Conway McLean, DPM, Journal columnist

Everyone wants to be healthy. This should go without saying. Perhaps the real question is what is health? Medicine has been slow to recognize the importance of “quality of life” as a component of good health.

This is a very specific term, incorporating various items, including mind, body, and spirit. With improved methods of analysis, health care as a science has come around on the topic.

Self-esteem is a vital component of quality of life, scientifically speaking. And our appearance is an essential part. One condition in particular is suffered by nearly half the population, one which causes considerable social anxiety and “angst,” yet has been taken lightly by established medicine. Cellulite is a condition which develops in 85% of women and causes significant self-esteem issues due to its effect on appearance.

Not a common topic of conversation amongst your average male social grouping, the understanding of this ubiquitous condition is limited. Cellulite is a skin condition, developing in most women at some point after puberty. It alters the surface of the skin, causing a dimpling of the skin, often described as an “orange-peel” appearance. Distributed around the buttocks and thigh region, it occurs to all manner of body types, although it is more pronounced in those with increased adiposity. And the percentage is increasing with more women afflicted with cellulite than ever before.

Much mystery surrounds the condition, likely a consequence of the lack of funding for research. There is much we do not know about the process leading to it. We know it involves both the capillaries, which are the tiniest blood vessels, as well as the lymphatic channels (tiny tubes in our tissues carrying away waste). Fat beneath the skin somehow bulges through the dermis, the lowest skin layer, creating the dimpling.

Some have theorized cellulite is a means of securing sufficient energy reserves for pregnancy and lactation, since this dermatologic condition seems to maximize fat retention under the skin. Studies have revealed a difference in the architecture of the fibrous tissues composing the compartments in this layer. Perhaps this is why it is not seen in males.

A better understanding of the etiology of cellulite is needed. Recent research has used ultrasound studies of affected tissues. These have demonstrated the herniation of this fat layer into the dermis, the adjacent and deepest layer of skin. The initial changes leading to cellulite formation appear to be deterioration of the capillary networks. This in turn leads to excess fluid retention within both layers. One theory proposes the loss of this capillary network may be due to engorged fat cells clumping together and limiting the return of blood through the veins.

EDITOR’S NOTE: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery and diabetic foot medicine. He is board certified in surgery, wound care and lower extremity biomechanics.