How fat cell accumulation within the skin leads to internal stretch marks and the appearance of cellulite

Given that opinion about the exact nature of cellulite is so varied between researchers, it is no surprise that everyday people are so confused about the subject and believe anything that is thrown upon them by advertisers and the popular media...

Several studies have been contacted over the years to elucidate the problem of cellulite and the study analysed on this page is one of the best. This study took place at the Department of Dermatopathology of CHU Sart Tilman, in Belgium and published in February 2000 in the American Journal of Dermatopathology. This study this paper describes the exact anatomy, physiology and pathology of cellulite and is aptly named...

Cellulite: From Standing Fat Herniation to Hypodermal Stretch Marks | Research Update

Specifically, Dr Gérald Piérard and his colleagues examined 24 cellulite tissue samples of women with cellulite (aged 28-39yo) and compared them with those of 4 women and 11 men who did not suffer from cellulite. The researchers surprisingly found that the lumpy aspect of cellulite is found in all women - but not men - regardless of cellulite, meaning that...

...the “cellulite” architecture already exists in women, merely becoming more pronounced and presenting as cellulite when the right conditions are met. This breakthrough discovery means that all women after puberty possess what we can call pre-cellulite, which is cellulite waiting to happen if excess food is consumed, a sedentary lifestyle is followed and contraceptive hormones are taken.

This architecture, the researchers suggest exists in order to prevent the excessive out-pouching of fat lobules when they enlarge. The collagen strands that create this “cellulite architecture” become more pronounced as a reaction to fat lobule enlargement, not unlike the growth of any other scar tissue in the body which is created as a result of excessive tissue stretching or damage. As fat accumulation increases, collagen strands also thicken in order to bring the fat lobule herniation under control, eventually leading to full blown cellulite.

But let’s analyze the study in more detail. As an introduction to the research paper, Dr Gérald Piérard and his colleagues very eloquently state: “Although cellulite has received little attention in the scientific world, it is a common condition afflicting women. A wealth of purported treatments flourishes in public magazines. Despite plentiful proclamations, such treatments might appear as elusive or illusive in many instances. In the area of cellulite physiopathology, little is known, research is scanty, and dissension and controversy are rife. This situation even leads to obvious misconceptions. In many instances, nothing could be further from the truth than accounts given by some claims devoted to aesthetics and cellulite. As a result, cellulite remains a disputatious condition.”

All women - but not men - have a pre-cellulite structure in their hips and thighs after puberty. It only takes fat to turn this structure into "cellulite proper".

The first thing that the researchers do is to draw our attention to incipient cellulite (= cellulite waiting to happen, or in other words normal female thigh skin structure) which is a mattress appearance that is not pronounced and can only be revealed in a very mild form by skin pinching. Incipient cellulite is scientifically called “Status Protrusus Cutis”, was first identified in 1978 by German scientists, is absolutely normal in women and is the result of tissue exposure to estrogen (this structure is not found in children neither in men, yet is found in men who change sex and is very pronounced in women who take hormonal contraception).

Nature wanted women's skin to be soft but firm on their thighs and buttocks...

Skin fat accumulation is a sexual characteristic that makes women softer and more gentle to touch and therefore more attractive to men, and is the equivalent of the lean, rugged appearance that makes men attractive to women. Obviously, with softer (i.e. more fatty skin) comes the need of controlling the levels of softness and maintaining the shape and firmness of the skin with connective tissue - hence the collagen strands. In simple terms, nature initially only intended to keep you soft yet firm and wisely devised the fat/collagen strand structure.

...but it could never anticipate that we would be spend our life sitting down and eating fat and sugar

Obviously, this structure was a huge success for thousands of years when women tended to be more active, eat less and more naturally, did not drink, smoke or take hormonal contraception. In fact, this structure is still a huge success for a small minority of generally younger women, who benefit from the “soft yet firm appearance” - until they hit 30 that is... Unfortunately, nature never anticipated such modern inventions such as the car, the refrigerator, the chocolate bar, the cigarette and the computer, among others...

The cellulite collagen fibres are there for a reason: to keep the fat contained and the skin firm. Surgical procedures that remove them do more harm than good.

