Cellulite is a common occurrence in the majority of women. Men can also have cellulite. It is not dangerous or wrong to have cellulite. This is of course at odds with modern day marketing and society. We are going to run through what cellulite is, if you can reduce it and why you should worry about it at all.

Definition

Definitions of cellulite range vary in the literature, both in their accuracy and their misogyny. Rawlings defines cellulite as an “aesthetically unacceptable cosmetic problem for most post-adolescent women”^[1]. This manages to be demeaning, misogynistic and inaccurate (the holy trinity of patriarchal statements). “Acceptable” is subjective (I would love to see this Scale for Acceptability of the Human Body pls). It is also a condition not limited to females, which a lot of the literature seems to omit.

Khan et al.^[2] provide a more objective definition. They define cellulite as an “architectural disorder of human adipose tissue”. Translation: atypical appearance of your body fat. It is characterised by padded, nodular appearance of skin in certain areas. You may have heard it referred to as “orange peel” or “cottage cheese” appearance. Cellulite is not dangerous or harmful.

Cellulite typically affects the back of the arms, glutes and thigh.

Pathophysiology/Causes

The exact cause and mechanism of cellulite is unknown. Cellulite is estimated to occur in up to 98% of post-pubertal women^[3]. It is far less common in men, but can still occur.

Female Predisposition to Cellulite

A number of different hypotheses have been suggested to explain its prevalence amongst females. These are hypotheses and not absolutes!!

#1: Differences in Sex Hormones

Oestrogen has been suggested as a proposed driver of increased cellulite. It has been hypothesised that oestrogen is responsible for the inter-gender differences in anatomy of the skin and subcutaneous tissue^[4]. Oestrogen is far higher in females than males, and may explain this.

#2: Female Skin Anatomy

One cadaver study concluded that cellulite is caused by weakened dermal tissue (skin cells). This weakness allows adipose to peer through in some areas, creating that “dimpled” effect on skin^[5]. Furthermore, females have less septal connections between fascia and dermis^[6]. This may indicate a further space for adipose protrusion. It is important to note this study only sampled the gluteal area. However, the glutes are an area highly susceptible to cellulite.

 There you have it girlos, its your weak lady skin that means you’re undesirable!

#3: Body Fat Percentage

Cellulite is more common in the overweight and at higher body fat percentages^[6]. Females naturally have a higher body fat percentage than males. Therefore, we are predisposed to developing cellulite. It also makes the reasoning behind fatphobic marketing of cellulite products more apparent. The leaner you are, the less likely you are to develop cellulite and have it show on you visually.

So, the causes of cellulite largely cannot be prevented. Sure, by maintaining a leaner physique you will be less likely to get it. But if you are a female, and any of the aforementioned hypotheses are accurate, your naturally higher oestrogen and body fat mean there’s nothing you can do to fight it anyway.

Something we cannot control makes us undesirable? Thanks patriarchy! *shakes fist*

Cellulite & Quality of Life

Physically, cellulite does not negatively impact the body. However, it can still affect your quality of life. In a world that places increasing worth on the physical, and the “ideal” body type, having cellulite can affect your body image and subsequently your mental health.

Indeed, the presence of cellulite is shown to affect people’s eating habits, clothing choices, self-esteem, sex life and social life^[7]. Indeed, the degree to which people are affected can be fully assessed using the Cellulite Quality of Life Questionnaire, linked here.

Reducing Cellulite

Cellulite is pretty much unavoidable for us gals, and now it’s coming for our quality of life. Oh hell no. So, it makes sense that a lot of us want to reduce it. Again, that is entirely your choice. It’s not going to kill you, but if you feel more confident with less cellulite, go for it sis.

Not all methods are created equal, and we’re going to run through a few methods and what the science says. Spoiler: it’s not great.

#1: Topical Creams/Massage/Scrubs

Topical (applied to the surface, in this case the skin) creams are commonly marketed treatments for cellulite. You may have heard of a few (Brazilian Bum Bum Cream being the most popular!). A challenge with topical cream/scrubs is that they are applied externally, and it is difficult for the active ingredients to reach their targeted areas^[8].

Creams typically contain methylxanthines or retinoids. Methylxanthines stimulate lipolysis (fat breakdown), and it is hypothesised this reduces cellulite in the targeted area. Retinoids increase dermal thickness and angiogenesis (new blood vessel formation). These creams have been proven effective at increasing collagen production and tightening skin^[8]. However, they are largely ineffective at reducing cellulite.

#2: Therapeutic Energy Treatments

A host of treatments and therapies that use various forms of energy have been developed.

Radiofrequency devices deliver heat to the skin via electrodes. This localised increase in tissue temperature stimulates lipolysis and collagen denaturation^[8]. This treatment is has shown some promising effects in reducing cellulite^[9].

Laser/light devices also act to heat the skin. They can smooth the skin surface, but do not offer substantial cellulite reduction^[8].

