include:

• Insulin: High levels of insulin, often linked to diets high in processed carbohydrates and sugar, promote lipogenesis (fat formation).
• Thyroid Hormones: An underactive thyroid can slow metabolism, leading to weight gain and fluid retention, which can worsen cellulite.
• Noradrenaline and Adrenaline (Catecholamines): These stress hormones can affect circulation and fat metabolism.
• Prolactin: This hormone, which rises during pregnancy, can also influence fat storage.

The hormonal shifts during puberty, pregnancy, and the approach to menopause are key periods when cellulite can first appear or worsen.

The Aging Process: Skin Elasticity and Collagen Loss

As we age, our skin naturally becomes thinner, loses elasticity, and is more prone to sagging.

This is due to a decrease in the production of collagen and elastin, the proteins that form the skin’s supportive scaffolding.

A thinner, less elastic “dermal envelope” provides less containment for the underlying fat layer.

This makes the existing structural irregularities of cellulite more visible, even if your body fat percentage hasn’t changed.

Lifestyle Factors: Diet, Exercise and More

While you can’t change your genes or anatomy, lifestyle factors can significantly influence the severity of cellulite.

• Diet: Diets high in fat, processed carbohydrates, and salt can lead to increased fat storage, inflammation, and fluid retention, all of which can exacerbate cellulite. A lack of fiber can also contribute.
• Sedentary Lifestyle: Lack of physical activity reduces muscle tone, which can make cellulite more apparent. Poor circulation from prolonged sitting or standing can also impair the health of the subcutaneous tissue.
• Hydration: Dehydration can make the skin look thinner and less plump, accentuating the appearance of dimples.
• Smoking: Smoking impairs blood flow to the skin, which weakens and damages collagen formation, leading to premature aging and potentially worsening cellulite.

Debunking Common Cellulite Myths: Fact vs. Fiction

The market is flooded with misinformation about cellulite. Let’s separate scientific fact from marketing fiction.

Myth 1: Only Overweight People Get Cellulite.

Fact: This is one of the biggest misconceptions. Because cellulite is a structural issue involving the connective tissue, it affects people of all shapes and sizes. While excess body fat can make cellulite more noticeable, many lean and fit individuals have it as well. It’s about skin structure, not just weight.

Myth 2: Cellulite is Caused by “Toxins”.

Fact: There is no scientific evidence to support the idea that cellulite is caused by an accumulation of “toxins” in the body. The concept of “detoxing” to cure cellulite is a marketing myth. The condition is caused by the interaction between fat and connective tissue, influenced by hormones and genetics.

Myth 3: You Can Eliminate Cellulite Completely with Exercise.

Fact: Exercise is highly beneficial, but it’s not a cure. Strength training can build muscle, creating a firmer, smoother base beneath the fat layer, and cardio can help reduce overall body fat. Both can significantly improve the *appearance* of cellulite, but they do not alter the fundamental vertical structure of the female connective tissue that causes it.

Myth 4: Liposuction is a Cure for Cellulite.

Fact: Standard liposuction is designed to remove deep fat, not address the superficial structural issues of cellulite. In fact, by removing fat unevenly, liposuction can sometimes create new depressions and make the dimpling of cellulite appear worse. Some newer, laser-assisted techniques are designed to address cellulite, but traditional liposuction is not a recommended treatment.

Can Diet and Exercise Really Help Reduce Cellulite?

While lifestyle changes cannot “cure” cellulite, they are the foundational and most accessible tools for improving its appearance.

A consistent approach combining targeted exercise and a healthy diet can yield noticeable improvements by reducing fat, building muscle, and improving overall skin health.

The Best Exercises for Cellulite Appearance

The most effective exercise strategy combines two key components:

1. Strength Training: Building muscle in the glutes, hamstrings, and thighs creates a stronger, smoother and firmer underlying layer. This “push-up” effect from the muscle can help smooth the overlying skin. Focus on compound movements.
2. Aerobic Exercise: Activities like running, cycling, or brisk walking help burn overall body fat. Reducing the size of fat cells means there is less fat to push through the connective tissue network.

