Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

Over 80.0% of women will develop at least some cellulite as they age, and almost all will be distressed about it. Cellulite is the dimpling appearance of the skin that most commonly appears on the buttocks and thighs, and sometimes the abdomen. While weight gain can contribute to the development of cellulite, even very thin women can have considerable amounts of cellulite too.

How does cellulite develop? Adipocyte cells store fat, and make up adipose tissue. Cellulite develops in the subcutaneous fat layer under the skin, which consists of chambers of fat separated by walls of connective tissue called septa. Fat cells become bigger as they store more fat, one of the consequences of eating a high-fat diet. Fat cells can grow to 2-3 times their original size. The bigger fat cells then start to clump together.

The septa can become weaker due to many factors, one of which is poor circulation. Capillaries deliver nutrient-rich blood to tissues, and the lymph system removes waste and toxins. Poor circulation, which can be due to many factors including lack of exercise and clogged arteries resulting from a poor diet, leads to fewer nutrients reaching the septa, and increased fluid and waste accumulation. The septa then become weaker and stiff as a result of lack of nutrients combined with toxic waste accumulation. Pressure from growing fat tissue against weaker, stiffer, and damaged septa results in bulging fat against the skin’s surface, creating the dimpled appearance women dislike and would like to be rid of. Weight gain makes things worse, since more fat is stored in deeper layers of the skin, which puts additional pressure on the subcutaneous layer where cellulite originates.

Women are more prone to develop cellulite than men due to differences in the connective tissue between the sexes. In women, connective tissue is organized in parallel structures that allow the expansion of adipose tissue into the dermis. In men, connective tissue is organized in a criss-cross pattern, which allow the fat tissue to expand laterally with little to no fat protrusion into the dermis. Men also have more dense layers of connective tissue, which lessens the risk of developing cellulite.

An additional factor is that cellulite appears to be influenced by estrogen since it is more prone to develop during the times when hormone levels fluctuate the most, during puberty, pregnancy, and menopause. Estrogen contributes to regulation of blood flow, lymph drainage, and fat storage. Excessively high estrogen levels, which result from poor diet, being overweight or obese, and other lifestyle factors, therefore can  contribute to cellulite development by increasing fat storage.[i]

Aging, by itself, does not increase the risk of cellulite, but it does increase the risk that it will be more visible. As people age, skin loses elasticity and structural integrity, which means imperfections, like cellulite, become more apparent. Connective tissue also loses structural integrity, which allows more adipose cells to protrude into the dermis, increasing the area in which cellulite is visible.[ii]

Most of the time, cellulite is a cosmetic problem, but left unchecked it can develop into full-blown edema. At this stage, the lymph system is almost completely unable to clear waste products from the interstitial areas, which can result in fibrosis, or excess tissue growth.

A Wellness Forum Health-style diet helps in several ways. Estrogen levels are lowered through several mechanisms, elimination of dairy products which contain estrogen metabolites, weight loss as fat cells produce hormones converted to estrogen in the bloodstream, and higher fiber intake, which reduces circulating estrogen by excreting it in feces.

Plant foods contain antioxidants, like vitamin C, which help to build stronger connective tissue. Diets high in plant foods also result in better circulation, which can reduce the formation of cellulite. And plant-based diets generally stop or reduce additional fat storage, which is related to cellulite.

Exercise burns stored fat, including the deeper layer of fat that puts pressure on the fat just under the skin that contributes to the appearance of cellulite, increases metabolic rate, which helps to reduce the development of fat stores;,  increases circulation and promotes weight loss, which results in shrinking of fat globules which then retract out of the dermis.[iii]  Weak muscles contribute to the uneven look of the skin associated with cellulite, which is why aggressive resistance exercise to build muscle can be helpful.[iv]

There are varying opinions about the efficacy and safety of treatments for cellulite. Liposuction is often used to reduce or eliminate cellulite, and while some people are happy with the results, some studies show that the procedure can often make things worse.[v]

Laser treatment has been shown to be effective because it breaks down the proteins which comprise connective tissue. As the tissue heals, it regains structural integrity.

Laser treatment also increases blood flow at the site.

One study including 35 women with cellulite showed that after between 8 and 16 treatments, all of the women showed positive changes in skin texture, and reduction of thigh circumference and cellulite, with some patients losing as much as two inches.[vi]  Another study which included 30 women who received a total of six laser treatments showed visible decreases in cellulite which remained at follow-up 6 months later.[vii]

Topical treatments are advertised as having positive effects and in some studies have shown decreases in cellulite or fat thickness. Common ingredients in these topical creams are methylxanthines, which stimulate lipolysis, and retinoids like vitamin A, which increase the density of the epidermis when applied to the skin for very long periods of time. Retinoids are often used in facial creams and promoted as anti-aging remedies.

Randomized controlled trials, however, do not confirm the positive effects of these topical treatments for cellulite.[viii] One of the limitations of topical treatments may be the inability of many ingredients to penetrate the skin enough to result in a positive effect.

Deep tissue massage can improve circulation, can soften stiffened and damaged connective tissue, improve lymph flow, and assist the body in removing fluid and waste accumulation that contributes to cellulite.[ix] Massage does not remove cellulite, and most of the time, the effect is temporary in the absence of dietary change, exercise and weight loss. Drinking 64 ounces of filtered water daily can assist the body in removing waste products too.

Success in reducing cellulite is based on many factors, including the amount of it that has accumulated, the length of time a woman has had cellulite, and the level of compliance with the right diet and lifestyle changes. Almost all women notice an improvement in their appearance, and for some, the problem can be eliminated entirely.

[i] Rossi A, Vergnanini A. “Cellulite: a review.” J Eur Acad Dermaol Venereol2000 Jul;14(4):251-262

[ii] Numberger F, Miller G. “So-called cellulite: an invented disease.” J Dermatol Surg Oncol 1978 Mar;4(3):221-229

[iii] Rawlings A. “Cellulite and its treatment.”Int J Cosmet Sci 2006 Jun;28(3):175-190

[iv] Rossi A, Vergnanini A. “Cellulite: a review.” J Eur Acad Dermaol Venereol2000 Jul;14(4):251-262

[v] van Vliet M, Ortiz A, Avram M, Yamauchi P. “An assessment of traditional and novel therapies for cellulite.” J Cosmet Laser Ther 2005 Mar;7(1):7-10

[vi] Sadick N, Mulholland R. “A prospective clinical study to evaluate the efficacy and safety of cellulite treatment using the combination of optical and RF energies for subcutaneous tissue heating.” J Cosmet Laser Ther 2004 Dec;6(4):187-190

[vii] Goldberg D, Fazeli A, Belin A. “Clinical, laboratory, and MRI analysis of cellulite treatment with a unipolar radiofrequency device.” Dermatol Surg 2008 Feb;34(2):204-209

[viii] Pierard-Franchimont C, Pierard g, Henry H, Vroome V, Cauwenbergh G. “A randomized, placebo-controlled trial of topical retinol in the treatment of cellulite.” Am J Clin Dermatol 2000 Nov-Dec;1(6):369-374

[ix] Rawlings A. “Cellulite and its treatment.”Int J Cosmet Sci 2006 Jun;28(3):175-190