HOW DOES CELLULITE DEVELOP?
To understand the physiopathology of cellulite it is mandatory to ascertain the structure of the skin and subcutaneous tissue as well as the differences between man and women.
The skin is the largest tissue of the body. It is composed of three layers, situated horizontally, from superficial to deeper layers: a) Epidermis (superficial layer), b) Dermis (medial layer), and c) Hypodermis or subcutaneous tissue (deep layer). Other structures are added to these layers such as hair, sebaceous glands and sweat glands.
La epidermis constituye el estrato superficial o externo de la piel, es delgado y sus células superficiales se cornifican.
The dermis is formed by lax conjunctive tissue composed of a fixed cell component (fibroblasts, among others), fibrous proteins (collagen, elastin), fundamental amorphous substance (water, mucopolysaccharides, salts and glycoproteins) and a migratory cell component (lymphocytes, plasmocytes, leukocytes). The dermis contains blood vessels, lymphatic vessels and nerves.
The hypodermis is formed by lax conjunctive tissue constituted by large fat tissue lobules (measuring between 0.5-1.o cm) that are limited by walls of thin, collagenous fibres perpendicularly arranged along the surface (reticulae cutis), few elastic fibres, blood and lymphatic vessels (adipocyte figure). Primary alterations of cellulite reside in this layer.
The reason for the difference in the development of cellulite between men and women lies in the different arrangement of the structure of subcutaneous tissue between both sexes.
In women, lobules of fat tissue in the hypodermis are large sized and are separated by thin walls of conjunctive tissue arranged perpendicularly to the dermis; moreover, the conjunctive separation between deep dermis and hypodermis is irregular and discontinued. However, in men and women who do not present the condition, these conjunctive walls are thicker and are arranged polygonally, seating on a dermis-hypodermis separation of a regular and continuous bed of conjunctive tissue. Due to these differences, fat tissue is capable of protruding towards the surface giving rise to the so called “orange peel skin”.
Mechanical pressure (squeezing) leads to the appearance of an irregular surface in females because pressure is distributed exclusively at height, whereas in men this pressure is directed in all directions and mainly towards the base with a more regular distribution.
This different arrangement of the tissue is conditioned by hormones (by the action of androgens). These changes become noticeable when testicular function occurs at the onset of puberty. In like manner, males with a severe deficit of androgens (primary and secondary hypogonadism) present an appearance and distribution of cellulite similar to that of women.