Cellulite can be illustrated further by dividing it into two distinct grades: incipient cellulite and full-blown cellulite. Incipient cellulite, which is hardly visible, is characterized by a discrete padded look or ‘orange peel’ aspect, demonstrable by the ‘pinch test’ (pinching the skin of a female thigh, for example, where cellulite is commonly manifested). Full blown cellulite, which is extremely noticeable on gross inspection of the skin, is recognized by a lumpy-bumpy and dimpled skin surface. Clinical evidence exists that demonstrates that full-blown cellulite is related to incipient cellulite. A continuum of morphologies exists between the two conditions [5]. In certain cases, striae distensae (stretch marks) are found within the connective tissue strand network [6].
The lumpy-bumpy appearance of a skin surface with cellulite results from a weakening and thinning of the connective tissue network that normally tethers the dermis to deeper skin layers. While some connective tissue strands become enlarged, others become loose, allowing edema and proteoglycan deposits to become part of this complex network. Consequently, the dermal-hypodermal interface is remodeled and the conformation of adipose tissue is altered [7].