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Leg cellulite

Leg cellulite

Written on 3rd November 2020
by Dr. Editorial Staff

Cellulite is one of the most widespread and common problems in contemporary society and is a major source of unease for those who suffer from it. Although it is a predominantly aesthetic problem, this particular condition has a major impact on people’s quality of life and can, in some cases, be a wake-up call to the presence of other accompanying pathologies.

The problem presents itself as an alteration of the normal condition of the skin, which gains an irregular appearance strewn with depressions and hollows. Commonly its aesthetic appearance is defined as “orange peel skin” while the active process in the subcutaneous layers is configured as a distortion of the normal architecture of the tissues and incorrect functioning of the lymphatic and microcirculatory system.

The most common areas of manifestation are generally located in the legs, buttocks, abdomen and more rarely in the neck and arms. There is also a greater predisposition in female subjects, while among men it is decidedly uncommon and with a limited occurrence to the abdomen and the back of the neck. At the base of this disorder, several factors have been identified, ranging from genetic predisposition to eating habits.

What is cellulite in the legs

In the medical field, this disorder is defined as oedematous fibrosclerotic panniculopathy or gynoid lipodystrophy, but other definitions are known, often linked to the distinctive appearance of the disorder. As can be seen from the names, cellulite is an altered condition of the hypodermis, i.e. the subcutaneous tissue that is close to the skin and which consists mainly of adipose reserves. In conditions of normal functionality, this layer plays a fundamental role in the daily balancing of caloric requirements by dispensing lipid reserves, through a process of lipolysis, or the accumulation of new reserves through liposynthesis. When the metabolic exchange is altered, the accumulation of fat, water and other waste substances is promoted, leading to the formation of swelling that alters the subcutaneous tissue and determines the subsequent unsightly development.

Specifically, cellulite on the legs, as well as on the buttocks, is the physiological consequence of the intervention of oestrogen hormones and progesterone, which promote an accumulation of lipid reserves in the lower part of the body rather than in other areas with a substantial difference between the genders. Hormones are the main suspects among the triggering factors of the disorder as well as genetic predisposition and malfunction of the circulatory and lymphatic system. Diet and lifestyle represent a determining factor in the progression of the disease but are only triggering causes in 10% of total cases.

How it develops

Cellulite is formed when the flow of body fluids from the circulatory and lymphatic system is disturbed at the subcutaneous level and no longer allows adequate metabolic exchanges. When the connective tissue undergoes a change in its consistency and viscosity, especially as water retention increases, the exchange of material between the tissues decreases and a build-up of fat, waste substances and water in the subcutaneous layer or cellulite is formed. The progressive increase in the volume of cellulite increasingly compresses the nerve endings and vessels causing a gradual increase in accumulation with the formation of real nodules that begin to behave like foreign bodies, often causing localised inflammation.

If the process of cellulite formation is not reversed, the effects of the accumulation of substances in the subcutaneous tissue amplify the negative effects on the skin, which begins to show the typical appearance of cellulite. In the early stages, the problem is almost invisible and still easily reversible. When the micronodules increase in size turning into macronodules, the effects on the skin surface become very evident and difficult to eliminate with cosmetic treatments.

Considering the fundamental circulatory factors for the appearance of cellulite, it becomes even clearer as to why cellulite concentrates on the legs and buttocks. In the lower part of our body, the return of blood to the heart encounters some difficulties both of a physical and mechanical nature. To these objective difficulties are often added posture or clothing stress, obesity and other factors that limit peripheral circulation or compromise it permanently. This condition can also lead to other pathological conditions such as varicose veins, phlebitis, thrombosis, etc. In the peripheral areas supplied with blood and oxygenated by the capillaries, just like the subcutaneous tissue of the buttocks and legs, the circulation gradually begins to decrease, affecting the metabolic exchanges between the adipocyte membrane and the surrounding tissues.

The main causes

The main causes of cellulite are attributable to hormonal and genetic factors; in fact, it is a disorder that afflicts most of the female gender due to the intervention of oestrogens and progesterones. The plasma concentration of these hormones, especially before the menstrual cycle and ovulation, promotes water retention, which is one of the determining factors in the onset of cellulite. It is for these reasons that cellulite affects women in 95% of cases and men only in 5% of cases. If we take into account dysmetabolic and endocrine disorders, which are more common in women, it is clear that the process is definitely influenced by hormonal disorders.

