Cellulite in slim women: why it appears and what helps

“If I'm slim, why do I have cellulite?” It is a frequent question, full of frustration, often from someone who exercises, eats well and still sees dimples on the thighs and buttocks. The short answer is that cellulite is not, essentially, a weight problem. It is a characteristic of the structure of the skin and the tissue beneath it, and is present in the great majority of women after puberty, regardless of body type.

Understanding this changes expectations. There is no diet, cream or exercise that makes cellulite disappear completely. But there are factors that make it more or less visible, and options with real, although modest, results.

What cellulite actually is

Cellulite (in technical terms, gynoid lipodystrophy) is a change in skin relief, with an “orange peel” or “mattress” appearance, more visible on the thighs, buttocks, hips and, sometimes, abdomen and arms. It is not a disease, it is not dangerous and it is not the same as localised fat.

The architecture of the skin

Beneath the skin there is a layer of fat (hypodermis) organised into small lobules. These lobules are separated by fibrous septa, bands of connective tissue that connect the skin to the deeper layers.

The difference between men and women lies in the orientation of these septa:

• In women, the septa are predominantly perpendicular to the skin, like the ties on a mattress. The fat lobules sit in “columns” that project upwards, against the skin, while the septa pull the skin down at the points where they attach. The result is dimples.
• In men, the septa form a crossed, diagonal network that distributes pressure and keeps the surface smoother. In addition, male skin is thicker.

Magnetic resonance imaging studies (Querleux et al., 2002) confirmed that women with cellulite have more perpendicular septa and greater irregularity in the transition between the dermis and the hypodermis.

The other players involved

• Hormones: oestrogens influence the distribution of fat (hips, thighs, buttocks), circulation and connective tissue. Cellulite appears after puberty and may worsen in pregnancy or with hormonal contraceptives in some women.
• Microcirculation and fluid retention: changes in local circulation and lymphatic drainage may accentuate the relief, although their exact weight is debated.
• Inflammation and fibrosis of the septa: over time, the septa may become stiffer and retractile, accentuating the depressions.
• Skin quality: thinner, less firm skin lets more of the relief beneath show through.

Why it appears in slim women

If cellulite depended only on the amount of fat, slim women would not have it. But since the main cause is the architecture of the tissues, fat is just one of the factors. In slim women, these weigh most:

1. Genetics

Cellulite tends to run in families. The way the septa are organised, skin thickness, fat distribution and the response of the tissues to hormones are, in large part, inherited. Exploratory studies (Emanuele et al., 2010) identified genetic variants associated with a greater likelihood of cellulite, but without practical application as yet.

2. Thinner or less firm skin

The skin works like a sheet over a mattress. A thin sheet shows every irregularity. Thinner skin, with less collagen or with laxity (through age, weight changes or sun damage) shows more cellulite, even with little fat beneath.

3. Fat distribution

Even slim women can have a “gynoid” distribution, with fat concentrated on the thighs and buttocks. A small layer of fat, if located exactly in the zone of perpendicular septa, is enough to create dimples.

4. Little muscle

A thin body with little muscle mass in the thighs and buttocks has less “firm volume” beneath the fat. Strength training can improve contour and firmness, even without changing weight much.

5. Recent weight loss

A study that followed women during a weight-loss programme (Smalls et al., 2006) concluded that, in most, cellulite improved. But in some of the participants it got worse, and this was associated with a lower initial body mass index, smaller weight losses, no reduction in thigh fat percentage and increased tissue laxity. In other words, losing weight when you are already slim can leave the skin looser and cellulite more visible.

6. Hormones and life stages

Pregnancy, hormonal contraceptives, menstrual cycle variations and, later, the menopause (with loss of collagen and a change in fat distribution) can influence cellulite, regardless of weight.

7. Posture and clothing

Some point to very tight clothing or long periods of sitting as aggravating factors, because of circulation. The direct evidence is weak. What is certain is that cellulite is more visible when sitting, as the skin is compressed, and in side lighting.

Myths worth forgetting

It is also worth stating the obvious, which marketing tends to hide: cellulite is normal. Most women have it. The decision to treat it is aesthetic and personal, not a health necessity.

What helps (and how much)

Lifestyle

• Strength training for the buttocks and thighs, two to three times a week. It increases muscle volume and improves the contour and firmness of the area. It is probably the most useful measure in slim women.
• Stable weight. Large weight swings stretch and loosen the skin. In someone who is already slim, losing more weight can make the appearance worse.
• A balanced diet with sufficient protein, which supports muscle mass and skin. There are no “anti-cellulite” foods.
• Not smoking, because of the effect on collagen and circulation.
• Sunscreen on the legs when exposed: sun damage thins the skin and makes it less firm.

Topical care

• Topical retinol: small trials (Kligman et al., 1999) showed a slight improvement in the appearance of cellulite after several months, probably through thickening of the skin. A modest effect.
• Caffeine and other methylxanthines: widely used in anti-cellulite creams; studies show small, short-lived effects, partly attributable to hydration and to the massage during application.
• Moisturisers and self-tanners: well-moisturised, lightly tanned skin (without sun) disguises the relief. An honest, immediate cosmetic effect.

Treatments in the clinic

A review of the evidence published in 2015 (Luebberding et al., 2015) concluded that most anti-cellulite treatments have small, short studies with modest results, and that none eliminates cellulite. That said, some have more support than others:

Two practical notes: the best results usually come from combining treatments with strength training and a stable weight, and almost all require maintenance. Be wary of promises of “permanent elimination”.

When it may not be (only) cellulite

There are conditions that are confused with cellulite and that deserve medical assessment:

This article is for information purposes and does not replace a consultation. The results of any treatment vary from person to person.

Frequently asked questions