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Streamlining Cellulite Concepts
cellulite represents a late stage of incipient cellulite. A range of thickened and fibrosclerotic and contain some myofibroblasts.
8
These
morphologies exist between the two.
8,9
features could represent a reactive process mediated by cytokines to
compensate for the sustained pressure exerted by the adipocyte
Non-invasive imaging methods generally show extrusions of adipose volume. In contrast, dimpling of the skin appears to be associated with
tissue into the dermis of affected women.
10–12
The standing fat lobules enlarged fat lobules bounded by thin and focally loose connective
called papillae adiposae rise into pits and dells of the undersurface of tissue strands.
8
Oedema and deposits of proteoglycans have been
the dermis. They represent a gender-linked feature typically seen in demonstrated. In addition, there are alterations in the shape and
women,
8,9
and this wavy pattern of the dermo–hypodermal junction is pattern of distribution of the elastic fibres.
8
Such histological changes
not restricted to the areas affected by cellulite.
9
In addition, the are reminiscent of striae distensae.
8,16
Most reported findings refute the
standing fat lobules may be recognised in some unaffected women. presence of enlarged lymph vessels in the dermis, thus impugning the
This evidence is consistent with the observation that the dimpled concept
13
claiming limitation of fluid movement and impairment in
areas are variable in location depending on the lower extremity lymphatic drainage in this condition.
posture. Compression of the adipose tissue in a specific area usually
enhances the dimpling in that area.
Cellulite is not the direct consequence of being overweight or obese. The mattress phenomenon demonstrated
However, the exacerbation of cellulite with weight gain and the
that the pinch test is often considered
correlation between body mass index and cellulite severity
13
probably
reflect the expansion of adipose tissue into the dermis resulting from as a cardinal sign for the cellulite-prone
the volume increase in fat.
condition and incipient cellulite.
Dermatopathological Aspect of Cellulite
Studies on the microanatomy of cellulite are few but contradictory.
8,13–16
Gender-related dimorphism in the connective tissue of the thigh Mechanobiology of Cellulite
supports clinical evidence that most women but very few men have The mechanical cause of skin dimpling in cellulite and in dermal striae
cellulite. The presence of papillae adiposae in areas where cellulite is distensae are probably similar. The latter condition results from
absent and the lack of correlation between their extent and the clinical excessive tension applied in parallel with the skin surface, whereas the
severity of cellulite point out their limited relevance to the skin former likely results from a continuous and progressive vertically
condition. In addition, papillae adiposae are tiny compared with the size orientated stretch in the subcutis. It is not uncommon to encounter
of the orange peel texture and that of the lumpy, bumpy cutaneous women exhibiting both conditions on the thighs and buttocks.
cobbles. Indeed, the two subtypes of cellulite are best appreciated
microscopically at the level of hypodermal connective tissue strands.
8
The mechanical properties of skin exhibiting cellulite are altered.
Changes in extensibility, elasticity and resiliency are improved on
The typical regional accumulation of fat in women’s thighs is treatment. The speed of shear-wave propagation is another indicator of
responsible for the vertical stretching of both the superficial fat lobules the intrinsic skin tensions.
17,18
There is evidence that this physical
and their partitioning connective tissue strands. The unremitting parameter is affected differently by cellulite and some of its treatments.
hypodermal pressure likely participates in the modelling of the
dermo–hypodermal interface. The organisation of the subdermal Any mechanical force applied to the skin is transmitted to connective
connective tissue structure of women’s thighs is more likely involved tissue cells. A feedback mechanism exists by which cells that
than the male pattern in dimpling of the skin. This evidence is sense mechanical stress via their substrate react by changing their
supported by differences in the volume of small hypodermal lobules metabolic activity, thus remodelling their environmental stroma to
and by irregularities in the integrity of the connective tissue meet changing mechanical requirements.
16
Such a mechanism is
surrounding these lobules.
8,14
The outpouching of adipocytes into thin conveniently illustrated in cellulite by looking at the number, size
hypodermal columns normally present at the base of sweat glands and and shape of myofibroblasts and factor XIIIa-positive dermal
hair follicles likely explains the formation of papillae adiposae. At the dendrocytes.
5,8
A correlation was found between the density of
stage of post-pubertal female skin development, the clinical dermal dendrocytes and the speed of shear-wave propagation in the
appearance may be unremarkable and cellulite-free. Even in very skin.
18,19
In cases of cellulite, a low number of dendrocytes is a marker
slender women, the presence of incipient cellulite is paralleled by these of mechanobiological alterations.
8,16
adipose tissue conformational changes.
Conclusion
The mattress phenomenon demonstrated that the pinch test is often Cellulite is not a disease but a physiological condition that is much
considered as a cardinal sign for the cellulite-prone condition and more prevalent in women than in men. Obviously, this physical feature
incipient cellulite. The uppermost fat lobules are probably enlarged, and has a negative impact on the perception of beauty. In the general
protrusion of adipocytes near the epidermis has been reported. It is population, there is some confusion and overlap between genuine
supposed that any external compression forces the bulging of single or cellulite and a waist-to-hip ratio outside the range perceived as an
globular clusters of papillae adiposae and pushes the overlying skin to attractive physical trait.
protrude. The bumpy appearance of the skin surface on pinching
tissues results from the fact that a network of connective tissue strands Incipient cellulite recognised by a discrete padded look appears to
strongly tethers the dermis to the deeper layers.
8
This functional aspect correlate with the presence of a network of focally enlarged
probably corresponds to the presence of areas where strands are fibrosclerotic strands partitioning the hypodermis and serving as a
EUROPEAN DERMATOLOGY 71
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