So-Called Cellulite: An Invented Disease*

F. N Ü R N B ER G E R , M .D.**, A N D G. M ÜLLER, M.D.***

The anatomic basis o f so-called cellulite, the hormonal

basis fo r the clinical condition, the prevalence o f it, the
essential normality and inevitability o f it in women, the
supervention o f it in hormonally fem inized men, and the
near fu tility o f treating the non-disease are explored in this
paper.

INTRODUCTION female male

For the past eight years, a research team in our clinics, in
Epidermis
collaboration with an anatomist (Prof. Dr. G. Müller,
Cori um
Mainz) and a pathologist (Prof. F. Niedobitek, Berlin),
has concerned itself with the structure o f human skin
and subcutaneous tissue. Initially, the impetus for these Upper Zone
studies was clarification o f so-called cellulite. O f partic­ of Subcutis

ular interest were the dependence on hormones o f sex- FIGURE 1. Schematic representation o f the sex-typical differ­
specific differences and age-related changes in skin, the ences o f the inner structure o f the skin and subcutaneous tissue o f
influence o f the latter on the surface appearance o f the the thigh and hip region.
skin, and the feasibility o f treatment over all.5-12*15-27 30
Investigation o f these points revealed hitherto unknown
differences in the structure o f the skin and subcutaneous THE ANATOMIC BASIS OF SO-CALLED CELLULITE
tissue o f the thighs and buttocks that are distinctively The following findings were derived from readings o f
typical for the sexes and in addition uncovered special deep biopsies (down to fascia lata) taken from the thighs
findings that can be correlated closely with aging o f skin and buttocks o f 150 cadavers and 30 living women with
and subcutaneous tissue. so-called cellulite.
The subcutaneous tissue o f the thighs is composed o f
*Presented in Summary-Abstract at the Fifteenth International
Congress of Dermatology, October 1977, in Mexico City. three layers o f fat with two planes o f connective tissue
**From the Hautklinik und Poliklink der Freien Universität Berlin between them. On the thighs o f women, especially
im Rudolf-Virchow-Krankenhaus (Direktor: Prof. Dr. G. Stüttgen). where the “pinch test” for the “mattress phenom enon”
***From the Abt. für angewandte und topographische Anatomie is elicitable, the uppermost subcutaneous layer consists
der Johannes-Gutenberg-Universität, M ainz/Rhein (Abt. leiter: Prof.
o f what are termed large “standing fat-cell chambers,”
Dr. G. Müller).
Address reprint requests to Prof. Dr. Nürnberger, Augustenburger which in average size as seen in cross section are
Platz 1, 1000 Berlin 65. 0.5 X 1.5 cm and are separated from each other by septa
o f connective tissue (“retinacula cutis”). These reti­
Editorial Note: This paper was submitted entirely in German. A near .
nacula cutis (binders o f the skin) run in a radial and
literal translation was made by Mrs. Hiroko Kiiifner and then that
translation was freely recast or paraphrased into technical and arched way and anchor into the overlying corium
idiomatic English by Morris Leider, M.D. (Fig. 1).

J. Dermatol. Surg. Oncol 4:3 March 1978 221

SO-CALLED CELLULITE: AN INVENTED DISEASE

From the fat-cell chambers, “papillae adiposae”

