Introduction
Cellulite
is a skin alteration often described as an ‘orange peel,’ ‘mattress,’
or ‘dimpling’ appearance on the thighs, buttocks and sometimes lower
abdomen of otherwise healthy women. Although some men may get it, 90-98% of cellulite
cases occur in women. The name originated from the French medical literature over
150 years ago. The original name, cellulite, implies that it is a disease. But
years of study now disprove this theory. As a matter of fact, some of the scientific
literature refers to this changed skin condition as ‘so-called cellulite.’
This article will present a comprehensive review of cellulite, answer several
pressing questions, discuss purported treatments, and provide some realistic ways
of minimizing its visibility. What
is Cellulite?
To better understand what cellulite is, let’s
begin this explanation with a review of skin anatomy (See below). The outermost
layer of skin is referred to as your epidermis. Immediately under this is the
dermis, which is richly filled with hair follicles, sweat glands, blood vessels,
nerve receptors and connective tissue. The next layer of tissue is the first of
three layers of subcutaneous (which means beneath the skin) fat. This is where
our discussion will keenly focus in describing cellulite. This uppermost layer
of subcutaneous fat has been described as “standing fat-cell chambers”
separated by connective tissue. From these fat-cell chambers, small projections
of fat cells protrude into the dermis. This unevenness and irregularity of the
subcutaneous fat gives skin the ‘bumpy’ appearance we call cellulite. The
reason cellulite is rarely seen in men (obese and non-obese) is because the epidermis,
dermis and uppermost part of the subcutaneous tissue is different in males. Men
have thicker epidermis and dermis tissue layers in the thighs and buttocks. More
distinctively dissimilar, the first layer of fat, which is slightly thinner in
men, is assembled into polygonal units separated by crisscrossing connective tissue
(See below). The
differences in subcutaneous fat cell structure in men and women occur during the
third trimester of fetus development and are manifested at birth. Variations in
hormones between genders largely explain this skin structure deviation. It has
been shown that men who are born deficient in male hormones will often have a
subcutaneous fat appearance similar to females. What
are The Two Types of Cellulite?
Research
has identified two types of cellulite. The first type of cellulite is from any
‘pinch’ or ‘compression’ of tissue in the thighs or buttocks.
An example of this is when you see the ‘mattress’ look in your thighs
when crossing your legs while seated. This is very gender-typical to almost all
women of various ages, and is suggested to be the compression of the fat-cell
chambers underlying the skin. The second type of cellulite is the ‘mattress’
or ‘orange peel’ appearance that a woman may have in her natural stance
or when lying down, which is referred to as cellulite. What
is the Connective Tissue in the Dermis?
The
connective tissue in the dermis provides the framework, insulation and stability
of the dermis layer below the epidermis. It offers a necessary insulation and
stability between the various organelles, permitting their proficient function,
without inhibition to adjacent structures. It’s composed primarily of collagen,
an inelastic tissue with great tensile strength, ground substance, and elastic
tissue, which gives the skin it’s ability to extend and return to normal
constituency. Do
You Have to be Over-Fat to Have Cellulite?
Since
cellulite is largely due to a structural conformation below the skin, it is often
common in very slender women. However, individuals who are over-fat will frequently
have a more pronounced cellulite development, while those with less fat and more
muscular definition tend to have less visible cellulite. Why
Does Cellulite Tend to Get Worse as You Age?
In
women, the dermis reaches its maximal thickness at 30 years of age. Secondly,
the dermis area, which is bound together by the connective tissue starts to get
looser, due to the aging process of the collagen and elastic fibers. This allows
for more adipose cells to protrude into the dermis area, accentuating the sight
of cellulite. In addition, an increased deposition of subcutaneous body fat may
often reflect a lifestyle of less exercise and changes in dietary consumption. Why
is Cellulite More Prevalent in the Thighs and Buttocks?
It
is well established that women generally have a higher percentage of body fat
than men. For instance, a healthy range of body fat for women is 20-25%, and a
healthy range of body fat for men is 10-15% (Robergs and Roberts, 1997). The thighs
and buttocks of women tend to store more of this body fat. This type of fat deposition
is characteristically termed gynoid, or pear shape. Body fat is stored largely
due to the actions of an enzyme know as lipoprotein lipase (LPL). LPL is located
on the blood vessel walls throughout the body. It functions like a ‘regulatory’
enzyme, which controls the distribution of fat in various depots in the body (Pollock
& Wilmore, 1990). It has been shown that women have a higher LPL concentration
and activity in the hip and thigh region (Pollock & Wilmore, 1990). Why
Don’t You See Cellulite in Young Females (Healthy and Over-Fat)?
