Contrary to popular belief, cellulite is not solely the result of excess fat. In fact, people of all body types can have cellulite. It is a multifactorial condition, characterised by significant individual variation linked to genetic makeup. The isolated concepts of ‘fatty cellulite’, ‘fibrous cellulite’ and ‘aqueous cellulite’ are now largely outdated. In reality, they coexist on a continuum, in varying proportions, according to four key mechanisms already highlighted in 2000 by Rossi and Vergnanini (2).
The architecture of adipose tissue: research shows that women’s adipose tissue has a very specific architecture which explains the appearance of cellulite (1). A protrusion of the fat lobules can be observed; in other words, the fat ‘pushes’ towards the dermis at an almost perpendicular angle, which distorts the skin’s surface and creates the well-known ‘orange peel’ effect. In men, this protrusion is oblique and therefore less pronounced.
Alteration of the connective tissue : the fat lobules are enclosed by partitions of collagen and elastic fibres known as ‘fibrous septa’. These keep the skin anchored to the muscle, so that when the fat pushes upwards, the septa pull the skin downwards. The resulting dimpled appearance on the skin’s surface is due to their orientation, but also to their rigidity, which further accentuates the orange-peel appearance (hence the term ‘fibrous cellulite’) (3).
Blood and lymphatic microcirculation : a reduction in blood flow, as well as poor lymphatic drainage, leads to a build-up of fluid, resulting in oedema. This was formerly referred to, somewhat subjectively, as ‘aqueous cellulite’. In reality, this excess interstitial fluid serves mainly to accentuate the characteristic dimpled appearance of cellulite, making it more visible (4).
The influence of oestrogens : our female hormones play a decisive role in the development of cellulite. Oestrogens act as a catalyst on the three key components of cellulite: fat, fibrosis and oedema. They promote fat storage in the lower body (the so-called ‘saddlebags’), alter microcirculation and also change the characteristics of connective tissue (2). This is why periods of elevated oestrogen levels, such as puberty, the menopause and pregnancy, are associated with the onset or worsening of cellulite.















