What causes cellulite?

I tell my patients that there are essentially two types of cellulite that we see most frequently. 

"Cottage cheese" cellulite

To simplify them, there seems to be one type that is like cottage cheese.  Where you see cells of fat under very thin skin, so it looks like tissue paper over cottage cheese.  Still this is a defect in the thickness of the skin or collagen of the dermis.  This is not the most common type of cellulite, and is more a function of having very thin skin (where the dermis has thinned too much).  Very thin skin can be genetic (such as many Scottish people) or it can be with age.  We know that menopause does affect the dermis, and that it thins out quite a bit.  

"Lattice-work" cellulite

A second type of cellulite that I see in my practice comes from losing elasticity from the skin elements.  There are little bands of collagen that run from the deeper structures (muscle or bone)  to the skin that hold the subcutaneous fat in a lattice work.  These bands are the steel bands that don't give way over time (collagen more like your fingernails).  As the skin loses its elasticity from getting older, smoking, sun exposure, and weight gain and loss, the skin sags around these steel bands and isn't as tight.  The lattice-work collagen holds onto the skin at spots, making indentations or cellulite. 

Anything that we can do to decrease the loss of elasticity of the skin and dermal elements will be helpful to keep cellulite in check. 

• We know that good hydration is helpful. 
• Since smoking decreases the elastic fibers, don't smoke (even when you are young and think it is cool--you will pay for it someday). 
• Radiation decreases the elastic fibers in the skin, and we get more radiation from sun exposure than any other way.  This is cumulative over your life.  So when you get sun at 20 years of age, you are going to pay for it when you are 60. 
• Having children makes it hard not to gain and lose weight. 
• And we all, as much as we hate it, get older. 

Keep it in perspective: getting older is better than the alternative of dying young!