(recently studied and so named by Müller and N ü m -
, ,, "I*- Corium
berger16) project into the corium (Fig. 2). These papillae p it 4 1< !
adiposae break up in the region o f the stratum reticulare * À 1—-Dell
o f the corium and surround hair bulbs, sweat glands and Septa
blood vessels, all o f which are thereby protected against
pressure ánd shearing forces. At the same time, the
subcutaneous tissue is thus mortised into the corium.
Since the fat-cell units—the standing fat-cell chambers
and the papillae adiposae—can, under pressure, change P a p illa e adip osae
shape but not volume, they are the elements o f the skin
that, in the region o f the junction o f corium and
subcutaneous tissue, can change the appearance o f the
gross skin surface, especially as the skin ages. In this 4-Subcutis
connection, one must advert to the mattress phenom e­
non, which unfortunately is still viewed by some as the
cardinal sign o f that invented disease cellulite. In our FIGURE 2. Reconstruction o f the border zone between corium
investigation o f about 1,000 wom en o f various ages, we and subcutis from histologic serial sections. The plane o f the
found the mattress phenom enon demonstrable by the subcutis with papillae adiposae rising into dells and pits on the
pinch test in almost all o f them. It is a sex-typical feature undersurface o f the corium is shown. In the upper part o f the
o f the skin o f the thighs o f women, not a sign o f disease. subcutis the septa are anchored in the corium.16
W e have therefore designated it “status protrusus cutis”
in order to express that it is compression and bulging o f U p to the 7th or 8th month, no sex-typical differences
the upper fat-cell chamber system that causes the are recognizable in the structure o f skin and subcuta­
overlying skin to protrude (Fig. 3, left). neous tissue. In both sexes the upper part o f the
In the comparable skin o f the thighs o f men (Fig. 1, subcutaneous tissue just below the corium consists o f
right)310 the uppermost part o f the subcutaneous tissue standing fat-cell chambers similar to those o f adult
is thinner and has a network o f criss-crossing septa o f women. Nor do the epidermis and corium show struc­
connective tissue that divide the fat-cell chambers into tural differences. Only toward the very end o f the third
small, polygonal units. Moreover, the corium is thicker trimester do sex-typical differences o f the upper part o f
in the skin o f the thighs o f men than it is in women. In the subcutaneous tissue become discernible; at birth
men, the pinch test (tangentially applied pressure or they are clearly manifest. In female fetuses, the standing
pull) can indeed fold or furrow the surface o f the skin, fat-cell chambers and septa o f connective tissue that run
but in normal men status protrusus cutis does not radially are markedly those o f female character; in male
appear, unlike the condition in m en with deficiency o f fetuses, small, polygonal fat-cell chambers and septa o f
androgens* which is discussed below (Table 1). netted, angled, criss-crossing connective tissue are
distinctly those o f adult males and, in addition, the
ARE THE SEX-TYPICAL DIFFERENCES OF THE SKIN corium is thicker and coarser in fibrous structure.
OF THE THIGHS AND BUTTOCKS GENETICALLY OR The fetal testes are hormonally active from the 6th or
HORMONALLY DETERMINED? 8th month on,32 whereas the fetal ovary is and remains
We were able to clarify this question by examining skin inactive in utero. The sex-typical structural differences
from the lateral aspect o f thighs o f ten female fetuses o f the skin o f the thigh o f males are probably called
and an equal number o f male fetuses (29-58 cm long forth by-the proliferative effect (fibroblast activity) o f
measured crown to heel).8 20 androgens on the mesenchyme.

FIGURE 3. The pinch test on the

skin o f the thigh o f a woman (left)
and a man (right). In women, the fat-
cell conglomerations o f the upper
part o f the subcutis (standing fat-cell
chambers, and papillae adiposae)
protrude upon the overlying cutis.
That produces deformation and pits,
i.e., the mattress phenomenon or
status protrusus cutis. In men merely
folds and furrows are produced. / / / / \

