“I have researched ands studied cellulite for the last 24+ years and I have to say that cellulite is a fascinating subject. As cellulite is so complex and difficult to treat it has kept my interest for more than two decades and just by studying it I have learned so much about the human body my nutrition studies could never, ever teach me. On this article I am discussing pre-cellulite and am delving into the anatomy of skin and connective tissue that eventually leads to the creation of cellulite proper. ”
Pre-cellulite and cellulite: what are they and how to prevent and reduce them
Pre-cellulite | In summary
Pre-cellulite and the structure of cellulite
How fat cell accumulation within the skin leads to internal stretch marks and the appearance of cellulite
"Cellulite: From Standing Fat Herniation to Hypodermal Stretch Marks"
Pre-cellulite exists in all women and is not pathological
Incipient cellulite and cellulite-proper
Nature wanted women's skin on thighs and buttocks to be soft, yet firm and elastic
Nature could never have anticipated that people would one day spend their lives sitting down, eating excessive fat and sugar or ingesting excessive doses of estrogenic contraception
Silly cellulite surgery
Cellulite is inflamed, deformed tissue - a pathological state
No septae in cellulite, just retinaculae
Cellulite can only be reduced or eliminated with an integrated approach. One-sided approaches are evidently not enough.
Cellulite: from standing fat herniation to hypodermal stretch marks
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Pre-cellulite | In summary
Cellulite develops from a natural structure in women’s skin called pre-cellulite, which appears after puberty and is absent in men unless they have been exposed to oestrogen. Scientifically known as “Status Protrusus Cutis” or incipient cellulite, it is made up of fat lobules supported by collagen strands (retinaculae) in the thighs and buttocks. Its original purpose was to keep the skin soft yet firm, an evolutionary feature linked to female attractiveness, giving a smooth, elastic look over a gentle layer of fat.
In the past, when people were more active, ate modestly, and did not take hormonal contraception, this structure stayed beneficial. Today, however, a sedentary lifestyle, high-calorie diets, and extra oestrogen can cause the fat lobules to swell. The collagen strands react by thickening and hardening to hold the fat in place, but this creates fibrosis, much like scar tissue. What starts as mild pre-cellulite, only noticeable when pinching the skin, can progress to “cellulite proper,” which is visible without pinching and often comes with inflammation, poor oxygen supply, and vertical internal stretch marks in the deeper skin layers.
Research shows cellulite is not caused by a continuous honeycomb-like structure, but by a 3D network of fibrous strands that suspend fat lobules. When these strands are overstretched by enlarged fat, the familiar dimpling appears. The change from pre-cellulite to full cellulite happens gradually, moving through mild, advanced, and severe stages. Some treatments, like subcision or laser-assisted Cellfina, cut these strands to smooth the skin temporarily. But as the strands are there to keep fat under control, removing them can leave the skin looking jelly-like, with scars or pigmentation changes.
Tackling cellulite effectively means addressing its root causes: fat build-up, water retention, poor circulation, inflammation, and connective tissue damage. This calls for a combination of healthy eating, regular exercise, quality anti-cellulite creams, and safe professional treatments such as deep radiofrequency or ultrasound cavitation. While complete removal is rarely possible because the fibres can’t be fully restored, results of up to 60% improvement are realistic, especially if treatment begins early. Prevention remains the best option, as the longer cellulite is left, the more stubborn and pronounced it becomes.
Pre-cellulite and the structure of cellulite
Or, how artificial living, combined with estrogen, transforms the - desired and normal - pre-cellulite structure into the unhealthy and abnormal structure of cellulite.
This is the second of our three articles regarding the nature of cellulite (the first article in the series is “What is cellulite” and the third article is “Is cellulite normal?”).
On this article we are presenting cellulite anatomy in detail and also the subject of pre-cellulite.
How fat cell accumulation within the skin leads to internal stretch marks and the appearance of cellulite
Given that opinion about the exact nature of cellulite is so varied between researchers, it is no surprise that most people are totally confused about the subject and believe anything that is thrown upon them by crafty marketers and the popular media.
Several studies have been contacted over the years to elucidate the problem of cellulite - some very good and some quite pointless - but the study analysed on this page is one of the best.
The study, published in February 2000 in the American Journal of Dermatopathology, describes the exact anatomy, physiology and pathology of cellulite and is aptly named...
"Cellulite: From Standing Fat Herniation to Hypodermal Stretch Marks"
The researchers examined 24 cellulite tissue samples of women with cellulite (aged 28-39 years old) and compared them with those of 4 women and 11 men who did not suffer from cellulite.
The researchers surprisingly found that a pre-cellulite structure is found in all women - but not men - regardless of cellulite. This means that the “cellulite” architecture already exists in women, merely becoming more pronounced, and manifesting as cellulite, when the right conditions are met.
