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International School of Aesthetic Medicine, Rome, Italy
The studies about cellulite published by indexed journals are limited in number and reach antithetical conclusions. Consequently, it is not possible yet to resolve the serious differences among the ideas that, for years, have been dragging on the nature of this disease, on its origin and even on the most basic aspects of its histopathology. All the various hypotheses that over the past decades have been advanced on pathogenesis must now be updated in the light of recent findings about the sophisticated and complex pathophysiology of adipose tissue. A wide range of data shows that visceral fat, when in excess, triggers a series of pathogenic mechanisms that provoke, in the tissue, a deep inflammatory remodelling with macrophage infiltration and fibrosis, and, at systemic level, the onset of a complex interweaving of disease states, named metabolic syndrome and including insulin resistance, diabetes, hypertension, dyslipidaemia and cardio-vascular atherosclerotic illness. The subcutaneous tissue of the lower limbs is well developed in women, where become the elective cellulite localization, and when in excess, it does not entail an increased risk of systemic complications, against which seems, in fact, to perform a protective function. Some observations lead, however, to believe that even in this place processes of inflammatory remodelling, may occur, capable of contributing to produce the typical alterations of cellulite.