Every week I am posting about  everything you need to know about hormones. This weeks topic is about cellulite.

Did you know …

  • Cellulite is not fat.
  • Every woman’s worse nightmare.
  • Cellulite is a term for the formation of lumps and dimples in the skin.
  • Is also known as orange-peel skin or cottage cheese skin
  • Is not a disease state, dangerous or contagious, it’s natural, it’s healthy, it’s how we women are structurally built.
  • Cellulite can affect both men and women.
  • But is more common in women, due to our anatomy.
  • Fat, muscle, and connective tissue are not created equal in men and women.
  • 80 to 90 % of women will experience cellulite at some point in their lives, even women who are otherwise slender and fit.
  • As common as cellulite is, there’s still a lot of misinformation and myths about what it is, what causes it, and how to get rid of it.
  • Numerous treatments are available, but their effects are mostly temporary.
  • A question you should ask yourself is ‘if cellulite isn’t a disease why then are treatments necessary?
  • A 2015 review of studies into the effectiveness of different techniques indicated that either the procedures did not work, or the research methodology was flawed.
  • Any promise to get rid of cellulite should be approached with caution and prudence, and often a very large purse.
  • Cellulite is part of being a woman and eliminating it isn’t really possible but CARING for your ‘happy healthy fat’ and the skin above is another matter.

Meet Sally and get to know all about cellulite

Intro cellulite

Cellulite fact or fiction

Cellulite grades

Cellulite 101

What makes cellulite more visible

Cellulite 101

  • Cellulite is a very common, harmless skin condition that causes lumpy, dimpled flesh often on the thighs, hips, buttocks and abdomen.
  • NB! It is not a fat disease.
  • Most prevalent in women.
  • Sometimes described as having a cottage cheese or orange peel texture.
  • It involves the fibrous connective cords that connect and tether the skin to the underlying muscle.
  • Fat cells are stored in small pockets in between the muscle and skin.
  • These pockets are created by the fibrous connective cords.
  • As fat cells accumulate, they push up against fibrous cords.
  • In women this creates an uneven surface or dimpling of the skin.
  • NB! It is a natural element of female anatomy, not a disease state.

Cellulite – Fact or Fiction

  • The invented medical term is Edematous Fibrosclerotic Panniculopathy (EFP), which means inflamed, hard fat and connective tissue.
  • The term Cellulite was given to describe the NATURAL packing of fat in connective tissue pockets just under the skin.
  • The word was first seen in 1873, where doctors Émile Littré and Charles-Philippe Robin included the word “cellulite” in the 12th edition of the Dictionnaire de Médecine.
  • The word is often confused with the term cellulitis where cells or tissues are in a state of inflammation, but cellulite and cellulitis are not in any way the same.
  • Directly translated the Greek / Latin the word literally means cellul /little cell, ite/stonelike – little stonelike cell.
  • The term was first used in the 1920s by the spa and beauty industry to promote their services.
  • Made popular in the 1960’s by the magazine Vogue.
  • The powers of the beauty world and media have invented a phenomena from what is natural female anatomy.
  • I vote that cellulite is fiction.

Grades of cellulite

A validated photonumeric cellulite severity scale PCSS, was published in 2009, in various medical journals.


As you can read there are many different ways to rank the level of cellulite

Clinically most accepted way

  • The Clinician Reported Photonumeric Cellulite Severity Scale (CR-PCSS).
  • The Patient Reported Photonumeric Cellulite Severity Scale (PR-PCSS).
  • Uses photographs in which cellulite severity is rated per area on a 5-point scale:

0 – none
1 – almost none
2 – mild
3 – moderate
4 – severe

Another way

Grade 1 – mild
There is an “orange-peel” appearance, with between 1 and 4 superficial depressions, and a slightly “draped” or sagging appearance to the skin.

Grade 2 – moderate
There are between five and nine medium-depth depressions, a “cottage cheese” appearance, and the skin appears moderately draped.

Grade 3 – severe
There is a “mattress” appearance, with 10 or more deep depressions, and the skin is severely draped.

Cellulite in a nutshell

  • Beneath your skin, there is a layer of fat, called subcutaneous fat.
  • The fat is held in place by connective tissue, forming a kind of net around the fat.
  • In women this net is very loose.
  • In men this net is very tight.
  • Hence the difference between men and women.
  • Women – When fat pushes against the net it gives way and the skin above puckers – giving the lumpy, bumpy appearance.
  • Men – When fat pushes against the net it doesn’t move maintaining the smooth look on the surface.
  • But Sally ‘cellulite only occurs in 80–90% of women how do I make sure I’m in the10% group’?
  • I guess the answer is you need more Testosterone as it is rarely seen in males.
  • Only seen in males with androgen-deficiency, such as hypogonadism, post-castration states and in those receiving estrogen therapy for prostate cancer or gender change.

