Cellulite: Inevitable or Preventable?

 Maryam Jawid

Cellulite is a well-known phenomenon affecting the majority of women and some men. While most people recognize cellulite’s characteristic dimpled appearance, few understand what this condition truly is; yet, fad products and celebrity recommendations targeting cellulite are endless. Diving into the research reveals the factors that truly influence cellulite’s development and the best strategies to treat, and perhaps avoid, this undesirable condition.

What Is Cellulite?

Cellulite, scientifically known as gynoid lipodystrophy, is the presence of dimpled, slightly lumpy flesh, most commonly on the thighs, hips, buttocks, and abdomen. The condition’s distinctive dimples occur when the body’s fat tissue pushes against or interferes with connective tissues, such as collagen fibers (aid skin structure) and ligaments (link bones together) or muscles. The fat consequently becomes trapped between the connective tissues, forming small pockets, or dimples. While carrying excess fat tissue can certainly amplify cellulite’s appearance, even active and lean individuals may discover dimples decorating their hips and stomach. 

The good news is, despite its less than preferable appearance, cellulite is considered harmless and almost universally present among women; so nearly no one rich, poor, fat, or thin escapes its grasps. Up to 90% of women and 10% of men develop cellulite during their lifetime. Today’s modern world of highly edited social media and magazine photos simply disguises cellulite’s prevalence and therefore hoodwinks the public.

What Causes Cellulite?

The Mayo Clinic states that hormones, genetics, skin texture, and body type all help to engender cellulite, though scientists still do not fully understand the factors that unequivocally determine whether cellulite develops and if so, when.

Scrutinizing research indicates that three hormones and two genes that particularly impact blood circulation and connective tissue (tissue other than muscle or fat that provide support and structure for the body) development appear correlated with cellulite.

Hormones: Estrogen, Adiponectin, and Leptin

Estrogen, the major female sex hormone that males also produce in lower concentrations, plays many essential roles, including increasing vascular permeability (making blood vessels such as arteries and veins more flexible and open to fluids moving in and out) when necessary. Although, chronically elevated estrogen can impair normal blood circulation. For example, an Advances in Dermatology and Allergology review connected high estrogen with excessive blood vessel relaxation and swelling that hampered circulation and stimulated cellulite. Also notable, the Journal of Cosmetic Dermatology acknowledges that since estrogen kindles rapid fat cell growth (characteristic of female puberty and pregnancy), high hormone levels may fuel cellulite.

Low estrogen similarly facilitates cellulite, though via different mechanisms. Menopause Reviews concluded that low hormone concentrations (as seen in menopause) cause decreased formation of and/or weakened dermal connective tissue (such as collagen and elastin). This loosens skin, thus making cellulite’s appearance more noticeable. 

Adiponectin is a hormone impacting several bodily processes, but notably, it acts as an anti-inflammatory and antiatherogenic (prevents fatty plaque buildup in blood vessels) agent. Research indicates a connection between low adiponectin levels and impaired blood vessel relaxation, which hampers blood circulation. Researchers hypothesize that low adiponectin frustrates adequate blood circulation in fat tissues and therefore may trigger cellulite.

Lauded for generating post-meal satiety, leptin is a hormone that not only affects appetite, but also blood circulation. In fact, chronically elevated hormonal levels are associated with abnormal blood vessel development and cardiovascular dysfunction. Leptin’s detrimental effect on blood vessels negatively influences blood circulation to bodily tissues, including fat tissues vulnerable to cellulite.

The bird’s eye view?—imbalanced estrogen (both too low and too high), lower adiponectin, and elevated leptin levels may all fuel cellulite development, likely based upon the ways that these hormones impact blood circulation and connective tissue.

Regarding sex and race, Caucasian women develop cellulite more frequently than others. Cellulite is also common within families; a mother afflicted with the condition more likely begets a daughter with it. However, a more in-depth gene analysis reveals that ACE and HIF1A appear to promote the offensive dimples.

