First thing to know: cellulite is totally normal, and women of all sizes and shapes have it.

If you don't have a problem with the dimpled skin on your thighs, buttocks, abdomen, or upper arms, there’s no reason to second-guess yourself. Cellulite is not a medical issue; it’s purely cosmetic, affecting 80-90% of women. Having cellulite is the norm for just about every woman (and even some men).

Though many women consider cellulite a body imperfection, it wasn’t always viewed this way. It’s been depicted in famous paintings and sculptures celebrating the female form, notes Anne Chapas, MD, founder and medical director of Union Square Laser Dermatology in New York City. But in the early 1900s, the French scorned its presence as an unattractive feature—and women began viewing it as a flaw to be banished. American magazines perpetuated the notion, Dr. Chapas tells Health.

If you’re bothered by cellulite’s orange-peel aesthetic, there are treatments for achieving a smoother look; more on that below. First, we asked dermatologists to address some of the common questions people have about cellulite.

What is cellulite?

Cellulite isn’t fat, so let’s just set aside that myth right now. Cellulite refers to the puckered appearance of skin when fatty tissue pushes through the fibrous bands, called septae, that connect skin to muscle.

These bands “pull down and tether the skin, and that’s what leads to the dimpled appearance of cellulite,” explains Deanne Mraz Robinson, MD, an assistant clinical professor of dermatology at Yale University in New Haven and dermatologist at Modern Dermatology of Connecticut in Westport.

Loss of skin thickness, which happens as we age, can contribute to the appearance of cellulite, as can loose skin and sun damage, Dr. Robinson tells Health.

What causes cellulite?

How cellulite develops is not clear, although several factors—sex, genetics, and lifestyle—are believed to be involved. A February 2019 review in the International Journal of Women’s Dermatology by Neil Sadick, MD, clinical professor of dermatology at Weill Cornell Medicine in New York City, cites possible causes ranging from vascular changes and inflammatory factors to hormonal changes and structural issues.

Dr. Chapas explains that the way females store fat differs from males.“We have fat in our thighs that’s stored in little columns, like an old mattress,” she says. “As our body ages, the fat kind of puckers out a little bit, and the skin thins, so you see more of this cottage-cheese rippling effect.”

In men, the bands that hold connective tissue in place are arranged in a “zigzag pattern,” according to a July 2012 review in the Journal of the European Academy of Dermatology and Venerology. If you do a pinch test on the thigh of a woman and a man, the female will develop peaks and valleys characteristic of a mattress, according to the review, while the male will only have “folds and furrows.”

Hormones may also have a hand in the matter. Case in point: While men typically don’t develop cellulite, guys with lower levels of male sex hormones, including those taking hormone-suppression therapy for prostate cancer, can develop it, Dr. Robinson points out.

Who is more likely to have cellulite?

Most women develop these puckered patches of skin after puberty, according to Dr. Robinson, and it doesn’t matter how much (or how little) weight they carry or how toned their muscles are. “I’ve treated many patients who were professional athletes or professional dancers,” she says. Cellulite can occur in adult women at any age, race, or BMI: “It’s not just predisposed to one particular type of woman,” she adds.

Cellulite can be more noticeable on some skin than others. Sometimes it’s barely perceptible: you would have to shine a light on it to even see it, says Dr. Chapas. Cellulite’s appearance can also be positional, she adds. You might see it when you’re standing but not when you’re lying on your stomach, for example.

Women have different reasons for wanting to get rid of their cellulite. Often it's about self-esteem—wanting to feel comfortable in tight-fitting clothing or at ease at the pool, says Dr. Robinson. But again, if you feel confident in your own skin, there’s no medical reason to seek treatment. The fibrous bands that pull on the skin are meant to be there—they’re physiologic, not pathologic.

Does working out get rid of cellulite?

Exercises that firm and tone muscles and tighten up your skin will help to reduce the appearance of cellulite, says the American Council on Exercise. On the other hand, one of the biggest misconceptions about cellulite is that it only affects people who are overweight or don’t take care of themselves, says Dr. Robinson. People think they exercise cellulite away, or if they lose weight, it’s going to be better, but “that’s not necessarily true,” she says.

Remember, cellulite is a structural issue, so losing weight may or may not help. Sometimes lax skin due to weight loss actually makes cellulite even more noticeable, adds Dr. Robinson.

