We often talk about cellulite on the blog, along with ways to look after your skin every day. But do you really know what cellulite is? Definition, how dimples form, the different types, the areas affected, causes, stages and the link with weight: let’s go through it all so you can get to know your enemy better!
What is cellulite?
Cellulite stems from a change in the structure of the tissues beneath the skin, where fat reserves are stored. Instead of smooth skin, you end up with unsightly “bumps” that can spread across a large part of the body, typically the legs and buttocks, but also the arms and stomach. When you have cellulite, fat cells have stored too much fat, causing them to enlarge and clump together. This is what creates dimples and gives the skin its bumpy texture.
Cellulite is a common and harmless phenomenon, found predominantly in women. Dimples result from an excessive build-up of fat cells, also known as adipocytes, housed within the hypodermis (the layer beneath the skin’s surface), in small compartments (1). When these adipocytes increase in number and volume, the compartments swell and take on a rounded shape, giving the skin’s surface its characteristic bumpy appearance.
Cellulite vs fat: what’s the difference?
The two are often confused, but they aren’t quite the same thing. Fat refers to the reserves stored in adipocytes, and everyone has some. Cellulite, on the other hand, isn’t an amount of fat. It describes the dimpled look the skin’s surface takes on when the structure of these tissues changes, as explained above.
So cellulite isn’t simply a question of weight: almost all women have it, whatever their body shape. We come back to this further down, in the section on weight.
How does cellulite form?
When the storage of adipocytes beneath the skin (known as lipogenesis) and the body’s consumption of fat are in balance, fat cells remain a normal size. However, when fat intake is too high, these cells become hypertrophied, compressing the blood and lymphatic vessels and forming dimples.
The different types of cellulite
Did you know? There are different types of cellulite, generally grouped into three categories that can sometimes overlap. If you haven’t yet identified your cellulite type, now is the time to find out!
Aqueous cellulite
Many women suffer from it: aqueous cellulite is linked to poor venous circulation and is generally accompanied by water retention and swelling. The skin’s texture resembles orange peel even without being pinched, the tissues tend to be puffy, and the skin lacks suppleness. This type of cellulite is the least visible of the three. Even slim women can be affected.
Learn more about aqueous cellulite
Adipose cellulite
Adipose cellulite is generally linked to a poor diet and a sedentary lifestyle. It is only visible when you pinch the skin or in certain positions, and it is not painful.
Learn more about adipose cellulite
Fibrous cellulite
Fibrous cellulite is unfortunately the type that calls for the most patience. It tends to be hard to the touch, and can even be painful in certain areas. If you experience any pain, seek advice from a doctor or healthcare professional. It is clearly visible to the naked eye and looks quite bumpy. These are deep-set dimples that have been embedded in the tissues for a long time. It will take consistency and motivation!
If you’re still unsure about your cellulite type, you can also take our online test in just a few minutes!
Learn more about fibrous cellulite
Which areas are affected by cellulite?
The main areas affected by this phenomenon are:
icon-arrow-circle-right the thighs,
icon-arrow-circle-right the buttocks,
icon-arrow-circle-right the hips,
icon-arrow-circle-right the stomach,
icon-arrow-circle-right the upper arms,
icon-arrow-circle-right the knees,
icon-arrow-circle-right the legs
The main causes of cellulite
A combination of several factors can explain the causes of cellulite. The main factor remains the hormonal fluctuations women experience at various stages of life: puberty, the contraceptive pill, pregnancy, menopause, etc. Cellulite is made worse by problems with blood and lymphatic circulation, lifestyle, age, stress and genetics.
Posing no risk to health, it is considered a normal physiological phenomenon. It can, however, cause discomfort and localised pain, and is often a source of self-consciousness (2).
Learn more about the causes of cellulite
Who is at risk of cellulite, and how can you prevent it?
Almost all women (92%) are affected by cellulite, while virtually no men are… Unfair, isn’t it? Cellulite can have various causes: a diet too high in fat, sugar or salt, lack of physical activity, a tendency towards water retention… That said, female hormones and genetics also appear to play a key role: puberty, pregnancy and oestrogen-based treatments can all contribute to cellulite. Smoking is also one of the factors often cited in the development of dimples.
To prevent or reduce cellulite, here are a few basic tips to follow:
- Avoid heat (sauna, hammam, very hot baths…) and take cool showers every day.
- Don’t overdo the heels, and alternate with flat shoes.