Problems related to obesity, diabetes, eating habits and daily life are not to be considered of secondary importance because although they are not triggering factors, they have the ability to affect the development of the disorder and cause permanent damage. By eliminating these contributing factors, it is possible to localise the problem at the reversible stages and contain its unsightly effects on the skin. With regard to the areas of the body that are most affected, the underlying principle of the woman’s genetic characteristics remains relevant, i.e. the natural tendency to accumulate fat on the buttocks and legs, as well as the restrictions on blood and lymphatic circulation in the lower limbs.

In summary, the main causes can be identified as:

  • Genetic factors
  • Hormonal factors
  • Dysfunctions of the circulatory and lymphatic system

The following are considered aggravating factors of the cellulite formation process:

  • Lower limb posture and fatigue
  • An improper diet
  • Obesity
  • Significant changes in body weight
  • Smoking
  • Tight clothing and shoes
  • Stress
  • A sedentary lifestyle

The stages of cellulite

Cellulite is a degenerative disorder and as such is characterised by several stages both in the active processes in the subcutaneous tissue and in the aesthetic expression. Aesthetic doctors divide the stages of the problem into 4 distinct phases:

  • Oedematous cellulite
    That is the first phase of cellulite characterised by venous stasis and accumulation of interstitial fluids. There are no obvious signs on the skin, and the process is easily reversible.
  • Fibrous cellulite
    Cellulite-related blemishes become more visible during this stage, especially along the legs and in the gluteal area. The first nodules are formed, which can still be easily eliminated by changing the diet and increasing physical activity to promote circulation.
  • Soft sclerotic cellulite
    The third stage of cellulite is characterised by the spread of nodules and their increase in volume. Circulation and nerve communication are impaired due to compression in the tissues. The skin begins to appear loose and highly irregular.
  • Sclerotic cellulite
    At this stage, the disorder usually becomes irreversible. The aesthetic effects become very evident while in the subcutaneous state, there is permanent tissue damage and generalised inflammation. Possible aesthetic medicine interventions become ineffective.

How to combat cellulite

Fighting cellulite is not as simple as some claims promoting miracle products or impromptu treatments would have you think. In practice, eliminating cellulite becomes a very long and complex process that involves psychological preparedness to undergo significant changes in daily life. Before starting any treatment, it is important to orient your diet and physical activity towards sustainable and healthy regimes for the body.

Diets based on anti-water-retention foods, such as fruit and vegetables, as well as low levels of sodium are the first important step in limiting water retention. Proper hydration, the intake of herbal teas and anti-water-retention infusions also play a fundamental role. For physical activity, you can encourage movement in the open air to increase oxygenation or rely on homemade leg stretching exercises to help blood circulation and strengthen muscle walls.

Ultimately, the buttocks and legs must be frequently massaged in order to promote circulation in the subcutaneous tissues and improve the tonicity and elasticity of the skin. The use of anti-cellulite creams and essential oils decisively promote the containment of the disorder in the initial stages.

Treatments for cellulite

Many aesthetic medicine treatments promise results for the treatment of cellulite despite the fact that not all of them ensure the definitive elimination of the problem. Some of the most frequently used methods in the fight against cellulite include radiofrequency, mesotherapy, cavitation and cryolipolysis. Other treatments such as pressotherapy or NIR (near infrared) can help to reduce the effects but are not effective against more advanced forms.

Radiofrequency is based on the principle of exposure of the tissues to electromagnetic waves which, by generating heat, help to burn significant accumulations of fat and other liquids and to promote the formation of new collagen. Medical cavitation, on the other hand, exploits the action of ultrasound to dissolve fat concentrations and promote their elimination. This treatment is very delicate and requires the intervention of qualified medical personnel.

Mesotherapy involves the injection of particular substances into the subcutaneous layer to reactivate the microcirculation and promote the exchange of metabolic fluids. The injections have the dual purpose of containing inflammation and allowing adipocyte cells and other tissues to recover their original function. With cryolipolysis, the properties of cold are applied for the destruction of adipocytes through apoptosis of the cells themselves, which are particularly sensitive to extremely low temperatures.


  • Carlo D’Aniello, Manuale di Medicina Estetica, Masterbooks, 2019
  • Alberto Massirone, Trattato di Medicina Estetica, Piccin Nuova-Libraria, 2010.

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