Cellulite, what is it and what can you do about it?

Skin concerns

So, whats it all about?

Cellulite goes by many names but what exactly is this dreaded yet common condition?
Dr Jenni Irvine, The Aesthetics Centre, South Africa explores causes, types and treatments.



Cellulite is an inflammatory process of the adipose (fat) tissue, interstitial tissue (connective tissue between elements of a body structure) and the small subcutaneous blood vessels. This causes changes in the fibrous connective tissue, an increase in adipocyte mass, fluid retention and fluid stagnation in the tissues. These changes result in a compromise of microcirculation, which further damages the adipose tissue. Cellulite affects the thighs, buttocks and abdomen and is more noticeable if you have a raised BMI.



Muti offers the BTL Exilis Elite, which is one of the most advanced body contouring systems available. Combining high frequency ultrasound (similar to Ulthera) with radiofrequency energy, the Exilis body contouring offers powerful deep tissue treatment as well as more superficial skin tightening.

Example in the before and after photos, 4 treatments to upper thigh and buttocks, one week apart.



Genetic influences –Cellulite has both gender and racial preferences. Cellulite is more common in women after puberty and it less commonly affects men. It is more common in Caucasian and black women.

Hormonal influences – pregnancy, hormonal irregularities affecting oestrogen, insulin, noradrenalin, thyroid hormones and prolactin will influence cellulite formation

Vascular influences – any conditions that affect small vessel circulation in the subcutaneous tissue will influence cellulite formation

Diet – A diet high in fats, carbohydrates and salt, and low in fibre predisposes individuals to cellulite.

Lifestyle influences – smoking, being overweight, and a lack of exercise will lead to cellulite formation.



Cellulite can be defined as being in different stages, according to the physiological processes going on and the physical appearance

Stage 1. The oedematous phase. This is due to the retention and stagnation of fluid in the tissue; the cellulite is only noticed on touch or pinching of the skin. At this stage your legs may look swollen and feel tingly or heavy.

Stage 2. The fibrous phase. The stagnation of fluid now affects microcirculation and damage occurs to the adipocytes. The adipocytes start to swell and cause pressure on the elastic fibres. We start to see dimpling and puckering on standing: this disappears on lying down. A thermal scan shows mouchete pattern – hyperthermic (warm) areas due to oedema or fluid and hypothermic (cold) areas due to poor circulation.

Stage 3. The sclerotic phase. The connective tissue is irreparably damaged. This affects the adipocytes, elastin, collagen and blood vessels. Connective tissue becomes thickened, hardened and we see micronodules of trapped fat within the connective tissue. On the skin, we now see micronodules with visible puckering and dimpling on standing and lying down (referred to as orange peel). A thermal scan shows a ‘leopard’ pattern. There are multiple small hot spots occurring around larger hypothermic spots. The cold spot represents the adipocytes and the hot spots are small areas of venous stagnation.

Stage 4. There is now complete loss of normal subcutaneous fat architecture. Larger stiff macromolecules are trapped in the hypodermis. There is further sclerotic degeneration of the adipocytes. This damage is irreversible. A thermal scan shows large cold holes due to the macronodules with smaller surrounding hot spots due to venous stagnation.



There is no cure for cellulite.

Weight loss, where appropriate, will help. Most recommended treatments will improve the appearance of cellulite, but will require ongoing treatment.

Clinic-based treatments consist of treatments that stimulate lymphatic flow such as massage, heat therapy, pneumatic massage and electrical stimulation or treatments that destroy fat cells. Ultrasound and radiofrequency therapies are effective. (For example, the BTL Exilis Elite.)

What about Lipo? Cellulite is a condition of the superficial adipose tissue, while liposuction works in deep subcutaneous fat. It does not treat cellulite but can decrease adipose tissue bulk.

At-home treatments (drugs or pharmacological agents) are used to improve cellulite appearance. These include

Retinoids – vitamin A derivatives

Botanicals – with new products emerging in this group, including Caffeine, capsaicin, green tea and theobromine, amino acids, ginkgo, biloba, rutin. To name a few.


Muti offers the BTL Exilis Elite, which is one of the most advanced body contouring systems available. Combining high frequency ultrasound (similar to Ulthera) with radiofrequency energy, the Exilis treatment offers powerful deep tissue treatment as well as more superficial skin tightening.

The mechanical effect of ultrasound helps create separation of the fat cell clusters, allowing more efficient radiofrequency thermal delivery to adipose tissue. Exilis is the only monopolar Radiofrequency system to incorporate ultrasonic energy in one hand piece.

Below, before and after 4 treatments with Exilis, one week apart.


Dr Jenni Irvine is one of South Africa’s leading Aesthetic Doctors and trainers in Aesthetic medicine. Her article is reproduced with her permission and my thanks. The Aesthetics Centre, leading dermatological and anti-ageing centre.


As with all aesthetic treatments which rely on your body’s natural response, results will vary; some skins will take longer to change, some will change more than others. Lifestyle factors, such as sun exposure, general health, diet, can also influence your response.