This breakthrough discovery means that all women after puberty possess what we can call "pre-cellulite", which is cellulite waiting to happen:
IF excess and/or unhealthy food is consumed
IF an artificial/sedentary lifestyle is followed
IF hormonal contraceptives are taken
Pre-cellulite exists in all women and is not pathological
This pre-cellulite architecture, the researchers suggest, exists in order to prevent skin laxity and the excessive out-pouching of fat lobules when/if they enlarge a bit.
The collagen strands (skin ligaments, retinaculae) that create the pre-cellulite architecture become more pronounced and fibrotic as a reaction to fat lobule enlargement.
This fibrosis is the same as any other scar tissue in the body that is created as a result of excessive tissue stretching or damage.
As fat accumulation increases, collagen strands also thicken in order to bring the fat lobule herniation under control, eventually leading to full-blown cellulite.
Pre-cellulite: cellulite waiting to happen
Incipient cellulite and cellulite-proper
So basically, all women, but not men, have a pre-cellulite structure inside the skin of their hips and thighs after puberty. It only takes excess excess fat accumulation to turn this structure into "cellulite proper".
The researchers have called this structure incipient cellulite (= cellulite waiting to happen). They explain that:
Pre-cellulite is a normal female thigh skin structure, a mild mattress-like appearance that is not pronounced and can only be revealed in a very mild form by skin pinching
With cellulite-proper, however, the mattress-like appearance is not mild, it is quite pronounced, it is visible without pinching and in many cases severe
Incipient cellulite, or pre-cellulite, scientifically called “Status Protrusus Cutis”, was first identified in 1978 by German scientists, and is the result of tissue exposure to oestrogen.
This structure is not found either in children or in men, but it is found in men who undergo sex change (male-to-female transexuals) and it is even particularly pronounced in women who take birth control (contraceptive pills, patches etc).
Nature wanted women's skin on thighs and buttocks to be soft, yet firm and elastic
Under-the-skin fat accumulation is an evolutionary sexual characteristic that makes women’s skin "softer" and more gentle to touch and therefore more attractive to men, and it is the opposite of the lean, rugged appearance in men, characterised by muscle definition.
This appearance requires a bit of extra fat on the surface of the thighs and buttocks and is one of the many sexual differentiation features that natural selection encouraged. This worked well over hundreds of thousands of years, contributing to an image of female beauty and harmony immortalised by artists throughout the centuries.
Obviously, with softer (i.e. more fatty skin) comes the need of controlling the levels of softness and maintaining the shape and firmness of the skin and keeping it all together nicely.
This job is ascribed by nature to connective tissue, hence the retinaculae (collagen strands) that exist in those areas.
In simple terms, nature initially only intended to keep women’s skin soft-yet-firm and wisely devised the fat-and-collagen-strand structure.
Nature could never have anticipated that people would one day spend their lives sitting down, eating excessive fat and sugar or ingesting excessive doses of estrogenic contraception
Obviously, this structure was a success for hundreds of thousands of years when people tended to:
Be more active
Ate less and more naturally
And did not drink alcohol, smoke or take hormonal contraception
In fact, this natural structure is still a success for a small minority of generally younger women, who benefit from the “soft yet firm appearance” (until they typically hit 30, if they follow the artificial, westernised lifestyle).
On the other hand, this natural structure remains a success for the hundreds of millions - perhaps billions - of women in the developing world unaffected by the artificial western lifestyles.
Unfortunately, nature never anticipated the invention of cars, computers, cigarettes, “the pill” and Krispy Kreme, and the consequent enlargement of the modest fat tissue that made skin soft and beautiful, to an extent where the skin actually becomes inflamed and puffy.
Neither could nature have imagined that the little connective tissue it put in place to maintain the firmness of this superficial fat, would be the cause of the mattress phenomenon, with protruding lumps of fat struggling to be kept in place by hardened, shortened connective tissue.
For this is exactly what cellulite is: excessive, ectopic, inflamed, hypoxic fat incorporated in the structure of female skin, accumulating after years of caloric excesses and inactivity, and combined with shortened, thickened, fibrotic connective tissue which desperately tries to keep the excessive, bulging fat into place.
Silly cellulite surgery
To some women these fibre strands might sound like a curse, as they are purported by some to be the root cause of cellulite.
In fact, some unscrupulous doctors remove those strands in order to - very temporarily - remove the cellulite appearance, with a "minimally invasive" surgical procedure called subcision and a similar one, assisted by laser, called cellfina.
However, as we stated before, those strands are there for a reason, to keep the fat under control and prevent the skin from looking excessively puffy, jelly-like and flabby. By removing those strands you do get rid of some of the cellulite appearance (not always) in those specific 15-25 spots (out of hundreds of spots), only to replace it with the jelly thigh appearance.
Not very wise. Plus you get 15-25 scars from the incisions, sometimes hyper-pigmented or even hypertrophic (especially in dark, black or asian skin).
To be honest, I don’t know what looks worst: orange peel thighs or jelly thighs littered with 15-30 hyper-pigmented mini-scars.
