Cellulite histopathology and related mechanobiology

Abstract

Cellulite, sometimes called gynoid lipodystrophy, is much more prevalent in women than in men. There are glaring discrepancies regarding the microanatomical descriptions of this condition in the literature. A lumpy aspect of the dermo-hypodermal interface is often cited, but it appears to represent a gender-linked characteristic of the thighs and buttocks 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 physiological buttress limiting the outpouching of fat lobules on pinching the skin. These connective tissue structures might represent 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 by cellulite process are altered, but may tend to resume to normal under treatment. These functional changes influence the mechanobiology of connective tissue cells, in particular the Factor XIIIa-positive dermal dendrocytes.

Longitudinal evaluation of manual lymphatic drainage for the treatment of gynoid lipodystrophy

“…1 So far, this apparently multifactorial disorder is believed to be caused by the following factors: anatomical changes; microcirculation failure; reduced production of the vasodilator hormone adiponectin by the subcutaneous cell tissue; genetic polymorphism; changes in dermal connective tissue; and inflammatory processes. 2 - 4 The method most widely used to classify cellulite is that proposed by Nürnberger and Müller, which was based on 4 grades defined according to clinical presentation: zero: no changes; I: visible changes at skin clamping or muscle contraction; II: visible changes when there is no manipulation; and III: visible changes associated with nodulations (Figures 1 e 2). 1 …”

Can cellulite be treated with low-energy extracorporeal shock wave therapy?

“…The patho-physiology of cellulite is understood today as being gender-specific to female skin (Müller and Nürnberger 1972; Nürnberger and Müller 1978; Scherwitz and Braun-Falco 1978; Quatresooz et al 2006). Based upon anatomy and histology of skin Nürnberger and Müller formulated a scheme for development of cellulite (see Figure 1).…”

Correlação entre alinhamento pélvico e fibroedema geloide

“…Guirro and Guirro 2 describe the postural changes as associated with an important hemodynamic disorder, which may interfere in the emergence or worsening of the cellulitis. Therefore, body postures that tend to compress the fatty tissue in specific areas commonly exacerbate the ripples 10 . Posture assessment is a method used in physical therapy to study the alignment of body parts; with a good evaluation we are able to draw a good treatment plan.…”

“…Cellulitis modifies the histological structure of the skin, altering the connective tissue, which results in increased retention of water, sodium and potassium, leading to increased interstitial pressure, compression of veins, lymphatic vessels and nerves, which generates a vicious cycle 9 . Among the predisposing or aggravating factors of cellulitis, we can cite: female gender, race (more common in Caucasian), increase of the fat tissue, age, genetic and familial predisposition, psychosomatic factors, pregnancy, intestinal dysfunctions, external compressions, smoking, medications, postural changes, among others 5,[8][9][10] . The classification criteria are variables, according to histopathological changes, macroscopic appearance of the skin and its clinical form.…”