The pathophysiology of cellulite is related to various predisposing factors such as biotype, heredity, race, body weight, age, hormonal changes, smoking, and genetic predisposition. Four main hypotheses regarding the etiopathogenesis of cellulite have emerged over the last decades: a different anatomical conformation of the subcutaneous tissue in women compared to men, changes of the biomechanical properties of epidermal and dermal tissues, excessive hydrophilia of the extracellular matrix increasing interstitious pressure and causing edema of the fatty tissue, and alterations of both microvascular and lymphatic circulation that result in the often painful protrusion of subcutaneous adipose tissue into the lower reticular dermis, causing the distinctive mattress-like surface irregularities. However, these hypotheses are mutually conflicting and do not consider recent advances in our understanding of the complex physiopathology of the adipose organ. For instance, one cannot exclude that inflammation also contributes to the formation of cellulite.