Acoustic therapy is also used to promote lipolysis. It can be slightly painful, and requires several sessions.

#3: Hook It to My Veins: Injections

Injectable treatments such as colleagenase enzymes have been used to stimulate collagen production. However, this is poorly evaluated in literature for effectiveness^[8]. Dermal fillers are also used to smoothen the surface of the skin^[8]. They do not treat cellulite, but can reduce its appearance.

#4: Leggings

What in the patriarchy is this? You may have seen “anti-cellulite leggings” on Instagram, that claim to reduce cellulite. It is highly important to note that at most these leggings can reduce the appearance of cellulite, but not “reduce” it. I know we love a tight legging, and indeed some people like them up their hole. But unless they are REALLY up your hole there’s no possible way they can interfere with your skin’s architecture. Studies have shown that compression/anti-cellulite clothing does not affect cellulite^[10].

#5: Exfoliation/Dry Brushing

This is not well-supported by literature. There are plenty of patents on Google Scholar to suggest that by using methods such as a loofah or a scrub to stimulate blood flow to the affected area, cellulite will be removed (https://patents.google.com/patent/US20090198198A1/en). This is not verified in literature, and therefore at best we can say it may reduce the appearance.

Conclusion

Most of us have cellulite. There’s very little we can do to predispose ourselves to developing it. However, it still remains a source of body image concern for a good proportion of the population. Should you decide to get it reduced, there are a number of options available to you, but they are not all effective.

References

1. Rawlings, A.V. (2006) ‘Cellulite and its treatment’, International Journal of Cosmetic Science, 28(3), pp. 175-190. Available at: https://pubmed.ncbi.nlm.nih.gov/18489274/ (Accessed 19 December 2020).
2. Khan, M.H., Victor, F., Rao, B., Sadick, N.S. (2010) ‘Treatment of cellulite: Part I. Pathophysiology’, International Journal of the American Academy of Dermatology, 62(3), p. 361-370. Available at: https://www.sciencedirect.com/science/article/pii/S0190962209014492 (Accessed 19 December 2020).
3. Avram, M.M. (2004) ‘Cellulite: a review of it’s physiology and treatment’, Journal of Cosmetic and Laser Therapy, 6(4), p. 181-185. Available at: https://pubmed.ncbi.nlm.nih.gov/16020201/ (Accessed 19 December 2020).
4. Rossi, A.B., Verganini, A.L. (2000) ‘Cellulite: a review’, Journal of European Dermatology and Venereology, 14(4), pp. 251-262. Available at: https://pubmed.ncbi.nlm.nih.gov/11204512/ (Accessed 19 December 2020).
5. Nurnberger, F., Muller, G. (1978) ‘So-called cellulite: an invented disease’, Journal of Dermatologic Surgery and Oncology, 4(3), pp. 221-229. Available at: https://pubmed.ncbi.nlm.nih.gov/632386/ (Accessed 19 December 2020).
6. Rudolph, C., Hladick, C., Hamade, H., Frank, K., Kaminer, M.S., Hexsel, D., Gotkin, R.H., Sadick, N.S., Green, J.B., Cotofana, S. (2019) ‘Structural Gender Dimorphism and the Biomechanics of the Gluteal Subcutaneous Tissue: Implications for the Pathophysiology of Cellulite’, Plastic Reconstructive Surgery, 143(4), pp. 1077-1086. Available at: https://pubmed.ncbi.nlm.nih.gov/30730492/ (Accessed 19 December 2020).
7. Hexel, D., Blessman-Weber, M., Taboda, M.L., DalForno, T., Zechmeister-Prado, D. (2011) ‘Cellulite and Quality of Life’, Surgical & Cosmetic Dermatology, 3(2), pp. 96-101. Available at: https://www.researchgate.net/publication/287450069_CelluqolR_-_a_quality_of_life_measurement_for_patients_with_cellulite (Accessed 19 December 2020).
8. Sadick, N. (2019) ‘Treatment for cellulite’, International Journal of Women’s Dermatology, 5(1), pp. 68-72. Available at: https://www.sciencedirect.com/science/article/pii/S2352647518300418 (Accessed 19 December 2020).
9. Wanitphakdeedcha, R., Sathaworawong, A., Manuskiatti, W., Sadick, N.S. (2017) ‘Efficacy of multipolar radiofrequency with pulsed magnetic field therapy for the treatment of abdominal cellulite’, Journal of Cosmetic and Laser Therapy, 19(4). Available at: https://www.tandfonline.com/doi/abs/10.1080/14764172.2017.1279332 (Accessed 19 December 2020).
10. Sharman, H., Smith, V., Whitley, M.S. (2015) ‘Cellulite: does wearing compression hosiery work?’, PMFA Journal, 3(1). Available at: https://www.thepmfajournal.com/media/2755/pmfaon15-cellulite-sharman-smith-whitely.pdf (Accessed 19 December 2020).