Cellulite is commonly considered a flaw by the public, but from a medical perspective, it is rather an anatomical feature present in almost all women. General practitioner Andrey Kostikov, in a conversation with Rambler, explained why this phenomenon is extremely rare in men and whether the manifestations of “orange peel skin” can be eliminated without professional intervention. What these changes represent A terminological confusion has occurred: what is normal and a natural state (“orange peel skin”) has begun to be called a disease. It is believed that the shift in emphasis began in the 1930s when French glossy magazines introduced the term “cellulite,” positioning it as a newly discovered ailment of modernity. Simultaneously, massive advertising campaigns for products supposedly fighting this fabricated problem began, mostly creams and various massage devices. In modern medical practice, it is customary to distinguish between two different conditions: Cellulitis: acute bacterial inflammation of the skin and subcutaneous fat that requires immediate treatment. Gynoid lipodystrophy (“orange peel skin”): the external manifestation of uneven skin texture, which is within the bounds of normal and does not require medical intervention. Nevertheless, in the field of aesthetic cosmetology, the term “cellulite” is traditionally retained for lipodystrophy. Causes of “Orange Peel Skin” “Orange peel skin” is nothing more than an uneven distribution of subcutaneous adipose tissue. Fat tissue is present in both sexes, but gynoid lipodystrophy predominates among women. Statistics show it is present in 80–90% of women. “This ‘peel’ can manifest even in women who lead an active lifestyle and have a slender figure, especially after reaching maturity. In such cases, it should be considered an aesthetic feature, not a pathology.” In men, this manifestation of lipodystrophy occurs extremely rarely and can be a sign of other ailments or hormonal imbalances. The reason for this gender distribution lies in deep biological differences. Eight factors causing cracked heels are listed, some of which may be unexpected. Hormonal Background In women, under the influence of estrogen, fat deposits form predominantly in the subcutaneous layer of the buttocks and thighs. Men, conversely, are more characterized by an android type of fat distribution, i.e., concentration in the abdominal area. Connective Tissue Structure Fat lobules in the subcutaneous layer are surrounded by connective tissue fibers—fascia and septa. “In women, these fibers are oriented perpendicular to the skin surface. When fat cells (adipocytes) increase in volume, for example with weight gain, they bulge through these relatively weak septa, creating visible unevenness,” explains the doctor. In men, the septa in the subcutaneous fat are located diagonally, often crisscrossing. This creates a more reliable fixation and prevents such a pronounced bulging of the fat lobules outward. Skin Characteristics Men’s skin is generally denser, which allows it to better conceal the unevenness of the subcutaneous layer. Will facial exercises help restore youth? When “Cellulite” is Considered Normal and When It’s Time to See a Specialist “Orange peel skin” usually does not pose a threat to health, but there are situations when manifestations called “cellulite” are grounds for a doctor’s visit: The unevenness appeared rapidly and over a short period without obvious reasons (no weight gain, no change in diet or lifestyle). Accompanying signs are present: pain, swelling, skin discoloration, or increased local temperature in the area of changes. “This may indicate true cellulitis inflammation or other conditions, such as lymphedema, and requires immediate consultation with a specialist,” warns the expert. The appearance of cellulite in men is always a reason to see a doctor, especially if it appeared suddenly. Impact on Psycho-emotional State Cellulite is, in most cases, an aesthetic rather than a medical issue. Nevertheless, “orange peel skin” can cause psychological discomfort. Scientists have even developed special assessment systems for how lipodystrophy affects body image and overall quality of life. For example, a study conducted by Loma Linda University found that women with pronounced “orange peel skin” more often suffer from dissatisfaction with their bodies, psychosocial stress, and anxiety. A survey conducted at the Hexsel Dermatology Clinic (Brazil) showed that half of the examined patients with cellulite had encountered unpleasant remarks about their appearance, and about 78% experienced pressure from others regarding the need to correct the condition. Is Elimination Possible, and Which Method is Preferable? It is practically impossible to completely get rid of gynoid lipodystrophy, as this would require the removal of all subcutaneous fat, which is associated with serious health risks. However, it is quite realistic to significantly reduce the manifestations and improve the appearance of the skin through a comprehensive approach. “The key moment in working with cellulite is a healthy lifestyle, including a balanced diet, regular physical activity, and proper skin care. The effectiveness of the measures taken will depend on the initial degree of cellulite severity, genetic predisposition, age, and personal discipline,” explains the general practitioner. Simply put: the less subcutaneous fat and the more muscle mass, the less noticeable the manifestations of cellulite will be. Consequently, controlling the caloric intake of the diet combined with cardio and strength training forms the basis for combating “orange peel skin.” Creams and Wraps The effect of anti-cellulite creams can vary: they may stimulate microcirculation, slow down lipogenesis (the process of fat accumulation), or activate lipolysis (fat breakdown). However, none of the existing compositions have received approval from the U.S. Food and Drug Administration (FDA). “You absolutely should not waste money on advertised ‘miracle cures.’ They promise complete cellulite disappearance, but their effectiveness has no evidence base,” emphasizes Andrey Kostikov. The unevenness arises due to the specific nature of the fat tissue in the deep layers of the dermis. No external product can penetrate deep enough to have a significant impact. Massage Manual massage is one of the oldest ways to combat “orange peel skin.” It can slightly aid in improving fluid drainage and slightly reduce lumpiness, but this effect is short-lived. Moreover, such a procedure is often traumatic and can provoke bruising. Mechanical vacuum massage shows greater effectiveness: by creating pressure, it affects adipocytes (fat cells). The fat itself does not disappear, but its redistribution occurs, which visually smooths the contour. Over time, the subcutaneous fat returns to its previous state, so sessions must be repeated regularly to maintain the result. Energy Techniques To increase skin elasticity and reduce local fat deposits in problem areas, light, radiofrequency, laser, and acoustic exposures are used. Their effect is limited and requires subsequent maintenance procedures. Studies show that the result varies from slight to moderate and depends on the initial volume of fat tissue and the duration of the courses. Subcision This is a surgical technique where, using vacuum, laser, acoustic pulses, or a specialized instrument, the septa—connective tissue fibers connecting the dermis (deep skin layers) with the subcutaneous fat—are incised. Simply put, the partitions holding the fat are cut. Such techniques are recommended when there are clearly defined depressions in the skin, noticeable even at rest. Liposuction, however, is not a method for treating cellulite. “Surgical liposuction removes deeper fat, but it does not affect the structure of the superficial fat layer that forms the ‘orange peel skin.’ Such an operation can even worsen the external contour,” the doctor warns. Key Takeaways What is commonly referred to as cellulite is, in most cases, gynoid lipodystrophy. This is a natural and normal characteristic of the structure of subcutaneous fat in women. There are no medical indications for treating “orange peel skin,” but if it causes psychological discomfort, its severity can be reduced. The starting point should be lifestyle modification: establishing a balanced diet and increasing physical activity. The less fat tissue and the more muscle mass, the less pronounced the cellulite. Aesthetic cosmetology can also help, but the effect is temporary, and sessions need to be repeated. In cases where skin dimples are noticeable even at rest, subcision—the cutting of connective tissue septa—may be indicated.
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