222 J. Dermatol. Surg. Oncol. 4:3 March 1978

 NÜRNBERGER AND MÜLLER

HISTOPATHOLOGY OF SO-CALLED CELLU LITE Table 1

Sex-Typical Differences of the Lateral Aspect of the Skin
In women, the corium, which is thinner than in men, of the Thighs of Adult Men and Women (16-50 years old)
reaches maximal thickness at age 30 years and thereafter
diminishes steadily.28 Also, as wom en age, deposition o f Cutis and Of men Of women
subcutis
fat in subcutaneous tissue tends to occur, but not
inevitably. In 30 biopsies o f skin from 30- to 40-year-old Epidermis Thicker (58-77/x) Thinner (47-62/i)
women with so-called cellulite, we were able to recog­ Corium Thicker Thinner
nize the first evidence o f aging o f skin in the collagen (1159-1798/*) (994-1349/i)
and elastic fibers o f the cutis and subcutis. As aging goes Border zone of Fewer papillae More papillae
on, the corium becomes thinner and looser. Globular the corium and adiposae adiposae
subcutis with
clusters o f fat appear in the corium and reach almost to
papillae
the dermo-epidermal junction (Figs. 6B and 7B). The adiposae
border between cutis and subcutis becom es more level; (containing
the septa o f connective tissue between the standing fat­ hair bulbs,
cell chambers become thinner; and the very fat cells sweat glands,
blood vessels,
themselves becom e hypertrophied as in obesity. The
larger in the
papillae adiposae, as we term them, becom e particularly elderly)
large. We view them as responsible for the “buck-shot”
Subcutis (mostly Variably thinner Variably thicker
feel o f so-called cellulite (Figs. 6B and 7B) because in 3-layered)
those cases in which granularity was unmistakably a) upper zone Small polygonal Large, standing
palpable, biopsies revealed large papillae adiposae. We fat-cell fat-cell
found in statistical significance that the skin o f wom en in chambers with chambers with
criss-crossing radially
almost all sites has more papillae adiposae than does
septa of running septa
that o f m en.16 connective of connective
Since there is no inflammatory infiltration, the sense tissue tissue
o f cellulitis in so-called cellulite is erroneous. Studies by b) middle zone Mostly squat fat­
histochemical methods revealed no proof o f excessive cell chambers
c) lower zone with oblique
polymerization o f glycoaminoglycans as has been
and tangen-
averred.2 The widely practiced treatment o f so-called tially running
cellulite with the “spreading” enzyme “thiomucase”2 has septa of
no rationale in pathology.3*413 N or did we find fibrosis connective
or sclerosis as some have claim ed.214 We did find tissue
“mucoid edem a”4 but then only if there was concur­ Status protrusus Does not develop Develops
rently venous stasis o f the lower limbs, principally in cutis (so-called
mattress
elderly women. In our histologic and physiologic stud­
phenomenon)
ies7 we found no evidence o f edema in so-called cellulite
under otherwise normal circumstances.6 phenomenon as a sex-typical sign elicitable by the pinch
test, we speak only o f status protrusus cutis and not o f
NOMENCLATURE AND CLASSIFICATION cellulite or panniculosis in order to avoid any connota­
That the sense o f cellulitis is false for so-called cellulite tion o f disease. Status protrusus cutis may progress to
has already been mentioned. Nevertheless, the designa­ dermo-panniculosis in time and with obesity, but that is
tion “cellulite” for the condition in point is known world not inevitable.
wide. As early as 1904, Stockman used the word “pan- For scientific rigor in classifying the conditions we are
niculosis” for it to indicate that the panniculus concerned with in both men and women, we consider
adiposus is the site o f degenerative changes. Since we, the following categories meaningful.
however, found that degenerative changes occur exclu­ Status protrusus cutis is the mattress phenomenon o f
sively in the collagen and elastica, not only in the bulging and pitting o f the skin on thighs and buttocks.
subcutis but also in the corium, we think the term Stage 0 (or zero) is the situation in which the skin on
“dermo-panniculosis” is the best designation from the the thighs and buttocks is smooth o f surface while a
point o f view o f histopathology. If the skin changes o f subject is standing or lying. The pinch test throws the
pitting, bulging and deformation on the thighs and skin into folds and furrows, but not into the mattress
buttocks have appeared spontaneously, we designate the appearance. This stage is common in slim, heavy-armed
clinical condition dermo-panniculosis deformans. On the women and in men who do not have a deficiency in
other hand, if young wom en merely show the mattress androgens.

