There is an interesting reason I wanted to talk about cellulite. In a poll I shared a while ago, I saw that most people ticked 'coffee increases cellulite'. But that is a misconception: coffee does not increase the appearance of cellulite — on the contrary, it can help reduce it. In fact, caffeine is an active ingredient in most anti-cellulite creams. Topics we assume are well known are often known incompletely or incorrectly by the public; that is why I prepared this article.
What is cellulite, and who gets it?
Cellulite is a condition that arises from a disorder in the arrangement of the skin and the tissues beneath it — that is, the fat and collagen tissues — and causes a dimpled appearance of the skin. It is not a disease.
About 90% of women experience cellulite at some point in their lives after puberty. It is generally not seen in men, because one of the most important factors in cellulite development is the hormone estrogen.
So what happens? Between the fat tissues under the skin and the membrane-like fascia that runs among them, there are collagen bands. Normally these bands and the fat tissue work in harmony and give the skin a smooth appearance. In cellulite, however, these collagen (fibrotic) bands shorten and become disorganized in places; they pull the skin down, while the fat becomes trapped between the bands and pushes upward, creating a dimpled, uneven appearance on the skin. According to another view, the opposite occurs: with loosening of the collagen fibers, the fat herniates toward the skin surface. In both cases the core problem lies in the structure of the collagen bands. Reduced microcirculation and lymphatic circulation in the area also worsen the picture.
Why does cellulite occur? (Causes)
Cellulite is multifactorial ; it arises from several factors coming together.
Hormones (estrogen)
The most important factor is estrogen. Estrogen disrupts the structure of fibroblasts, the cells that produce collagen; this disrupts the arrangement of the collagen bands in the area. For this reason, an excess of estrogen increases cellulite. (In men too, cellulite can appear if there are hormonal disorders such as androgen deficiency.)
Estrogen can rise during pregnancy and menopause. In menopause the ovaries lose their function, but the ovaries are not the only place that produces estrogen: fat cells — especially in the hip and buttock area — contain the enzyme aromatase, which converts testosterone into estrogen. So even in menopause, thanks to this enzyme in the fat tissue, estrogen production continues and the appearance of cellulite can persist or even increase. Hormonal disorders such as polycystic ovary syndrome and birth-control pills with high estrogen levels can also contribute to an increase in cellulite.
Genetics
As with many other conditions, genetic predisposition also plays an important role in the development of cellulite.
Lifestyle
This is actually the factor most within our control; but it is also often the most neglected.
The effect of nutrition and exercise on cellulite
Nutrition: it is important to stay away from packaged foods and bad fats and to reduce sugar as much as possible. The appearance of cellulite can be much more pronounced in people with diabetes, because high blood sugar/insulin increases swelling in the area and weakens circulation, worsening the appearance. Alcohol and smoking also worsen the appearance by increasing water retention. Drinking too little water is another contributing factor in the development of cellulite.
Exercise: one of the most effective ways of increasing blood flow to the area is exercise. Squats in particular, and walking backwards , which has become popular recently, work the muscles in that area more and so help to reduce cellulite.
Treatments
Manual treatment (massage, lymphatic drainage)
Massages that do not require a device — cellulite brushes, dry brushing and lymphatic drainage massage — contribute to reducing the appearance of cellulite. However, they are not enough on their own; they are more effective when combined with lifestyle changes and creams. In very severe cellulite they remain insufficient on their own.
Creams (topical treatments)
- Those containing caffeine / theophylline: they belong to the 'methylxanthine' group; they are thought to accelerate fat breakdown by inhibiting certain enzymes and to reduce the appearance.
- Retinol (vitamin A derivatives): positive effects have been shown, as it increases collagen production by stimulating fibroblasts.
- Those containing phosphatidylcholine: there is data suggesting they are effective.
- Those containing an aromatase inhibitor: since aromatase converts testosterone into estrogen in fat cells, creams with this ingredient have been shown to reduce the appearance.
An important limitation: these creams are mostly effective in mild cellulite. In severe cellulite the fibrotic bands thicken, so the creams are absorbed less easily through the skin and their effectiveness drops. Also, creams containing theophylline, phosphatidylcholine or an aromatase inhibitor may not be easily available in every country.
Non-invasive treatments
- Radiofrequency: there are different device types (monopolar acts deeper, bipolar acts more superficially). New-generation multipolar devices are more effective because they act on both the deep and the superficial layers. By delivering heat to the lower layer of the skin, they increase collagen production and circulation. For example, when applied after liposuction, results have been shown to last longer.
- Laser: not every laser; in particular, the 1440-nanometer laser contributes to skin firmness by increasing blood flow and collagen production in the area.
- Acoustic wave therapy: it has similarly been shown to reduce the appearance by increasing collagen and circulation.
