Cellulite: Adipose, Aqueous, and Fibrous—Targeted Treatments

What is cellulite, and what are its different types?

Cellulite is a skin condition characterized by a dimpled skin texture—the “orange peel” appearance—primarily found on the thighs, buttocks, abdomen, and hips. It affects 85 to 90% of women after puberty, regardless of weight. There are three types, each with distinct mechanisms and treatments:

• Adipose cellulite: soft to the touch, linked to excess fat storage in the subcutaneous lobules. Responds well to exercise and weight loss.
• Aqueous cellulite: appears swollen and soft, associated with water retention and poor lymphatic circulation. Prioritize drainage and venotonic herbs.
• Fibrous cellulite: hard, painful to the touch, with deep, long-standing dimples. The most resistant to treatment, it requires targeted mechanical or medical techniques.

Identifying your type of cellulite guides the choice of treatments: there’s no point in investing in a lipolytic treatment for aqueous cellulite, and vice versa.

What are the hormonal and biological factors behind cellulite?

Estrogens are the primary hormonal factor in cellulite: they increase water retention, stimulate lipogenesis in the thigh and buttock areas, and weaken capillary walls—three mechanisms that contribute to the development of dimples. This is why cellulite appears or worsens during puberty, pregnancy, while taking oral contraceptives, and during menopause (redistribution of fat from the extremities to the abdomen). Collagen also plays a key role: as we age, it becomes stiffer and thinner, making dimples more visible. Supplementing with marine collagen and vitamin C (a cofactor in its synthesis) can improve skin elasticity and reduce the visibility of dimples.

What medical treatments target cellulite based on its type?

Professional treatments are tailored to the type and depth of the cellulite:

• Adipose cellulite: cryolipolysis (fat cell destruction using cold), liposuction for stubborn cases, and focused ultrasound.
• Aqueous cellulite: manual lymphatic drainage, pressotherapy, horse chestnut and witch hazel as oral venotonics.
• Fibrous cellulite: endermology (mechanical kneading and rolling), targeted mesotherapy, deep radiofrequency to soften the fibrous septa.

Anti-cellulite creams (caffeine, retinol) are useful for maintenance but are insufficient on their own for long-standing fibrous cellulite—they do not penetrate deeply enough to affect the hardened septa.

How can you reduce cellulite through diet and supplements?

Diet works through two mechanisms: reducing fat storage and limiting inflammation in the subcutaneous tissue:

• Reduce salt, simple sugars, and alcohol, which promote water retention and lipogenesis.
• Omega-3s: reduce inflammation in adipose tissue and improve the fluidity of adipocyte membranes.
• Antioxidants (vitamins C and E, polyphenols): protect capillary walls and skin collagen from oxidative damage.
• Internal drainage: birch, cherry stem, and red vine to reduce fluid retention, which causes fat lobules to swell.

Is exercise alone enough to eliminate cellulite?

Exercise is essential but not sufficient on its own. It has a dual effect: it reduces overall fat mass (less fat in the lobules) and improves blood and lymphatic circulation (less stasis, which causes the dimpled appearance). HIIT and targeted strength training (squats, lunges, hip thrusts) yield the best results for adipose cellulite. For fibrous cellulite, exercise must be combined with mechanical techniques (endermology, palpate-and-roll) to break up the adhesions in the septa. Without accompanying weight loss in cases of excess body fat, results remain limited.