J. Dermatol. Surg. Oncol. 4:3 March 1978 223

SO-CALLED CELLULITE: AN INV EN TED DISEASE

Stage I (or one plus) is the c o n d it io n in w h ic h the skin

surface is s m o o th w h ile a su b ject sta n d s or lies, b u t in
w hich the p in ch test is clearly p o sitiv e for the m attress
p h e n o m e n o n . T h is is n o r m a l a n d typ ical for the f e m a le
sex, but in a m a le is a sign o f d e fic ie n c y o f a n d r o g en s.
Stage I I (or two plus) is the c o n d it io n in w h ic h the skin
surface is sm o o th w h ile a su b jec t is ly in g , b u t sh o w s the
m attress p h e n o m e n o n (d e r m o -p a n n ic u lo s is d e fo r m a n s )
sp o n ta n e o u s ly w h e n sta n d in g . It is c o m m o n in w o m e n
w h o are past 3 5 - 4 0 years in a g e a n d are o b e s e . It is
s e ld o m se e n in m e n d eficien t in a n d r o g e n s.
Stage I I I (or three plus) is the c o n d it io n in w h ic h the
m attress p h e n o m e n o n (d e r m o -p a n n ic u lo s is d e fo r m a n s )
is s p o n ta n e o u s ly p o sitiv e in b o th ly in g a n d sta n d in g
positions. It is very c o m m o n after m e n o p a u s e a n d in
obesity. S e ld o m is it se e n in m e n d e fic ie n t in a n d r o ­
gens.
FIGURE 4. Status protrusus cutis (mattress phenomenon, Stage
In short, o n ly S ta g es II a n d III m a y p ro p erly be I) in the buttocks o f an eight-year-old female child.
d esig n a ted d e r m o - p a n n ic u lo s is d e fo r m a n s a n d m a y b e

FIGURE 5A. Status protrusus cutis (mattress phenomenon. FIGURE 5B. A deep biopsy o f skin o f the lateral aspect o f the
Stage I) in the thighs o f the 33-year-old mother o f the child in thigh o f the patient o f Fig. 5A showing: (I) relatively thick,
Fig. 4. She also shows “riding-breeches" type o f obesity. coarse fibrous corium (I360p); (2) small papillae adiposae with
hair bulbs, sweat glands and blood vessels; (3) upper zone o f
subcutis with standing fat-cell chambers, dells, and relatively
thick, radially running septa o f connective tissue; (4) middle zone
o f subcutis layer with squat fa t chambers and septa o f connective
tissue that run tangentially to the fascia lata; (5) tower zone o f
224 J. Dermatol. Surg. Oncol. 4:3 March 1978 subcutis.
 NÜ RNBERGER A N D MÜLLER