Incorporate these exercises into your routine 2-3 times per week:

• Squats: A fundamental move for targeting the glutes and quads.
• Lunges: Excellent for targeting each leg individually and improving stability.
• Glute Bridges: Isolates the gluteal muscles, helping to lift and firm the buttocks.
• Deadlifts (especially Romanian Deadlifts): Fantastic for strengthening the hamstrings and glutes.

Nutritional Strategies to Support Your Skin

Your diet can either help or hinder your efforts. To support healthier skin and reduce factors that worsen cellulite, focus on:

• Hydration: Drink plenty of water throughout the day. Well-hydrated skin is plumper and can help mask the appearance of dimples.
• Increase Fiber: Eat plenty of fruits, vegetables, and whole grains. Fiber aids in digestion and helps maintain a healthy weight.
• Lean Protein: Protein is essential for building muscle and repairing tissue, including collagen. Include sources like chicken, fish, beans and lentils.
• Reduce Processed Foods: Limit your intake of foods high in sugar, unhealthy fats and sodium. These can contribute to inflammation, fat storage and fluid retention.

Do Supplements like Collagen or Grape Seed Extract Work?

The evidence for supplements is mixed and generally not as robust as for diet and exercise. Some theories suggest that certain supplements might help:

• Collagen Peptides: The idea is that ingesting collagen could help strengthen the skin’s dermal layer. Some small studies have shown modest improvements in skin elasticity and cellulite appearance after several months of use, but more research is needed.
• Grape Seed Extract & Ginkgo Biloba: These are thought to improve circulation. Since poor microcirculation is a contributing factor to cellulite, there is a theoretical benefit, but clinical evidence of a significant impact on cellulite is lacking.

Always consult your doctor before starting any new supplement regimen.

What are the Most Effective Medical Treatments for Cellulite?

For those seeking more significant and targeted results, several medical treatments have been developed to address the underlying structures of cellulite.

These procedures, performed by board-certified dermatologists or plastic surgeons, offer varying degrees of efficacy, longevity and cost.

It’s crucial to have realistic expectations, most treatments improve appearance but are not permanent cures.

Minimally Invasive Procedures: Breaking the Bands

These treatments physically disrupt the fibrous septae that pull the skin down.

• Subcision (e.g., Cellfina®): This FDA-cleared procedure uses a needle-like device inserted under the skin to precisely cut and release the tethered septae. By severing the bands causing the dimples, the skin is allowed to spring back, creating a smoother surface. According to the American Academy of Dermatology (AAD), results can last for two to three years or longer, with high patient satisfaction rates.
• Laser Treatment (e.g., Cellulaze®): This is another minimally invasive option where a tiny laser fiber is inserted beneath the skin. The laser energy works in three ways: it melts small pockets of fat, severs the fibrous septae, and heats the skin to stimulate collagen production, which can thicken the skin over time. Results can last for a year or more.
• Vacuum-Assisted Precise Tissue Release (e.g., Avéli™): This is a newer, targeted approach. A handheld device is used to hook, verify, and release individual septae responsible for dimples. This precision allows the practitioner to confirm they are cutting the correct bands. Results are seen quickly and can last for several years.

Energy-Based Devices: Heating and Sound Waves

These non-invasive treatments work from outside the body to improve skin texture.

• Acoustic Wave Therapy (AWT): This treatment uses a handheld device to deliver pressure waves to the skin. These waves are thought to break up the fibrous bands, stimulate circulation, and encourage collagen production. Multiple sessions are required to see results, which are often temporary and require maintenance.
• Radiofrequency (RF) Treatments: Devices using RF energy (sometimes combined with infrared light or massage) heat the deep layers of the skin. This heat promotes new collagen growth and can temporarily shrink fat cells. While it can improve skin texture and laxity, results are generally modest and require a series of treatments followed by regular maintenance sessions.

Injectable Treatments

Injectables offer another avenue for treating cellulite.

