Cellulite On Legs: What Is It?

Sebastiano Accaputo
March 15, 2023

Did you know that 80% of women have Cellulite on their legs?

Let’s start saying that cellullulite on legs and bum is not strictly related to body wight. Gaining weight may result on a more visible cellulite but usually also lean people have it and this is minly because of genetics and hormons. In fact most of women have cellulite on legs but the appearance vary and affect women in different ways. Although nearly 90% of women experience cellulite sometime during their  lifetime, misinformation about it is just as common as the condition. Cellulite is not a medical issue; it’s purely cosmetic. Having cellulite on legs, thighs, buttocks, abdomen, or upper arms is the norm for just about every woman. How cellulite develops is not clear, although several factors—sex, genetics, and lifestyle—are believed to be involved.

The Science Behind

The arrangement of the superficial adipose tissue is different in men and women. In men, fat is deposited mainly at the level of the upper portion of the body, while in women it is deposited mainly in the lower part. In addition to the different arrangement, body fat also presents a different ease of metabolization. The fat of the upper body is metabolized more easily than that of the lower body in women.  

This phenomenon reveals an evolutionary function. The woman has the task of procreating and providing food support to the new-born, regardless of her feeding situation. For this reason, the fat of the lower part of the body is resistant to any energy request until the moment of delivery in which it becomes sensitive to lipolysis, freeing the fatty acids necessary for the energy needs of the infant.  

Estrogens, as well as insulin, act at the level of adipocyte DNA by stimulating an operon, PPAR (perissosome activation receptor), which induces the synthesis of liposynthetic enzymes and shifts the construction / destruction balance towards construction

Another peculiarity of the adipose tissue is that of having a low amount of water (18%) compared to other tissues (60%).

Let us now examine some available treatments considering that aesthetic problems (habitus and muscles) must mainly be solved by the patient (physical activity).

So Let's Analyse PEFS As A Pathology

The term edemato-fibro-sclerotic panniculopathy refers to an alteration of the microcirculation of the adipose tissue with a tendency to evolution and chronicization, which induces an increase in volume at the trochanteric level.

Let's analyse the etiopathogenesis of PEFS. This arises from an alteration of Sterling's equilibrium which follows a venolymphatic stasis and consequent slowdown in the outflow of tissue fluids and tissue hypoxia.

The modification of the microcirculation of the adipose tissue leads to its chronic alteration (panniculopathy) which evolves over time first into an oedema, then into a fibrosis and, finally, into a sclerosis.  

What Cotributes To Causing Cellulite

As in all "pathologies", treatment must begin with the elimination of the triggering causes.

An increase in weight on the lower limbs slows down the return circulation.

A diet rich in simple carbohydrates and salts, substances with a high hygroscopic action, increases tissue water retention.

Constipation causes stagnation of the faecal mass in the intestine, which compressing the iliac veins leads to circulatory stasis in the lower limbs.

The absolute, relative or iatrogenic increase of estrogen determines the activation of vasoactive quinines which, by increasing the vessel permeability, induce edema. Hyperestrenism (excess estrogen) can be assessed with the dilution test. One liter of water is drunk with an empty bladder and the quantity of urine emitted in the following four hours is measured (without eating or drinking). A normal value must be greater than 900 cc. The test is performed on the 7th and 21st day from the beginning of the menstrual cycle.  


Even clothing, if tight, can slow down the lymphatic circulation mainly (this moves at low pressure 30-40 mm of Hg). High-heeled shoes create foot cavity and prevent regular compression of the venous sole of the Lejar.  

Having Analyzed The Root Causes, We Can Move On To Treatment

Is there a best treatment for Cellulite?

The therapy will be aimed at improving the consistency of the vessel wall and reducing tissue edema.

Mesotherapy involves the use of multiple intradermal or subcutaneous injections of a mixture of active substances in minute doses, by means of very fine needles, directly over/near the affected sites.

The drugs used to reduce cellulite include pentoxiphylline, carnitine, coumarin, hyaluronidase/collagenase, calcium pyruvate, aminophylline/caffeine, artichoke, melilotus or ginko biloba.

In addition to the strengthening of the vessel wall to avoid the leakage of liquids, we must remove the liquid present in the tissues

One of the recommended techniques, to reduce edema, is manual lymphatic drainage according to Vodder, a series of manual maneuvers useful for activating the progression of liquids in the lymphatic system. Lymphatic drainage is performed 1-2 times a week.

The lymphatic system performs the main function in regulating the exchange of tissue fluids. It is a liquid circulation system with unique histological features.

The lymphatic capillary presents itself with a series of cells spaced from each other by the endothelial pores and with a pole connected to the fibrous filament that runs parallel to the capillary. This particular structure, characteristic of the lymphatic capillary, allows to maintain the right volume of water in the tissues.  

This allows, as the perivasal volume increases due to edema, the filament from the capillary moves away, opening, like a trap door, the endothelial cell and varying the size of the pores. In this way water and proteins can be drained.

We can also improve PEFS with the use of Carboxytherapy. That is, with the introduction of this gas into the adipose tissue.

Acidification, resulting from the solubilization of carbon dioxide in water, allows an improvement of the microcirculation and the mobilization of the storage fat.

The first effect of carboxytherapy is the increase in the vascular bed, due to an increase in the number of perfused capillaries.

This follows the release of the muscle fibrocells that close the arteriovenous anastomoses, allowing the flow of blood into normally closed capillaries.  

Another action of carboxytherapy is the increase in blood flow, i.e. the volume of blood that passes per unit of time

Finally, acidification also leads to the shift of the Bohr equilibrium with the release of oxygen from the hemoglobin and oxygenation of the tissue

All these effects also allow to activate the lipolytic process by reducing the amount of triglycerides in the adipocytes.

To improve cellulite on legs, thighs, buttocks, abdomen, or upper arms, a course of minimum six sessions, once a week, is recommended for Carboxytherapy.