FIGURE 6A. Status protrusus cutis (mattress phenomenon, FIGURE 6B. A deep biopsy o f the skin o f the lateral aspect o f
Stage III) in the thighs o f the 59-year-old grandmother o f the the thigh o f the patient o f Fig. 6A showing: (I) moderately
child in Fig. 4. She shows obesity, a fa t apron and striae narrowed, loosened corium (1250p); (2) enlarged papillae
distensae. adiposae (in cross section); (3) upper zone o f subcutis with large,
standing fat-cell chambers, dells and thin septa o f connective
tissue, and hypertrophied fa t cells.
c o n sid ered as sig n s o f a g e -r e la te d d e g e n e r a tio n o f
co lla g e n an d ela stica o f b o th cu tis a n d su b cu tis an d
a ssocia ted w ith d e p o s itio n o f fat. a 59-year-old g r a n d m o th e r (F ig. 6) an d a 7 9 -y ea r-o ld
great g r a n d m o th e r (F ig. 7). T h e p ictu res o f e a c h s h o w
IS SO-CALLED CELLULITE PAINFUL? severe grad es o f so -ca lled cellu lite; i.e., status p rotrusus
Contrary to m a n y c la im s in the literature, o u r fin d in gs in cutis.
e x a m in a tio n o f o v e r 1,000 w o m e n are that so -c a lle d F ro m our stud ies, the p rogression o f the m attress
cellulite is n o t p a in fu l. I f pain is c o m p l a in e d of, the p h e n o m e n o n w ith a g e is n ot a p a t h o g n o m o n i c sign o f a
possibility o f a true cellu litis or p a n n ic u litis, i.e., a true d isease that ca n b e la b e lle d cellu lite, b u t m erely
in flam m a to ry process, h a s to b e c o n sid e r e d . exp resses the sex-typ ical structure o f the skin o f the
thighs an d b u ttock s o f w o m e n an d the age-r ela ted
PREVALENCE OF SO-CALLED CELLULITE ch a n g es in skin, fat, an d c o n n e c tiv e tissue, an d the
In the co u rse o f o u r stu d ies, w e a ls o p u r su e d the d ep o sitio n o f fat s u b c u ta n e o u s ly . In short, so -c a lle d
q u estio n o f w h e th e r so -c a lle d c e llu lite s h o w s a fa m ilia l cellu lite is an in v e n te d d isease.
ten d en cy . In so d o in g w e e sta b lis h e d that so -c a lled M oreo v er, o u r far-flung stu d ies o f m e n a n d w o m e n in
cellu lite is o fte n c o m b i n e d w ith o b e sity a n d that there is C h i n a 10, S ou th A frica ( a m o n g B a n tu s)22, E gypt, Brazil,
a fa m ily t e n d e n c y that d o e s n o t req u ir e in v o c a t io n o f M e x ic o , A fg h a n ista n , R ussia, Jap an , T h a ila n d , an d
in h erita n ce.23 29 W e h a d a rare o p p o r tu n ity c lin ic a lly an d In d o n esia s h o w that sign s o f so -c a lle d cellu lite are
h isto lo g ica lly to o b s e r v e the c o u rse o f s o -c a lle d ce llu lite o b serv a b le in w o m e n o f all races. A lso , rep resen tation s
in c o m b in a tio n w ith o b e sity in fo u r g e n e r a tio n s (a n 8- o f artists o f earlier tim es s h o w that su ch sign s w ere
y ear-old d a u g h te r (F ig . 4), a 3 3 -y e a r -o ld m o t h e r (F ig . 5), a lw ays arou n d . It w as o n ly w h e n a c o n c e r n e d g ro u p