But I do know that if you leave the fibrous strands alone and concentrate on the root causes of cellulite (i.e. fat accumulation, the fibrosis process, skin laxity, poor circulation), you will be more satisfied with your appearance - and save a few thousand pounds in the process.
Cellulite is inflamed, deformed tissue - a pathological state
As you have probably already guessed, full-blown cellulite, is simply taking pre-cellulite to the next level by filling those fat cells with fat and, in some cases, filling the tissues that surround fat tissue with water.
Full-blown cellulite is scientifically called “Dermopanniculosis Deformans”, which basically means:
“inflammation of the fat tissue in the skin" (Dermopanniculosis)
accompanied by deformity (Deformans)
In full-blown cellulite the mattress appearance is no longer mild or normal and can be revealed with the lightest of pinching or with no pinching at all.
In fact, the researchers have shown that "cellulite proper" is structurally different to incipient cellulite, with deformity and scar tissue observed in the deeper layer of skin (hypodermis).
We may say that in cellulite-proper this deformity looks like vertical stretch marks located under the surface of the skin, equivalent to the normal stretch marks which are horizontal and found on the surface of the skin.
Finally, we should also note that pre-cellulite does not become full-blown cellulite overnight. There are several intermediate phases, which are simply called mild cellulite, advanced cellulite, severe cellulite etc.
No septae in cellulite - just retinaculae
The examination undertaken by the research team revealed a 3D network of fibrous strands that partition the lower part of the skin (hypodermis), keeping the fat lobules suspended and the skin firm. This, structure, as we explained above, looks not just normal but actually contributes to female attractiveness in women WITHOUT cellulite.
Another important finding in this study was that, contrary to previous belief, there exist no continuous connective tissue sheaths, also known as septa/septae, that separate the fat lobules.
There is no honeycomb structure, as such. What was in the past seen on an ultrasound scan and erroneously described as septa and “honeycomb” was just connective tissue strands: some thick, some thin - but strands nevertheless and not septae.
These connective tissue strands / collagen bands actually exist throughout the body - and face - and have a name: skin ligaments or retinaculae.
As we discussed, this connective tissue over-stretching leads to the formation of internal stretch marks. Again, the researchers eloquently describe this process in a few words:
“The latter condition [stretch marks] results from excessive tension applied in parallel with the skin surface, whereas the former [cellulite] likely results from continuous and progressive vertically oriented stretch in the subcutis" [I would correct this as hypodermis and NOT subcutis].
Again, it is important to emphasise here that normal-sized hypodermal fat lobules are only found in women, but they are not cellulite.
Only when these lobules enlarge and start stretching the supporting connective tissue strands, with all the complications described above, we have the appearance of cellulite.
Cellulite can only be reduced or eliminated with an integrated approach. One-sided approaches are evidently not enough.
Now we know what cellulite is and how it develops, is there anything we can do to reverse the situation?
Absolutely. A well-designed anti-cellulite program, consisting of:
a real cellulite cream, i.e. one with multiple, high-purity anti-cellulite actives in high concentrations
an intensive but safe cellulite treatment (the most effective safe cellulite technologies are currently deep-acting, high-power radiofrequency and high-power ultrasound cavitation; high-power LED red/infrared light therapy right after RF/ultrasound also helps)
…can:
affect fat cell size and number (and therefore fat lobule size)
diminish water retention
improve circulation
iliminate inflammation
and to some extent repair the connective tissue deformity known as fibrosis
However, it is impossible to completely repair and "even out" the thousands of connective tissue fibres after they get deformed, and this is the reason why it is impossible to eliminate cellulite 100%, unless it is very recent and/or very mild and not much permanent deformity has already occurred.
Still, something like a 60% improvement is not bad and much better than doing nothing and allowing skin on the thighs, hips and buttocks to become more and more bumpy, loose and inflamed.
As we already know prevention is better than cure and the time to prevent is now. If we leave it too long it may be too late.
Cellulite: from standing fat herniation to hypodermal stretch marks
Research paper link: https://journals.lww.com/amjdermatopathology/pages/articleviewer.aspx?article=00007&issue=02000&type=abstract&year=2000
Abstract: There are glaring discrepancies in the microanatomical descriptions of cellulite in the literature. We revisited this common skin condition in women with a microscopic examination of 39 autopsy specimens. A control group consisted of 4 women and 11 men showing no evidence of cellulite. The lumpy aspect of the dermohypodermal interface appeared to represent a gender-linked characteristic of the thighs and buttocks without being a specific sign of cellulite. Incipient cellulite identified by the mattress phenomenon was related to the presence of focally enlarged fibrosclerotic strands partitioning the subcutis. Such strands possibly serve as a physiologic buttress against fat herniation limiting the outpouching of fat lobules on pinching the skin. These structures might represent a reactive process to sustained hypodermal pressure caused by fat accumulation. Full-blown cellulite likely represents subjugation of the hypertrophic response when connective tissue is overcome by progressive fat accumulation. Histologic aspects reminiscent of stretch marks are identified within the hypodermal strands, resulting in clinical skin dimpling.
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