“I have been specialising in cellulite for 25+ years and I have lost count how many times I have read or heard inaccuracies and urban myths about fibrosis, connective tissue in cellulite and fibrous cellulite. Everyone has an opinion, even doctors and surgeons without having studied cellulite anatomy properly. On this page I am analysing this important issue which is central to the nature of cellulite.”
Fibrosis, cellulite and fibrous cellulite: what is the connection?
Fibrosis is one of the most important aspects of cellulite…
Fibrous septae or retinaculae cutis in cellulite?
A visual representation of fibrosis in cellulite
Without fibrosis there would be no cellulite
Cellulite: a multi-faceted aesthetic condition
WHat is fibrous cellulite then?
What causes fibrosis in cellulite (and fibrous cellulite)?
What can be done to break down the fibrosis and improve all other factors of cellulite?
Fat: the elephant in the room
Focus on fat or focus on fibrosis?
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Fibrosis is one of the 7 aspects of cellulite…
…together with fat accumulation, water retention, skin laxity. inflammation, free radical damage and glycation.
Fibrosis in cellulite refers to excess accumulation and contraction of collagen in the hypodermal skin ligaments that connect skin above with the fascia below.
(These skin ligaments are also called cutaneous retinaculae, fibrous “septae” or “collagen bands” by different people. Fibrosis occurs at the deepest skin layer, called the hypodermis.)
The contraction and thickening of these collagen fibre bundles means that skin is pulled down by the retinaculae cutis, while it is pushed up by fat adjacent to them.
The end result is the “orange peel skin” (also known as “cottage cheese skin”) appearance.
Fibrous septae or retinaculae cutis?
By the way, the term fibrous septae, although widely used is wrong. Research has shown that there are no septae in cellulite, i.e. there exist no walls that separate fat compartments from each other. There are skin ligaments instead, that connect skin above to fascia underneath.
On ultrasound and MRI these things may deceivingly look like septae. Merriam-Webster defines a septum as “a dividing wall or membrane especially between bodily spaces or masses of soft tissue”.
However, microphotography reveals just retinaculae cutis. Merriam-Webster defines a retinaculae cutis as “One of the numerous small fibrous strands that extend through the superficial fascia attaching the deep surface of the dermis to the underlying deep fascia determining the mobility of the skin over the deep structures”.
Much more accurate.
So the term “fibrous septae” or “cellulite septae” is downright wrong and based on erroneous assumptions about the nature of cellulite, which have been debunked for more than 15 years now.
In fact, fibrous septae are found on the subcutaneous adipose tissue (what people call ‘fat’) but not on the hypodermal adipose tissue (what people call ‘cellulite’). And this is probably the root of all the confusion about “septa” in cellulite.
Yet most cellulite “experts” still talk about “septae” in cellulite.
Oh well…
A visual representation of fibrosis in cellulite
The cellulite appearance is equivalent to a leather couch upholstery. In this representation:
Leather equates to skin: the thinner leather/skin is, the saggier it looks
The buttons attached to the bottom of the upholstery equate to the retinaculae: the tighter the buttons/retinaculae, the more pronounced the bumpy appearance
The foam inside, which pushes the leather upwards, equates to fat: the more foam/fat, the more pronounced the bumpy appearance
Without fibrosis there would be no cellulite
As we see in the example above, the thicker and more shortened the retinaculae are, the worse cellulite looks. And of course the more fat accumulation there is, the worse cellulite also looks.
Without fibrosis, i.e. with the retinaculae being of normal thickness and not shortened, there would be no cellulite. And of course, without excessive fat accumulation, the primary cause of cellulite, there would be no cellulite either.
Cellulite: a multi-faceted aesthetic condition
This means that cellulite is not just a connective tissue (i.e. retinaculae) problem, as some simpletons claim.
Neither, of course it is “just fat”, as some other simpletons claim.
Nor is it just a water retention issue, so “all you need to do is have lymphatic massages” every week, forever, as some really simple simpletons believe.
The reason for simple minded options not doing much is because cellulite is a multi-faceted aesthetic condition: it is both a connective tissue and a fat accumulation problem, with skin laxity and water retention also being very important. Inflammation, free radical damage and glycation are also part of the problem.
WHat is “hard cellulite” / fibrous cellulite then?
Fibrous cellulite or “hard cellulite”, is cellulite with a high degree of fibrosis.
Fibrous cellulite usually occurs in people with stronger connective tissue.
Not always though. In severe cellulite we may observe both extremely fibrous cellulite AND skin laxity. This makes treating hard cellulite even more difficult, leading to a choice between breaking down the fibrosis or tightening up the skin.
In most cases of fibrous cellulite, cellulite looks worse than loose skin, so priority on breaking down cellulite fibrosis makes more sense than tightening up the skin.
What causes fibrosis in cellulite and fibrous cellulite?
So what causes fibrosis in the fibrous bands / skin retinaculae?
It is simple:
As fat accumulation in the hypodermis pushes skin up, retinaculae are chronically stretched
When these skin ligaments are stretched - especially in a chronic, low grade inflammation environment, such as the one which occurs in cellulite - they react by becoming shorter and more fibrous / thicker
The result is shortened and thickened fibrous retinaculae, while at the same time the dermis itself is quite often too thin and lax, i.e. the opposite of fibrosis
The combination of fat accumulation, fibrosis in the collagen bands, skin laxity on the dermis, inflammation and water retention makes cellulite very complicated to treat.
