Fascia and cellulite: what cellulite is, fascia blasting, rolling and massage, what the evidence shows, and what changes the skin

Cellulite is normal

It affects 80 to 90% of women after puberty, mostly on the thighs, buttocks and hips. Women's fibrous bands under the skin are fewer and break more easily than men's, which is why it's so much commoner in women.

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Fascia is part of the scaffold, not the cause people sell

Thin bands tie the skin to a layer of fascia within the fat, and thicker bands lay under almost every dimple on scans. But fat in cellulite holds no extra water, and dense tissue doesn't change shape at the forces hands or tools apply, so "tight" or "dehydrated" fascia isn't the cause.

Sources 1, 3, 4, 5

Fascia blasting: one study, written with its inventor

In 33 women, 12 weeks of FasciaBlaster use reported thinner fat under the skin on ultrasound, in a study whose authors included the tool's inventor; we could read only its summary, which leaves the design unclear. We found no independent trial.

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Harms have been reported

The US Food and Drug Administration (FDA) holds 140 voluntary reports naming the FasciaBlaster, most from 2017, describing bruising, pain, swelling, tissue damage and skin infection among other problems. The reports are unverified and can't show how often harm happens.

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Nothing removes it for good

Of 67 studies of cellulite treatments, none showed clear evidence of working well, and a review of 24 trials with about 3 weeks of follow-up found only a few treatments promising. "There is no effective treatment for cellulite," a 2023 review concludes.

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Strength and fat loss change some legs

We found no trial of exercise alone removing cellulite. Weight loss improved it for most women in one study and made it worse for some, so train for strength and health, not to erase dimples.

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Bruising isn't progress

Bruising is bleeding under the skin, not therapy, as our fascia blasting verdict says. Bruising easily, especially on blood thinners, is a reason to stop and ask a doctor.

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Skin that turns hot and swollen

• Ask for an urgent GP appointment or get help from NHS 111 if your skin is painful, hot and swollen.
• Call 999 or go to A&E if you have cellulitis with a very high temperature or you feel hot, cold or shivery, a fast heartbeat or fast breathing, purple patches on your skin, feeling dizzy or faint, confusion or disorientation, cold, clammy or pale skin, or unresponsiveness or loss of consciousness.

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A swollen, painful leg

Calf or leg pain or swelling with breathlessness or chest pain. It could be a clot that has reached the lungs. Do not drive yourself to A&E.

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What cellulite is

The dimpled, uneven surface of the skin, mostly on the thighs, buttocks and hips, in 80 to 90% of women after puberty. Its causes are many and not fully understood. It isn't a disease, and our thigh fat guide notes that it affects women of every size.

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The layers under the skin

In the buttock, the tissue under the skin has five layers: the skin's deep layer, superficial fat, the superficial fascia, deep fat and the deep fascia, with fibrous bands running between them. In 20 body donors, men had more bands tying the superficial fascia to the skin, and their bands took more force to break (about 38 against 23 newtons). On scans, thicker bands running straight down lay under 96.7% of dimples. In women with cellulite, fat pushed further up into the skin, and the fat held no extra water.

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Where fascia fits

Short, thin bands connect the superficial fascia to the skin, and long, thick bands connect the deep fascia to the skin. That is the grain of truth in "fascia causes cellulite". But the dimples come from the balance between bands pulling in and fat pushing out, and reviewers argue the bands are the main cause. Dense tissue doesn't change shape at the forces of hands or tools.

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Hormones

The female hormone oestrogen likely plays a big part, which fits cellulite appearing after puberty. In men it is rare, and in the few who have it (about 2%) it usually comes with low male hormone levels.

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Cellulite isn't cellulitis

Cellulitis is a skin infection, with skin that turns painful, hot and swollen, and it needs a doctor. The names are similar; the conditions aren't.

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Or lipoedema

Lipoedema is a build-up of fat in both legs that is often painful, tender or heavy and bruises easily. Our lipoedema guide covers it, including the National Institute for Health and Care Excellence (NICE) view that treatments such as drainage massage are ineffective at removing its fat.

The one studyEmerging evidence

Thirty-three women used FasciaBlaster tools 5 days a week for 12 weeks. Fat under the skin of the thigh measured thinner on ultrasound at 4, 8 and 12 weeks than at the start, and the authors concluded that cellulite looked better. The summary mentions a control group but doesn't say how many people were in it or whether the groups were randomised, and the tool's inventor was among the authors. We could read only the summary, as the full text was blocked. It is not independent evidence, and it can't show fascia "releasing".

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The FDA reports

The FDA's database of device problem reports holds 140 voluntary reports naming the FasciaBlaster. Of the first 100, 98 arrived in 2017. Their coded problems included injury (88 reports), weight changes (76), pain (54), bruising (42), tiredness (36), inflammation (26), swelling (16), tissue damage (12), skin infection (cellulitis, 10) and tissue breakdown (8). The reports are voluntary, and the FDA warns that they are unvalidated, so they can't show how often harm happens or that the tool caused it.

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What the bruises are

A bruise is bleeding from small blood vessels damaged under the skin. Repeatedly injuring the skin and the fat beneath it isn't the same as changing fascia, and skin that splits, stays discoloured or turns hot and swollen needs a doctor.