Know your Fat Depots

Fat tissue is called adipose tissue or body fat and is not just composed of fat.

Adipose Tissue 101

  • Store triglycerides –  groups of 3 fats, often long chain fatty acids, which can be a combination of saturated or unsaturated fats.
  • Contains fibroblast cells that make collagen.
  • Contains blood vessels.
  • Contains lymph vessels.
  • Produces immune cells, such as inflammatory cytokines.
  • Produces hormones such as leptin, testosterone and estrogen and is recognized as a major endocrine organ.

Fat Depots

– just under the skin – healthy fat – women prefer to store their fat here

– around the internal organs – dangerous fat – men prefer to store their fat here

Bone marrow
– Bone marrow fat (BMF) is located in the bone marrow cavity and accounts for 70% of adult bone marrow volume. It also accounts for approximately 10% of total fat in healthy adults above the age of 25 years.

– in muscle tissue close to the mitochondria  important for energy production.

Breast tissue
– the percentage of fat weight of total breast weight varies from 3.6 to 37.6%, depending on the size of the breast.

Subcutaneous fat

  • Is composed of fat cells, which are grouped together in small lobules or pockets separated by connective tissue.
  • The number of fat cells varies among different areas of the body – hips, thighs and butt have more.
  • Their size varies according to the body’s nutritional state ie. if you’re overweight or slim.
  • Is an essential energy reserve.
  • Acts as padding.
  • Provides insulation.
  • Can be measured using body fat callipers to give a rough estimate of total body fat.
  • Can be used as a route for the administration of injections, vaccines etc.

Visceral fat / abdominal fat

  • Is not stored in connective tissue units.
  • Is packed between the organs.
  • There are several fat depots in this area.
  • Is semi fluid.
  • Is metabolically very active.
  • High levels increase risk for Type 2 Diabetes, CV problems, etc.
  • Can be evaluated by:

– Waist circumference – Female >80cm – Male >94 cm indicates high levels of visceral fat.

– Body Volume Index / BVI – 3D technology analyses overall body shape, identifying where fat is distributed.

– DEXA – Dual Energy X-ray Absorptiometry measures fat in the abdomen.

The Cellulite Myths

Myth 1 – Cellulite is a disease

Hell NO – cellulite is the ‘unfortunate’ name given to describe the NATURAL packing of fat in connective tissue pockets just under the skin. The word is a combi of Greek and Latin and literally means little, stonelike cells. The term was used by in the 1920s by spa and beauty industry to promote their services and made even more popular in the 1960’s by Vogue magazine

Myth 2 – Only overweight people get cellulite

Nope – while being overweight might make it appear more noticeable, cellulite can happen to women of all shapes and sizes.

Myth 3 – Losing weight will make cellulite disappear

Probably not – it may even make the cellulite more noticeable as skin can become more sagging as fat tissue shrinks

Myth 4 – Cellulite is caused by toxins in your body

Nope – though some over-the-counter cellulite products may claim the opposite and state that their potions will help remove impurities and toxins from the body. Know this – neither their efficacy nor their claims are supported by science

Myth 5 – Detoxing reduces cellulite

Nope – while supporting liver detoxifications pathways is always a good idea following a ‘weekend cleanse’ or weeks detox will not reduce cellulite.

Myth 6 – Women get more cellulite than men

Yeps – women carry more fat around their hips and thighs and have loose connective tissue to keep it all in place.

Myth 7 – Cellulite may be in your genes

Absolutely – just having XX chromosomes will increase your risk, but it may also run in families; if your mother and grandmother had cellulite, you’re probably going to develop it. There are specific genes that can increase your risk, but remember genetics is only one small part of the cellulite puzzle


Myth 8 – Cellulite gets worse with age

Yeps – as women age, their bodies produce less estrogen. Estrogen is important for blood flow, collagen production, hydration all of which will affect the quality of connective tissue. But cellulite is ageless it can become visible at any age

Myth 9 – Certain foods can help fight cellulite

Nope – diet alone will not determine whether you will or will not get cellulite, but eating a diet filed with foods that contain protein, good fats and antioxidants will aid the maintenance of collagen, reduce inflammation and oxidative stress keeping connective tissue strong and supple. Focus on organ meats and meats from pasture raised animals, deep coloured fruits and lots of water

Myth 10 – Taking specific often expensive supplements reduces cellulite

No way – there is currently no medication or supplement proved to help.

Myth 11 – Exercise is the answer to cellulite

Nope – while exercise is important for increasing muscle tone and cardiovascular health, it won’t erase cellulite. It may give the illusion that cellulite is less noticeable. Remember female athletes can have cellulite.