About 50% of the United States population carries the I/D ACE gene variation that stimulates increased ACE enzyme production (responsible for blood vessel constriction and increasing blood pressure). These people also develop more cellulite. Precise mechanisms remain muddled, but researchers hypothesize that over the long term, this gene variation promotes chronically elevated blood pressure and constricted blood vessels, thus impairing proper circulation and stressing the body’s tissues. Further supporting this, less ACE enzyme activity (the opposite of what the I/D ACE variation causes) is shown to enhance blood circulation. In summary, the I/D ACE gene variation increases the likelihood of cellulite development via sub-optimal blood circulation.

A rare HIF1A gene variant, which greatly decreases production of a protein called hypoxia inducible factor one (HIF1), seems to lower the chances that cellulite develops. HIF1 can stimulate both fibrosis (when connective tissue develops abnormally or excessively) and constricted blood vessels. Women with the HIF1A T allele variant (present in about 10% of the population) produce little to no HIF1, and also experience cellulite far less frequently than others. Thus, the HIF1A T allele promotes healthy connective tissue (the opposite of fibrosis) and unhindered blood circulation, therefore helping to prevent cellulite.

Can Cellulite Be Prevented?

Even though research investigating the factors that may escalate or reduce cellulite remains underdeveloped, supporting healthy blood circulation and connective tissue likely aids cellulite reduction and/or prevention. How can one achieve this? Genetics are unalterable, but achieving optimal hormone levels and addressing other factors that may support cellulite prevention are not.

The most well-supported and implementable starting points promoting stable estrogen adiponectin, and leptin levels are general wellness practices, including following an ancestral (paleo eating pattern) dietary approach (fruits, vegetables, and animal products) and supporting stress management and mental health.

Dietary Considerations
Consuming highly processed foods, and legumes such as soy, can raise estrogen and lower adiponectin levels. Additionally, today’s conventional, processed diet is far less micronutrient rich than ancestral eating patterns and consequently may facilitate deficiencies that not only imbalance hormones, but also impair connective tissue formation.

Regarding leptin, hormone level disruptions as well as leptin resistance (the body does not properly respond to leptin) are mitigated via anti-inflammatory diets and those containing abundant omega-3 fatty acids. Ancestral eating patterns, such as a paleo diet, provide far more of these components than today’s standard Westernized diet.

Mental Health and Stress Management
Stress plays a role as well. Mental pressure does not only impact stress hormones such as cortisol. Instead, chronic stress has far-reaching bodily effects, including reproductive system damage, impaired blood sugar management, and thyroid dysfunction. Particularly relevant, a Journal of Neuroendocrinology connected high life stress with estrogen disruptions (both increases and decreases) that even interrupted female menstrual cycles and affected fertility, making it highly likely that blood circulation and connective tissue were also impacted. Therein lies the potential to stimulate cellulite.

 Knee-Jerk Questions

What about Exercise?
Physical activity is not a cellulite-preventative “silver bullet,” but its consequences, such as amassing muscle and minimizing body fat, likely help mask cellulite’s appearance. The more muscle one builds, the tighter the individual’s skin and underlying flesh will appear. This partially obscures dimples and lumps. Additionally, even though cellulite afflicts lean people  just as frequently as obese individuals, the less fat present, the less fat to dimple.

Why are Women More Cellulite-prone than Men?
Connective tissue structure and fat cell distribution differ between men and women. Female connective tissue is organized into compartments underneath the skin. Fat cells easily expand into these compartments and create a dimpled appearance. Male connective tissue, on the other hand, is flatter with fewer compartments, thus partially evading a bumpy appearance. Additionally, female hormones and genetics stimulate more fat deposition in the buttocks and thigh regions than their male analogs. This issue is further complicated since women’s buttocks and thigh skin is significantly thinner than that of men, making cellulite dimples more pronounced.