J. Dermatol. Surg. Oncol. 4:3 March 1978 225

SO-CALLED CELLULITE: AN INVENTED DISEASE

FIGURE 7B. A deep biopsy o f the lateral aspect o f the thigh

showing: (I) markedly thinned, loose, finely fibrous corium
(900ii); (2) very large papillae adiposae (anatomical basis o f the
“buck-shot”phenomenon) that almost reach the epidermis and
contain hair bulbs, sweat glands and blood vessels; (3) upper
zone o f the subcutis with large, standing fat-cell chambers,
FIGURE 7A. Status protrusus cutis (mattress phenomenon. dispersed dells in corium, very thin septa o f connective tissue, and
Stage III) in the thigh o f the 79-year-old great grandmother o f hypertrophied fa t cells.
the child in Fig. 4. She shows obesity, a fa t apron and striae d eficien cy o f a n d r o g e n s in s e v e n w ith K lin e f e lt e r ’s
distensae. The “buck-shot”phenomenon is palpable. syn d rom e , in three w ith s e q u e la e o f orch itis from
su c c e e d e d in e le v a tin g the sex -ty p ic a l a p p e a r a n c e o f the m u m p s , in tw o w h o h ad h ad “c h e m ic a l ca str a tio n ” w ith
skin o f the th igh s o f w o m e n (th e m attress p h e n o m e n o n ) cy p roteron acetate, in o n e w h o h ad s e n ile in v o lu tio n o f
to a sign o f a “ d is e a s e ” w e r e 90% o f w o m e n said to the testes, in 122 w h o h a d had e s tro g en th era p y for
“suffer” from so -ca lled cellu lite. F in a lly , o n e m u st g iv e c a rcin o m a o f the p rostate, an d in. o n e w h o h ad h y p o -
th o u g h t to h o w the id ea l o f p u lch r itu d e has c h a n g e d in fu n ctio n o f th e p ituitary g la n d . Particularly in terestin g
ou r tim es. T h e “ id e a l” w o m a n is n o lo n g e r the robust w ere the fin d in gs in p atien ts w ith K lin e f e lt e r ’s s y n d r o m e
“ R u b e n s -ty p e ” but rather the sv elte “ C r a n a c h -ty p e .” (F ig. 8). T h o s e w ith n o r m a l a n d r o g e n le v els in b lo o d
seru m had skin structure that w as ty p ica lly m a s c u lin e ,
SO-CALLED CELLULITE IN MEN b ut th ose w ith d e fin ite d efic ie n c y o f a n d r o g e n s (less
W e garnered d efinite e v id e n c e that the se x -ty p ica l than 3 0 0 n g) h ad skin structure th at w a s typ ically
differen ces b e tw e e n the skins o f m e n a n d w o m e n are fe m in in e an d a p o sitiv e m attress sign. S in c e all p atien ts
h o r m o n a lly d e te r m in e d b y fin d in g so -c a lle d c e llu lite in w ith K lin efelter’s s y n d r o m e h a v e X X Y c h r o m o s o m a l
m en w ith d eficien cies o f a n d r o g e n s, in s o m e ca se p roved patterns, the fact is further p r o o f that th e sex -ty p ic a l
by r a d io im m u n o lo g ic a ssa y .20,25-27 M o s t o f su ch m e n h ad structure o f skin in the region o f the th igh s a n d h ip s is
fe m a le d istrib ution s o f fat in the th ig h -h ip reg io n , a h o r m o n a lly , n o t g en etica lly , d e te r m in e d .
p ositive m attress p h e n o m e n o n , g y n e c o m a s tia an d the W e did n ot find th e m attress p h e n o m e n o n in m en
fe m a le pattern o f p u b ic hair. H isto lo g ic a lly m o st w ere w h o h ad n o rm a l le vels o f a n d r o g e n s w h e th e r or n o t th ey
fo u n d to h a v e the typical structure o f skin an d su b c u ta ­ w ere o f n o rm a l or o v e r -w e ig h t, n or in m e n w ith C u s h ­
n e o u s tissue a n d sta n d in g fat-cell c h a m b e r s that are in g’s d isease, n or in tran svestites w h o w ere n o t u n d e r
characteristic o f w o m e n . estrogen therapy.
W e w ere a b le to d e te ct the m attress p h e n o m e n o n in S o -ca lled cellu lite is said to b e o b s e r v a b le in h o m o ­
m en w ith prim ary o r s e c o n d a r y h y p o g o n a d is m an d sexu al m en . E v en i f true, in o u r o p in i o n , it has n o th in g

226 J. Dermatol. Surg. Oncol. 4:3 March 1978

 NÜ RNBERGER AN D MÜLLER

FIGURE 8. Deep biopsies ofskin from the lateral aspects o f the thighs o f six patients with Klinefelter’s syndrome (section lOOfi
thick, polarized light). Upper row: typical male structure o f skin (no mattress phenomenon, normal androgen levels); middle
row: mixed form (mattress phenomenon not clearly evident, androgen levels depressed, but not under 300 ng); bottom row:
typical female structure o f skin (positive mattress phenomenon, androgen deficiency).

to d o w ith h o m o s e x u a lit y in itself. T h e m attress therapy o f so -c a lle d cellu lite is su m m a r iz e d in T a b le 2.

