Cellulite is a condition of adipose origin in which adipose tissue protrudes through the dermis causing an ‘orange peel’ or ‘cottage cheese’ type dimpling of skin seen most commonly on the thighs and buttocks of many post-pubertal women. The initial changes leading to cellulite formation appear to be deterioration of the capillary network, vascular changes and abnormal deposits of glycosaminoglycans, leading to excess fluid retention within subcutaneous tissues. A variety of treatments ranging from topical creams to laser therapies are currently available, claiming to reduce the dimpled skin appearance however successful results are often anecdotal, subjective or not present at all.
Cellulite can be primarily found in any area of the body that contains subcutaneous adipose tissue such as the upper outer thighs, the posterior thighs, abdominal region and buttocks. It is mainly a female phenomenon, seen in 85 – 98% of women which may be due to genderspecific differences in the structure of subcutaneous fat of men and women according to Nurnberger and Muller. Their findings suggest that cellulite originates in the areolar layer where fat cellsare arranged perpendicular to the dermis in females, weakening the connective tissue and allowing for fat herniation. By contrast, the smaller fat lobules in males are compartmentalized by septae that are oriented in an oblique fashion, preventing herniation of fat into the dermis resulting in a smooth, rather than dimpled cutaneous surface.
Other theories suggest that cellulite is a degradation process initiated by deterioration of the dermal vasculature. Deposition of excessive fat is stored in fat cells or adipocytes in the ﬁbrillary network of the connective tissue between the superﬁcial dermal layer and muscle ﬁbres. Venous and lymphatic stimulation will be decreased resulting in fluid accumulation within the dermal and subcutaneous tissues. Increased capillary pressure leads to increased capillo-venular permeability and the retention of lymph fluid, provoking metabolic changes of the reticular network in the form of deposits of fibres around the capillaries and adipocytes. The inability to repair tissue damage due to continued oedema and vascular congestion can lead to thickening and sclerosis of the fibrous septae in the superficial adipose tissue and deep dermis, creating the clinical appearance of cellulite.
Cellulite is an unwanted condition and a rising demand for cellulite reduction has new non-invasive treatment modalities becoming popular. Currently there are numerous medications, devices and diverse therapies that allegedly treat cellulite however there is little evidence to support long term effectiveness. Due to the nature of cellulite, effective treatment would need to repair and strengthen the dermis as well as expel the fat protrusion back underneath the dermis. Retinoids are thought to increase dermal collagen fibres, allowing the dermis to prevent further herniation of fat as the...