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 it (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 and water retention.

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.

We could potentially ad the word toxic to the above definition, as the creation of cellulite is significantly accelerated  by the accumulation of fat soluble toxins in adipose tissue. So a revised, all-inclusive definition of cellulite could be: "Toxic Oedematous FibroSclerotic Superficial Panniculitis"

Another, more concise scientific definition of cellulite is: “Dermopanniculosis Deformans”. This basically means “inflammation of the fat tissue in the skin" (dermopanniculosis), accompanied by deformity (deformans) - the second word denoting the fibrosclerosis mentioned above.



Peaks and troughs

To start explaining how cellulite develops, it is 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, forming "fat parcels".

(Note: connective tissue is tissue made of a network of collagen, elastin and other proteins. Connective tissue keeps everything together and gives shape to our body.)

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 that makes female skin soft, but firm and elastic at the same time. In addition, the surface of the skin is literally tethered directly to the superficial fascia below by longer and thicker collagen strands, and these are the collagen strands most responsible for the mattress cellulite appearance (see picture below).

Note 1: Male skin has exactly the same structure, but usually without too much fat in the fat pouches, and appears as firm and elastic, but not very soft. Note 2: As we will see below, cellulite skin appears more "squidgy" (as in spongy soft) than soft and firm. This is due to water retention and/or skin laxity, which usually accompany cellulite.



The (fat pouch) peaks and the (collagen strand) troughs

Now, it is 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.

On the other hand, in reaction to the pushing of fat outwards, the collagen strands that connect the surface of the skin above to the deeper tissues below, become overstretched and injured. This eventually leads to scarring, contraction and hardening of the collagen strands, eventually culminating in the skin being pulled downwards at those points.



Cellulite anatomy: 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 that we call cellulite. This also resembles the appearance of "orange peel" (peau d 'orange) and cottage cheese, hence the "cute" names used to describe cellulite...

The cellulite mattress appearance

In the photo below you can clearly see the fat pouches (hypodermal fat) and collagen strands that connect them together and attach them to skin on top and the "superficial fascia" below. Below the "superficial fascia", at the bottom 30% of the picture, you can see the deep, "subcutaneous fat", which is NOT part of cellulite.




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 of cellulite. 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 at almost the same spot you also have skin looseness; and water retention; and inflammation; and fat accumulation. And each of those things reinforce the other, in a perpetual vicious circle that gradually destroys the very fabric of the skin in the legs and buttocks (and quite often stomach and arms). An analysis of this vicious circle follows.



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:

  • 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 (i.e. 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 oestrogen, 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 attached 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), and vice versa, all reinforcing each other
  • anti-nutrients and toxins from food and cigarettes accumulate in the fat tissue and cause further fat tissue inflammation, hypoxia and glycation

As you 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.


The vicious circle of cellulite must be broken at multiple points

Attempting to break this web at just one point, as in with a caffeine-only cream or with a "fascia massage" is naive, to say the least.

In addition 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 its 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 healthy eating, vigorous exercise (relaxing Yoga and Pilates don't count) 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.



Pre-cellulite and the ethics of cellulite

Now that we have covered the basics of "what is cellulite" we can move into "pre-cellulite" and also discuss the questions regarding how normal cellulite is and if anyone should be bothered to reduce it or not. If you are interested, just scroll down or click on the link above.



Check our "How to get rid of cellulite?" guide

We have put several months of hard work, lots of love and all our knowledge and 17-year experience in our detailed "How to get rid of cellulite" guide, comprising 50+ tips. It really contains (almost) everything you need to know to combat cellulite - so make sure you check it out!


Jump to:

Pre-cellulite: cellulite waiting to happen

Is cellulite normal?



© 2017 Georgios Tzenichristos & LipoTherapeia Ltd