Myth 12 – Smoking can affect the appearance of cellulite

Hell yes – cigarette smoke reduces blood vessel flow, weakens even disrupts the formation of collagen. Connective tissue stretches and is more easily damaged making fat more visible. And smoking make you look bad in many other ways, such as premature wrinkles, dry, discoloured, aging skin, may even contribute to stretch marks, to name a few.

Myth 13 – Topical skin-firming lotions and potions remove cellulite

Nope – despite what their labels ‘promise’, no creams (over the counter or prescribed) have succeeded in ‘permanently’ reducing cellulite. The topical formulas will keep skin moisturized and may temporarily smooth the appearance of your skin, especially if they containing retinol / Vitamin A and caffeine.

Myth 14 – Liposuction removes cellulite

Nope – this expensive and painful procedure could actually make cellulite worse. You’re messing with your fat distribution, which could create ‘new’ lumps and bumps and dips in the skin that you didn’t have before

Myth 15 – The clothing you wear can make an impact

Yes – but only the appearance and only when you’re wearing the clothing, such as compression-style leggings or stockings

Myth 16 – There’s no permanent cellulite solution

Fact – cellulite is a natural female trait – the best solution is for you to fall in love with your cellulite.

What Increases Cellulite Visibility?


  • Men have less cellulite than women – women have 10% more fat than men and hips, thighs, and buttocks are the main storage areas.
  • Fat is stored in pockets created from connective tissue, which is looser in women to allow for the storage of more fat when needed, such as during pregnancy.

Genetic factors

  • Genetic variations involved in the makeup of connective tissue and collagen, some have stronger connective tissue, some weaker


  • The increase of Estrogen during the fertile years increases fat storage – the number of fat cells increases.
  • The decrease of Estrogen during menopause and after increases the thinning of the skin – the fat layer becomes more visible.
  • High levels of Cortisol due to stress breaks down collagen and thins the skin and increases inflammation – the fat cells swell and the fat layer becomes more visible.
  • Increases in Insulin increases fat storing – the fat cells swell and become more visible.


  • Impaired fat burning, due to hormonal imbalances – the fat cells swell and become more visible.


  • Increased intake of omega 6 fatty acids / seed oils – the fat cells swell and become more visible.
  • Increased intake of alcohol – the fat cells swell and become more visible. Increased alcohol may affect nutritional status, less nutrients to build collagen and connective tissue – the fat cells become more visible.


  • Sunburned skin can increase visibility
  • Smoking – no good for anything


  • Lack of movement, sedentary lifestyle, stationary work, ie. sitting for long periods of time – leads to poor circulation


  • High fat % enlarged fat cells – the fat cells become more visible

Microcirculatory system

  • Poor blood flow maybe due to the squeezing of the tissue, less nutrients delivery and less waste removed – the fat cells may swell and become more visible.
  • Poor lymphatic draining maybe due to the squeezing of the tissue – build-up of waste products between the cells – the fat cells may swell and become more visible.

Subtle inflammatory alterations

  • Chronic, low grade inflammation maybe due to the build-up of waste products due to poor lymphatic and blood circulation and or excess omega 6 fatty acids and sugar in the diet – the fat cells may swell and become more visible.

Cellulite Care

Cellulite is the name describing the layer of subcutaneous fat, which is stored in pockets of connective tissue, just under the skin

Women in general have more fat, store more fat under the skin and have looser connective tissue to accommodate the extra fat.

If this fat tissue becomes visible it creates the lumpy, bumpy, dimpled appearance.

This is not a disease state that needs to be ‘treated’, this is a natural part of a woman’s anatomy.

So let’s ‘care’ for this happy, healthy, fat.

  • Move the tissue with DAILY movement – exercise your muscles as strong muscles under the ‘lumpy areas’ can even out the skin and remember muscles burn fat.
  • Move the tissue with DAILY GuaSha massage – take a few extra minutes every day to give your areas a firm rubdown, like every time you apply your body oil, grab your GuaSha tool and spend a few minutes massaging the part(s) of your body that need a bit of extra LOVE. For chronic issues, you will want to press firmly and move up and down about 15 times, wait a few seconds and repeat. For less chronic and more for lymphatic drainage and an immune boost, less pressure. Massage improves blood flow and gets rid of excess fluid, which may make dimples less noticeable – for a while.



