Let's clear this up: Cellulite is natural and normal. But what is happening inside the skin and why? Here, everything you need to know.

By By Stephanie Dolgoff and Jessica Matthews
Photo: Pavlovska Yevheniia / Shutterstock

What Is Cellulite, Exactly?

Cellulite is the result of subcutaneous fat-the kind beneath the skin-protruding into the dermis, the layer of skin just below the epidermis (the outermost layer). Within the dermis is a network of connective tissue that looks like honeycomb. As fat cells increase in size, the connective tissue within this layer become weakened and fat bulges through, giving the skin a dimpled appearance, says Len Kravitz, Ph.D., an exercise science researcher at the University of New Mexico in Albuquerque.

Your amount of body fat, distribution of fat (which is influenced by genetics), skin thickness, and the strength of your connective fibers all factor into if you get cellulite. And thank hormones for sparing guys but giving most women this condition. According to a study in the Journal of Cosmetic and Laser Therapy, nearly 85 percent of women over the age of 20 have cellulite while, according to the American Society for Aesthetic Plastic Surgery, only about 10 percent of men have it. Guys have thicker layers of skin, so it's harder for fat to push through to the dermis.

Starting around age 25, women who do not regularly exercise lose an average of 5 pounds of muscle per decade and gain 15 pounds of fat, says Wayne Westcott, Ph.D., author of the book No More Cellulite: A Proven 8-Week Program for a Firmer, Fitter Body. Throw in the fact that collagen stores decrease by about 1 percent per year and that females naturally have a higher body fat percentage than men, and it's no surprise that as women get older, cellulite becomes more prominent. (Related:5 Cellulite Myths to Stop Believing)

Beyond that, surprisingly little is understood about cellulite. Here are seven things docs do know.

  • It's more than skin-deep. In the simplest terms, cellulite is pockets of fat that have squeezed between bands of tissue, called septae, that are under your skin.
  • Cellulite definitely discriminates. Women of all races get it, while virtually no men do. That's because septae are different in women than they are in men. Guys have sturdier bands in a crisscross formation that keeps fat in place more effectively. Women have flimsier vertical septae that fat can more easily push through.
  • Size doesn't matter. Women of all body types and weights get cellulite. The more body fat you have, the more likely you are to also have significant dimpling. But even leaner women have some fat between their muscles and skin. That's all it takes for cellulite to happen.
  • You can't diet cellulite away. Losing weight sometimes makes it better, but ironically, it can also make it worse. When you drop pounds, your skin can become saggy after weight loss-making cellulite more pronounced.
  • Cellulite runs in families. Genes help determine how you store fat and how likely that fat is to push through the septae that are supposed to contain it.
  • Hormones play a role. But exactly what role isn't known. Because cellulite starts at puberty, doctors think estrogen is involved. However, that hasn't been proved.
  • Treating it isn't easy. Liposuction, which has been marketed as a treatment for cellulite, often makes the condition worse. Removing fat with lipo can leave your skin even bumpier-looking than it was before.

Why Cellulite Happens

Cellulite is sneaky. Even the experts don't agree on the reason it suddenly appears. Some derms say that cellulite is due to poor circulation in the skin covering your butt, thighs, and the back of your upper arms. They believe that the capillaries and blood vessels that bring nutrients to the skin there begin to deteriorate and leak lymphatic fluid into your fat cells, which get engorged. These fat cells cluster together, poofed up with liquid, and move toward the surface of the skin, causing lumps and bumps.

The health of the skin itself deteriorates in this scenario, says Howard Murad, M.D., a dermatologist in Los Angeles and the author of The Cellulite Solution, who is a proponent of the circulation theory. That, combined with declining amounts of collagen-a protein that gives skin its structure-as we age, causes our skin to slacken and become weaker, making any engorged fat cells even more visible.

The trouble is, there's not much reliable scientific data behind this rationale, says Molly Wanner, M.D., an instructor in dermatology at Harvard Medical School. Yet it's the basis for many popular treatments, including endermologie, in which your fat is vigorously squished and rolled in a machine that supposedly increases circulation and removes stored fat. Numerous treatments, at $100 a pop, are recommended.

