|
Figure 16.1 Cellulite is a connective tissue disorder that afflicts over 90% of non-Asian women. Source: Peter Paul Rubens (1640). The Three Graces (Museo del Prado, Madrid). Permission received from Bruno Dillen – www. artinthepicture. com on 8/8/07. |
Cellulite, also known as dermopanniculosis, status protrusus cutis, and adiposis edema – tosa, afflicts over 90% of non-Asian women. The origin of the word cellulite dates back to 1922, when the French doctors Alquier and Pavot defined the condition as a dystrophy of the mesenchymal tissues characterized by interstitial fluid retention [1]. In 1978, Nurn – berger and Muller expounded on Alquier and Pavot’s definition when they illustrated that cellulite is caused by papillae adipose, herniations of fat that protrude at the dermo-hypo – dermal interface from the subcutis through a weakened dermis [2] (Fig. 16.1).
A more recent explanation that is frequently referenced is given by Goldman, who describes cellulite as a normal physiologic state in postadolescent women. Goldman hypothesizes that cellulite is a means to maximize subcutaneous adipose retention, ensuring sufficient caloric availability for pregnancy and lactation [3].
However, Goldman’s definition must be clarified. Cellulite, which is mainly located on the lateral aspects of the thighs and buttocks, is thought to primarily exist due to the underlying connective tissue anatomy rather than from excessive adipose tissue. Therefore, cellulite is not synonymous with obesity, which is marked by hypertrophy of adipocytes. Since it can be located in any area of the body that contains subcutaneous adipose tissue, thin and obese women, alike, are inflicted with this condition. While many women may view cellulite as a pathologic condition, there is no morbidity or mortality associated with it. However, if serious cases of cellulite are not adequately treated, this condition can cause pathological tissue alterations such as lipodystrophic and fibrosclerotic degeneration [4] (Fig. 16.2).
More recent advances have focused on the endothelium, which modulates blood-tissue exchanges and maintains microcirculatory homeostasis by balancing fibrinolytic, vasodila- troy, vasoconstrictory, and coagulant factors. The female microcirculation has been distinguished from the male system by the presence of oestrongen receptors in smooth muscle cells and endothelial cells. The distribution of female fat can be explained by the presence of these oestrogen from these adipocyte receptors modulate the lipase activities of the microcirculatory system. The effects of hormones on cellulite formation will be discussed in the next section.
Figure 16.2 An outline of the history of cellulite.