Machine and hand massageEmerging evidence

In 52 of 69 women who finished 12 weeks, twice-weekly machine massage (Endermologie) on one thigh, or aminophylline cream, made no measurable difference between legs; by the women's own judgement, 10 of 35 massaged legs and 3 of 35 creamed legs looked better. Three kinds of massage each thinned fat measurements a little in 60 women, with no untreated group to compare. In 40 women, a handheld vibrating massager reduced cellulite on the outer thigh at 12 weeks, in a study with an author from its maker; in those who then stopped, the cellulite soon returned to where it started, while in those who carried on it stayed reduced.

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Rolling, cupping and massage guns

We found no trial of foam rolling, massage balls, massage guns or cupping for cellulite; our rolling, gun, cupping and gua sha guides say the same.

Cellulite treatments overallStrong evidence

Of 67 studies, only 19 were randomised and placebo-controlled, most had serious flaws, and none showed clear evidence of working well. In 24 randomised trials (2,084 people, with an average follow-up of 3.3 weeks), shock wave therapy, radiofrequency and an enzyme injection looked promising. A 2023 review: "There is no effective treatment for cellulite", and improvements "are short lived".

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Treatments aimed at the bandsEmerging evidence

In two placebo-controlled trials of 843 women, injections of an enzyme that loosens the bands made more women look at least a little better (37.1% against 17.8%, and 41.6% against 11.2%), but few looked clearly better (7.6% against 1.9%, and 5.6% against 0.5%); most side effects were at the injection site. Reviewers argue that only treatments aimed at the bands can give lasting change. These are cosmetic medical treatments, not home tools.

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Exercise and weight changeEmerging evidence

We found no trial of exercise alone removing cellulite. In 42 women who finished a trial, shock wave therapy added to aerobic exercise reduced cellulite more than exercise alone. When women lost weight on supervised programmes, cellulite improved for most and got worse for some, more often those who started lighter and lost less.

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For how your legs feel

Rolling the front, back and inside of the thigh: about 90 seconds per muscle, for example 2 or 3 slow rounds of 30 to 45 seconds, the move pages' dose, from a review of rolling studies. It gives a few minutes of easier movement; it doesn't reach the bands under dimples.

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For strength and fitness

Goblet squats at 3 or 4 sets of 8 to 12, lunges or split squats at 3 sets of 8 to 12 each leg, and Romanian deadlifts at 3 sets of 8 to 10: our bigger legs guide's doses, as our thigh fat guide gives them. Build towards 150 minutes a week of moderate activity, as the NHS advises.

For cellulite itself

No dose of rolling, massage or exercise has been shown to remove it. If it bothers you, a dermatologist can explain the medical treatments and their limits; their results are modest and often short-lived.

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Ask first

Keep the pressure light, or ask your doctor first, if you take blood thinners, which make bruising more likely, or have a nerve condition such as peripheral neuropathy: the NHS lists these among the reasons hands-on treatments may not be safe.

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Fragile skin

Skip massage balls, guns and scraping tools on thin, fragile skin, for example after long-term steroid tablets (our suggestion).

Expert cautions for rolling

In an expert consensus of 37 researchers, open wounds and broken bones were reasons not to roll, and inflammation, a clot, a bone infection or bone forming in a muscle after an injury were at least reasons for caution.

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Pregnancy

In later pregnancy, avoid lying flat on your back for more than a few minutes. Clots are more likely in pregnancy and for 6 weeks after birth: a pregnant woman had a clot reach her lungs shortly after a leg massage, so never roll or massage a swollen or painful leg.

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Where not to press

• Bruises, broken skin, rashes and varicose veins.
• A leg that is swollen, red, hot or painful.
• Anywhere a scraping tool leaves you bruised: stop.

A clot in the leg

Throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin around the painful area, which may be harder to see on brown or black skin; or swollen veins. This can be a deep vein thrombosis (DVT). It is more likely after surgery, a hospital stay, 3 or more days in bed, a journey of over 4 hours, pregnancy or a recent birth, cancer, a previous clot, or contraception or hormone replacement therapy (HRT) that contains oestrogen.

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See a GP

See a GP if:

• your legs (and sometimes arms) are out of proportion with the rest of your body, feel painful, tender or heavy, and bruise easily: it could be lipoedema

After a tool or a treatment

Skin that is painful, hot and swollen after scraping, cupping or any cosmetic treatment needs the cellulitis advice above, not more pressure.

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"Fascia blasting gets rid of cellulite"Mixed evidence

One study, with the inventor among its authors and its design unclear from the summary; no independent trial; and no cellulite treatment has clear evidence.

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"Tight, stuck or dehydrated fascia causes cellulite"Mixed evidence

Cellulite reflects fibrous bands and fat pushing between them, and fat in cellulite holds no extra water.

Sources 2, 3, 4, 15

"Bruising means it's working"Mixed evidence

Bruising is bleeding under the skin, not therapy, and bruising was among the problems people reported to the FDA.

Source 8

"Cellulite is toxins or trapped water"Mixed evidence

Scans found no extra water in the fat of women with cellulite, and no study shows toxins cause it.

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"Only overweight women get cellulite"Mixed evidence

Most women have it, at every size, and weight loss helped most women in one study and made it worse for some.

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"The right exercise removes cellulite"Mixed evidence

We found no trial of exercise alone removing it. Exercise is worth doing for strength and health.

Sources 11, 7