What is lipedema?
Lipedema was first described by Allen and Hines as a disease characterised by a symmetrical, pathological accumulation of subcutaneous fat and swelling in the lower limbs, primarily affecting women. The rare occurrence in men is rarely documented in published case studies and is more likely to occur within families. Lipoedema is often confused with obesity – however, the irregular fat deposits are highly resistant to diet or exercise. Clinically, lipedema is described as a chronic condition that typically begins in puberty and progresses gradually. The feet are typically spared. In around 30% of cases, the upper limbs are also affected. It is less common for the upper limbs to be affected without involvement of other areas. Apart from the negative aesthetic aspects, lipedema can lead to symptoms such as fatigue, pain, swelling, a tendency to bruise and, ultimately, imbalance and musculoskeletal discomfort. The pain can vary from mild to severe and can be constant, intermittent or triggered by pressure on the affected area. It is accompanied by an atypical fat accumulation and texture that resembles grains of rice or walnuts under the surface of the skin. It is therefore a pathological alteration of the adipose tissue: its distribution, quantity and quality.
Diagnosis and disease progression
The diagnosis of lipedema is based on the clinical examination and medical history. Those affected usually show a striking contrast between the body firmness and symmetrically enlarged limbs, often together with a higher body mass index (BMI). Lipedema goes through three stages, which are characterised by changes in skin texture, sensation in the tissue and pain symptoms. In stage I , apart from the disproportionate distribution of fat, the skin appears smooth, although nodules may be felt along with reversible swelling. Stage II is characterised by an uneven skin surface with walnut-sized nodules and swelling, which may or may not be reversible. In stage III , the skin thickens and hardens, showing disfiguring fatty deposits and larger, often painful nodules.
Treatment options
It is important for both you and me to formulate realistic expectations. The most important goals in the treatment of lipedema are to improve quality of life, relieve heaviness and pain, improve the functionality and aesthetics of the affected limbs, manage weight and improve mobility.
Conservative treatment
Conservative treatments include lifestyle adjustments such as a balanced diet and healthy exercise, compression garments, bandages, intermittent pneumatic compression and lymphatic massage.
Liposuction
Although conservative treatments help to some extent against the progression of the disease and reduce edema, they cannot prevent the growth of subcutaneous fatty tissue and the worsening of symptoms in most patients. Liposuction as tumescent liposuction is a validated and highly effective treatment for lipedema. The infiltration of an anesthetic solution with adrenaline (to reduce blood loss) and the tumescent technique – tumescence describes the amount of infiltration solution in relation to the volume of fat removed, which enables large-volume liposuction – is aimed at reducing the diseased subcutaneous fatty tissue.
Skin tightening
Skin tightening procedures such as thigh and upper arm lifts are often required for a better aesthetic and functional result. If there is little excess skin, long scars can be avoided with radiofrequency-based skin tightening technology such as BodyTite™. I do not recommend radical techniques where all subcutaneous fatty tissue is removed and the skin is left attached directly to the muscle. Although this will cure some of the symptoms of the disease, you will be left with very unsightly discolored, scarred and uneven skin and a general body disfigurement that is far more noticeable than a well-executed skin tightening procedure. Based on extensive knowledge and experience, I can provide improved aesthetics combined with a significant reduction in pain, edema, bruising, mobility restrictions and an increase in quality of life compared to the pre-operative state without removing all the fat. Plastic and reconstructive surgery is about achieving optimal results through the right balance between form and function.
Early treatment
In view of the risk of secondary lymphedema and permanent damage to the lymphatic system in advanced stages of lipedema, liposuction should ideally be part of the standard therapy in the early stages of the disease. This approach aims to prevent the disease from progressing and minimise the need for laborious and usually inadequate conservative therapy.
Multimodal treatment
Liposuction in combination with skin tightening leads to a significant reduction in the need for conservative lipoedema treatment and therefore helps to improve quality of life. However, it is important to note that lipoedema is a chronic condition, especially the inflammatory aspect. A significant number of patients will require some form of conservative treatment after surgery. This emphasizes the need for a multidisciplinary and holistic approach to lipedema, ideally accompanied by a plastic surgeon.
If you have any further information or questions about lipoedema, please feel free to contact me. I will be happy to help you and provide you with additional resources to further your understanding and offer customised solutions.