How to Get Rid of Cellulite

There is limited evidence to back up claims that topical creams, medications, or liposuction eliminate cellulite for good. As for the FDA-approved, one-time laser-assisted procedure Cellulaze-which purports to level out bumps and dimples while stimulating collagen production to increase skin elasticity and thickness by more than 25 percent-the long-term effects are yet to be fully known (and the short procedure costs anywhere from $2,000 to $10,000 depending on the size of the area treated).

If you read cellulite treatment claims closely, you'll notice that reputable ones tend not to say that their cream, laser, or massage therapy will get rid of cellulite. The truth is that because cellulite is most likely a structural problem, it's going to return like the proverbial bad penny if the structure is unchanged. "You cannot cure it," says Neil Sadick, M.D., a clinical professor of dermatology at Weill Cornell Medical College in New York City, who has conducted much of the available research on cellulite and its causes. "But you can help make it look significantly better."

That's the good news: There are ways to temporarily minimize the appearance of cellulite. Here are five to try:

  • Hit the weight room. Exercise is crucial. While there is-shockingly-no specific research on how working out affects cellulite, a toning routine can tighten up the whole package. "Women need to start lifting weights two to three times a week. I'm a big proponent of this," says Patricia Farris, M.D., a dermatologist in New Orleans. "Resistance exercise acts like fillers for your skin. If your muscles are more defined, your skin will look smoother." Dr. Wanner agrees: "If you lose weight and replace it with muscle, you're going to have a fat layer that's not as thick, and your cellulite is going to improve." (Psst...foam rolling might help, too.)
  • Scale back. Getting to a healthy weight can help reduce cellulite. Yet just ditching pounds without firming up is not always the no-brainer cellulite-reduction move you would think it is. When you lose weight, "your skin may be more lax, pulling on the septae, and cellulite may become more visible," says Dr. Wanner. The younger you are and the better your skin elasticity is, the smoother the results. For the rest of us, strength training is the number-one way to keep things as taut as possible. In an eight-week study conducted by researchers at the South Shore YMCA in Quincy, MA, pairing a healthy diet (heart-healthy grains, lean proteins, fruits, vegetables, low-fat and nonfat dairy, and healthy fats) with 40-minute exercise sessions (half cardio and half strength) three times a week helped women shed an average 9.1 pounds of fat and 1.8 inches from their hips while adding 1.2 pounds of lean muscle. All 79 of the women in this study self-reported some level of improvement in cellulite-even those who only followed the workout routine-with more than 70 percent of them noting less observed cellulite in addition to a more well-defined and improved overall physique.
  • Make your skin stronger. Topical treatments that may build collagen in the skin, like Retin-A or creams with retinol or vitamin C, couldn't hurt and may help, Dr. Sadick says.
  • Stop smoking (if you do). Research published in the Journal of Cosmetic Dermatology shows that cigarette smoke can weaken the formation of collagen, the main structural component of connective tissue, making cellulite more visible.
  • Don't get sucked into trying lipo. A lot of doctors still suggest it, but it doesn't work and can actually make skin look more dimpled by removing too much fat, Dr. Wanner says.

The bottom line: The same things you would do to keep your body fit and healthy are your best tools if you're wondering how to get rid of cellulite.

The Future of Cellulite Treatment

Clinical trials are underway for a remedy developed by Stony Brook University researchers Marie A. Badalamente, Ph.D., and Alexander B. Dagum, M.D. Their work has led to the development of a collagenase injection, a nonsurgical method aimed at smoothing skin by breaking down the collagen that secures fat tissue beneath the skin. The 10 women treated had an average 76 percent reduction in the appearance of cellulite and reported being extremely happy with the results six months after. While a larger phase 2 study is still taking place, researchers are optimistic that this could potentially be the first medically based effective and FDA-approved treatment for cellulite.

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