Streamlining of cellulite concepts.

Basically, 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 recognized by a discrete padded look or “orange peel” aspect appears correlated with the presence of a network of focally enlarged fibrosclerotic strands partitioning the hypodermis and serving as a physiologic 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 recognized 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.