Hence we always insist on a combination of treatments and creams plus healthy nutrition and exercise.
Just doing some lymphatic massages or using “fascia blaster” tools (they actually do not even “blast” the retinaculae at all, they mainly work deeper, in the subcutaneous fat, so big waste of time and too many bruises for nothing), or even just diet and exercise will not work.
A holistic, combined approach is needed.
What can be done to break down the fibrosis and improve all other factors of cellulite?
It is important to note here that:
Unlike the example of the leather sofa above, the fibrous retinaculae are not equal/identical: some are very thick or very thin and some are very long or very short
Once fibrosis gets established in the hypodermis, it cannot be totally broken down
These two things are the reason why cellulite cannot be totally eliminated or gotten “rid of” completely. So in 95% of the cases is is all about cellulite reduction, not cellulite elimination.
The best anti-fibrotic cellulite treatments are
High-power ultrasound cavitation, primarily
And strong, cellulite-specific massage, secondarily
The best anti-fibrotic natural molecules that can be included in cellulite creams are:
centella asiatica triterpenes: asiatic acid, asiaticoside, madecassic acid, madecassoside
curcumin
EGCG
Fat: the elephant in the room
Breaking down fibrosis is all good, but it will achieve nothing unless we first reduce the fat accumulation, which is the primary cause of cellulite.
This can be done with healthy diet, exercise, deep-acting, high-power radiofrequency and and high-power ultrasound cavitation.
(We always insist on “deep acting” and/or “high-power” for RF and cavitation treatment, as the usual superficial or low-power versions achieve absolutely nothing.)
The following cellulite cream molecules, found in those rare real cellulite creams, can also be helpful: forskolin and caffeine (primarily) and centella asiatica triterpenes, curcumin and EGCG (secondarily).
So although breaking down the fibrosis is important, reducing hypodermal fat (cellulite fat) will act on the primary causes of cellulite and offer maximum benefits.
Focus on fat or focus on fibrosis?
Unfortunately today most people instead of focusing on removing cellulite fat, the elephant in the room, focus on removing the fibrosis:
Either by cutting out the retinaculae completely (subcision, cellfina etc), which is quite often disastrous
Or by dissolving all collagen in the area with injections (collagenase injections, qwo), which is downright stupid
The retinaculae and collagen are there for a reason: to keep skin in place. By breaking them down in order to reduce cellulite (which in most cases does not even happen, i.e. cellulite is not really reduced) you end by making skin jelly-like loose. Not smart…
Yes, it’s good to focus on fibrosis but not primarily. Cellulite fat reduction should be the primary aim, not reducing fibrosis at the cost of undermining skin firmness.
In fact, by creating firm skin and reducing fat, fibrosis immediately becomes irrelevant, as the firmer skin automatically hides the cellulite bumps. But that’s material for another article…
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At LipoTherapeia we have specialised 100% in skin tightening and cellulite reduction for more than two decades and 20,000+ sessions.
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As strong, deep acting radiofrequency and deep-acting, high-power ultrasound cavitation are the technologies of choice for skin tightening and cellulite reduction, we have invested in the best RF/ultrasound technologies in the world.
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Our focus is on honest, realistic, science-based treatment, combined with caring, professional service, with a smile.
We will be pleased to see you, assess your cellulite, skin laxity or fibrosis, listen to your story, discuss your case and offer you the best possible treatment.
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Look Inside Your Skin™ with a Cellulite Ultrasonography™ scan, exclusive to LipoTherapeia in London, and assess your cellulite, skin laxity, post-liposuction fibrosis and more
We are proud to be the first and only cellulite clinic in the world to offer Cellulite Ultrasonography™ to our clients, for accurate assessment, better treatment and enhanced results. Since 2022 we have assessed and provided valuable insights to hundreds of clients to better understand their specific case, see how their skin looks from inside and make informed decisions.
You can now book your Cellulite Ultrasonography™ session and assess your:
Cellulite
Skin laxity
Lipedema
Subcutaneous fat levels
You can also assess the presence and severity of fibrosis and adhesions after:
Liposuction in all its forms, including vaser, smart lipo, bodytite, abdominoplasty/tummy tuck, thigh lift, arm lift, lipedema surgery etc
Cellulite surgery, such as cellulaze, cellutite, cellfina, subcision etc
Face-lift surgery
Non-surgical procedures, such as RF microneedling, extreme intensity HIFU, extreme intensity RF, extreme intensity ultrasound etc
Everything will be shown and explained to you clearly and you can see and understand how the different structures inside your skin affect your appearance.
If there is scar tissue / fibrosis, those will be clearly seen and you can differentiate between fibrosis, water retention or unremoved fat after all types of cosmetic surgery or harsh non-surgical procedures such as RF microneedling, extreme intensity HIFU etc.
(DISCLAIMER: Please note that this service is for your informational purposes only and does not constitute medical diagnosis or advice.)
The 45’ appointment includes full assessment and consultation and optional treatment plan for cellulite reduction and/or skin tightening.
If you do wish to have treatment with us, the ultrasound scan, assessment and consultation will be used to optimise your course of treatments and maximise your results.
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