Many women are familiar with this: the skin, especially on the thighs, hips and upper arms, changes, develops unsightly dents and looks like the surface of an orange. But anyone who thinks that orange peel skin is a purely aesthetic problem and tries to get rid of it with expensive miracle cures is ignoring the real causes of the problem.
What actually is "cellulite"?
What is cellulite?
A "cellulite", "cellulitis" or "cellulite" is a change in the skin structure that occurs especially on the thighs, hips and upper arms in women. It consists of an increased rippling or dimpling of the skin with retractions that resemble an orange peel or a mattress. It is called "orange peel" or "mattress phenomenon".
Diseases ending in "-itis" always represent inflammation. However, "cellulitis" is not an inflammation at all! Inflammation plays, if at all, a very subordinate role. Other terms such as cellulite or cellulite, are common in France and Italy. Medically, one also sometimes speaks of panniculosis or dermatopanniculosis deformans.
From a medical point of view, cellulite is not understood as a disease and sometimes it is not taken quite seriously. It is said to be a purely cosmetic problem. A health insurance company will therefore also refuse to cover any costs for treatment.
Causes
Thin-skinned women - thick-skinned men

The causes of the phenomenon of cellulite can be understood only with the help of anatomy. The anatomy of the skin is fundamentally different in men and women in the area of fatty tissue. The skin is composed of three layers: the epidermis with the cornea, the elastic dermis and the hypodermis with the insulating fatty tissue.
In men, the cornea is about 20% thicker than in women, their dermis contains more elastic fibers and can bind more water, and finally, the subcutaneous fatty tissue is organized differently. The connective tissue chambers in which the fatty tissue is embedded are smaller and run diagonally. Finally, the skin contains significantly more sebaceous glands than a woman's and is thus better lubricated and kept supple.
Men's skin also ages differently. It is not prone to small wrinkles ("does not wrinkle") but rather forms coarser, "prominent" wrinkles. Healthy men practically never suffer from cellulite, unless they have a hormonal disorder and are very overweight.
With so many advantages, women can at most console themselves with the fact that men have coarser skin pores and are much more prone to acne due to increased sebum formation.
In women, the fatty tissue of the subcutis is organized in larger, vertically arranged chambers. Each of these chambers, which consists of countless fat cells, is bordered by connective tissue septa. The more the fat chambers are filled, the more they bulge towards the dermis and epidermis. If skin folds are pushed together, these "standing fat chambers" become particularly visible (pinch test). Depending on the extent of the skin change, slight retractions (orange peel skin) or more pronounced waves and humps (mattress phenomenon) are now visible. In most women, some degree of cellulite can be demonstrated by pinching.
Risk factors
Weight gain
The more the fat chambers fill up, the more their upper edge bulges out and creates the undesirable skin appearance. Severe overweight is automatically accompanied by cellulite, as the fat chambers become bulging due to weight gain.
Thickness of the skin
The thicker the dermis is, the less visible the standing fat chambers are, as they are hidden deeper under the epidermis. As we grow older, the thickness of the skin decreases. Then many women are startled because they suddenly discover the mattress phenomenon in themselves, from which they were spared until then.
Elasticity of the skin
The more elastic the holding apparatus of the fatty tissue and the elasticity of the skin in general, the less the fat chambers bulge out. The number and quality of elastic fibers are determined by many factors. The hormonal situation is essential. Female sex hormones (estrogens, progestins) have a positive effect here and increase the elasticity of the skin. This also explains why the skin becomes more wrinkled and brittle with age, as hormone production continually decreases.
Fluid content of the skin
The more fluid the upper layers of the skin can store, the less the fat chambers of the subcutis become visible. Above all, the proportion of collagen and other protein molecules is decisive here. Again, female hormones have a favorable influence on the production of these proteins.
Swelling of the fat cells
Women who are more prone to water retention also suffer from a slight tendency to swelling of the subcutaneous fatty tissue. The background must be suspected to be alteration of microcirculation, similar to lipedema. Water and protein leak out of the capillaries and cause the fat tissue chambers to swell further. Fine tissue examination reveals dilatation of the lymphatic vessels of the skin. In this way, the stagnant chambers now become even more prominent.
In contrast to increased fluid in the dermis and epidermis, swelling in this area is unfavorable because it increases the phenomenon of cellulitis.
As always, when protein remains in the tissues for a long time, after a while hardening occurs. The subcutis becomes coarser, white blood cells migrate, the tissue becomes inflamed and the septa become more prominent. As a result, one now palpates small nodules and larger lumps in the fatty tissue.
Lack of exercise
Any exercise not only promotes fat loss. It also leads to improved blood circulation. Less fat is deposited over muscles with a good blood supply. These are only two of the factors why exercise is an extremely important factor in cellulite. Those who do little exercise are definitely at greater risk. It is also easy to understand that above a well-developed buttock musculature, the skin appears firmer.
Circulatory disorders
Between arteries and veins exists a regulatory mechanism called veno-arterial reflex. Whenever veins register congestion, they send a signal to the associated arteries, which then contract and reduce blood flow. As a result, blood flow decreases and vein overfilling stops.
In patients with cellulitis, this reflex in the skin is disrupted for unknown reasons. Without this protective reflex, the subcutaneous tissue becomes overfilled and the tendency to edema increases.
Smoking
Smoking is responsible for many diseases. Also for cellulitis? Indirectly yes, because smoking makes the skin thinner! Between 25 to 40% the skin is to lose by the Glimmstengel, so the comparison between smoking with nonsmoking twins. At the same time, cigarettes cause the skin to lose elasticity, resulting in smokers' characteristic fine-featured skin. Both factors make the fat chambers more prominent.
Pregnancy
The skin also changes after pregnancies as part of the natural fluctuation in weight. Not only do the dreaded stretch marks show the damage to the subcutaneous tissue, but cellulite can also increase by leaps and bounds. The reasons are manifold. In addition to weight gain, the general tendency to edema during pregnancy and, of course, hormonal changes play a major role.
Genetics
Women often report that their mothers and sisters are also prone to cellulite. At the same time, "bad connective tissue" is common in the family. Although I am not aware of exact figures on this subject, a certain predisposition is probably not insignificant in the case of cellulitis. If the mother suffers from a pronounced cellulitis, the daughter does not have to get it fatefully. However, it is then very important to minimize the above risk factors.
Summary
In summary, cellulitis is a condition with multiple causes. It could be called a "mini-lipedema", i.e. a disease mainly based on a disturbance of microcirculation, increased fat storage, a protein-rich edema and subsequent hardening. Treating it only as a "cosmetic problem" does not do justice either to the suffering of the affected women or to the complicated medical phenomenon.
Stadiums
Stadiums

