Cellulite grades: how they are classified and why it matters

“I have grade 2 cellulite” or “it's grade 3, there's nothing to be done”. Cellulite grades appear in magazines, on social media and in consultations, but not always with the same meaning. Some classifications used in marketing have never been validated; others are scientific scales used in clinical trials.

Knowing the grade has a concrete use: it helps you have realistic expectations, choose what makes sense to do and measure whether a treatment is working. This article explains the most widely used scales, how you can assess it at home and what each grade means in practice.

The Nürnberger-Müller scale

In 1978, two German researchers, Nürnberger and Müller, published an anatomical study that explained cellulite by the orientation of the fibrous septa in women, and proposed a simple classification, based on observing the skin in different positions and with the so-called pinch test.

Why it is useful: it is simple, quick and can be done without equipment. It is a good way to get a sense of the general “stage”.

Limitations: it is not very detailed. Two people with grade II may have very different cellulite (few deep depressions or many superficial ones, with or without laxity). That is why, for clinical trials and treatment follow-up, a finer scale was needed.

The Hexsel severity scale (CSS)

In 2009, the Brazilian dermatologist Doris Hexsel and colleagues published a validated photonumeric scale, the Cellulite Severity Scale (CSS), today one of the most widely used in studies. It assesses five characteristics, each scored from 0 to 3 points:

Source: Hexsel et al., 2009.

The total (from 1 to 15) classifies cellulite as:

• Mild: 1 to 5 points.
• Moderate: 6 to 10 points.
• Severe: 11 to 15 points.

Why it is useful: it separates components that respond to different treatments. For example, many deep depressions suggest retractile septa (which may benefit from subcision, a medical procedure), whereas dominant laxity calls for skin-firming treatments.

Other classifications

• More recent photonumeric scales, developed for clinical trials of new treatments, mainly assess overall severity by comparison with reference photographs.
• The “oedematous, fibrous, sclerotic” classification (or “soft, hard, oedematous”): widely used in aesthetics, it is based on a historical theory about stages of cellulite that has never been validated or consistently demonstrated. It can be a useful description of the feel of the skin, but it is not a scientific classification.
• Terminology: in some studies, cellulite is also called “oedematous fibrosclerotic panniculopathy”, a technical name that does not change the essentials.

How to assess your cellulite at home

You need a large mirror, side lighting (from a window, for example) and, ideally, a phone to take photographs.

1. Standing, relaxed. Stand sideways to the light, with your feet slightly apart and your weight spread over both legs. Observe the thighs, buttocks and hips, from the front, side and back (with the help of a second mirror or photographs).

• Do you see dimples or relief without doing anything? Grade II or III.
• Does the skin look smooth? Move on to the next test.

2. Pinch test. With your thumb and forefinger, gently pinch together the skin and fat of the thigh or buttock, or tense the buttock.

• Does an orange-peel or mattress appearance appear? Grade I.
• Only smooth folds form? Grade 0.

3. Lying down. Lie face down or on your side and observe (or photograph).

• Is the cellulite still visible? Grade III.
• Does it go away? Grade II.

4. Count and observe. For a closer idea of the CSS scale:

• How many distinct depressions can you see in an area?
• Are they superficial or deep?
• Does the surface look like orange peel, cottage cheese or a mattress?
• Is there laxity, with skin that “falls” over itself?

5. Photograph with a method. Same light, same distance, same position, no filters. Repeat every 2 to 3 months, or before and after a treatment. Cellulite changes in appearance with light, temperature, the phase of the cycle and even the time of day; standardised photographs avoid wrong conclusions.

What can distort the assessment

• Strong overhead or side lighting accentuates relief; frontal light disguises it.
• Posture: with weight on one leg or when sitting, cellulite becomes more visible.
• The premenstrual phase and heat can accentuate swelling.
• Tan and moisturising disguise it.

If you ticked any of them, the assessment should include the possibility of lipoedema. See Cellulite or lipoedema: how to tell the difference.

What makes sense at each grade

Grades do not dictate an automatic treatment, but help to adjust expectations.

Three important notes:

• Laxity changes everything. When the skin is loose, treatments that act only on fat or on the septa can even make the appearance more irregular. It is common in women who have lost a lot of weight or after the age of 40 to 50.
• A higher grade does not mean more urgency. Cellulite is not a disease. Treating it is always an aesthetic choice.
• The assessment should be repeated using the same method to know whether a treatment is working.

Can cellulite change grade?

It can change, in both directions. The factors most associated with worsening are:

• Weight gain, especially fat on the thighs and buttocks.
• Weight loss in someone who is already slim, with increased laxity.
• Age and menopause, with thinning of the skin and loss of collagen.
• Pregnancy, because of hormonal and weight changes.
• A sedentary lifestyle and loss of muscle mass.

And those most associated with improvement:

• Weight loss in someone who is overweight, with a reduction in thigh fat.
• Gain in muscle mass with strength training.
• Combined, maintained treatments.

Monitor methodically

If you are going to have a treatment, ask for the initial assessment to be recorded: grade, score (if they use the CSS), standardised photographs and, if possible, measurements. It is the only honest way to know whether it was worth it.

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