To some women these fibre strands might sound like a curse, as they appear to be the root cause of cellulite. In fact, some unscrupulous Brazilian doctors remove those strands in order to, very temporarily, remove the cellulite appearance. However, as we stated before, those strands are there for a reason, to keep the fat under control and prevent the skin from looking excessively puffy and flabby. By removing those strands you do get rid of cellulite appearance only to replace it with flabbiness... To be honest, I don’t know which looks worst, but I do know that if you leave the fibrous strands alone and concentrate on the root cause of cellulite, i.e. superficial fat accumulation, you will be more satisfied with your appearance, and save a few thousand bucks...

Cellulite proper

As you have probably already guessed, full-blown cellulite, is simply taking incipient cellulite to the next level by filling those fat cells with fat and, in some cases, the tissues that surround them with water. Full-blown cellulite is scientifically called “Dermopanniculosis Deformans”, which basically means “inflammation of the fat tissue accompanied by deformity”. In full-blown cellulite the mattress appearance is no longer mild, neither normal and can be revealed with the lightest of pinching or with no pinching at all. In fact, the researchers have shown that "cellulite proper" is structurally different to incipient cellulite with deformity and scar tissue observed in the deeper layers of the skin.

In fact we may say that in cellulite this deformity looks like vertical stretch marks located under the surface of the skin - in contrast to normal stretch marks that are horizontal and found on the surface of the skin, also known as epidermis.

Finally, we should also note that pre-cellulite does not become full-blown cellulite overnight - there are several intermediate phases which are simply called mild cellulite, advanced cellulite etc.

How cellulite develops, step by step

The examination undertaken by the research team revealed a 3D network of fibrous strands that partition the lower part of the skin (the subcutis or hypodermis), keeping the fat lobules suspended and the skin firm. The most important finding in this study was that, contrary to previous belief, there exists no continuous connective tissue sheath, also known as septum, that separates the fat lobules.

As the enlarged subcutaneous fat lobules unremittingly push upwards towards the dermis (the main part of skin) they also stretch the fibrous strands and irritate them, leading to thinning of the weaker strands and thickening of others, thereby creating an irregular connective tissue architecture, characteristic of cellulite. Specifically, the research team reports: “Strands are thickened, fibrosclerotic, and contain myofibroblasts. This could be a reactive process mediated by cytokines to compensate for the sustained pressure exerted by the adipocyte volume”.

Many of those vertical fibres look not dissimilar to the familiar stretch marks we find on the surface of the skin, with the only difference being that the “cellulite stretch marks” are vertical - not horizontal - and that they are found in the hypodermis not the epidermis. Again, the researchers eloquently describe this process in a few words: “The latter condition [normal stretch marks] results from excessive tension applied in parallel with the skin surface, whereas the former [cellulite] likely results from continuous and progressive vertically oriented stretch in the subcutis.

Again, it is important to emphasise here that normal-sized hypodermal fat lobules are only found in women, but they are not cellulite. Only when these lobules enlarge and start stretching the supporting connective tissue strands we have the appearance of cellulite.

The pre-cellulite structure is already there in women, as a result of evolution...

Cellulite can only be reduced or eliminated with an integrated approach  - one thing is not enough

OK, now we know what cellulite is, is there anything we can do to reverse the situation? Absolutely! A well-designed anti-cellulite program, consisting of quality treatments and creams, and of course diet and exercise, can directly and indirectly affect fat cell size and number (and therefore fat lobule size), diminish water retention, improve circulation, eliminate inflammation and to some extent repair the architecture of the cellulite tissues.

Due to permanent damage to the connective tissue architecture of the skin, cellulite can be completely removed in only 20% of the cases

In fact, it is impossible to completely repair this architecture, and this is the reason why cellulite is impossible to eliminate 100%, unless it is new or little and permanent damage has not occurred. Still, a 60% or 80% improvement is not bad and much better than doing nothing and allowing your legs to become more and more bumpy, loose and unhealthy. As you already know prevention is better than cure and the time to prevent is now - if you leave it too long it will be too late...