Cellulite 101

Have you ever noticed orange peel-like skin? It is commonly known as cellulite. It affects almost 9 in 10 women and 1 in 10 men. Here is what you need to know about the dreaded lumps and bumps.


To understand how cellulite develops, lets first understand the anatomy of the fatty tissue underlying the skin.



The Anatomy of Cellulite

Most of us know that a layer of fat tissue lies between the skin and the underlying muscles. However, this fat tissue has two compartments – superficial and deep. Separating these two layers is a very thin but surprisingly sturdy membranous structure called fascia.

The skin is held in place by bands of sturdy fibrous collagen and flexible elastic bands called elastin. Collagen holds the skin in place and elastin provides flexibility and elasticity. Fat is deposited in both subcutaneous compartments into bundles, called lobules, which are separated by these collagen bands. In the superficial compartment these bands are tightly attached to the skin and to the fascia.


In women these bands run vertically so the fat lobules between adjacent collagen bands have a direct path upward toward the skin. The female subcutaneous fat layer is organized in large vertical chambers where an abundance of fat can be stored. The chambers in men are arranged as small diagonal units, which not only store smaller quantities of fat but are also unlikely to result in cellulite formation. As a result, cellulite is common in women and rare in men.


In women, superficial compartment fat lobules grow in size as age-related decreases in estrogen levels increase fat deposition and fluid accumulation. As they expand, these lobules migrate upwards toward the skin. At the same time, both collagen and elastin fibers weaken and become more lax and their ability to hold the growing fat lobules in place lessens. A bumpy, irregular skin surface is the result, with areas of stronger collagen and elastin fibers interspersed between areas of weaker fibers unable to contain the enlarging, upward migrating fat lobules.


In the deep compartment the collagen bands are less numerous, more loosely organized and run from the fascia down to the deeper muscle surface.


Causes of Cellulite

It is important to understand that cellulite does NOT only occur in those that are overweight. However, its aesthetic appearance does tend to worsen in these cases.


There are many different contributing factors to the development/worsening of cellulite, some still unknown. The main known factors are:

  • Excess fat/weight gain

  • Hormones

  • Water retention

  • Age

  • Genetics

  • Poor diet

  • An unhealthy lifestyle (smoking, etc.)

  • Accumulated toxins

  • Inactivity

  • Pregnancy




Formation of Cellulite

The formation of cellulite is intrinsically linked to one main hormone, estrogen, and one structural protein, collagen. This is one of the reasons why cellulite is much more prevalent in women than men, as estrogen plays a key role in its formation and development.


This is also why some women experiencing worsening of cellulite as they age (not producing as much collagen and existing collagen weakening) or as they gain weight/go through pregnancy (increased estrogen levels).


The structural matrix of the dermis is held together by collagen, a protein produced by fibroblast. Fibroblasts are skin cells that give skin strength and elasticity.


How is cellulite formed?

1. Estrogen stimulates the fibroblasts to make collagenase, which acts on collagen and breaks it down, starting the cycle of cellulite formation.

2. Collagen is lost in the formation of cellulite.

3. Without collagen fibers, fat cells escape out of tightly packed groups and move toward the skin surface and enlarge to their full size (hypertrophy).

4. When fat cells reach their full size, they stimulate preadipocytes to develop to form new adipocytes or fat cells.

5. Estrogen naturally acts on or stimulates the preadipocytes to form new adipocytes, and the more fat you have, the more the ovaries are stimulated to produce estrogen.



Types of Cellulite

There are many different scales of classification for cellulite developed by various experts in the field.


To simplify classifications, I will be explaining the Nurnberger-Muller Cellulite Classification Scale. This scale classifies cellulite based on two factors: visible dimpling and pinch test.


Stage (or Grade) 0: No dimpling visible when standing or laying down, and no dimpling when pressure is applied.

Stage (or Grade) 1: No dimpling visible when sitting or laying down, but dimple is revealed when pressure is applied.

Stage (or Grade) 2: Dimpling is visible when standing, but not when laying down.

Stage (or Grade) 3: Dimpling is visible when standing and laying down.


Side note: Endosphères Therapy is an appropriate treatment for each of these four stages, however management of expectations in terms of the number of sessions required to achieve the desired results is important particularly in later stages.

For example, while a client with Stage 1 cellulite might see their ideal treatment outcome with 12 sessions, a client with Stage 3 cellulite may require 24 sessions to see results.


Cellulite is not just a single problem. Knowing the different types of cellulite is essential to find the most effective type of treatment. Today it is known that there are about 29 different situations that may cause the orange peel appearance of skin, which can be combined into six main groups:


1. Lipoedema: increase in subcutaneous adipose tissue and in free water.

2. Lipo-lymphoedema: increase in subcutaneous adipose tissue and the quantity of lymphatic fluid

3. Fibrous cellulite: fibrosclerosis of connective fibers

4. Lipodystrophy: interstitial and adipose alteration

5. Localized adiposity: increase in localized adipose tissue

6. False cellulite: sagging of the skin with fibrosis



Treating Cellulite

Cellulite is not just the accumulation of excess fat. It is a mixed disorder related to fat and fluid accumulation, changes in blood supply and hormone induced alterations in connective tissue – principally collagen and elastin. Optimum improvement in cellulite appearance requires removal of some of the superficial fatty tissue but also requires remodeling and regeneration of collagen bundles, which occurs over a period of weeks to months.

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