Cellulite can be broken down into types and stages or degrees, according to the evolutions of the symptoms if manifests:
It is frequent in the first and second stage and is associated with water retention. The skin appears swollen, paler, with possible marbling in some areas. It is generally accompanied with circulatory insufficiency.
In the FIRST STAGE there is an initial retention of fluid in the connective tissue caused by a slowdown in local microcirculation. In the phase the volume of adipocytes also starts to increase. The patient does not feel any pair even on palpation.
Even if not perceived, this is the stage where it all begins. An alteration of the vessel walls occurs due to an increase in capillary permeability, which leads to the interstitial discharge of the plasma, thus creating a stagnation of liquids and toxins, with subsequent triggering of the inflammatory process.
In the SECOND STAGE, the inflammation meditators, the prostaglandins, which contribute to the formation of inflammation and increase capillary permeability are released. This intensifies water stagnation and lymphatic obstruction and increase the synthesis of triglycerides of the adipocytes, which increase in volume to aggregate with each other.
Toxins spill over into tissues and stagnate, in an inflammatory process of substantial severity that leads to the following outcome: swelling of adipose cells, destructuring of supporting elastic fibres (collagen), appearance of edema and swelling due to the presence of fluids that have leaked out of blood vessels into adipose tissue.
The Collagen and elastin fibres that surround the adipocytes multiply and harden, resulting in the formation of fibrous tissue, similar to scar tissue (beginning of the process leading to sclerosis).
Despite the absence of any pain, pressing on the affected area with a finger will leave a visible imprint on the skin. In these early stages, the skin's surface appears smooth, though dry, in anycase still even, with a normal colour.
Symptoms may manifest themselves as a result of insufficient circulation, including tingling, heaviness and leg cramps, especially in the evening.
FIBROUS CELLULITE (Micronodules)
In the THIRD STAGE, also called fibrous stage as collagen fibers are involved, the connective tissue becomes even harder and starts enveloping the adipose lobules as if in a vice, preventing them from receiving a proper fluid supply.
The collagen fibers form a sort of palisade around the edematous area, which gives the skin a nodular appearance. Tissues are subjected to considerable stress, giving rise to the formation of the first micro nodules, which on the skin surface give rise to the characteristic "orange peel" appearance in the some ares, visible only when "pinched".
The skin moreover becomes pale and hypothermic due to the impossibility for arterial blood to reach tissues and for venous blood to be cleaned from toxins.
Picture illustrates the evolution of untreated edema: enlargement of the adipocytes, with resulting asphyxia of the adipocytes themselves, micro circulation almost completely blocked, situation of stagnation and build-up of toxins. There is no cell renewal. The oxygen and nutrient supplies are cut off and waste is not eliminated. The area becomes cold. Collagen fibrils surround the affected adipocytes ad the fluid that has leaked from the interstitial space, forming a veritable barrier devoid of blood vessels. This is how the micronodules form: small clusters of adipocytes surrounded by collagen.
SCLEROTIC CELLULITE (MACRONUDULES)
In the FOURTH STAGE the collagen fibers embed the adipocytes, forming a sort of capsule, which then sclerotizes, or closes in itself, causing the withdrawal of the connective tissue.
This gives origin to areas of flaccid tissue with thinneddermis due to a hypoactive metabolism. Hard Macronodules form (about 2 to 20 mm) and come into contact with the nerves, thus originating a strong pain when touched.
The circulation and the fragility if the capullary are altered, the skin is cold, weak and looks like a "mattress" This is the most difficult form of cellulite to treat and indicates an often irreversible stage of development.
This type of cellulite mainly affects the thighs, but it can also be found in other isolated areas.
Sclerotic Cellulite- A number of micronodules, which have microscopic dimensions, merge to form so-called macronudules, perceptible on palpation and characterized by the presence of pain. This stage is also defined as "painful subcutaneous nodules" of stage 4 cellulite.
From Professional Guide to Recognising and Treating Cellulite by Sabrina Valvassori