Cellulite

Cellulite is a very common, harmless skin condition that causes lumpy, dimpled flesh on the thighs, hips, buttocks and abdomen. The condition is most prevalent in women.

Many people try, with variable success, to improve the appearance of their skin through weight loss, exercise, massage and creams marketed as a solution to cellulite. Medically proven treatment options are available as well, though results aren't immediate or long lasting.

Cellulite looks like dimpled or bumpy skin. It's sometimes described as having a cottage cheese or orange peel texture.

You can see mild cellulite only if you pinch your skin in an area where you have cellulite, such as your thighs. Cellulite that is more severe makes the skin appear rumpled and bumpy with areas of peaks and valleys.

Cellulite is most common around the thighs and buttocks, but it can also be found on the breasts, lower abdomen and upper arms.

When to see a doctor

Treatment isn't necessary. But if you're concerned about the appearance of your skin, talk with your primary care doctor or a specialist in skin diseases (dermatologist) or plastic surgery about treatment options.

Little is known about what causes cellulite. It involves fibrous connective cords that tether the skin to the underlying muscle, with the fat lying between. As fat cells accumulate, they push up against the skin, while the long, tough cords pull down. This creates an uneven surface or dimpling.

In addition, hormonal factors play a large role in the development of cellulite, and genetics determine skin structure, skin texture and body type. Other factors, such as weight and muscle tone affect whether you have cellulite, though even very fit people can have it.

Cellulite is much more common in women than in men. In fact, most women develop some cellulite after puberty. This is because women's fat is typically distributed in the thighs, hips and buttocks — common areas for cellulite. Cellulite is also more common with aging, when the skin loses elasticity. Weight gain can make cellulite more noticeable, but some lean people have cellulite, as well. It tends to run in families, so genetics might play the biggest role in whether you develop cellulite. An inactive lifestyle also can increase your chances of having cellulite, as can pregnancy.

A diagnosis of cellulite involves looking at the skin to assess the dimpling and what may have caused it. This helps determine which treatment may improve the look of your skin. Some methods treat fat but don't remove the dimpling. And methods that remove cellulite aren't intended to remove excess fat.

A variety of treatment approaches are available to improve the appearance of cellulite, at least temporarily. Each has its own set of potential results and side effects. Some studies indicate that a combination of treatments may yield the most satisfying results.

• Laser and radiofrequency treatments. Various wounding (ablative) laser treatments are available to treat cellulite. In one method, a thin fiber is slipped under the skin to deliver laser heat that destroys the fibrous bands binding fat. This approach has shown to reduce the appearance of cellulite for six months to a year. Further study is needed.

  There's also a device that uses heat (radiofrequency) for nonablative treatment that improves how the skin looks. You'll likely need several sessions before you notice an improvement in the appearance of your skin. Nonablative treatments typically need to be repeated more often than do ablative treatments.

• Acoustic wave therapy. With this technique, a technician applies gel to the affected skin and runs a small, hand-held device (transducer) over the area. The transducer sends sound waves into your body, breaking up cellulite. You'll likely need several sessions before you notice an improvement in the appearance of your skin.
• Massage. Some cellulite treatments are based on the concept that vigorous massage will increase lymphatic flow, remove toxins and reduce excess fluid in cellulite-prone areas. One method uses a hand-held machine to knead the skin between rollers (Endermologie). Endermologie has FDA approval as a medical device with little potential to cause harm. You might notice a slight improvement to your skin after a number of sessions. The results are short-lived.

• Surgery. Your doctor may offer one of various procedures that use needles, blades or other special tools to separate the fibrous bands under the skin (subcision) in an effort to smooth the skin. One method also uses fat grafting to improve skin appearance. Results from these techniques may last two to three years.

  Complications of these techniques may include pain and bleeding beneath the skin.

Cellulite treatments aren't usually covered by insurance. Also, any of the procedures can have side effects, so be sure to discuss them with your doctor. Make sure your dermatologist or plastic surgeon is specially trained and experienced in the technique you're considering.

Potential future treatments

Researchers are studying possible medical treatments. Some that show potential use a combination of liposuction and ultrasound or laser. Liposuction alone won't remove cellulite, and it might worsen the appearance of your skin. But when combined with ultrasound or laser treatment, it might be effective at skin tightening. More study is needed.

Self-care can help improve the look of your skin.

• Medicated creams. Applying 0.3% retinol cream has been shown to improve the appearance of cellulite. Retinol helps thicken skin, which reduces the dimpling. Such products are applied once or twice a day. Any effect from a retinol cream won't be noticeable for six months or longer.
• Weight loss. If you're carrying extra weight, losing pounds and toning muscles may help improve the look of dimpled skin.
• Physical activity. Activities that tone muscles may help improve the appearance of dimpled skin. They also help with circulation and lymphatic drainage. Find one or more activities that you enjoy and can fit into your routine, such as yoga, Pilates, swimming, walking, biking, stair climbing and dancing.

Preparing a list of questions will help you make the most of your time with your doctor. For cellulite, some basic questions to ask your doctor include:

• What is the best course of action?
• What are my treatment options and the pros and cons for each?
• What will the treatments cost?
• What results can I expect?
• What kind of follow-up, if any, will I have?