Fascia glutealis as mediator of musculocutaneous dynamics in the buttocks region

Cellulite is a change of the skin and subcutaneous tissue that develops mainly in the thighs and gluteal region of almost all women. Many concepts in the pathological physiology of cellulite are to some extent contradictory and inconclusive; however, some studies point to structural changes in the dermis and subcutaneous tissue. A correlation of cellulite with focal hypertrophic subcutaneous connective tissue strands and lower density of connective tissue septa in subcutaneous tissue also point to changes in the related gluteal fascia and thus in the closely interlaced gluteal muscles. A rapid degenerative development of the muscle dynamics that were originally gained over generations unquestionably occurs in the Caucasian race and its related urbanization. The gender-specific dimorphism in the subcutaneous area must also be investigated further, since almost exclusively women are affected. For this reason we have anatomically examined male and female gluteal zones and demonstrated significant genderspecific changes. In particular, a weakening of the muscle-tendon and muscle-fascia dynamics of the gluteal muscles appears to be responsible for the round, superficially visible dermal changes. The entire embryonic unit of the muscle-fascia-skin structures in the buttocks and thigh area is involved in female cellulite. A transformation of these degenerative changes through regenerativemeasures, such as active movement and shock wave therapy is, therefore, appropriate and necessary.