Cellulite is characterised by several small bumps or a cottage cheese / orange peel appearance in the skin, which is primarily found on the hips, buttocks and back of thighs, though can appear other places on the body and is mostly seen in women.

Fat cells and connective tissue are organised differently in women than in men, which makes the cellulite more visible.
Cellulite is in reality a description of the fat tissue called adipose tissue, which is stored between the dermis layer of the skin and the muscles. This layer or area is called the subcutis which also contains connective tissue and is part of the extensive superficial fascia system

The largest amount of the body’s fat is stored in the subcutis, which in a woman of normal weight amounts to approx. 20% – 30% of body weight, but it is way from all this fat that becomes cellulite.

Adipose tissue in the subcutis is stored in small compartments, formed by connective tissue. Connective tissue is somewhat elastic and can stretch to make room for any extra fat storing, such as during pregnancy or with an increase in weight and with weight loss the connective tissue can, in principle gradually regain its original firmness and elasticity.

The structural cause of cellulite is that adipose tissue presses up against the connective tissue, the question is why does it sometimes create bumps and other times not?

Possible causes can be that the connective tissue has become too stiff, i.e. less elastic or has become weaker due to the lack of collagen or the adipose tissue is inflamed or the dermis layer in connection with aging has become thinner making the subcuitis more visible.

Other causes can include genes/DNA, stress, inflammation, hormones, low metabolism / Thyroid, lack of movement, consumption of harsh fats, together with poor circulation and fluid retention, which can indicate blocked or poor lymphatic drainage.
Chronic stress and inflammation can have negative consequences for the lymphatic system.

Cellulite can occur at any age, also if a person is overweight or thin, it is estimated that 80-90% of all women will in some way or form, at some time in their lives suffer with cellulite. Although it is not typical before puberty.

For women in peri-menopause can the sudden appearance of cellulite be due to hormonal changes, especially the fall in Estrogen. Low Estrogen levels can also be seen in younger women with lower fat percentages, which can be an associated cause of their cellulite.

Estrogen is not just an important fat storing hormone, which dictates where fat is stored, such as hips, bittocks, thigh and breast tissue, but it also plays a key role in extra cellular matrix (ECM) modulation (the ‘stuff’ surrounding the cells) by preventing fibrosis and inflammatory activity, which will affect connective tissue stiffness and nocireceptor/pain receptor sensitivity.

Even though the exact cause of cellulite is unknown it can be said that cellulite in its self is not a risk factor for disease, but can the appearance of cellulite for some be an indication of future possible health problems?

When cellulite fat cells are compared with ’normal’ fat cells physical and chemical changes are found.
Cellulite fat cells are inflamed and pinched by the connective tissue, which can prevent blood circulation through the tiny blood vessels, which reduces the delivery of oxygen and nutrients to the fat cells, and thereby reduces fat cells metabolism, leading to less fat burning and the possible retention of waste products, which can increase the amount of cellulite even further.

The small lymph vessels are also squeezed, so the extra cellular fluid gets blocked together with waste products, which can possibly explain the soreness some complain of.
In time the stagnation becomes visible and the tissue can resemble a piece of old, hard cheese.

Should you be worried about cellulite?

Well it depends on the cause of the cellulite, i.e. if the cause is due to excess weight, inflammation and/or stress it is probable that other systems in the body are affected and negative health conditions are underway.
But remember when you focus on making changes in the underlying causes of the cellulite the different lifestyle diseases will also improve.

Can it be removed?

First of all cellulite is at some level ’normal’, but some lifestyle habits and situations can increase the amount, so if your cellulite bothers you there are several actions that you can do that can make it less visible, but gone forever – no that you must not expect.

What to do?

Increase circulation in the tissue

Remember cellulite typically collects on the hips, thighs and buttocks, think about how often/much we sit in a given day, and imagine how much exactly those tissues are squashed and pressed, which affects blood and lymphatic circulation in a very negative way. So, you need to ramp up the circulation and this can be done in many different ways, both outside and in.

1. Movement and exercise

Movement is the absolute best way to treat cellulite in all ages. Many are sitting in front of computers all day long, sitting down to eat, sitting in front of the TV in the evenings, etc. – which makes for many hours of squashed fat cells and the consequential poor circulation.
As a physiotherapist I have always recommended some kind of movement every hour and this is also important related to cellulite
Set an alarm to ring every hour so you get up and move, such as go for a walk, do 10 squats or lunges or other movements that increase blood and lymphatic circulation, especially to the hips, buttocks and thighs.
Exercises which create strong muscle tissue under the fat can make the skin look smoother. H.I.T is the best way to build muscle tissue, heavy weights, 8-10 repetitions, approx. 30 minutes at a time minimum twice a week. Focus on building the muscles under the cellulite. Muscle work increases the production of a hormone called Irisin, which increases muscle and fat metabolism, and can have a positive effect on the amount of cellulite and thereby decrease its visibility.

2. Massage techniques

Every type of massage will increase movement in the tissues, but the massage type called ’fascia manipulation’ with a jagged edge GuaSha stone has the best effects.

