Is this fascia, cellulite, bad genetics? How can this be improved? (Photos)

Hi Summersamantha ! Thank you so much for your question and for sharing this here.
Based on what you described and from what you are showing in your photos — this can definitely represent more than one thing at the same time. Cellulite, skin laxity, adiposity patterns, and lipedema can all overlap — and each one behaves differently depending on position, bending, tension and load on the tissue. That does not mean something is “wrong” with you — it means the physics change under load. Lipedema is a chronic condition where abnormal fat deposits (mainly in the extremities). Lipedema is diagnosed based on physical exam and medical history — and requires exam, staging, history, symptom evaluation, and proper clinical assessment. A photo alone cannot diagnose this.
Aveli is a great tool in my hands for the buttocks inner quadrant dimples. The thigh irregularities in many patients are significantly less predictable because they are often driven more by skin laxity + adipose pattern rather than pure isolated septa tethering — so your experience is unfortunately very real and not uncommon.
Every patient is unique — anatomy, history, physical exam, tissue quality, goals, skin elasticity, and surgical risk profile all change what is indicated / recommended. Because of this, this should not be taken as personal medical advice. The next step is always an in-person evaluation with a board certified plastic surgeon that can examine you and discuss individualized plan options.
Hope this helps!
— Georgina Nichols, MD FACS