Minimally invasive treatments
- Subcision: a procedure in which a fine needle or a special instrument is passed under the collagen bands to cut/release them. It may require local anesthesia and can be more painful; it has been found more effective in advanced cellulite. If done too superficially, tissue nourishment can be impaired; if done too deep, it can be ineffective; temporary swelling, bruising and, rarely, permanent color change can occur. (Methods such as radiofrequency, laser and acoustic waves can also cause temporary bruising.)
- Injection treatments: using enzymes such as collagenase, lipase and hyaluronidase, they aim to increase fat breakdown and collagen production in the area; collagenase derivatives in particular appear more promising.
- Fillers: hyaluronic acid and diluted calcium hydroxylapatite fillers are also being tried. However, since the change in the shared results is often limited, they do not currently stand out as a primary method.
Which treatment suits whom? (Cellulite stages)
- Mild cellulite: a slight appearance that is not visible while standing/sitting but appears when the skin is pinched. Massage + creams + nutrition and exercise contribute greatly.
- Moderate cellulite: an appearance not visible while lying down but appearing on standing up. Non-invasive methods such as radiofrequency, laser or acoustic waves are recommended (in the literature radiofrequency stands out slightly; more studies are needed for all of them).
- Severe cellulite: an advanced appearance seen both lying down and standing. Here, minimally invasive methods such as subcision or enzyme injections come to the fore.
Realistic expectations
Whatever treatment is done, cellulite treatment is not a lifelong solution. The expectation 'I had it done once, so I will never have cellulite again' is not correct; because the core problem is related to persistently poor circulation in the area. Poor nutrition, smoking, alcohol and water retention can worsen the appearance again. For this reason, device treatments should be repeated at certain intervals.
For results to last longer:
- reduce sugar, poor-quality/packaged fats, alcohol and smoking, and drink plenty of water (the goal is not to go hungry but to eat well);
- continue with creams and manual massage at home;
- keep up circulation-boosting exercises (squats, reverse walking), even at home.
These both make treatment results more lasting and provide the greatest support for reducing the appearance of cellulite.
Summary
- Cellulite is not a disease but an appearance issue related to a disorder in the arrangement of the subcutaneous fat and collagen tissue.
- The most important factor is estrogen; that is why it mostly occurs in women. Genetics and lifestyle also play a role.
- Coffee does not increase cellulite; caffeine is an active ingredient in most creams.
- Nutrition (less sugar, quality fats, plenty of water) and exercise (squats, reverse walking) are the strongest supports for reducing the appearance.
- Treatment varies by stage: massage/creams/lifestyle for mild; radiofrequency/laser/acoustic waves for moderate; subcision/enzyme injections for severe.
- No treatment is lifelong; regular repetition and lifestyle support are needed to maintain results.
Frequently Asked Questions
Does coffee cause cellulite?
No. Contrary to popular belief, coffee does not increase the appearance of cellulite — on the contrary, it may help reduce it. Caffeine is an active ingredient in most anti-cellulite creams.
Why does cellulite mostly occur in women?
One of the most important factors in the development of cellulite is the hormone estrogen. For this reason, about 90% of women experience cellulite at some point after puberty, whereas it is generally not seen in men.
Does cellulite go away completely and permanently?
Cellulite treatment is not a lifelong solution. The problem is largely related to persistently poor circulation in the area; poor nutrition, smoking, alcohol and water retention can worsen the appearance again. For this reason, device treatments should be repeated at certain intervals and maintained with lifestyle support.
Do anti-cellulite creams work?
Creams are mostly effective in mild cellulite. In severe cellulite, the fibrotic bands thicken, so the absorption and effectiveness of the creams decrease. Also, creams containing certain active ingredients may not be available in every country.
Which is the most effective cellulite treatment?
There is no single 'best' method; the appropriate treatment varies by the stage of cellulite. In mild cellulite, massage, creams, diet and exercise; in moderate cellulite, radiofrequency, laser or acoustic waves; in severe cellulite, subcision or enzyme injections come to the fore. The decision is made by the doctor after an examination.
Is exercise good for cellulite?
Yes. One of the most effective ways to increase blood flow to the area is exercise. In particular, squats and the recently popular reverse walking work the muscles in that area and contribute to reducing the appearance of cellulite.
About the Author
Op. Dr. Yasemin Aydınlı is a graduate of Hacettepe University English Medical Faculty and completed her specialty training at Ankara University. She is a member of TPRECD and ISAPS and works in aesthetic and reconstructive surgery in Istanbul.
This content is for general information only and does not replace medical advice. Every person is different; suitability and the process can only be determined by a personal examination and consultation.
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Op. Dr. Yasemin Aydınlı
Plastic, Reconstructive and Aesthetic SurgeonOffers personalized aesthetic solutions with a priority on naturalness and balance.