Understanding the Complexities of Cellulite
Cellulite, from the French word cellule, which means “small cell,” is not only an unsightly condition that affects more than 80 percent of postpubertal women, but is a veritable pathology: an alteration of the topography of the skin that in medical literature is sometimes referred to as “edematous fibrosclerotic panniculopathy.” Visually, cellulite is often described as “dimpling” or having the texture of an “orange peel.” It mostly affects the upper side of the thighs (near the upper extremity of the femur) as well as the buttocks, the inside of the knees and inner thighs, the arms, and the upper part of the legs. For estheticians and spa owners who work with their clients on finding longer-term, lasting treatments for cellulite, it’s critical to first understand the complexities of cellulite before learning what works — and what doesn’t — about various treatment options on the market.
Cellulite: A Tissue Issue
Cellulite is a localized metabolic disorder of the subcutaneous tissue. To better visualize the physiological intricacies of cellulite, it’s best to first understand the architecture of the skin. The outermost layer of the skin — the epidermis — provides a waterproof barrier for the layers underneath. Beneath the epidermis is the dermis (or corium), which contains hair follicles, sweat glands, blood vessels, nerve receptors and tough connective tissue. Beneath the corium is the hypodermis, or subcutaneous layer, which is made up of a matrix of adipose connective tissue (panniculus adiposus) and fat lobules (adipocytes) separated by a dense lattice of pre-collagen, collagen and elastin fibers.
Adipose connective tissue is nourished by an intricate lymphatic and capillary network, which regulates the exchange of nutrients between your blood and tissues through fluids in the interstitial space (i.e., the space between tissue cells). Any disruption of alteration to the vessel network — including when the exchange of nutrients is slowed — can result in fluids and metabolic toxins actually accumulating in the collagen-mucopolysaccharide matrix of the interstitial space. This is known as edema. Edema is viewed as detrimental to tissue function because it prevents proper local circulation. This causes an increase in the number of connective cells and a consequent hardening of the tissue (sclerosis). Left unchecked, this can develop into a second phase where the nerve structures, collagen and elastin fibers of the dermis can also be affected, leading to the development of cellulite. This can proceed to a further degeneration where nodular visible formations develop on the epidermis, and can be hard and painful to the touch.
The Types and Stages of Cellulite
There are three main types of cellulite, which can be broken down into further stages or degrees. The type and stage of cellulite depends on the evolution of the symptoms it manifests.
Oedematous Cellulite
Oedematous cellulite is associated with water retention and issues of circulation. Here, the skin actually appears swollen, paler, and with potential marbling in some areas. In the first stage, a slow-down of microcirculation leads to a build-up of fluids in the interstitial space between tissue cells, retaining fluids and increasing the volume of adipocytes. Though imperceivable, this is where cellulite begins. The resulting stagnation of liquids and toxins leads to the second stage, where prostaglandins, or inflammation mediators, are released, thereby triggering even more lymphatic obstruction and greater stagnation and volume in adipocytes. Toxins that accumulate and spill over into the tissues lead to widespread inflammation of adipose cells and the breakdown of collagen, which hardens and multiplies, leading to beginning stages of sclerosis. It’s important to note that, in this second stage, there are still no visible signs of cellulite formation on the epidermis and the affected areas are not painful to the touch. Identifying and targeting treatment on oedematous cellulite is one of the most effective treatment prerequisites.
Fibrous Cellulite
In the third stage, or fibrous stage, the connective tissue continues to harden and even “strangles” adipose lobules, cutting them off from receiving proper fluid supply. The stress that tissues undergo during this stage result in the formation of micronodules, which are reminiscent of the “orange peel” or “mattress” texture on the skin.
Sclerotic Cellulite
Finally, in the fourth stage, collagen fibers embed the adipocytes in a sort of capsule, causing the connective tissue to withdraw. Hard micronodules develop and come into contact with the nerves, yielding pain when touched. In this stage of cellulite manifestation, circulation and the capillary network are altered and the skin is cold. This stage of development is the most difficult to treat. Indeed, there’s enormous benefit in identifying the stages and getting treatment as early as possible — once a person enters the fourth stage, a course of treatment must be extensive and repeated in order to take care of the connective tissue (by reducing inflammation and increasing circulation) and address any adipose tissue that needs to be reduced.
The Cellulite and Fat Connection
Thus, when we consider the true nature of cellulite, the name itself becomes somewhat of a misnomer. After all, cellulite has less to do with cellular inflammation as it does a chronic-degenerative dysfunction of the connective tissue. Furthermore, the notion that cellulite is solely associated with fat or adiposity is a myth. These are distinct phenomena that may manifest simultaneously but are otherwise not dependent upon one another. Most women collect pockets of excess fat in areas of cellulite as the condition progresses from the oedematous stage to the fibrous and/or sclerotic stages. The stagnation of the area — along with improper diet or a sedentary lifestyle — can lead to the enlargement of fat cells. That said, cellulite should not be confused with obesity, where a gain in adipose tissue mass results from an increase in adipocyte cell size and number. Cellulite is largely indiscriminate in that it affects nearly all postpubertal women, overweight or not (slender and wiry women aren’t exempt). A woman can even have an ideal ratio of body weight to height and still develop evident manifestations of cellulite. To remedy the issue, then, it’s important to get treatments that tackle the connective tissue and reduce fat simultaneously. Many traditional treatment methods are effective but only superficially so — they do not target the underlying issues that originate cellulite.
To learn more about cellulite, please visit the second piece in our Cellulite Series: Cellulite: Treat the Cause Not The Symptom.
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