The process initiates with the enlargement of naturally occurring fat cells that are located in the deeper areas of the skin. The gradual enlargement of these cells will compromise the circulatory system and hinder the regional inflow of the nutrients and the outflow of the waste products. This will cause a gradual stiffening, contraction, and shortening of the surrounding connective tissue, resulting in tight fibrous bands (septae) and the entrapment of the enlarged fat cells and the inward pull of the over laying skin. The eventual outcome will be the creation of a rough, uneven, dimpled, and cottage cheese appearance in the areas of thigh, buttocks, stomach and arms.

Distribution of Cellulite

 Cellulite Anatomy:

Underneath the skin there are three (3) layers of fat.  Factors such as hormones, genetics, life style, level of exercise and diet regulate the fat storage and metabolism in these layers.  The superficial top fat layer is structurally unique from the deeper two layers.  In the deeper fat layers fat lobes are stored in a very loose patch work.  These layers are not responsible for production of cellulite.  In contrast, in the top fat layer the fat lobes are organized into separate chambers.  These chambers are surrounded by strands of connective tissue and bands.  Due to this unique structure, cellulite specifically develops in this layer. 

Women vs. Men:  In women, the superficial top fat layer is organized into large vertical chambers where an abundance of fat can be stored.  In men, the superficial top fat layer is organized into small diagonal chambers, which only store small amount of fat.   

Cellulite is manifested as a bumpy or dimpled appearance of the involed skin.  In medical terminology, cellulite is known as edematous fibroscelrotic panniculopathy.  The pathophysiological factors that are involved in the generation of cellulite unclude:

• Swelling of the stored fat calls.
• Leakage of fluid due to permeability of the small capillaries and subsequent localized accumulation of excess fluid.
• Reduction of localized blood flow due to increased tissue pressure as a result of the excess fluid.
• Retardation of removal of the excess fluid secondary to poor lymphatic drainage.
• Worsening of the impairment of blood flow due to clustering of the fat lobes and tightening of the fibrotic collagen bands.
• Stiffening of the fibrotic collagen bands cause pulling down of the skin at their anchor sites.

Cellulite Identification & Classification:

There are several ways to evaluate and classify cellulite. 1. The pinch test is a simple way to locate cellulite. Pinch the skin on your outer thigh between your index finger and your thumb, and look for dimpling. You can also try other regions of the body, namely the buttocks and abdomen. 2. The Nurnberger - Muller scale can be used to classify cellulite based on a four-stage process, beginning with normal skin and terminating with its most advanced stage

• Stage 0
No dimpling when the subject is standing and lying. The pinch test reveals “folds and furrows”, but there is no mattress-like appearance.

• Stage 1
No dimpling while the subject is standing or lying, but the pinch test reveals the mattress-like appearance.

• Stage 2
Dimpling appears spontaneously when standing and not lying down.

• Stage 3
Dimpling is spontaneously positive standing and lying down.

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Questionnaire:

Determine your Cellulite Profile by answering the following questionnaire:
1. Do you have visible cellulite (no pinching needed)?

2. Is your cellulite painful when you pinch your skin?
 
3. Do you have cellulite in more than 1 area of your body?

4. Did you start noticing cellulite before the age of 25?
 
5. Do you suffer from marked premenstrual syndrome?

6. Do you have water retention?
 
7. Do you suffer from chronic constipation?
 
8. Has your weight fluctuated more than 5% in the last three years?
 
9. Are you taking any hormones?
 
10. Do you drink a lot of coffee, tea or alcoholic beverages
on a daily basis?

11. Do you smoke?
 
12. Do you drink under 8 glasses of 8 ounces (2 liters)
of water per day?

13. Is your diet rich in saturated fats (meat and dairy) and/or
high glycemic carbohydrates (pasta, rice, bread, etc)?
 
14. Do you prefer salty foods?
 
15. Have you gone over 3 months without regular exercise?
 
Total your score giving yourself 1 point per question answered YES.

If your score is above 8, it is recommended that you make lifestyle changes to minimize further worsening of cellulite.
• Increase water intake to a minimum of 8 glasses of 8 ounces (2 liters) per day.
• Minimize consumption of coffee, tea and alcohol.
• For each serving of coffee, tea or alcoholic beverage, drink 2 glasses of water.
• Exercise regularly.
• Minimize consumption of saturated fat and carbohydrates.
• 75% of the food should consist of fruit, vegetables, and whole grains. The remaining 25% may consist of meat, fish, eggs, nuts, and whatever one likes best.
• Incorporate an effective cellulite treatment, such as Acoustic Wave Treatment (AWT)® that targets cellulite at its source.