Cellulite

Cellulite, also known as orange-peel skin, is a change in the skin surface that creates dimples and bumps, mainly on the thighs, buttocks and abdomen. It affects 80–90% of women after puberty, so it is considered an almost normal feature of female skin rather than a disease. It should not be confused with cellulitis, a bacterial skin infection that is unrelated.

What cellulite is

Cellulite appears when the fat under the skin pushes towards the surface while fibrous bands that anchor the skin to deeper layers pull it down. The result is the uneven, dimpled surface typical of orange-peel skin. In women these bands run vertically and in parallel, which lets fat bulge between them; in men they form a criss-cross network, which is why cellulite is much less common in men.

Why cellulite appears

Several factors contribute to cellulite at the same time:

• Hormones: oestrogen favours fat storage on the hips and thighs, which is why cellulite usually appears at puberty and can worsen with pregnancy or hormonal contraception.
• Genetics: the structure of the fibrous bands and fat distribution are inherited.
• Fat and weight: weight gain makes cellulite more visible, although it also appears in slim women.
• Skin laxity: with age the skin loses firmness and cellulite becomes more noticeable.
• Circulation: poor venous return and fluid retention can accentuate it.

Grades of cellulite

Cellulite is usually graded: in grade I it is only visible when the skin is pinched; in grade II it is visible when standing but not lying down; and in grade III it is visible in any position, with obvious bumps. More detailed scales, such as the Cellulite Severity Scale (CSS), are used in clinical studies.

Treatment of cellulite

No treatment removes cellulite permanently, and many advertised treatments lack solid evidence. The best-supported options are:

• Subcision: the fibrous bands that create the dimples are released with a needle or device. It gives the longest-lasting results for marked dimples.
• Energy-based devices: radiofrequency, shockwaves and laser moderately and temporarily improve skin texture; several sessions are needed.
• Body mesotherapy: micro-injections into the area; results depend heavily on the product and evidence is limited.
• Lifestyle: losing weight if overweight, strength training and looking after circulation make cellulite less visible.

Liposuction does not treat cellulite: it removes localised fat but can even make irregularities more visible. Anti-cellulite creams have at most a mild, temporary effect.

Cellulite and lipedema

Cellulite should not be confused with lipedema, a condition in which fat builds up disproportionately on the legs and arms, is painful to the touch and bruises easily. If the legs are much larger than the rest of the body and hurt, a medical assessment is advisable.