What Causes Cellulite and Can It Be Removed?

Cellulite is the dimpled change in the skin's surface that the American Academy of Dermatology (AAD) puts in a category of its own: "cellulite differs from fat," the academy tells patients, and "treatment that can effectively remove fat often has no effect on cellulite."

An estimated 80-90% of post-pubertal women have it, according to a 2015 evidence-based review — a commonly cited estimate, not a population count.

Mechanically, a 2023 expert roundtable review in Dermatologic Surgery concluded that cellulite "primarily involves fibrous septal changes" — changes in the connective bands under the skin — and that female sex, older age and higher BMI all contribute.

The AAD's other point is scale: most women, even very fit women, have cellulite.

It is one of the skin and body concerns we cover, and the one where it pays most to separate what the marketing says from what the studies and clearance documents actually show.

The clearest answer is structural: the 2023 roundtable review lists female sex among the factors contributing to the fibrous-septa changes behind cellulite, alongside older age and higher BMI.

The 80-90% estimate above refers specifically to post-pubertal women — that is the group the figure describes.

You may have seen the tidy diagram: women's fibrous septa run perpendicular to the skin while men's run at a 45-degree angle, so fat pushes up between the bands.

Treat it as a simplification.

One MRI study found that women with cellulite did have more perpendicular septa, but that the three-dimensional network could not be modeled that simply — perpendicular planes for women, tilted planes at 45 degrees for men.

Hormones, circulation and genetics are often named online as causes too.

Our sources for this page captured no verified figures on those, so we leave them out rather than repeat them.

Sometimes it helps, and sometimes it backfires.

The AAD's guidance is two-sided: losing weight can reduce visible cellulite for some people, but if loose skin develops during weight loss, cellulite can become more noticeable.

Fitness is not protection.

The AAD notes that most women, even very fit women, have cellulite — its framing is that cellulite differs from fat, and treatments that remove fat often have no effect on it.

Exercise can still change the picture: the AAD says building muscle can make cellulite less noticeable.

Devices built for muscle rather than fat exist in this space — BTL's HIFEM body devices are 510(k)-cleared as powered muscle stimulators, and its BTL 799-2 was cleared in 2018 for improving abdominal tone and strengthening the abdominal muscles, and for strengthening, toning and firming the buttocks and thighs, with arms and calves added in later clearances.

Our Emsculpt guide covers BTL's device line and what its clearances do and don't say.

On the fat side, the mismatch is the point.

The AAD says treatments that effectively remove fat often have no effect on cellulite — which is why a body contouring plan aimed at fat bulges is not automatically a cellulite plan.

Liposuction makes it starkest: the AAD does not recommend it for getting rid of cellulite, and warns it can make the dimpling more obvious.

The AAD sorts the in-office options by how well they are supported.

It rates acoustic wave therapy, some laser treatments, subcision (Cellfina) and vacuum-assisted precise tissue release as having the best research support for cellulite, and it does not recommend cryolipolysis (fat freezing), mesotherapy or supplements for cellulite.

The 2023 review points to the same theme from the mechanism side: strategies that target the fibrous septa have shown the most consistent results.

Here is what the FDA clearance documents actually say for the devices whose cleared wording names cellulite — all clearances (510(k)), none approvals, and every wording about the appearance of cellulite:

Read the wordings closely: short-term, temporary or long-term improvement in appearance — never removal.

Note how narrow the cleared claims are, too: Cellfina's and Avéli's name the buttocks and thighs of adult women specifically, and both are subcision — the AAD rates subcision (Cellfina) among its best-supported options, and Avéli is a handheld subcision device.

On fat freezing specifically, the AAD's words are that while it can be very effective for getting rid of small pockets of unwanted fat, it "currently cannot get rid of cellulite."

On injectables, the record is cautionary.

QWO, an injectable the FDA approved for cellulite on July 6, 2020, is no longer sold: its maker, Endo, announced on December 6, 2022 that it would cease production and sale because of concerns about bruising and potential prolonged skin discoloration.

Adjacency is not clearance.

Morpheus8's current 510(k) (K231790, decided July 20, 2023) covers dermatologic procedures needing coagulation or contraction of soft tissue, or hemostasis — cellulite does not appear in that cleared text.

The test for any radiofrequency microneedling brand is the same: "cleared for cellulite" is true only if that exact indication appears in its own 510(k).

The procedures, session patterns, side effects and prices behind the options that are available sit in our cellulite treatment hub, treatment by treatment.

A 2015 systematic review set the baseline expectation.

Across 67 cellulite-treatment studies, most had important methodological flaws, and no clear evidence of good efficacy could be identified for any treatment evaluated; the "some evidence" it did find was limited to acoustic wave therapy and a 1440-nm minimally invasive laser.

Duration follows the same modest pattern.

The AAD describes most cellulite results as temporary: radiofrequency gives a small, short-lived improvement, endermologie results fade within about a month of stopping treatment, and some laser results last 6 months or more before dimpling returns.

The longest follow-up among the clearance wordings we read, in the table above, belongs to Cellfina: long-term improvement in the appearance of cellulite in the buttocks and thighs of adult women, with data showing no significant loss of benefit through five years.

Note the wording — improvement in appearance, supported by an observation window, not a permanent change.

So the realistic version is the sourced version: improvement in appearance, with most results temporary, one cleared option with data through five years, and none of the cleared wordings above promising removal or a cure.

Which treatment, if any, suits your skin is a question for a licensed provider at a consultation.

Start from the treatment, not the brochure.

A practice that can name the exact device or procedure, and say what its FDA clearance actually covers for cellulite, is having a very different conversation from one that promises smooth skin.

Two red flags follow from the evidence above: anyone promising permanent cellulite removal, because no treatment has been shown to achieve it; and anyone dismissive about the research, because a 2015 review of 67 studies found no clear evidence of good efficacy for any treatment it evaluated.

For the full checklist — credentials, questions to ask, who may perform what where you live — see our how to choose a med spa guide and our guide to med spa laws by state.

What any of it would mean for your own skin is not something a list like this can answer: a consultation with a licensed provider is where your case gets assessed.