• Collagenase Clostridium Histolyticum (Qwo®): Note: As of early 2023, Qwo has been discontinued in the U.S. by its manufacturer. This injectable enzyme was FDA-approved to break down the collagen-rich septae. While effective for some, it was associated with significant and prolonged bruising, which ultimately led to its market withdrawal. This is an important detail demonstrating the evolving landscape of cellulite treatment.
• Biostimulators (e.g., Diluted Radiesse®, Sculptra®): This is a popular off-label use of fillers. When diluted and injected into areas with cellulite, these products act as biostimulators, triggering the body to produce its own new collagen. This process thickens the skin and creates a smoother canvas, effectively masking the dimples. A 2024 study in Aesthetic Plastic Surgery found that diluted calcium hydroxylapatite (Radiesse) was safe and effective for improving cellulite dimpling. Multiple sessions are needed, and results can last up to two years.

A Comparison Table of Top Medical Treatments

Treatment	How It Works	Efficacy / Duration	Average Cost (per session/area)	Downtime
Subcision (Cellfina®, Avéli™)	Mechanically cuts fibrous septae causing dimples.	Significant improvement; lasts 2-3+ years.	$3.000 – $6.000	2-7 days of bruising, swelling, soreness.
Laser (Cellulaze®)	Laser fiber cuts septae, melts fat, stimulates collagen.	Noticeable improvement; lasts 1+ year.	$3.500 – $7.000	1-3 days of mild swelling, bruising.
Biostimulators (Radiesse®, Sculptra®)	Injectable stimulates new collagen growth to thicken skin.	Moderate improvement; lasts 1-2 years.	$1.000 – $2.500	Minimal; some bruising or swelling possible.
Acoustic Wave Therapy (AWT)	Sound waves disrupt septae and improve circulation.	Modest, temporary improvement; requires maintenance.	$300 – $500	None.
Radiofrequency (RF)	Heats tissue to stimulate collagen and tighten skin.	Mild, temporary improvement; requires maintenance.	$400 – $800	None.

Costs are estimates and vary widely by geographic location and provider. Always consult a qualified professional for accurate pricing.

What About Topical Creams and Home Remedies?

The market for at-home cellulite solutions is vast, but it’s essential to approach these with realistic expectations.

While they won’t eliminate cellulite, some can offer temporary cosmetic improvements.

Do Cellulite Creams Actually Work?

No cream can dissolve fat or rebuild connective tissue. However, certain ingredients can temporarily improve the skin’s appearance:

• Caffeine: A common ingredient, caffeine works as a diuretic, temporarily dehydrating fat cells. This can make them appear smaller and reduce the puckering effect. It also improves blood flow. The effect is short-lived and requires daily application.
• Retinol (0.3% or higher): A derivative of Vitamin A, retinol can help thicken the epidermis (the outer layer of skin) over time. A thicker skin layer can better conceal the underlying dimples. It typically takes at least 6 months of consistent use to see any potential results.

These creams work by masking the problem, not fixing it. Their effects are temporary and cease when you stop using the product.

The Truth About Dry Brushing and Massage

Dry brushing and manual or mechanical massage are often promoted as cellulite remedies.

The theory is that these techniques stimulate lymphatic drainage and blood flow.

By helping to move stagnant fluid out of the tissues, they can temporarily reduce swelling and make the skin appear smoother and less puffy.

However, like creams, these methods do not change the underlying structure of the fat and connective tissue.

The results are fleeting but can be a pleasant part of a self-care routine.

Compression Garments: A Temporary Fix?

Compression garments, such as leggings or shorts, work by physically compressing the tissue.

This can create a smoother silhouette and may temporarily improve blood and lymph flow.

While they can reduce the visible appearance of cellulite while being worn, they offer no long-term structural change.

The Psychological Impact of Cellulite: It’s More Than Skin Deep

While medically harmless, the presence of cellulite can have a profound psychological and emotional impact.

In a society that often promotes an ideal of flawless skin, the appearance of dimples and bumps can lead to significant distress.