Young
females will clearly have the ‘pinch’ or ‘compression’ cellulite,
as this is due to a structural mechanism. However, the cellulite seen while standing
or lying down is often not apparent in young females. Although there is very little
scientific research in this area, it is hypothesized that hormonal changes during
puberty contribute to this phenomenon. What
are Some Common Myths and Misconceptions About Cellulite?
Numerous
myths and misconceptions about cellulite have been popularized in print, media
and the internet. Some of the most well known will now be clarified. First and
foremost, cellulite is not a disease. As explained above, it is due to fat-cell
chamber structure below the skin dermis. Secondly, although the skin is richly
vascular with blood vessels, cellulite is not caused by damaged blood vessels.
In addition, cellulite is not due to a weakening of capillaries or a decreased
circulation in the subcutaneous area. Some sources have suggested that cellulite
is a lymphatic disease or abnormal hormone condition, yet there is no scientific
support for this contention. However, limitations to fluid movement and drainage
may contribute to the appearance of cellulite. Also, hypotheses that cellulite
is a result of the body’s lack of lypolytic responsiveness, which means ability
to breakdown fat to be used as fuel, has not been supported by science. Is
Cellulite Hereditary?
Since
the subcutaneous fat tissue structure is gender-typical to females, the question
should actually be is fat deposition hereditary. Although the exact percentage
is not fully clarified in the research, there is a meaningful hereditary component
to fat deposition. Do
Women in All Countries Have Cellulite?
It
appears that cellulite is observable in women of all races. Studies involving
women from China, South Africa, Egypt, Brazil, United States, Canada, Mexico,
Afghanistan, Russia, Japan, Thailand and Indonesia all report cellulite in women. Why
does Cellulite Affect Some People More than Others?
There
is much variation in anatomy and skin anatomy from person to person. Women have
unequal amounts of subcutaneous fat, as well as variable thickness and denseness
of the dermis and epidermis skin layers. Why
do women who lose weight still have cellulite?
The
underlying fat-cell chambers do not change with a loss of weight. For optimal
skin adaptation to weight loss, it is advisable for weight loss to be progressive
and not extreme (such as repeatedly seen with fad diets). Also, skin elasticity
is best up to the age of 35 to 40 years. Collagen and elastic fibers can retract
best to lesser volumes (from fat loss) before this chronological age. Will
Liposuction Surgery help Reduce Cellulite?
Quite
the contrary! Liposuction is not very successful in treating cellulite and may
actually worsen the dimpled skin appearance. So,
What Are Some Realistic Recommendations?
Several
studies note that female athletes, who generally have a lower percent body fat
regularly have less cellulite. So, a caloric-restricted diet plan to help reduce
some of the underlying body fat should be implemented. Aerobic exercise at least
3 to 5 times a week for at least 20 to 60 minutes will help create a satisfactory
caloric deficit. Choose a mode of exercise that you enjoy such as walking, jogging,
aerobic dance, elliptical training, rowing, cycling, swimming or stair stepping.
If available, alternate modes of aerobic exercise to regularly give your body
some variety. Perhaps most essential to your exercise agenda is your resistance
exercise program. The subcutaneous fat rests on top of muscle, and if the muscle
is weak and flaccid, this can contribute to the ‘bumpy’ effect of cellulite.
Although there isn’t one best system of sets and repetitions to firm all
of your leg muscles, regularly include the following exercises in your resistance
training program.
Squats and leg press for the buttocks and thigh muscles.
All
types of lunges for the thighs and buttocks.
Hip adduction exercises for the
inner thighs.
Hip abduction exercises for the outer thighs.
Leg curls for
the back of the thighs. Summary
From
this review it is clear that the cause of cellulite is much more sophisticated
than just saying it is extra fat underneath the skin. It is noteworthy to appreciate
the fact that cellulite is a unique and distinctive layer of subcutaneous body
fat that is common to females. Although numerous topical treatments and involuntary
manipulative techniques may seem enticing, no research supports their long-term
effectiveness. However, several studies have noted how female athletes, who typically
have less body fat, seem to have much less cellulite. So, incorporating a caloric
restrictive diet with aerobic exercise and resistance training has the most promising
and realistic results.
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Cellulite Facts & Information