  • Burn fat – extra fat makes can make cellulite more visible. Increase fat burning with TRE- time restricted eating, lower carb meals and H:I strength training.
  • Camouflage with “Bottle Tan” – dimpled areas are less noticeable on darker skin. Remember the ‘real’ tan ie. sun-’burn’ can damage your skin and make cellulite more visible.
  • Cream with retinol (vitamin A) – increase skin quality so cellulite may be less visible. Products with 0.3% retinol work best as does patience
  • Caffeine creams – dehydrates cells, making them less visible, but needs to applied daily
  • Hit the spa – and spoil yourself with a body wrap, which can tighten and smooth (for a while). Look into home wraps for price and frequency.
  • Lipo-massage by Endermologie – massage and suction team up and 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.
  • Sweet Cheeks Massage Mat – sit on a silicone mat, with pyramid-like nodules that press into your skin, for 30 minutes

An hour later the’ look’ of your cellulite is reduced.

  • Compression style leggings and support stockings – not like those your granny wore. With regular wear they help prevent fluid retention and with time may make the skin smoother.
  • Drop the Smokes – every puff affects the blood supply to your skin, so it gets thinner and more likely to sag and remember thin skin makes cellulite more visible.

Professional Cellulite Treatments

Several therapies have been suggested for removing cellulite, but none have yet been confirmed by scientific research.

The American Academy of Dermatology (AAD) has reviewed a number of techniques that may be successful in reducing the appearance of cellulite by breaking up the bands of connective tissue under the skin’s surface – ouch!


Is there really anything wrong with the connective tissue? What are the long-term effects off chopping up the connective tissue? As women genetically have a looser connective tissue – why make it weaker?

In short – There’s no miracle treatment. 

Skin fillers – Injectable dermal fillers like Restylane and Radiesse
Can plump up and even it out dimply skin at least temporarily just like putting icing on a lumpy cake to make it look better. However, the procedure can cost hundreds or even thousands of dollars per leg and the results may only last a few months.

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 maybe be worthwhile if cellulite is severe. 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 (works 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 DIY machine that can perform the 3 treatments is called Silk’n Silhouette

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.

Acoustic wave therapy
Uses a hand-held device to transmit sound waves. It may work, but it can take several sessions.

Vacuum-assisted precise tissue release
Cuts the bands using a device containing small blades. As it cuts the connective bands, the tissue underneath moves up to fill the space under the skin, removing the appearance of cellulite. This may last for 3 years, but data on its success is limited.

Involves inserting carbon dioxide gas under the skin. Side effects include bruising and discomfort after the procedure, but some cellulite might disappear for a while.

Ionithermie cellulite reduction treatment
Involves covering the affected area with a special mud or clay, then wrapping the area in plastic before applying an electric current. It is not proven to be effective.

Aims to reduce cellulite by heating it, but any results are short-term.

Laser-assisted liposuction
Removes small amounts of fat, but this may make dimpling worse. Research has not yet shown that it works to reduce cellulite.

Ultrasonic liposculpting
Targets and destroys fat, but again, research is lacking to show that it works.

Techniques the AAD do not recommend

Fat freezing

Which involves injecting a mixture of substances under the skin.

This 2015 scientific review of current studies evaluating the effectiveness of various techniques for cellulite

Conclusion: This article provides a systematic evaluation of the scientific evidence of the efficacy of treatment for cellulite reduction. No clear evidence of good efficacy could be identified in any of the evaluated cellulite treatments.


NB! – Any treatment that promises to remove cellulite should be approached with caution and often a very large purse.

My Cellulite Caring Routine

  • I accept – that Cellulite is ‘normal’ for a woman
  • I know – that at 66 my skin is aging and thinning even sagging which increases the visibility of the underlying fat and connective tissue, but that’s not the same as having more cellulite.
  • I don’t eat – plant and seed oils. These contain long chain fatty acids, especially omega 6 which create inflammation and are MUCH more difficult for the body to breakdown.
  • I don’t eat – grains and pulses, if I eat nuts they are pre-soaked to neutralise the anti-nutrients that can create inflammation, gut dysbiosis and thereby negatively affect skin, fat and connective tissue
  • I eat – animal foods, organ meats, bone broth, eggs, cheese, fruit and avocados
  • I drink – minimum 1.5 litres of hot lemon water everyday
  • I use Estrogen cream – I use Estriol cream Ovestin – approx. 1 cm 2 – 3 times a day
  • I use Testosterone gel – I use testogel – approx. the size of a pea every am from Monday to Friday, weekends testosterone free.
  • I move – daily, minimum a 30 minute walk every day, 5 – 10 squats and lunges throughout the day are great to mobilise and strengthen butt, hips and thighs.
  • I sleep – from 10pm minimum 5 nights per week.
  • I GuaSha – everyday, even twice a day to increase blood flow, lymphatic drainage and flexibility in the tissues.




I use a stay on body mask with polypeptides after the GuaSha.


  • I don’t drink alcohol every day – max 3 times a week and I try to limit to one drink
  • I don’t smoke – never have.

Questions? Please don't hesitate to contact me

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