Morphological description of hypothetical cellulite starting unit. The first step to explain cellulite development

Introduction: Cellulite is a complex pathology that affects about 85% of women. The origin of cellulite is poorly understood, even if some studies describe different hypotheses based on the observation of subcutaneous architecture, vascular and lymphatic patterns. Material and methods: in this work an ultra-structural description of cellulite specimens, harvested from fifteen healthy women affected by first degree cellulite, was provided. Specimens were harvested from trochanter, after local anaesthesia using punch biopsy. Samples were fixated, immediately after biopsy, in glutaraldehyde 2% and processed for electron microscopy. Results: with scanning and transmission electron microscopy it was possible to describe the hypothetical cellulite starting unit, consisting of mature unilocular adipocytes strictly connected with sweat glands. The peculiar structure of this complex was not described in other adipose depots, even if this formations resembled the mammary glands during the pubertal phase in which there is a hormonal influence, leading to breast augmentation. With the ultra-structural and morphological analysis of cellulite specimens it was possible to define the possible role of sweat glands associated with mature adipocytes in the dermis of patients. Sweat glands probably stimulate mature adipocytes and mesenchymal stem cells to cause an increase in adipose tissue. In the case of cellulite the increase in adipose tissue was associated also with the stimulation of fibroblasts with the effect of collagen fibres deposition and with the consequent formation of the typical cellulite morphology. Discussion: understanding cellulite origin might be conducive to developing more specific and accurate treatments and to hypothesize novel prevention strategies.