As a manual therapist, this layer holds additional significance. When I work on a specific “muscle,” I am actually working through this layer, in addition to the skin. Unlike the skin, the subcutaneous adipose layer is more uneven in thickness and depth. Generally the adipose tissue is firmly attached to the skin and moves along with it, but its relationship with muscles is more complex.
Subcutaneous adipose tissue is loose, areolar connective tissue with collagen fibers that provide structure. If you were to remove all the lipids from this tissue, a scaffolding-like matrix made of collagen fibers would be revealed. In Integral Anatomy, this is referred to as superficial fascia. In the human body, adipocytes—commonly know as fat cells—are embedded in this collagen matrix and cannot be separated from it. A typical fat cell has a diameter of about 0.1mm, making it too small to be seen with the naked eye. The lobules you observe at a gross level are not individual fat cells but rather clusters of them, encapsulated within the matrix. Each fat cell is enclosed by a cell membrane, with lipid stored inside. Under normal conditions, body fat doesn’t melt and can’t be sucked out like melted butter—unless it’s in a state of putrefaction.
In meditation, I imagine fat cells dissipating like dew on a spider web touched by the first summer sun, leaving a soft, white, flexible, three-dimensional lace-like structure. The cosy beeswax-yellow fleece onesie transforms into a milky-white dress, gently covering my body like summer clouds in the sky. Though it appears ephemeral, the fabric is deceivingly strong. It holds the weight of skin—the epidermis, dermis, and hypodermis—in places. The skin, after all, is the largest and heaviest organ, weighing between 5 and 10 kilogram. Gil Hedley, Ph.D., demonstrated the strength of superficial fascia with and without adipose. He could lift 22 kilograms with a piece of superficial fascia that had adipose intact, and 14.5 kilograms with it removed. I personally participated in this experiment, and the tactile sensation of handling the piece of superficial fascia without adipose has stayed with me ever since. In a tub of warm water, it floated and danced like a mystical creature.
Subcutaneous Adipose Tissue Removal
I’m not talking about liposuction, which I consider a form of amputation, given the destruction of structural, vascular, lymphatic, and nervous elements. Subcutaneous adipose tissue has structural integrity.
On dissection tables, human forms lie without the boundary that usually blocks observers from entering the inner space. I’ve never sensed hesitation to cut from workshop participants at this stage. They are usually eager to cut into the tissue and reveal the familiar, anatomy-book-defined muscles hidden beneath the shapeless yellow. I used to feel the same.
Without the dermis, human forms become transparent in a way. The dermis layer is relatively uniform in depth, while the subcutaneous adipose layer varies considerably from one area to another. When manual therapists manipulate soft tissue, they typically aim to target specific muscles. However, this work is done through the dermis and the subcutaneous adipose tissue. I need to be mindful of the variability in adipose layers. For example, the glutes are covered with thick adipose tissue, while the adipose tissue covering forearm is generally thin.
The process to remove subcutaneous adipose tissue is a significant learning opportunity. When you carefully incise the tissue with the tip of scalpel, it opens up with relative ease. Most of the time, you still see the yellow tissue, and you have no idea how deep it goes. You cut again until you finally reveal the familiar brown muscular tissue, covered with a transparent sheen. The energy around the table shifts from weariness to excitement and expectation. Suddenly energized, you eagerly remove the yellow, wet substance. However, if you become too hasty and task-oriented, you risk missing the wealth of information this process can reveal.
This is where tactile learners, like myself, have an advantage. Unlike the removal of skin (dermis), subcutaneous adipose tissue allows blunt dissection by fingers. The relationship with the underlying structure can be loose, and tissue planes can be easily separated. A scalpel cuts through the connecting structure between tissue planes with little effort. It almost feels as if the subcutaneous adipose layer slide over the muscular structure beneath it.
When you grasp your forearm and twist it without moving the forearm itself, your skin (all three layers) slides over the muscle. There is a massage technique called skin rolling, where a therapist pull the skin away from muscle tissue and “rolls” it forward. This is possible because the bond between the skin and underlying muscular structure has some play, allowing for movement. In some areas, subcutaneous adipose tissue is firmly anchored to the structure beneath, preventing the skin from slipping. In other areas, the plane where two layers meet is so intimately bonded that the only way to separate them is to carve the adipose tissue away.
Because of sudden weight loss, I have an abundance of extra skin, which is somewhat loose. It’s relatively easy for me to pull up and “roll” the skin. For some people with tighter skin and/or firmer fat, it’s not as easy. However, there is a limit how much the skin can “slip.” There’s always a connection at the interface. No part of my body wants to be a separate entity.
We shouldn’t overlook the perforating nervous and vascular structure that travel continuously through the layers. Nerves exit from muscular structures and extend into the subcutaneous adipose tissue, then continue to the dermis like a branching tree. Remember, the nerve endings are the furthest end of your brain, constantly searching for proof of life throughout the body. When I use a scalpel to separate subcutaneous adipose layer, I feel a consistent rhythm of bumps. This resistance occurs when the scalpel encounters something firmer than collagen fibers. Even though the nerves are very fine at the ending, they are strong enough to be part of the structure that physically hold your body in place.
I imagine my brain reaching out, through adipose tissue which cocoons me. How would it feel? The moist, warm, soft beeswax-yellow tissue moves, changes shapes, slides, and dances, conducting heat, sound, and energy. Don’t you feel the love in this layer?
Somatic Awareness 