Do topical treatments for cellulite work?

If only there were a lotion or cream you could apply and—voila!—your dimples would miraculously disappear. Truth is, there’s no off-the-shelf fix.

That said, products containing ingredients like caffeine and retinol, for instance, may improve the appearance of skin. Caffeine is thought to break down fat, while retinol thickens the top layer of skin. But such formulations are rarely effective on cellulite, “which requires extensive fat, collagen, and connective tissue remodeling,” per Dr. Sadick’s review.

Says Chapas:“I always explain to patients: ‘This will help. It will make it look a little bit better, but don’t expect that a cream is going to take away your cellulite.’”

How can cellulite be treated?

If you’re dead-set on doing something about cellulite, doctors say the key is to attack the fibrous bands beneath the skin. Even then, no solution is permanent. Over time, “people can have new bands that become visible,” Dr. Robinson explains.

Consult a dermatologist or cosmetic surgeon about what might work best for you. Be sure to ask about side effects, complications, recovery time, expected results, and cost. Prices can be quite steep and will vary depending on where you live, what treatment you’re having, and the size of the area being treated. You’ll also want to ask about the length of the procedure and the number of procedures you’ll need to see some improvement, according to the American Society for Dermatologic Surgery.

Surgery. Manual “subcision” is a surgical procedure that involves inserting a needle, blade, or other tool under the skin to break up those fibrous bands. The doctor might even use some of the patient’s own fat as a filler. Pain and bleeding may occur, states the Mayo Clinic, and the results can last two to three years.

Mechanical subcision. Cellfina, a minimally invasive device, automates the process via mechanical subcision. The device suctions up each dimple, making way for a thin blade to release the underlying band, explains the American Board of Cosmetic Surgery (ABCS). It’s the only treatment cleared by the US Food and Drug Administration (FDA) to demonstrate five-year improvement in the appearance of cellulite on the thighs and butt.

“It’s hard to do this type of procedure this time of year [meaning summer] if you’re planning to go out in the sun and show off your thighs or your bottom because that generally does have a lot more swelling and bruising,” says Dr. Chapas.

Laser treatment. Using a device called Cellulaze, the doctor inserts a tiny laser fiber under the skin to heat and melt fat cells and slice the fibrous bands that pull down on the skin. It can also help thicken the skin. But swelling, bruising, and hyperpigmentation may occur after treatment. Cellulaze has been shown to improve the appearance of cellulite for one year. “It’s not a device without potential side effects or downtime, and it doesn’t have a long-lasting effect,” Dr. Robinson notes.

Non-invasive energy-based therapies. This category includes devices that use radiofrequency (such as VelaShape) or acoustic wave therapy (such as ZWave) to amp up collagen production and thicken and tighten skin. These treatments may also decrease fatty tissue and relax the fibrous bands beneath the skin, notes ABCS. Radiofrequency results are short-lived, according to the American Academy of Dermatology. And acoustic wave therapy can take seven treatment sessions, on average, writes Dr. Sadick.

There are many different energy-based devices touted for the treatment of cellulite. Patients may see a temporarily improvement, says Dr. Robinson, “but unless you’re releasing the fibrous septae, you’re not meaningfully treating cellulite.”

Dermal fillers. Doctors are using injectable fillers like diluted Radiesse (calcium hydroxylapatite) or diluted Sculptra (poly-l-lactic acid) to stimulate collagen production and improve the appearance of cellulite, according to a November 2019 article in The Dermatologist.

Dr. Robinson says she often combines treatment modalities. She might use Cellfina to release dimples on a patient’s buttocks and then inject a biostimulatory filler in the thigh to help with new collagen synthesis in the area.

Qwo (collagenase clostridium histolyticum-aaes). This injectable, approved in July 2020, represents a new paradigm in the treatment of moderate to severe cellulite in female buttocks. Each doctor visit may necessitate as many as 12 Qwo per butt cheek. Treatment involves three rounds of injections spaced 21 days apart. The most common side effects are injection-site bruising and pain.

These injections are thought to work by releasing the fibrous bands that tug on the skin. Dr. Chapas, whose practice was involved in the clinical trials, said Qwo won’t be available to most patients until Spring 2021—giving you plenty of time to truly decide if your cellulite needs to go, or if you can live with it or even start viewing it as a normal body feature just about all women have.

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