Aside from changes to diet and exercise, which typically provide only limited benefits, there are two key ways to reduce cellulite: application of topical products that stimulate blood circulation, and medical treatment to break up fatty deposits beneath the skin.

Cellulite appears as dimpled skin or fat on or around the outer thighs, buttocks and other body areas. It is caused by the fibrous septae, the underlying supports of the skin, not holding the skin together evenly. The skin is tethered down by these string-like tissues that pull it inward, toward the interior of the body. The tension of these strings pulls sections of fat in along with them; this, as well as the body’s inability to completely remove toxins and other cellular debris, causes the fat cells to increase as much as 300 times their original size and stick together within the connective tissue fibers. In women, the fibers connect to the undersurface of the skin and run at a 90-degree angle, which allows bulging and puckering. In men, these fibers run at a 45-degree angle, so the fat is less likely to accumulate in pockets.

This physiology, as well as the effects of estrogen, heredity and age, makes women more susceptible to cellulite than men. The condition usually starts in puberty as hormones change and becomes more noticeable with age. Nearly 80% of women over age 18 have some degree of cellulite. A person does not have to be overweight to develop cellulite and dimpled skin is not always reduced by weight loss.

Topical treatment of cellulite is the easiest and least expensive option. Products are designed to stimulate blood flow, thereby enhancing the body’s ability to eliminate toxic cellular buildup. They may be either synthetic or natural.

Synthetic cellulite products contain ingredients engineered in a laboratory, often from petrochemical derivatives. They include proprietary ingredients such as Liporeductyl, a synthetic peptide contained in Dermaxine’s Cellumend.

Natural products often contain caffeine or green tea, which has been shown to effectively boost circulation when applied topically. Paul Penders Body Firming Cellulite Serum uniquely contains pegaga, an herb found in the Malaysian rainforest that is used for both medicinal and cosmetic purposes to stimulate blood flow.

Medical treatment of cellulite is the other alternative. Although liposuction reduces cellulite for some people but not others, several newer procedures including endermologie, radio frequency and laser provide more consistent results. Each, however, requires a series of treatments costing from $150 to $500 per session.

Endermology, also known as liponic sculpturing, operates on the principle of mechanically smoothing the skin by stretching or separating the fat from the fibrous septae, using a machine to push and pull the skin into position. It has become extremely popular, with tens of thousands of systems in use throughout the world. Some people, however, need several dozen treatments to see noticeable results then must continue treatment to maintain results.

Other equipment like Syneron’s VelaSmooth couple massage with radio frequency and infrared light energy to heat the fat. This makes fat cells softer and more amenable to mechanical manipulation. In clinical studies, participants experience an average improvement in cellulite of 65%, although anecdotally, several physicians who use the device claim the improvement is closer to 25%.

Cynosure’s Tri-Active diode laser, which was introduced in early 2003, uses a three-step process to address cellulite. The device first delivers localized cooling that quickly reduces excessive accumulations of fluid that make tissue appear puckered. Second, Tri-Active performs a rhythmic massage that simulates the lymphatic system and promotes elimination of cellular wastes and toxins. It then delivers laser to stimulate microcirculation at a sub-dermal level. This progressive massaging and stimulating action on the connective and adipose tissue promotes waste elimination and tissue oxygenation, restoring alignment of the connective tissue. Although results are usually good, practitioners typically recommend a series of 15 or more treatments to start, coupled with a low-fat diet and regular exercise.