Introduction to Lipedema

Introduction to Lipedema Treatment and Disease

Although Lipedema was first described by Dr. Edgar Allen and Dr. Edgar Hines in 1940 at the Mayo Clinic, many physicians remain unaware of this medical condition or its symptoms.

Lipedema is a chronic progressive medical disease that causes disproportionate swollen fat deposition in the arms and legs.  Lipedema is disproportionate, meaning that accumulation of fat is much greater in legs and/or arms than the rest of the body.  As lipedema worsens it causes symptoms in the limbs which feel heavy and can be painful.  Lipedema is associated with easy bruising, especially in the affected limbs.  As a result of the lack of awareness many patients are not diagnosed or properly treated or not treated until they have progressed to more advanced stages of the disease.

The Names and Synonyms of Lipedema

Lipedema is also called Lipoedema [mostly in Europe], Lipodema, swollen fat syndrome and the painful fat syndrome.  In medical literature, Lipedema is also referred to by the following medical terms:  Lipohyperplasia Dolorosa, Lipalgia, Adipoalgesia, Adiposis Dolorosa, Lipomatosis Dolorosa of the legs, and Lipohypertrophy Dolorosa.

Cause of Lipedema and Pathogenesis

The exact cause and parthenogenesis of lipedema is not known.  It is thought to be a genetic disorder with autosomal dominant inheritance with sex limitation[2].  It occurs much more frequently in first and second degree relatives of affected individuals.  Reported rates of family clustering are from 16% to 64% of cases[3][4].  Lipedema usually occurs in women, although it can occur in men.  Hormonal influences play a role in the development and progression of the disease and in the majority of patients, the disease usually starts imperceptibly after puberty, but may also develop at other periods of hormonal change, such as pregnancy or menopause.

Grading of Lipedema

Stage I: In the first stage, the skin is smooth and the subcutaneous layer is thickened; soft possibly with small nodules and even structure. The skin may be cool in certain areas as a result of functional vascular disbalance [Figure 1: Lipedema Stage I]. Stage II: Subcutaneous nodules and the skin surface becomes uneven [Figure 2: Lipedema Stage II]. Stage III:  Patients have huge amounts of tender subcutaneous tissue and bulging protrusions of fat, often at the inner side of the thighs or knees or gluteal area [Figure 3: Lipedema Stage III].
Figure 1
GradingLipedema_Stage1_Figure1
Figure 2
lipedema stage 2 pictures
Figure 3
lipedema stage 3 pictures

Signs, Symptoms and Progression of Lipedema

Individuals with Lipedema have a marked discrepancy between their slim upper body and symmetrically enlarged with subcutaneous fat lower body.  This is often called the two body condition where a top half of the body is a size 6 and the lower half of the body is a size 16.  For the vast majority, almost 100%, of women with lipedema, the thighs and hips, often the lower legs as well are affected.  The upper arms are affected in about a third of lipedema patients; with a smaller percentage having the forearms to the wrist involved<[5].Types of Lipidema

Early on most patients with lipedema experience either no symptoms or mild symptoms.  Often in the early stage the fat accumulation may appear similar to the much more common cellulite fat.  As lipedema progresses the fat hyperplasia becomes lumpier and more disproportionate than regular cellulite fat to a trained observer.  Women with lipedema report a spontaneously occurring feeling of pressure or swelling and a hypersensitivity to touch and pressure in the thighs and lower legs.  The symptoms generally worsen as the day progresses, particularly after standing or sitting for long periods.  Easy bruisability is reported with minor bumps creating bruising.  Over time, the hyperplasia [over accumulation] of fat in the subcutaneous tissue can begin to affect the channels of lymphatics.  Lymphangiography show the curved course of lymphatics, but, at least early on, the lymphatic flow is usually preserved.  The fatty accumulation can affect mobility and the disproportionate fat accumulation can become very distressing, especially if there is no recognition or understanding of its cause.  The secondary weight gain often occurs with patients who become distressed over this painful and possibly disfiguring condition.  These two factors can lead to calorie balance excess, eating more calories than expending through activity, which subsequently leads to obesity.  Later in the course lipedema patients may develop overt swelling with lipolymphedema only if they also become secondarily obese, which can interfere with lymphatic drainage.

What Lipedema can be confused with?

