Understanding & Healing Cellulite

November 2, 2017

One more way to classify and criticize ourselves?  No, not today.  Cellulite affects 90% of women and 10% of men, some people are bothered by it, some aren't. What causes cellulite is debatable, but most scientists agree that it results from some combination of reduced microcirculation, interstitial edema, localized hypertrophy of fat cells, oxidative stress, persistent low grade inflammation, and extracellular matrix alterations from collagen degradation.  Huh?  Don't worry, I'm going to break that down for you...


I don't know about you, but I am overwhelmed by the non-science (nonsense) when I look for help from the beauty industry.  I am also too old to beat myself up over a few lumps and bumps on my thighs.  On the other hand, if cellulite reflects the health of my body (my skin, connective tissue, adipose, microcirculation, estrogen levels, collagen production, diet, habits), perhaps it is worth understanding the pathology so I can make some informed decisions regarding my lifestyle.  According to Pavicic et al, up to 98% of women are concerned about their skin changes due to cellulite and the changes decrease their self-esteem.  Whoa, that's upsetting.  So, if it is bothering you, it is bothering me.   



Let's begin by classifying cellulite, the Nurnberger and Muller scale is the most commonly used classification for cellulite.  This is a simplified version:


STAGE 0        No visible cellulite while standing

STAGE 1        The skin is smooth while standing or lying down, but the                          Pinch Test produces an orange peel appearance

STAGE 2        Cottage cheese appearance to the skin is visible while                            standing.  It disappears when laying down.

STAGE 3        Dimpling appearance is visible regardless of whether                              the woman is standing or lying down.




STAGE 1: Smooth skin while standing, bumps and dimples appear while sitting.


STAGE 2: Orange peel or cottage cheese appearance sitting or standing.


STAGE 3: Orange peel appearance present while sitting or standing with deep raised and depressed areas.


• What causes cellulite?


Cellulite Formation:

Cellulite is a condition where fat cells push through the connective tissue beneath the skin.  The image below depicts the normal architecture of the layers under the skin. The subcutaneous layer of fat lies below the skin on top of a layer of fascia (fascia is a collagen-based sheet of connective tissue).  There are vertical, fibrous cords connecting the fascia to the skin.  There are also arteries and veins running through this superficial fat layer.  When the structure of this superficial layer becomes disturbed (via inflammation, estrogen, aging, trauma, edema, oxidative stress, decreased blood flow, fat cell enlargement) the fascia, fibrous cords, skin, and fat cells lose this organized structure.     

 As mentioned, cellulite formation is multifactorial, this image depicts the enlargement of adipose cells; as they get bigger they protrude through the skin while the fibrous cords tether the skin the the underlying fascia resulting in the visible skin dimple.  

This might explain cellulite as it relates to increased body fat, but other factors are at play.  The dermis is held together by a protein called collagen, made by fibroblasts. Fibroblasts are skin cells that give the skin its strength and resilience.  As we age, our fibroblasts produce less and less collagen and the existing collagen becomes weaker.  As the collagen in the skin decreases these protruding fat cells become more visible (the orange peel appearance).  So now we have 2 issues, enlarged fat cells and weakened skin. Imagine now that there is injury to the vertical cords of connective tissue from trauma, decreased circulation (smoking or aging), UV damage, and/or free radical accumulation.  Injury results in inflammation, this causes the fibrous cords to contract and thicken and potentially shorten, which tethers the fascia to the skin at each cord.  And the result?  The overlying skin becomes dimpled as the cords pulls down and fat cells protrude up.  


What can we do about it? 


We have to address the pathology, notice I said "healing" cellulite.  


1.  Improve circulation

2.  Reduce inflammation

3.  Increase collagen regeneration; reduce breakdown and increase formation

4.  Release the tethering of the fibrous cords

5.  Reduce the size and number of fat cells


 1.  Improve circulation

While the actual cause of cellulite is the result of a breakdown in the connective fibers, one must remember that the reason for this breakdown is most likely a decline in the circulatory system. Loss of circulation to an area – whether caused by lack of exercise, too much sitting, clogged arteries, tight