The Anatomy of Cellulite: is It Just Fat?

If there’s one thing more annoying than too much thigh fat covering up the beautiful muscles you’ve worked so hard to build, it’s lumpy thigh fat and dimpling. You often hear people describe cellulite as being “fat,” but, if so, why does it look so bumpy and uneven?

Is calling cellulite fat oversimplifying things? After all, when you lose body weight, cellulite doesn’t always go away. In fact, even ultra-lean people can have cellulite. Why might that be? Let’s look more closely at the anatomy of cellulite and why it often persists even when you lose weight.

First, if you have cellulite, you’re in good company. Estimates are that nine out of ten women over the 18 have some degree of cellulite. Cellulite is divided into grades based on its severity:

Stage I  – No obvious dimpling when you’re standing up or lying down. However, if you pinch the skin, you see dimpling.

Stage II – You can see dimpling when you’re standing but not when you’re lying down.

Stage III – dimpling is visible in any position.

Anatomy of Cellulite: What Makes It Look So Different?

What makes cellulite different from ordinary fat? It all comes down to the way fat interacts with the fibrous connective tissue that encases it.  Picture a muscle in your thigh. Above the muscle lies a layer of fat. Then covering the fat are thick fibrous cords. As the fat cells enlarge, they push against these fibrous cords and herniate upward into the lower layer of skin called the dermis. This creates “bulging” where the skin texture looks uneven or dimpled.

You may have noticed that men are less likely to have “cottage cheese” thighs. One reason men aren’t susceptible to cellulite has to do with the way the fibrous cords that encase thigh fat are constructed. In men, the bands are crisscrossed, giving them greater strength, and the bands are firmly attached to the skin above it. This helps keep the fat underneath from poking through the dermis. In women, the bands are arranged diagonally and only loosely attached to the skin overhead. This makes it harder to keep the fat under wraps.

The female hormone estrogen, which men have far less of, is also a factor that predisposes women to cellulite. Before menopause when estrogen levels are high, women store fat in the thigh and buttock areas, body parts where you see the most dimpling.

The tendency for women to develop cellulite in the thighs and buttocks also has to do with an abundance of receptors in these areas called adrenergic receptors. There are two kinds of adrenergic receptors: alpha and beta. Alpha receptors, when stimulated, promote the storage of fat whereas beta-receptors, when stimulated, break down fat. Women have a high ratio of alpha to beta receptors in their hips and thighs, so the tendency is to store fat in these areas. Combine that with the way the fibrous bands that hold the fat in place are constructed and you have a recipe for fat herniation and dimpling.

If estrogen is a driving force behind cellulite in women, why does cellulite worsen after menopause? As estrogen production drops after menopause, women store less fat in the thigh and hip area, but collagen, the protein that keeps your skin firm and youthful starts to break down. As collagen becomes damaged, it can’t keep the underlying fat from poking through as well.

Genetics is also a factor. The tendency to develop visible cellulite is at least partially influenced by your genetic makeup, but don’t forget factors like sun exposure and smoking (breaks down collagen), diet, and lack of exercise can predispose you to cellulite even if you don’t have a strong genetic tendency.

Getting a Handle on Cellulite

Unfortunately, there’s no sure-fire cure for cellulite but there are things you can do from a lifestyle perspective to keep it under control.  When you eat a clean diet that limits processed foods and sugar, it helps balance your estrogen level and reduce fat storage. Exercise helps too by improving your body composition, so you have less stored fat. Plus, if you have cellulite, it’s less noticeable when you have more muscle definition.

Wouldn’t it be wonderful to have a topical cream that would magically remove the dimpling? Don’t get too excited. The “cure” has yet to be found. On the other hand, small studies looking at retinoids, a vitamin A-derivative in prescription acne and anti-aging creams, suggest they may be beneficial, although the benefits are likely modest. Retinoids boost collagen production, thereby making the dermis of the skin firmer and thicker. A thicker dermis helps keep the underlying fat from poking through.

Another popular treatment that doesn’t deliver consistent results is massage. The theory is that massage boosts circulation and lymph drainage, thereby reducing congestion. Although massages are relaxing, they won’t lead to a lasting improvement in cellulite. At best, you’ll get temporary benefits that you’ll have to repeat every day.

If you’re willing to go a step further and visit a plastic surgeon’s office, you can undergo a procedure, a combination of laser and radiofrequency waves to boost collagen production and help loosen those tight fibrous bands that pull on the fat. Expect to pay a hefty price, though. You’ll need 4 or more sessions at around $400 a treatment. Even then, you’ll only see about a 50% reduction in cellulite. Plus, you’ll have to repeat the procedure in a year or two.

Another newer treatment, approved the by FDA, called Cellulaze, uses a laser beam to break up fat cells as well as the fibrous cords that encase the fat and cause it to herniate. The laser is directed underneath the skin through a tiny cannula or tube and it as the added bonus of stimulating collagen production, so you may notice some skin-firming action. It doesn’t come cheaply, though. You’ll have to shell out as much as $5,000. Even then, the results may not be permanent. Some people notice a recurrence of cellulite after only a year or two.

The Bottom Line

Even if you’re willing to pay $5,000 to improve the appearance of cellulite, the results won’t be permanent. So what should you do? Focus on the obvious things; wear sunscreen, avoid processed foods and sugar, and resistance train. When you have a fit, toned body cellulite is much less noticeable. Chances are no one is looking at your cellulite anyway. They’re admiring the fact that you’re in such good shape because you exercise!

 

References:

J Eur Acad Dermatol Venereol 14 (4): 251-62.

Cosmetic Dermatology: Principles and Practice. Leslie Baumann, M.D. (2002)

 

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