What is cellulite (and why is it so difficult to get rid of)?

What is cellulite?

Cellulite is inflammation and fibrosis (scarring) of the superficial fat tissue, usually accompanied by skin laxity and oedema (water retention).

In cellulite, shortened and hardened collagen fibres anchor the skin surface down to the deeper tissues, while at the same time pouches of enlarged fat tissue push the - typically loose - skin upwards, making it protrude and causing the mattress appearance.


The scientific definition

The best scientific definition of cellulite that describes cellulite (almost) accurately is: "Oedematous FibroSclerotic Superficial Panniculitis (OFSB)". This in plain English translates as: inflammation of the superficial deposits of fat, accompanied by scar tissue.

The above includes all the hallmarks of cellulite in one elegant, four-word definition:

  • oedema (water retention)
  • inflammation of superficial fat (panniculitis)
  • fibrosis (scar tissue / hardening of connective tissue)

Although skin laxity is found in 90% of cellulite cases, it is not found in all women, so this definition still stands accurate.


Peaks and troughs

To start explaining how the whole thing develops, it's worth noting that fat in the deeper layers of the skin is always enclosed in little compartments wrapped up by a thin sheath of connective tissue (connective tissue is made of collagen, elastin and other proteins).

These fat pouches are literally suspended by collagen strands that attach them:

  • to each other
  • to the surface of the skin above
  • and to deeper tissues underneath

This forms a three-dimensional suspension structure.


The (fat pouch) peaks

Now, its also worth noting that fat cells can swell several times their normal size. As these fat pockets enlarge with excess fat and water, they expand and push the skin surface upwards.


The (collagen strand) troughs

On the other hand, in reaction to the pushing of fat outwards, the collagen strands that connect the surface of the skin above with the deeper tissues below, become overstretched and injured. This eventually leads to contraction and hardening/scarring, pulling the skin down in the process.


The cellulite mattress appearance

The peaks (caused by fat pushing the skin out) and troughs (caused by collagen stands pulling the skin down) cause the mattress appearance we call cellulite (see photo below).


90% of women will develop cellulite at some point in their lives

There are hundreds of anti-cellulite creams around but 90% of those creams don't really work. 90% of beauty salons offer some sort of cellulite treatment. And 90% of those treatments fail to offer you anything more than a slight, temporary reduction for the so called cottage cheese skin or orange peel skin (peau d' orange) appearance. And the obvious question is, why?

The answer to the why question is the multi-faceted nature of cellulite. In one small area of skin you can have connective tissue hardening yet skin looseness; water retention; inflammation; fat accumulation. And all of these things reinforce the other, in a vicious circle, as we will see in the next paragraph.


Cellulite: a web of complications - literally and metaphorically 

Remember how we described cellulite earlier as a three-dimensional web structure? Well, that was referring to a literal, physical web. However, the problem with cellulite is also another, metaphorical web: the web of complications.

Cellulite is characterised by a web of complicated feedback mechanisms that, unless something is done about them, they can lead into a vicious circle:

  • inflammation, as any biology student knows, leads to water retention and vice versa, in a perpetuating negative loop
  • inflammation quite often leads to fibrosis / sclerosis (scar tissue / tissue hardening, in plain English)
  • water retention inhibits fat removal, but does not prevent fat accumulation ("fat trap" effect)
  • an excess of adenosine and alpha2 adrenoreceptors in the fat tissue, due to chronic exposure to estrogen, also inhibits fat removal, but does not prevent fat accumulation ("fat trap" effect)
  • ever expanding fat tissue (due to excess calorie / sugar consumption) further injures the connective tissue strands next to it, causing more fibrosis / sclerosis
  • on the other hand, ever expanding fat tissue breaks down the connective tissue around it, causing skin looseness (ever wondered why fat makes your skin flabby? that's why)
  • furthermore, ever expanding fat tissue mechanically inhibits circulation, causing more water retention
  • water retention / poor circulation leads to adipose tissue hypoxia, which is well known to cause inflammation, oxidative damage, fibrosis and glycation (connective tissue protein damage due to sugar consumption), which reinforce each other
  • anti-nutrients and toxins from food and cigarettes cause further fat tissue inflammation, hypoxia and glycation


The vicious circle of cellulite must be broken at multiple points

As you can see, it just goes on and on and on...

One complication causes another, which causes another, which causes another, and the whole thing becomes a never ending vicious circle that must be broken at various points, if we want to make some real progress with cellulite reduction. Breaking this web at just one point is usually pointless.

After reading the above, it also becomes quite clear how pathetic those caffeine-only cellulite creams sound; or the pointless "cellulite exercises"; or the ridiculous "fat melting" tights; or "dry body brushing"; or the so called "detox diets"; or some "gentle manual lymph drainage massage" etc.

  • Reducing food intake is, by itself, not enough either, as evidence shows
  • And the same applies to "cellulite exercises", as every woman knows
  • A bit of lymphatic drainage to - very temporarily - reduce water retention is clearly nowhere near enough. And let's not even talk about the joke of "dry skin brushing"...
  • Some caffeine cream to marginally boost fat removal and circulation will not do it either. Otherwise, with the amounts of coffee women drink today, there would be no such a thing as cellulite. Caffeine does help, but on it's own is not even close enough to effectively remove cellulite. And let's not even mention the sheer time-wasting ritual of rubbing ground coffee on thighs...


A comprehensive approach is needed

  • A good cellulite treatment should work on both skin laxity and fat reduction and poor circulation (there is no known technology that directly works on inflammation, fibrosis, oxidative damage or inflammation)
  • And the same applies to creams: a good cellulite cream must contain actives which are well established to work against many, if not all aspects of cellulite: fat and poor circulation and oxidative damage and glycation and fibrosis and inflammation and skin laxity
  • And all these have to be combined with clean eating, vigorous exercise (Yoga and Pilates don't really work) and sugar/smoke/alcohol/contraceptive pill avoidance, if some good results are to be expected

That is how cellulite is reduced: by attacking it on all seven fronts.


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