- Keep moving throughout the day and avoid sitting for more than two hours without stretching your legs.
- Opt for comfortable clothing that isn’t too tight.
- Adjust your diet: you can eat everything, but prioritise vegetables, protein and wholegrain starchy foods, and limit refined sugar, excess salt and saturated fats.
- Take up targeted physical activity: certain exercises can complement your routine if you do them regularly.
- Take care of yourself: this includes massage sessions with your Cellublue cupping cup. Also remember to exfoliate your skin regularly with a body scrub, and to use targeted skincare…
The different stages of cellulite
In addition to the different types of cellulite, there are different stages depending on how far the orange-peel skin has progressed. Cellulite — whether fibrous, aqueous or adipose — doesn’t appear overnight: it is more of a gradual process that evolves through several key stages.
Cellulite is generally classified according to a few established frameworks: either the “Nurnberger & Muller” scale, developed by the first two scientists to propose a cellulite classification system (in 1978), or for example that of dermatologist Doris Hexsel who, in 2009, introduced a new way of classifying cellulite (the “Cellulite Severity Scale”, also known as “CSS”).
Cellulite grade, stage or level: what does it mean?
Depending on the source, you’ll see cellulite described by “grade”, “stage”, “level” or “step”. These words all refer to how far cellulite has progressed, but not necessarily on the same scale. The Nurnberger-Muller classification has 4 levels, from 0 to 3. The Doris Hexsel scale gives a score from 0 to 15 points: mild, moderate or severe cellulite. Finally, the typical progression, described further down, is divided into 4 steps, from 1 to 4.
So “grade 3” or “grade 4” cellulite doesn’t mean the same thing from one scale to another. Always check which classification is being used.
The Nurnberger-Muller Classification
The Nurnberger-Muller classification is the most widely used, as it is based simply on how cellulite looks to the naked eye. It has 4 stages (from 0 to 3), corresponding to increasingly pronounced cellulite.
Stage / Level 0 cellulite
No dimples or visible surface irregularities when standing, lying down, or when the skin is pinched.
Stage / Level 1 cellulite
No dimples or visible surface irregularities when standing or lying down. However, when you pinch the skin, dimples (fatty deposits within the tissues) appear.
Stage / Level 2 cellulite
Dimpling appears spontaneously when standing, but not always when lying down. The orange-peel appearance of the skin is clearly visible to the naked eye, with no need for manipulation.
Stage / Level 3 cellulite
Dimpling is present spontaneously whether you are standing or lying down. Cellulite is clearly visible to the naked eye with no manipulation required. The skin has an “orange-peel” appearance with particularly raised areas.
The Doris Hexsel Classification
Entirely different in approach, this classification assigns a score to your cellulite: a highly detailed image (using magnetic resonance) is taken of the affected area. The doctor then answers 5 fairly technical questions (the last of the 5 being somewhat particular, as it draws on the Nurnberger-Muller classification — meaning the Doris Hexsel classification is partly dependent on it).
At the end of this process, which only a doctor can carry out (since a magnetic imaging scan is required and the test cannot be performed alone), a score between 0 and 15 is assigned. From 1 to 5 points: mild cellulite; from 6 to 10 points: moderate cellulite; from 11 to 15 points: severe cellulite.
Here again, when someone refers to “severe cellulite”, it is important to clarify which scale is being used.
The typical clinical progression of cellulite
Progression and classification are often confused. There are dozens of ways to describe how cellulite evolves, whereas there are only 2 well-documented methods for classifying it. Below, we outline the typical progression of cellulite — referring to “stages” rather than “levels”.
Stage / Step 1 of cellulite
The skin shows no visible signs yet, but changes are already taking place beneath the surface. This first stage is therefore not yet identifiable to the naked eye. In more detail: there is an increase in the volume of fat tissue cells in the affected area, caused by a build-up of fat at that location. There is no circulatory disruption (at the blood level) or tissue damage — only a slight dilation of the small veins within the fatty tissue. No pain is felt. Using a thermal image of this area of skin, a so-called “mottled” pattern can be seen, reflecting the rise in temperature caused by the developing oedema (which compresses the vessels and therefore raises the temperature).
Stage / Step 2 of cellulite
Orange-peel skin has not yet appeared, but on closer inspection, the skin looks paler in certain areas and is less elastic (a sign of poor circulation — a phenomenon closely linked to cellulite).
