Cellulite: Why It Develops and Why It Is Not Just a Fat-Related Problem

Cellulite is one of the most common aesthetic skin changes in women. It is estimated to affect approximately 80–90% of women after puberty, regardless of body weight, fitness level or lifestyle. This means that cellulite can also occur in slim women, physically active women and women with a normal body weight.

It most commonly appears on the thighs, buttocks, hips and abdomen, where the skin develops a characteristic appearance of small dimples, irregularities or so-called orange peel skin.

Although cellulite is often primarily associated with fat, this is a very simplified explanation. In reality, cellulite is mainly a problem of microcirculation, connective tissue, the extracellular matrix and chronic low-grade inflammation. Fat tissue does play a role, but it is not the only cause — and often not the main cause — of the problem.

The Medical Term for Cellulite: Edematous Fibrosclerotic Panniculopathy

In medical literature, cellulite is also described as edematous fibrosclerotic panniculopathy, or PEFS. The term was introduced by the Italian physician Sergio B. Curri, who studied changes in the subcutaneous and connective tissue in cellulite in the 1990s.

The term itself describes what happens in the tissue:

Edematous means that there is fluid retention or swelling of the tissue.

Fibro refers to changes in the connective tissue.

Sclerosis means that the tissue gradually becomes harder, thicker and less flexible.

Panniculopathy refers to changes in the subcutaneous fat-connective tissue layer.

Cellulite is therefore not simply "fat under the skin", but a change in the entire tissue microenvironment.

Why Does Cellulite Develop?

Under the skin, there are fat cells, connective tissue fibres, blood and lymphatic vessels, intercellular fluid and the extracellular matrix. The extracellular matrix can be understood as the support network of the skin and subcutaneous tissue. It consists of collagen, elastin, hyaluronic acid and other molecules that provide tissue structure, elasticity and the ability to maintain normal fluid exchange.

In cellulite, several changes occur at the same time:

• microcirculation worsens,
• lymphatic flow slows down,
• fluid begins to accumulate in the tissue,
• connective tissue fibres become more rigid,
• the extracellular matrix loses its organised structure,
• chronic low-grade inflammation develops,
• the skin loses firmness and elasticity.

When this happens, the tension between the skin, subcutaneous tissue and connective tissue septa changes. This creates the characteristic dimples and uneven skin surface.

Therefore, when discussing cellulite, it is not enough to think only about reducing fat. The key question is: what is the condition of the tissue, microcirculation and supportive matrix?

Why Is Cellulite More Common in Women?

Cellulite is significantly more common in women than in men. The main reason is the different structure of the skin and subcutaneous connective tissue.

In women, connective tissue septa in the subcutaneous tissue are arranged more vertically, allowing the subcutaneous compartments to bulge more easily towards the skin surface. In men, connective tissue is usually more cross-linked, which is why the typical "orange peel" appearance is less common.

Cellulite Is Not the Same as Obesity

Weight gain can make cellulite more visible because the volume of subcutaneous fat cells increases. However, cellulite should not be equated with obesity.

It can also occur in very slim individuals. Weight loss often does not completely eliminate cellulite, because it does not necessarily change the connective tissue septa that have already been altered by chronic inflammation.

Stages of Cellulite

Cellulite can present in different ways. According to the Nürnberger–Müller classification, cellulite is classified into 3 grades.

Grade 1: Early cellulite

The skin appears smooth when standing, but irregularities become visible when the skin is pinched or under certain lighting conditions.

Grade 2: Moderate cellulite

Irregularities are visible when standing. The skin has the characteristic orange-peel appearance with small dimples and reduced skin tension.

Grade 3: Severe cellulite

Dimples are visible when standing and sitting, often deeper and more clearly defined, with more pronounced irregularities.

What Can We Do Ourselves?

A comprehensive approach is best when dealing with cellulite. Important measures include:

• regular physical activity,
• strength training, especially for the thighs, buttocks and core,
• maintaining a stable body weight,
• a healthy diet with sufficient protein intake,
• adequate hydration,
• stopping smoking,
• massage or lymphatic drainage in cases of fluid retention.

The New Paradigm: Tissue Restructuring and Extracellular Matrix Renewal

A modern regenerative approach focuses on improving microcirculation, reducing fluid retention, supporting lymphatic flow, improving connective tissue quality, stimulating fibroblasts, restoring collagen and elastin, and restructuring the extracellular matrix.

The goal of a modern approach is to support, restore and restructure the tissue, rather than simply damage or break it down.

Sunekos Cell: A Regenerative Approach to Cellulite

Sunekos Cell is a treatment specifically designed to address cellulite and improve skin quality on the body. It is a formulation containing low molecular weight hyaluronic acid, a patented formula of six amino acids in a specific ratio, and a carbonate-bicarbonate buffer.

Unlike traditional fillers, Sunekos Cell is not intended to add volume. Its goal is to improve tissue quality: to increase hydration and elasticity, and through signalling molecules to influence key connective tissue cells — fibroblasts — which support microcirculation, connective tissue renewal and cellular regeneration.

How Does Sunekos Cell Work?

Sunekos Cell works on several levels.

1. Support for Fibroblasts

Fibroblasts are the most important cells responsible for producing collagen and elastin. Sunekos Cell contains a patented combination of six amino acids that influence fibroblasts in tissue renewal.

2. Hyaluronic Acid for a Better Tissue Environment

Low molecular weight hyaluronic acid contributes to hydration and a better microenvironment within the tissue.

3. Local Tissue Buffering

The carbonate-bicarbonate buffer helps improve the local tissue pH, supporting better tissue oxygenation and further enhancing regeneration.

How Is the Treatment Performed?

The treatment is performed with small injections or a cannula in the areas where cellulite is most pronounced. The thighs, buttocks, hips and abdomen are the most commonly treated areas.

The procedure is performed on an outpatient basis and takes approximately 30 minutes. It is minimally painful. After treatment, minor bruising or redness may occur and subsides within a few days. Physical activity can be resumed the following day.

When Are the Results Visible?

With regenerative treatments, results develop gradually over several weeks. The skin gradually becomes smoother, firmer, more elastic and less visibly uneven.

Who Is Sunekos Cell Suitable For?

Sunekos Cell is suitable for anyone bothered by the appearance of cellulite who wants a more biological, regenerative approach without surgery. It is most suitable for early to moderate cellulite, poorer skin quality, orange peel appearance and mild fluid retention.

Where to Start?

At Klinika Višnjar in Ljubljana, during the consultation and examination, we assess the stage of cellulite, skin quality and your goals, and prepare an individual treatment plan. Book a professional consultation to find out whether Sunekos Cell is the right approach for you.