What about Today’s Conventional Treatments?
The American Academy of Dermatology lists laser therapies and subcision as some of the most evidence-based cellulite treatments. These therapies generally use lasers to disassemble connective tissue bands while also stimulating the skin to thicken, resultantly decreasing cellulite’s visibility. Subcision works similarly, but achieves the aforementioned results using a small needle rather than a laser beam.

While these treatments are less invasive than many other procedures, they are costly in both time and finances. It makes sense then that the most commonly seen cellulite treatments are topical products, such as creams, oils, and lotions. Unfortunately, little evidence exists to support these topical options. Note, more importantly, that cellulite is a subcutaneous (beneath the skin) condition, meaning that many creams and ointments may not even affect, or treat, the condition unless they include specific and often pharmaceutical-grade ingredients. Before choosing a topical remedy, at least ensure that the label lists a specific active ingredient delivery system, such as liposomes or phosphatidylcholine (special microscopic fat molecules that aid skin absorption). In fact the benefits garnered from anti-cellulite creams may be more attributed to the act of massaging the cream into the skin rather than to the cream’s ingredients.

Does Massage Work?
Interestingly enough, massage and/or manually stimulating cellulite-affected areas may be useful. When forty women massaged their thigh cellulite using a vibrating device for twelve weeks (15 minutes at a time, every other day), dimpling diminished. Notably though, women that continued using the device for a subsequent twelve weeks observed further cellulite reduction, but the dreaded dimples and lumps returned to nearly pre-treatment levels after ceasing regular massages. Why massage reduces cellulite remains unclear, but researchers speculate that increased circulation may play a role. At a minimum, it appears that massaging cellulite-prone areas is certainly not harmful, and likely even beneficial.

The Bottom Line

Despite the endless stream of diet ads, fad supplements, and celebrity recommendations, there is no silver bullet to prevent or cure cellulite. With its extremely high prevalence (~90% of women), it appears that for some, cellulite may be inevitable. Nonetheless, leading an overall healthy lifestyle that supports healthy hormonal, circulatory, and connective tissue function is undeniably a step in the right direction. When an individual adds to that a focus on building muscle and minimizing body fat, that person is on the ideal path towards minimizing cellulite.

Medically Reviewed: Meaning, Purpose, and Intent
THE provides research-based, leading-edge health and wellness news and insights to help readers prevent and reverse chronic and acute maladies so as to live a disease-free, vital life. To that end, original content is medically reviewed by a medical (MD or DO) or naturopathic doctor (ND, NMD, or DNM) or a doctor of philosophy (PhD) for authenticity, validity, and accuracy, ensuring that THE’s content reflects relevant and reliable information. Please click the Medical Reviewer’s name to review his/her credentials.


Dr. Nikisha Richards

After graduating cum laude with a Bachelor of Science degree in biology from LeMoyne-Owen College, the only historically black college in Memphis, TN, Nikisha Richards completed medical school at Wayne State University School of Medicine and her internship at Michigan State University. She went on to complete her ophthalmology residency at Howard University Hospital and an ophthalmic plastic reconstructive and aesthetic surgery fellowship at the University of Pittsburgh Medical Center. Dr. Richards is a diplomate of the American Board of Ophthalmology and is currently on faculty as an assistant professor of ophthalmology at Virginia Commonwealth University Health System as well as the school of medicine. She has several publications in medical science journals, has written four medical-surgical book chapters, and has served as an editor for other publications. She excels in teaching both medical students and residents and is the recipient of the 2016-2017 ophthalmology instructor of the year award at Virginia Commonwealth University. Dr. Richards is a member of the greatest sorority, Delta Sigma Theta Sorority, Inc and she loves jazz.

Maryam Jawid
Maryam Jawid holds a double Bachelor’s of Science in Nutritional Biochemistry and Public Health. She has conducted research to understand the relationship between diet, exercise, and the microbiome. Through her writing, Maryam aims to spread relevant, science-backed information that empowers readers to reach their best health.

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