What causes cellulite?

French food gives you cellulite! (But, I love it).

Cellulite refers to the lumpy fat bulges on the thighs and buttocks of over 95% of the normal female population.  Women have three layers of fat beneath the skin.  The top layer is called the subcutaneous layer and this is where cellulite occurs.  The bottom two layers are the fat reserves where excess calories are stored.  Cellulite does not occur in these deeper layers.  Directly beneath the subcutaneous fat layer there is a layer of connective tissue comprised of collagen called the “fibrous septae.”   This septae separates the fat cells into compartments to provide structural support for the skin and to conserve heat within the body.  When the fibrous septae becomes damaged, the subcutaneous fat cells are pushed through the damaged regions and are squeezed into small bulges that give the overlying skin the “puckered” or “dimpled” appearance that we call cellulite.

There are many reasons why most women are predisposed to cellulite whereas the condition is much rarer in men.  To begin with, the underlying structure of the skin is different in males verses females.  Male skin tends to be thicker and the fibrous septae has strong cross-linking of the connective tissue.  Females have thinner skin and no cross-linking of the underlying septae.  Women have more fat layers than men, and the subcutaneous fat layer in women is regulated by hormones and does not respond to diet and exercise.  The female hormone estrogen causes these fat cells to store fat, whereas the male hormone testosterone stimulates the fat cells to break down fat.  So, women are genetically superior at storing energy in the form of fat to provide energy during pregnancy.  Women also have a higher percentage of body fat in the areas of the thighs, hips, and abdomen, and these fat cells are resistant to diet and exercise. 

Several factors can contribute to the decreased circulation and fluid retention that gives rise to cellulite.

Genetics- Cellulite does seem to run in families and the weak veins and poor lymphatic drainage seems to be genetically inherited.

Smoking- Cigarette smoke contains free radicals that damage the blood vessel walls, leading to inflammation and leakage.  In addition, the nicotine in cigarettes constricts the blood vessels, further reducing the microcirculation to the area.  It has been shown that the blood perfusion to the skin in a smoker is 65% less than in that in a non-smoking individual. 

Estrogen and Progesterone- Estrogen determines the number of fat cells in the body and promotes the accumulation of these cells in the buttocks, legs, and thighs.  Progesterone can lead to weight-gain, fluid retention, and leaky blood vessels.

Pregnancy- Aside from the increased hormone fluctuations in pregnancy, the expanding womb exerts increased pressure on the veins and lymphatic vessels in the lower body, predisposing cellulite formation.

Diet- There is no direct link to diet and cellulite reduction.  Once cellulite is formed, the fat cells have enlarged and the fibrous septae has been damaged.  Diet and exercise can shrink the size of the fat cells, but if the weight is regained the cellulite will return.  There has been some suggestion that following an organic diet results in less toxin accumulation in the fat cells and can in some instances prevent the formation of cellulite.

Cellulite is a progressive disease that develops in phases:

Phase One- Blood circulation and lymphatic drainage to the subcutaneous layer are impaired.  This leads to fluid retention and the accumulation of toxins that damages the connective tissues making them more fibrous.  This stage is primarily asymptomatic and no cellulite is visible to the naked eye. 

Phase Two- Decreased circulation damages the capillaries and veins and the blood vessels become more “leaky” increasing the pressure in the tissues and further restricting circulation and fluid drainage.  Cellulite bumps have still not appeared at this stage.

Phase Three- After a few months of lymphatic fluid  accumulation the fat cells become swollen and begin to push up against the skin.  At this stage, the first “lumps and bumps” of cellulite appear.

Phase Four- The accumulated lymphatic fluid causes the fibrous septae to further thicken, trapping and squeezing the fat cells, thus further reducing circulation to the area.

Phase Five- The presence of this high pressure system shunts bloodflow away from the affected area and the fibers thicken more, trap more fat cells, and form a huge honeycomb-like structure that gives rise to the hallmark appearance of cellulite.

The most common sites for cellulite formation are the thighs and buttocks.  However, cellulite can form on the lower abdomen, and is sometimes associated with digestive disorders.  Cellulite can also form on the upper arms in response to poor bloodflow to the region.

Liposuction does not cure cellulite, and in fact can make it worse.  As mentioned above, women have three layers of fat stores, the subcutaneous fat layer that resides just below the skin surface, the superficial reserve fat layer, and the deep fat reserve layer.  The subcutaneous fat layer is controlled by hormones, and liposuction in this layer actually worsens the appearance of cellulite.  The superficial reserve fat layer and the deep reserve fat layers in females are the prime targets that can be reduced by liposuction. 

In order to consider a particular therapy a cellulite “treatment” that therapy must address some component of the underlying physiological problems that leads to the formation of cellulite, namely, decreased microcirculation, fibrous septae damage, and the accumulation of fat in engorged fat cells.  Creams and lotions that do not penetrate the skin or deep tissue massage only act to temporarily improve the appearance of cellulite by causing localized tissue swelling that hides the dimples of cellulite.  Effective cellulite therapies include carboxytherapy, Thermage, and mesotherapy.

Have a Beautiful Day!

Dr. Lisa