p h e n o m e n o n is d e p e n d e n t o n ly u p o n the le v e l o f T h e m o st im p o rta n t factor is a v o id a n c e o f o v e r w e ig h t
a n d ro g en s, w h ic h in turn in flu en c e the se x u a l p r o c liv i­ from c h ild h o o d on . W h e r e there is n o o b e s ity th ere is n o
ties o f m en . T o d a te, th ere are n o p u b lis h e d rep orts o n so-called cellulite. W e m a k e this s t a te m e n t w ith o u t
th ese p oin ts. H o w e v e r all that may be, a p o sitiv e qu alification . F r o m ou r h is to lo g ic stu d ies, it a p p ea rs that
m attress p h e n o m e n o n in a m a n is a n o th e r , h itherto w eig h t loss to b e effective as th erap y m u st b e in tim e,
u n k n o w n , clin ic a lly d ia g n o s tic sig n o f a n d r o g e n -d e fi- i.e., b efore 3 5 - 4 0 years o f a ge, w h ile c o lla g e n fibers an d
ciency. elastica are still elastic e n o u g h an d can adjust b y
retraction to lesser v o lu m e s as fat is lost. In o u r trials, w e
PREVENTION A N D THERAPY O F SO-CALLED saw m a n y w o m e n e n jo y m ark ed im p r o v e m e n t in the
CELLULITE d egree o f the m attress p h e n o m e n o n w h e n th ey had
In o u r v ie w th e o n ly su c c e s sfu l p r e v e n tio n a n d a v a ila b le distinct w eig h t losses. H o w e v e r , i f a rather ab ru p t loss o f

J. Dermatol. Surg. Oncol. 4:3 March 1978 227

SO-CALLED CELLULITE: AN INVENTED DISEASE

weight occurs in persons whose skins and connective Table 2

Therapy and Prevention of So-Called Cellulite
tissues are already undergoing changes from aging, the
cutaneous integument remains too loose and the A. Therapy of So-Called Cellulite
mattress phenomenon becomes intensified. The indi­ 1. Weight reduction by protein-rich, low carbohydrate,
vidual who is slim throughout life and has a thin and low-fat diets.
subcutaneous fat layer and remains so into old age, 2. Exercise (athletics, gymnastics, bicycle-riding, hiking)
3. Brush massage
retains a skin that is not too loose and does not have so- B. Prevention of So-Called Cellulite
called cellulite. 1. Avoidance of overweight, that is, overweight from
Physical activity o f any kind is important. Athletes not childhood on
only do not put on weight, but good tone o f the 2. Pregnant obese women should be forethoughtful of
their female fetuses and eventually their daughters. The
musculature o f the thighs and buttocks seems to have a
number of fat cells of children is seemingly determined
beneficial effect on the tone o f the skin. We observed, as by the nutritional state of mothers.
did Kreysel13, little or nothing o f so-called cellulite
among female athletes.
Massage with the hand or a brush, self administered nor the so-called “rice” treatment (Nemectron, Alec
and always directed from the periphery toward the heart Eden-Slendertone) are more effective than placebo
is beneficial. Also, the physical exercise o f massage tends therapy.6,7 917,18,24,30 The only effective measure, from
to improve circulation o f blood and lymph, especially in our studies, is weight loss by means o f low-calorie diets
women with vascular stasis in the lower extremities. and exercises.
World-wide ballyhoo notwithstanding, there is up to It has been claimed2, but never proven that so-called
now, no other cosmetic or medical (short o f surgical) cellulite is attributable to internal illnesses, birth-control
treatment to improve so-called cellulite, certainly none pills, environmental pollutants, and miniskirts.
at all to cause complete disappearance o f it. In long­ It is an important obligation o f physicians to teach the
term, double blind studies, we were able to confirm that fact that so-called cellulite is not a disease, but is the
neither the French spreading enzyme thiomucase (in result o f the sex-typical structure o f the skin o f wom en
salves or suppositories, by injection or iontophoresis) and a natural consequence o f aging.

9. Howe, R., and Pirk, E. Slendertone-Reizstrombehandlung ohne

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