The fat cells are slightly fattier, and those deeper down are beginning to undergo the same process. Blood and lymph (the watery fluid that bathes the cells) become congested. A more significant “swelling” of the fat cells occurs, and fluids tend to build up. The normal hormonal activity of women increases bodily fluid, causing additional swelling. Contraceptive use and pregnancies, due to hormonal activity, cause tissue swelling and worsen the changes. In the skin, irregularities can already be detected by touch, but there is still no pain. In thermography, the “mottled” pattern is much more visible and pronounced.
Stage / Step 3 of cellulite
There is a disorganisation of the tissues and the emergence of dimples which, despite their depth, are perceived as surface irregularities even without palpation. The dimples become even more apparent when the skin is pinched, and you can feel a rougher, less smooth texture to the touch.
Fibrosis begins to set in — meaning the hardening of the tissue (where the fibres are located) — and circulation becomes even more disrupted. Micro-varicose veins may develop. The skin takes on the appearance of “orange peel”. A sensation of heaviness and fatigue in the legs then occurs (it is worth noting that cellulite is linked to local circulatory functional issues at the level of the skin and fatty tissues, and that at this stage, circulation within the fatty tissue is already compromised).
Stage / Step 4 of cellulite
The final stage of cellulite progression — where deeply embedded cellulite remains constantly visible. It can be clearly felt to the touch and may even become painful.
The disordered swelling of fat cells is more pronounced, the tissue becomes increasingly hardened (fibrosis) and blood circulation is severely disrupted. At this stage, cellulite is firm and the skin appears “shiny”, with a quilted texture. The legs become heavy, swollen and painful, and a persistent sense of fatigue is common — even without physical exertion.
Does weight have an influence on cellulite?
There are many misconceptions surrounding cellulite. One of the most widespread claims is that if you have cellulite, it’s primarily because you’re overweight and should go on a diet to lose weight!
As we’ve seen above, cellulite is mainly caused by a structural change in the tissues, an imbalance that affects our fat reserves.
While it does involve fatty deposits, the appearance of cellulite isn’t always linked to weight. Almost all women have cellulite, even the slimmest ones: it can affect every body shape. So the appearance of cellulite is not simply a matter of weight or diet.
Whatever your cellulite type and stage, you can add the pinch-and-roll massage technique to your routine to take care of your skin. This technique can be quite tricky to perform by hand, but that’s where the Cellublue cupping cup comes in! Thanks to its suction effect, it replicates the pinch-and-roll technique to support your daily massage sessions.
Learn more about ALL anti-cellulite solutions
Sources and references
(1) Rawlings, A. V. (2006), Cellulite and its treatment. International Journal of Cosmetic Science, 28: 175-190. doi:10.1111/j.1467-2494.2006.00318.x
(2) Angehrn F, Kuhn C, Voss A. Can cellulite be treated with low-energy extracorporeal shock wave therapy?. Clin Interv Aging. 2007;2(4):623-30. PMC2686339
Cellulite: Classification and Scoring – Doris Hexsel, Camile L. Hexsel, and Fernanda Naspolini Bastos
Frequently asked questions
What is cellulite?
Cellulite is a change in the structure of the tissues beneath the skin, where fat reserves are stored. It gives the skin a dimpled look, often called “orange-peel skin”. It is a common and harmless phenomenon, particularly in women. The process is explained in more detail in the “What is cellulite?” section.
Why do we get cellulite?
Several factors combine. The main one remains hormonal fluctuations in women (puberty, the contraceptive pill, pregnancy, menopause). Genetics, age, stress and lifestyle also play a part: a diet too high in fat, sugar or salt, lack of physical activity and smoking. You’ll find more detail in the section on the causes of cellulite.
What are the different types of cellulite?
There are generally three types of cellulite, which can sometimes overlap. Aqueous cellulite is often associated with water retention. Adipose cellulite is linked to diet and a sedentary lifestyle. Fibrous cellulite is harder to the touch and has been there for a long time.
How do I know which type of cellulite I have?
Aqueous cellulite shows orange-peel skin even without pinching, with rather puffy tissues. Adipose cellulite only appears when you pinch the skin or in certain positions. Fibrous cellulite is hard and clearly visible. Our online test can help you find out. If you experience any pain, seek advice from a doctor.
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- How to practise the pinch-and-roll massage on your thighs?
- Cupping massage: how many times a week?
- CelluBlue Body Challenge – Day 25
- 5 things you may not know about cellulite!
- Challenge 2016: Day 2
Useful categories: All About Cellulite.
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