Introduction
Cellulite is a particularly actual and uncomfortable theme. In fact, especially this time of the year, when summer is around the corner, women’s attention seems to be focused on this ‘terrible’ problem commonly known as ‘cellulite’.
With the support of our experts, like Doctor Catia Trevisani, we will try to understand which are the cellulite causes and try to suggest the best behaviors to adopt to actively counteract it. By the way, we should precise we won’t treat cellulite like a simple imperfection, but like a degenerative disease, as it actually is, that needs to be treated continuously and not merely during the summertime when its effects are more exposed.
Percentage
Cellulite, one of the most common problems among European and American women, is an alteration in the deepest skin layer, the hypoderm or subcutaneous tissue, which causes the cellulite imperfections.
Almost all overweight women have to face it; among healthy weight women it affects 30% young women and 40% mature age women, 60-70% among women after the menopause.
The average age for cellulite onset is around 31 years, though in 70% cases it appears between 11 and 25 years of age. Cellulite is usually related to the following factors: oral contraceptive in 85% cases, lack of sport practice in 93% cases, circulatory diseases in 64%, water retention and menstrual pain in 85%.
Terminology/glossary
Actually, the term “cellulite”, usually used to identify this disease, is not the proper term, as there is no inflammation, as the Latin suffix “-ite” would indicate; researchers would preferably talk about liposclerosis or edematous fibro-sclerotic panniculopathy. Main symptoms include tired heavy-feeling legs and the orange-peel effect, which becomes noticeable by pinching the skin.
Brief anatomo-physiological considerations skin is constituted by three layers: from depth to superficies we respectively find the subcutaneous adipose tissue or hypodermis, the dermis and the epidermis. The subcutaneous tissue is constituted by the lax connective tissue and by the adipose panniculus: in particular, it’s constituted by a scaffolding made of connective fibers issued from the upper laying dermis, which separate ovoid areas containing the adipose tissue. Adipose cells (adipocytes) are voluminous and round shaped cells, which enclose an organelle containing cholesterol, carotene and fatty acids, in particular oleic and linoleic acids.
The physiological process cellulite is a gender bound concern, which particularly affects women, also due to the anatomic differences in skin texture between men and women. This difference is particularly evident in thighs’ subcutaneous tissue: women epidermis is far more subtle than men’s, the superficial layer of the subcutaneous tissue is thicker and the adipose cells are larger and separated by radially running partitions of connective tissue, while men’s adipose cells are smaller and spaced out by connective tissue fibers forming a criss-cross pattern.
Women’s corium, the connective tissue that separates dermis and subcutaneous tissue gets thinner and loses its firmness with age, thus allowing the extrusion of adipose cells in the dermis. Besides, the connective tissue branches edging the areas containing the adipose cells get thinner, too, thus determining the cells enlargement.
The break down and reduction of the connective tissue is a crucial factor in cellulite development and, furthermore, it is the cause of the sensation of coarseness that often goes together with cellulite. The ‘orange-peel’ effect is due to the alternation, on the superficial layer, of depressions and lumps in the adipose tissue caused by the extrusion of the adipose cells in the dermis. In addition, there may also be a distension of corium’s lymphatic vessels.
In the subcutaneous tissue we may see some nodules which contain adipose cells that have undergone an alteration surrounded by sclerotic connective tissue containing a few vessels.
Adipose cells are supplied by the microcirculation. When cellulite appears there is always an alteration into the microcirculation, with vasodilatation (microectasia: capillary dilation) and an alteration in capillary permeability. As a consequence, an edema follows, which causes the flooding of the interstices and the breakup of the adipose cells, thus leading to disruption and death of part of them. Subsequently, phenomena of connective neofibrillopoiesi appear, with formation of reticular fibrils, first around adipose cells and capillaries, then around the dead tissue areas. Finally, we find micronodular structures encapsulated by collagen fibrils at various evolutionary stages, whose aggregation leads to the formation of bigger nodules (macronodules).
At the final stage (the fourth stage) there is a profound alteration in the tissue structure; adipocytes become fibrocytes, so that in the tissue we’ll only find connective bundles.
Cellulite types
We find three main types of cellulite according to the skin appearance: compact, loose and edematous. The first type is painful when touched and is usually localized in the inferior part of the body. The second type is not painful, tissues appear loose and cellulite is particularly visible on the anteromedial surface of arms and thighs, it may appear together with stretch marks.
The third type has a mellow consistence; it’s painful to the touch and is mostly localized on thighs, knees, legs, calves and ankles; signs of venous and lymphatic insufficiency localized on the inferior limbs are present, too.
Causes and prevention
The main cause of cellulite seems to be an alteration of estrogen target cells, and the absence of cellulite in prepubescent girls would provide evidence. The premenstrual syndrome (a collection of symptoms, such as tiredness and swelling, announcing the menstruation) seems to be a precise indicator of a general intoxication whose major manifestation is cellulite.
Cellulite causes are still object of study and research, but it seems evident that this manifestation is due to intoxicating factors, which, acting in different ways, lead to the alteration of tissue metabolism and open the way for a degenerative process that progressively damages the structure and the function of the adipose tissue. From this point of view, we definitely may say that cellulite is the symptom of a general intoxication.
Hence, a correct therapeutic treatment should act not merely at the symptomatic level, for instance sustaining and draining the microcirculation and normalizing the connective tissue, but it should also take into account, and eventually correct, a wide variety of factors such as: digestive apparatus diseases, unbalanced thyroid, pancreatic or ovarian hormones and even factors such as anxiety and depression, etc.
Among the various factors, which include lymph stasis, we may also add incorrect diet and lack of physical activity.
All this obviously impacts on circulation and intestinal functionality with significant consequences in the long term, in fact, cellulite clinical picture is usually composed of a range of diseases including constipation, hemorrhoids and heavy-feeling legs.