Studies show that fascia manipulation increases metabolism in the treated area and the hormone Irisin is most probably involved, i.e. an increased fat burning, increased extra cellular matrix modulation, etc. but the frequency and sustainability of the treatment is also crucial, I.e. daily treatments, even several times in the day is possibly necessary.

Use 5 – 10 minutes per area every day, do it while you’re in the shower or when you put cream / oil on, etc. Making it part of your normal daily routine is often easier than making extra time for a new routine.

Reduce extra fat

As a woman if your fat percentage is over 30% it will be to your advantage to increase your fat burning, although both overweight and underweight women can have cellulite it is more probable if you are overweight.

Important to reduce weight at an easy speed, with long-term excess weight can the skin and connective tissue lose its elasticity and ability to re-establish its tightness, which can lead to loose skin and connective tissue especially if weight loss is sudden or goes to quick.

The best way to increase fat burning is to reduce the number of eating hours, i.e. your eating window should be max. 10 hours, e.g. 8am – 6pm during the remaining 14 hours the body will (in time) burn fat.

It’s a good idea to check your metabolism / Thyroid as a slow metabolism will decrease your ability to burn fat. For those of you that have persistent problems related to weight loss getting your cellular energy production checked for possible B vitamin and amino acid deficiencies would be a good idea.

Support Estrogen

If you are 45, even 40+ you can expect that the fall in Estrogen will play an important role in cellulite formation.

Estrogen has several roles related to skin and connective tissue, such as increase the production of collagen, even elastin, increase the production of hyaluronic acid, modulate the extra cellular matrix (ECM), and store fat in the subcutis.

In short Estrogen makes the skin and connective tissue strong, flexible, moist and plump.

When Estrogen production falls the skin becomes thinner and subcutis more visible, ECM less moist and fluid, and changes in where fat is stored.

The solution here is to support Estrogen with one or other form of Estrogen supplementation, where my recommendation lays with bioidentical Estriol, the mildest of the Estrogens, which can be bought in chemists without prescription in many European countries or through the internet.

Read more about Estrogen as a supplement in my blog.

If you are under 40 with a fat percentage under 19% Estrogen deficiency will be part of the cause. One solution is to do everything in your power to increase your fat percentage and thereby Estrogen production, such as train less and eat more, also check your Thyroid for possible hyperthyroidism.

Unfortunately, the picture of the ’ideal’ female body has changed and many wish to be more masculine with a lower fat percentage and bigger muscle definition, which can make cellulite more visible. Remember our fat and connective tissue is different to men’s. Learn to be happy and proud of your female curves.

Food and lifestyle

The way you live your life and the foods you eat are crucial and next to movement the most important area to focus on. Not only for cellulite but for health in general and remember the quality of your skin reflects your level of health.

By adopting a diet consisting of ‘real’ food filled with nutrients void of chemicals, lots of water and vegetable juices, relinquishing destructive habits, such as smoking, binging on alcohol, getting regular exercise and movement, and de-stress activities, not forgetting gut balance, it is possible to reduce cellulite.

The is the best and cheapest way to achieve long-tern results especially when combined with GuaSha massage and exercis

Extra lifestyle tips

Cream with retinol (vitamin A)
Cream with retinol (vitamin A) can, through time increase the skins quality and thereby make cellulite less visible. Produkts with 0.3% retinol work best.

Support stockings
Support stockings today are not like those your granny wore. With regular wear they help prevent fluid retention and with time make the skin smoother.

Professional treatments

Spoil yourself with a Body Wrap
Hit the spa and spoil yourself with a body wrap, which can tighten and smooth (for a while) by amongst other things increasing micro circulation in the skin. Look into home wraps for price and frequency.

Where massage and suction team up. The skin is sucked up and massaged via a rolling tool. Frequency and maintenance are important to retain results, which can become a costly affair.

Laser and radio waves (RF)
Bombard the skin with heat, massage and suction, which can give the ’bumps’ a smoother appearance, for up to 6 months, but again its costly as many treatments are necessary.

FDA-approved laser treatment with an optic laser, that ’melts’ fat cells, breaks down the fibrous connective tissue and stimulates the growth of new collagen. The treatment is only available from a dermatologist. Cellulaze treatment is said to remove cellulite with just one treatment, but like all treatments the effect is temporary as cellulite regenerates with aging in line with the reduction of collagen. The treatment can be worthwhile if cellulite is intense. The effects can last a year or more though long-term effects are as yet unknown.

Bi-polar radio waves, LED-light and infrared heat
Is a combination of Bi-Polar radio frequency energy, which tightens the skin and forms the deeper layers of the skin (go down to 10 mm), and can thereby reduce cellulite. LED-light balances and reconstructs the structure of the skin. Infrared heat improves the visibility of the cellulite by omitting intense heat waves. The machine that can perform the 3 treatments is called Silk’n Silhouette, and can be bought here.

Another FDA approved treatment, which involves a dermatologist placing a small tool the size of a needle under the skin and cutting the tight connective tissue responsible for creating the bumps. This treatment can last up to 2 years.

Closing remarks

Cellulite is to a certain level ’normal’ and women have always had some. It can be very much affected by movement and diet, but never expect it to be gone for ever.

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