Cellulite, or sometimes referred to as orange peel skin, is a widespread female problem affecting almost only women.
Why are almost only women affected by cellulite?
Cellulite is mainly caused by the increase of the fat deposits around the buttocks and thighs and the skin’s aging process that causes the collagen layers to become thinner and thinner. This predisposition is genetic and lies in the structure of the connective tissue of women and the higher number of fat cells stored in the female fatty tissue: women have 21 to 22 billion fat cells, men only 17 to 18. As the fat reserves of women serve as an energy store during pregnancy their fatty tissue also stores fat more quickly and easily. The structure and condition of the male and female connective tissue are also different and another main cause for the appearance of cellulite. While the septa of connective tissue of men run crosswise the septa of women run almost perpendicular to the surface of the skin.
How does cellulite appear?
An imbalance between fat production (lipogenesis) and fat breakdown (lipolysis) within the cells leads to the formation of large fat cells that bulge towards the surface of the skin, giving the skin the characteristic dimpled orange peel appearance that is typical of cellulite. In addition to this the often very taut and inelastic septa of women are incapable of accommodating the increase in volume in the surrounding adipose tissue, and thus further accelerate the appearance of cellulite.
The enlarged fat cells also increase the pressure in the tissue, thus diminishing local microcirculation which results in decreasing lipolysis. Over time oedema and local inflammations also occur, and the advanced-stage cellulite displays the typical fibrotic nodules.
Changes in the hormone balance, for example during menopause, can also add to the formation of cellulite. Because the skin, and especially the female skin, is an organ that is dependent on hormones changes in the hormone balance result in changes of the skin structure. In addition to this the changes in the hormone balance accelerate skin aging; the skin becomes more flaccid, is frequently dry and loses freshness and tautness.
With the loss of oestrogens during the menopause the formation of new collagens also declines and the quality of the newly formed collagens is impaired. Accompanied with a decline of the number of elastic skin fibres the epidermis becomes more flaccid, whereas the subcutis becomes harder. Due to aging processes the defensive forces of the female skin also decline gradually. Processes such as smoking, stress, poor diet or obesity further accelerate skin ageing and the appearance of cellulite.
Another factor concerns a reduction in the microcirculation of the skin caused by a mainly sedentary lifestyle. The reduced blood flow interrupts the transport of oxygen and nutrients, fat deposits build up and if the procedure continues it leads to visible changes of the skin, the cellulite.
Are there different stages of cellulite?
To measure the severity of cellulite the scale according to Nürnberger-Müller, that categorises cellulite in four different stages, is the most commonly used.
- Stage 0: No dimpling when the skin is pinched
- Stage I: No spontaneous displays of alterations, pressure is required to show dimpling
- Stage II: Dimpling is visible when standing, not while lying
- Stage III: Skin alterations while both standing and lying
- G. Sattler, U. Pohl, K. Raegener: Pilotstudie Akustische Wellen Therapie (AWT) bei Cellulite, Ästhetische Dermatologie 2-2008, S.16-25
- C. Christ, R. Brenke, G. Sattler et al.: Steigerung der Hautelastizität und Revitalisierung der Dermis bei Cellulite und Bindegewebsschwäche durch die extrakorporale Acoustic-Wave-Therapy (AWT), Ästhetische Dermatologie 1-2008, S.2-10