Body Image and Self-Esteem

For many women, cellulite is a source of self-consciousness and dissatisfaction with their bodies.

This can lead to lowered self-esteem and a negative body image.

Studies have shown that a significant percentage of women with cellulite feel embarrassed by its appearance, which can affect their confidence in social situations and intimate relationships.

Impact on Quality of Life

The concern over cellulite can influence daily life in tangible ways. It may dictate clothing choices (avoiding shorts, skirts, or swimsuits), prevent participation in activities like swimming or going to the beach and create anxiety.

Research into health-related quality of life has confirmed that cellulite can be a source of psychosocial distress, impacting overall well-being.

Shifting the Narrative: Acceptance and Empowerment

It is crucial to remember that having cellulite is a normal and incredibly common aspect of being a woman.

It is not an indicator of health, fitness, or self-worth. Shifting the focus from “getting rid of” cellulite to “improving skin health” can be an empowering change in perspective.

The decision to pursue treatment is a personal one, and it should be driven by a desire to feel more comfortable in one’s own skin, not by external pressure.

Accepting that cellulite is a normal variation of the human body is the most powerful step of all.

Frequently Asked Questions (FAQ)

1. What is the main cause of cellulite?

The main cause is structural. It’s the result of fat pushing against vertically-oriented connective tissue bands (septae) under the skin, common in women. This anatomical structure, combined with genetics and hormones, creates the dimpled appearance.

2. Can you ever get rid of cellulite permanently?

Currently, there is no treatment that can permanently eliminate cellulite. Procedures like subcision (Cellfina®, Avéli™) offer the longest-lasting results, often for three years or more, but maintenance or repeat treatments may eventually be needed.

3. Does drinking water help with cellulite?

Yes, staying well-hydrated helps improve the skin’s overall health and plumpness, which can make cellulite less noticeable. However, drinking water alone will not eliminate the underlying structural cause of cellulite.

4. Does losing weight get rid of cellulite?

Losing weight can reduce the amount of fat pushing against the connective tissue, often making cellulite less visible. However, it doesn’t change the skin’s structure, so even very lean people can have cellulite.

5. What is the best exercise to reduce cellulite?

A combination of strength training (like squats and lunges) to build muscle in the legs and glutes, and consistent aerobic exercise to burn fat, is the most effective strategy for improving the appearance of cellulite.

6. Do men get cellulite?

Yes, but it’s much rarer, affecting only about 10% of men. This is because men’s connective tissue is arranged in a stronger, criss-cross pattern that better contains fat cells, preventing them from dimpling the skin’s surface.

7. At what age does cellulite appear?

Cellulite can appear at any time after puberty, as hormonal changes begin to influence fat distribution and skin structure. It often becomes more noticeable in one’s 20s and 30s and can worsen with age as skin loses elasticity.

8. Are cellulite treatments painful?

Pain levels vary. Non-invasive treatments like RF or AWT are generally painless. Minimally invasive procedures like subcision or laser treatments are performed with local anesthesia to manage discomfort, but some post-procedure soreness and bruising are common.

Conclusion

Cellulite is a complex and common condition rooted in anatomy, genetics and hormones—not a personal failing or a sign of being unhealthy.

While its appearance is influenced by lifestyle factors like diet and exercise, its fundamental cause is the unique structure of female subcutaneous tissue. Understanding this science is the first step toward managing it effectively.

Improving the appearance of cellulite is possible through a combination of a healthy lifestyle and, for those who choose, effective medical treatments that target its underlying structure.

From building muscle and reducing fat to procedures that release fibrous bands or stimulate collagen, there are more evidence-based options available today than ever before.

If you are concerned about the appearance of your cellulite and wish to explore treatment options, the most important step is to consult a board-certified dermatologist or plastic surgeon.

They can provide an accurate diagnosis of your cellulite grade and help you create a personalized treatment plan that aligns with your goals, budget, and expectations.

What are your experiences with cellulite? Do you have questions about treatments or lifestyle changes? Share your thoughts in the comments below to join the conversation.