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WHAT IS CELLULITE?

Optically, cellulite is characterised by the appearance of orange peel skin, its presence is more frequent in the buttocks and back and external regions of the thighs. As time passes and age advances, it also lodges in the inside thighs and arms. The truth is, it can appear in any part of the body where there is hypodermal adipose tissue and accordingly it could appear on the stomach, lower abdomen, back and waist. (Avram)¹.

Cellulite as such is not considered a disease, but an aesthetic problem that affects 90% of women, which makes it highly important in the field of female medical-aesthetic treatments.

Within the female universe, its appearance is more common in Caucasian women than Asians.

It is difficult to associate the appearance of cellulite with one sole cause. Nowadays, it is commonly accepted that it is due to the presence of several basic concomitant factors, which are:

• The different skin structure influenced by gender.
• The alteration of the conjunctive tissue’s septa which are interwoven in the subcutaneous cellular tissue between the fat lobes and are anchored to the muscle fascia and the dermis.
• Local influence with micro-vascularisation.
• The presence of inflammatory phenomena.

Accordingly, nowadays cellulite is defined according to the mechanisms that rule its pathophysiology such as dermopanniculosis deformans, adiposis edematosa and gynoid lipodystrophy. Its treatment is based on prevention of the aggravating factors and the use of mechanical and pharmacological treatments, laser and radiofrequency.

An ultrasound study has shown that the dermis proper of cellulite is characterised by areas of soft tissue with low ultrasound density between areas of denser ultrasound tissue.

The fibrous structure of the interlobular septa that compartmentalise the subcutaneous cell tissue in women is shown as a basically perpendicular structure to the skin's surface. This facilitates the fat lobules located between each septum in having the option of projecting towards the skin's surface with no other contention mechanism but the dermal surface. This protuberance of fat lobules does not occur in the male, given that the disposition of his conjunctive fibrous tissue tracts on a hypodermic level are arranged in a mesh shape and therefore this structure controls the pressure of the fat lobules towards the skin surface with greater efficiency and the dermo-epidermal junction is smoother and more homogenous. (Nürberg and Müller)²

Source: http://anushkaonline.com/skinny_celllulite.asp³

On the other hand, other authors such as Pierard4 have found no clinical correlation between the appearance of these herniations of the fat tissue lobes against the dermo-epidermal junction and the appearance of optimally visible cellulite. The appearance of optimally visible cellulite with vertical elongation of the conjunctive fibres is related to their weakening and lengthening and the manifestation of fat protuberance.

Curri^{5 y 6} y Ross - Vergnanini⁷ report that there is an alteration in capillary circulation (especially on the arteriolar precapillary sphincter) caused by the increased depositing of hyperpolymerised glycosaminoglycans (GAGs) in the extracellular matrix, in the external medium that surrounds the capillaries, the elastic and collagen fibres. Glycosaminoglycans are hydrophilic and capture water in the interstitial medium with oedema aggravation. The increase of oedema favours microcirculation vasoconstriction and the appearance of ecstatic vessels with reduction of the venous return and the manifestation of tissue hypoxia. An analysis of the interstitial tissue shows an increase in the concentration of proteins and the interstitial pressure increases from 75-91 mmHg, which is the normal pressure, to 150-200 mmHg. (Ross-Vergnanini and Smith)⁸.

Fuente: http://www.spa-medical.com

The imprisonment of the perivascular space leads to an increase in pressure in the precapillary sphincter which then leads to an increase in the permeability of the capillary and venular structure. With all of this, fluid retention results in the extracellular space on a dermal and hypodermal level (between the lobules and the conjunctive septa). Recently, through the use of magnetic resonance imaging, no increase in the interstitial fluid in tissue affected by cellulite has been observed, as suggested by some authors, unless the fluid is located in the conjunctive septa. (Querlleux)⁹.

Another factor that influences this is the presence of lipogenesis probably activated under the influence of the female hormones (oestrogens and prolactin) as well as a diet overly rich in carbohydrates. This, together with the lipolysis through hypoxia causes adipocyte hypertrophy. The adipocytes become larger and more numerous, hypertrophic and hyperplasic adipocytes surrounded by a much thicker and rigid fibrous septal tissue. All of this in a medium characterised by hypoxia and vascular congestion and oedema, which affect the superficial adipose tissue and finally the base of the dermis, turning into optimally visible cellulite.

Other authors such as Kligman10 consider chronic inflammatory phenomena of great importance, since macrophages and lymphocytes have been found in biopsies of skin septa with cellulite.