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Aesthetic Dermatology Cellulite
Streamlining Cellulite Concepts
Gérald E Piérard, Céline Devillers and Claudine Piérard-Franchimont
Department of Dermatopathology, University of Liège
Abstract
Cellulite is a gender-related condition. It is not a result of increased body mass, but its aspect may be influenced by the
waist-to-hip ratio. There are glaring discrepancies in the microanatomical descriptions regarding this condition. A lumpy aspect of
the dermo–hypodermal interface is often mentioned, but this aspect rather represents a gender-linked characteristic of the thighs and
buttocks of women without being a specific sign of cellulite. Incipient cellulite recognised by a discrete padded look or orange peel aspect
appears to be related to the presence of a network of focally enlarged fibrosclerotic strands partitioning the hypodermis and serves as a
physiological buttress limiting the outpouching of fat lobules on pinching the skin. Such connective tissue structures have been ascribed
to be the result of a hormonal-dependent reactive process to sustained mechanical tensions caused by the adipocyte lobules. Full-blown
cellulite is recognised by a lumpy, bumpy and dimpled skin surface. It likely represents subjugation of the hypertrophic response of the
hypodermal connective tissue strands when their resistance is overcome by progressive fat accumulation. In these cases, histological
aspects reminiscent of striae distensae are identified within the hypodermal connective tissue strands. The mechanical properties of skin
involved in the cellulite process are altered. They influence the mechanobiology of connective tissue cells, in particular the factor
XIIIa-positive dermal dendrocytes.
Keywords
Cellulite, mechanobiology, hypodermis, dermal dendrocyte
Disclosure: The authors have no conflicts of interest to declare.
Received: 24 February 2009 Accepted: 13 March 2009
Correspondence: Gérald E Piérard, Department of Dermatopathology, University Hospital Sart Tilman, B23, B-4000, Liège, Belgium.
gerald.pierard@ulg.ac.be
Cellulite, sometimes called gynoid lipodystrophy, is prevalent to a The presentation of cellulite is possibly linked to the waist-to-hip ratio,
greater or lesser degree in the vast majority of women.
1,2
The which reflects the distribution of fat in the lower body relative to
perception of cellulite is influenced by ethniciy, civilisation, culture, the amount of abdominal fat.
3–5
In Caucasian women, the most
social group and individual feelings about the ideal body image. In attractive waist-to-hip ratio ranges from 0.6 to 0.8.
4
These values are
western societies, any lumpy, dimpled or puckered element of the perceived to be more attractive compared with figures depicting
skin on the upper outer thighs, posterior thighs and buttocks other waist-to-hip ratios. A prominent gynoid aspect with a reduced
generally generates a high level of discomfort and alters a patient’s waist-to-hip ratio or, conversely, overweight and obese women with
feeling of self-esteem and youth. Similar aspects are occasionally an increased waist-to-hip ratio often interfere with the global
reported on the breasts and upper arms. The severity of this perception of body image.
gender-linked skin condition may be straightforward, but may also
be more subtle and even be present only in the body image From the Genuine Incipient to
representation of some women. Full-blown Cellulite
The basic structural and metabolic features of cellulite are not clearly
Overall, those women who do not claim to suffer from cellulite may identified. It may be wise to substitute the single term cellulite for two
be regarded as oddities. Cellulite is considered to be a physiological distinct grades of this condition, namely the genuine incipient cellulite
condition, but its basic structure and metabolic features are not so and full-blown cellulite.
5
Incipient cellulite is barely visible, being
clearly identified. Cellulite has tentatively been ascribed to recognised only by a paddled or ‘orange peel’ aspect when the skin is
modifications in the metabolism and biochemistry of the adipose pinched (pinch test). This condition is common in women, in whom it
tissue. However, there is no evidence of any primary differences merely corresponds to a gender-typical feature of the skin of the
between affected and unaffected areas of the adipose tissue thighs and buttocks. This condition may be present when the waist-
physiology, blood flow, biochemistry and metabolism that would to-hip ratio remains in the ideal range. Full-blown cellulite is
account for the anatomical background of cellulite. Cellulite characterised by a mix of irregular dimpling and lumpy-bumpy
morphology is believed to result from the adipocyte structure and cutaneous cobbles.
6,7
It appears to be a distinct condition on gross
perhaps increased fat herniation into the dermis. inspection of the skin. There is clinical evidence that full-blown
70 © TOUCH BRIEFINGS 2009
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