Like most diseases, cellulitis is divided into several degrees of severity. Here, the staging is based on the external appearance. The term "orange peel" refers to the fine punctiform contraction of the skin, while the term "mattress phenomenon" refers to a significantly coarser, humpy form of skin irregularity.
Stage 0 (normal): The skin is smooth even when standing. In the pinch test, wrinkles and furrows are seen, but otherwise at most a slight orange peel phenomenon
Stage 1: The skin surface is smooth both when standing and lying down, but the pinch test reveals a pronounced mattress phenomenon.
Stage 2: The skin surface is still smooth when lying down, but a spontaneous mattress phenomenon is noticeable when standing up.
Stage 3: The mattress phenomenon is now also present when lying down.
The transition from one stage to the next usually occurs smoothly and over the course of years. Rapid worsening occurs frequently after pregnancies or with strong weight gain.
Nonsensical measures
You can save this

The number of suggestions against cellulite are probably uncountable. As always, when there are so many different forms of therapy, one should be cautious. If there were a therapy method with resounding success, then it would probably gain acceptance in a very short time. One should be particularly critical of all recommendations that are widely advertised in various magazines and entice one with sensational therapy successes in the shortest possible time.
Likewise, the greatest caution is recommended if the advertised preparations can be ordered immediately on the same page or in the same magazine. Very popular in this connection are preparations of exotic origin, age-old remedies, which were again discovered or substances, which are treacherously concealed by the bad school medicine.
It is certain that a number of therapeutic approaches are fundamentally ineffective or not effective at all. These include all creams and ointments. One can safely save the costs for these care products. A possible exception could be ointments containing higher amounts of estrogens or progestins. However, before using these prescription substances, medical advice should be sought to ensure that there are no significant objections to their use.
Oral medications ("fat-removal pills"), purification teas and probably the vast majority of devices also benefit the manufacturer rather than the women concerned.
Meaningful measures
Meaningful
The treatment methods are basically the same as forlipedema. Which therapies are used ultimately depends on the severity of the symptoms, the accompanying symptoms and also the extent of the condition on the patient's own skin. Diagnosis is therefore the first step before therapy.
Suppose a slim, young woman has mild cellulitis in the thigh area. She exercises three times a week, has a normal weight and is otherwise in perfect health. In her case, certain massage techniques will be completely sufficient.
It is quite different with an overweight woman in whom the cellulitis is already strongly generalized with diffuse swellings of the entire skin, feelings of tension in the legs, pain before the period, gastrointestinal complaints and many other symptoms. Here one will combine several therapeutic methods, since the symptom "cellulitis" is only the partial symptom of a much more extensive edema tendency.
Cupping app
On the topic of lipedema and cupping, we have developed an app for self-help at home.
Skin training
In the therapy of cellulite, many women encounter a problem: the skin is not only wavy, but also prone to "bruises". Accordingly, they try to avoid everything that could irritate or stress the skin.
But a rolling stone gathers no moss! In order to make the skin more elastic and stronger, it must not be spared but, on the contrary, challenged. But which stimulus promotes the elasticity of the skin?
Muscles become strong through movement. Bone strengthens under pressure. But what about the skin? Here, only the "pull" remains. This does not cause the skin to wear out (within reason), but instead strengthens and tightens it.
In recent years, we have therefore been focusing intensively on therapies that stimulate the skin to build up new elastic and collagen connective tissue. The main focus is on massage techniques that involve pulling on the skin.
There are also effective self-help techniques that can be performed at home, especially cupping massage. Here the results - when applied consistently - are often amazingly good. We are currently working on systematic programs with daily instruction.