Deep and superficial cellulite: what are the differences?

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• Cellulite = fat + fibrosis

• Superficial cellulite (upper hypodermal cellulite)

• Treatment for superficial cellulite

• Deep cellulite (lower hypodermal cellulite)

• Treatment for deep cellulite

• Pseudo-cellulite (very deep cellulite” / subcutaneous “cellulite”)

• Treatment for very deep cellulite

• Liposuction and very deep “cellulite”

• Check our professional consultancy for a masterclass in radiofrequency, ultrasound cavitation, cellulite and skin tightening

Cellulite = fat + fibrosis

Cellulite is defined as hypodermal adipose tissue., i.e. fat within the lower skin layer.

Cellulite comprises fat pockets within the skin that are attached to and/or surrounded by fibrotic (hardened) collagen strands.

The fat pockets push up and bulge out of the surface of the skin, while the collagen strands pull down skin adjacent to the bulges. The combination creates the cellulite peaks (fat pocket makes skin push out) and troughs (collagen strands keep skin down).

Cellulite can appear at three depths inside the skin:

• At the upper hypodermis level (superficial cellulite)

• At the lower hypodermis level (deep cellulite; most common and annoying cellulite)

• And at the subcutaneous fat level (very deep “cellulite”; not true cellulite)

We will look at each of them in detail.

Superficial cellulite (upper hypodermal cellulite)

Superficial cellulite occurs within the upper part of the third layer of the skin, i.e. upper hypodermis.

As this layer is not very thick, the fat pockets are quite small (about 0.5cm or smaller), but they are still visible and there are literally 100s to 1000s of them on the thighs, buttocks, calves, stomach and arms.

(Obviously, cellulite surgery like subcision/cellfina, which only removes 15-25 deep bumps, cannot do anything for the 100s and 1000s of superficial cellulite bumps.)

Superficial cellulite is not as visible as the two other deeper types, but can still be unsightly.

Treatment for superficial cellulite

Superficial cellulite is removed best with deep-acting, high-power radio frequency/ultrasound cavitation - in addition to diet and exercise, of course. Strong cellulite massage can help.

Ultrasound cavitation seems to be more targeted on that layer.

Deep cellulite (lower hypodermal cellulite)

Deep cellulite refers to fat pockets in the lower hypodermis.

As this layer can be quite thick, fat pockets are larger (about 0.5-3cm) and there can be literally 10s to 100s of them throughout the body.

(Again, cellulite surgery such as subcision/cellfina, which only removes 15-25 deep bumps, does very little for the 10s or 100s of deep cellulite bumps.)

This is the most common type of cellulite.

Treatment for deep cellulite

Deep-acting, high-power radio frequency/ultrasound cavitation remains the best method to remove hypodermal cellulite - always in addition to diet and exercise. Strong cellulite massage can help.

Deep tissue radiofrequency seems to be more targeted on that layer.

Deep cellulite may also be removed with cellulite surgery with an upward-facing laser or ultrasound cannula, but results are usually worse after the procedure than before it, due to the scar tissue bumps produced and other surgery complications.

Pseudo-cellulite (very deep cellulite” or subcutaneous “cellulite”)

Very deep “cellulite” refers to fat pockets in the subcutaneous fat. Unlike the two other types of cellulite, very deep “cellulite” is not part of the skin, and therefore it is not true cellulite really - it is just called so.

Cellulite is defined as “skin fat”. So technically very deep “cellulite” is not real cellulite, it is just plain fat (i.e. subcutaneous adipose tissue / SAT) with the odd connective tissue retinaculae and septae inbetween fat deposits. Hence the term ‘pseudo-cellulite’.

However, since people still call it “cellulite”, so be it.

This layer can be very, very thick, so “cellulite” here can be any size from 3cm upwards and there is a smaller number of bumps, counted in single digit numbers to 10s of them in the whole body.

This cellulite-like appearance is due to deeply rooted connective tissue strands (retinaculae) that originate from the deep fascia at the bottom all the way to the superficial fascia at the top.

(Since the number of such bumps is very small, cellulite surgery such as subcision/cellfina, does remove enough number of them (15-25) but it leaves you with 15-25 incision scars, which may become hyper-pigmented in darker people.

Moreover, subcision/cellfina sometimes do not really work or make things worse.

And finally, as the collagen strands are there for a reason - to keep skin firm - cellfina and subcision, by definition, leave skin looser and then you need a course of deep-acting, high-power RF to tighten it.)

In this layer we also have long linear pockets of fat (as opposed to the round ones of the superficial and deep cellulite) separated by long troughs, up to 20cm in length. This is not cellulite really. This is good old subcutaneous fat, which is longitudinally segmented.

Treatment for very deep cellulite

Deep-acting, high-power radio frequency/ultrasound also remains the best method to remove subcutaneous / very deep “cellulite”, in addition to diet and exercise, with ultrasound cavitation being less useful.

A strong and deep-acting RF machine can easily tackle the subcutaneous “cellulite”.

Strong cellulite massage can also help, but to a much lesser extent than superficial or deep cellulite.

liposuction and very deep “cellulite”

Very deep “cellulite”, belonging to the subcutaneous fat layer, can be broken down and sucked out of the body by good old liposuction, also leaving behind skin looseness.

Obviously liposuction does not apply to superficial or deep cellulite (real cellulite) which are part of the skin, as no-one wants their actual skin removed and sucked out of the body.

Liposuction can - and quite often does - leave behind:

• Scar tissue/fibrosis

• Skin looseness

• Incision marks

• Hyperpigmentation

Check our professional consultancy for a masterclass in radiofrequency, ultrasound cavitation, cellulite and skin tightening

Do you want to deeply understand radiofrequency, ultrasound cavitation, cellulite and skin tightening? Attend a half-day, 1-day, 2-day or 3-day professional consultancy / one-to-one training and confidently offer your clients the safest, strongest and most effective treatment possible. Service available via Zoom or at our central London practice.