Anatomic update on the 3‐dimensionality of the subdermal septum and its relevance for the pathophysiology of cellulite

Abstract

Background Cellulite is an aesthetic condition affecting the appearance of skin in specific body regions. When reviewing past literature, a 2‐D image of a subdermal septum was created most likely due to the applied cross‐sectional investigative methodology. Despite practitioners being aware of the 3‐D nature of the subdermal architecture, this is not reflected in the present scientific literature. The aim of this anatomic review is to summarize the past literature and to provide an update on the 3‐dimensionality of a subdermal septum with a specific focus on the pathophysiology of cellulite. Materials and Methods This review is based on the literature search performed in the PubMed database using the keywords: cellulite (n = 777), cellulite, AND pathophysiology (n = 53). The articles obtained were screened and those focusing on “cellulitis” or other non‐cellulite‐related topics were additionally excluded resulting in a total of n = 38 relevant articles which were evaluated for the purpose of this anatomic review. Results The skin is comprised of two fat layers (superficial and deep), separated by the superficial fascia. The dynamic 3‐D interplay between retinacula cutis, fascia, and fat, with anatomic differences between men and women, highlights a complex anatomic construct with direct implications for the formation and treatment of cellulite. Conclusion The 3‐dimensionality of a subdermal septum provides important clinical clues to understanding the underlying mechanisms and pathogenesis of cellulite. The 3‐D approach, in contrast to the past 2‐D models, presents a robust foundation for understanding and developing future cellulite therapeutic strategies.

Improvement in Cellulite Appearance After a Single Treatment Visit With Acoustic Subcision: Long-Term Findings From a Multicenter Clinical Trial

“…1,6 In men, the septa stretch from the dermal undersurface at a 45°angle and form a crisscross pattern, resulting in smaller fat lobules and a denser subdermal arrangement. 2,3,[7][8][9] In women, the septa are oriented perpendicularly to the skin and are less numerous, resulting in larger fat lobules and less structural stability, thereby allowing subdermal adipose tissue to become displaced. 9,10 Estrogen may also play a role in cellulite development because of involvement in adipocyte hypertrophy, lipogenesis, and collagen formation.…”

“…2,3,[7][8][9] In women, the septa are oriented perpendicularly to the skin and are less numerous, resulting in larger fat lobules and less structural stability, thereby allowing subdermal adipose tissue to become displaced. 9,10 Estrogen may also play a role in cellulite development because of involvement in adipocyte hypertrophy, lipogenesis, and collagen formation. 11 Studies and surveys have demonstrated that cellulite can negatively affect self-esteem, body image, and quality of life.…”