In Germany and the Netherlands, Lipedema is well known and there are many textbooks and articles written about the condition.  In the United States, even though it was originally described here, Lipedema is not well known and articles and texts are few.  This results in a confusion and lack of recognition.  Obesity, which causes increased fat all over the body including the stomach, is sometimes confused with Lipedema.  Lipohypertrophy or cellulite, which also causes a disproportionate fat accumulation in the legs, but does not cause pain or swelling, is often confused with lipedema.  Lymphedema is also often confused with Lipedema.  Lymphedema is asymmetric swelling of the limbs often only one arm or leg is affected.  Lymphedema causes swelling down to the feet and hands whereas Lipedema spares the hands and feet.  Lymphedema is not painful or associated with easy bruising like Lipedema.  Chronic venous insufficiency can cause swelling and pain; however, it is not usually symmetric, has associated and characteristic skin changes, and usually has varicose veins.

Lipedema Treatment

Conservative therapy with combined decongestive therapy (CDT) has a long track record as being an effective lipedema treatment.  The central component of CDT is Manual Lymphatic Drainage (MLD), which is light massage therapy started centrally with a pump and scoop motion toward the heart. The manual lymph drainage is combined with compression wraps to complete the CDT.  This conservative therapy can bring a reduction in circumference of approximately 10% and improves pain and symptoms of hyper-sensitivity to pressure.  If the CDT is discontinued, the swelling and symptoms return.  Compression stockings, which often need to be custom fit, can be helpful in maintaining progress of combined decongestive therapy. However; the compression only works for the swelling component of the lipedema and does not address the lipo-hypertrophy or excess fat.

Surgical treatment has become much more common in the last fifteen years and offers a greater chance of sustained improvement.  Liposuction surgery of old was performed with general anesthesia, not tumescent anesthesia, and was associated with postsurgical complications and lymphatic vessel damage and was not an effective lipedema treatment.  However, modern tumescent liposuction performed with a wet tumescent technique is not associated with significant bleeding and does not damage superficial lymphatic vessels according to macroscopic and anatomical studies[6][7].   The application of blunt micro cannulas measuring 2mm – 4mm allows surgeons to use a gentler technique and avoid damaging important structures, which results in a faster recovery and a significant net improvement of lipedema symptoms.  Dr. Wright has modified the liposuction technique developed by Dr. Jeffery Klein and Dr. Stefan Rapprich[8] to include preoperative assessment and mapping of lymphatics to minimize the chance of lymphatics injury. The tumescent liposuction procedure not only improves physical appearance by returning some balance to the body’s proportion, it also can significantly reduce and eliminate the symptoms. Postoperatively combined decongestive therapy should be initiated or continued along with strict adherence to compression.

before and after lipedema treatment
Actual Patient – Individual Results May Vary

Long term studies show that true tumescent liposuction can result in improvement of fat reduction if performed properly by surgeons.  It can reduce the circumference of the hips and lower extremities balancing the disproportionality of the upper and lower parts of the body and can improve or contribute to the relief of pain and pressure sensitivity; even reduce bruisability over an extended time period.   However, the tendency for edema usually persists and physical therapy and compression is often still necessary for patients, but to a lesser degree.

In conclusion, tumescent lipedema liposuction surgery is a great lipedema treatment and provides significant improvement in body shape, improvement of symptoms, and improvement in mobility.  It also lessens the need for conservative treatment and significantly increases quality of life.  Because of the level of expertise and understanding required to successfully perform tumescent liposuction surgery on these patients, they should seek treatment in centers where the surgeon and staff are specifically trained in lymphology and the needs of these unique patients. Call today for more information about our liposuction for lipedema treatment

The Names and Synonyms of Lipedema

Lipedema is also called Lipoedema [mostly in Europe], Lipodema, swollen fat syndrome and the painful fat syndrome. In medical literature, Lipedema is also referred to by the following medical terms: Lipohyperplasia Dolorosa, Lipalgia, Adipoalgesia, Adiposis Dolorosa, Lipomatosis Dolorosa of the legs, and Lipohypertrophy Dolorosa. 


[1] Allen E. Hines, Lipedema of the legs:  A Syndrome Characterized by Fat Legs and Orthostatic Edema. (Proc Staff Meet Mayo Clinic), 1940; 15184-187.

[2] A.H. Child, K.D. Gordon, P. Scharpe et al. Lipedema:  An Inherited Condition. (Am J Med Genet A 2010), 152:970-6. PMID: 20358611 (PubMed – Indexed for MEDLINE).

[3] L.E. Wold, E.A. Hines, E.V. Hines, Lipedema of the Legs:  A Syndrome Characterized by Fat Legs and Edema. (Ann Intern Med) 1949; 34: 1243-1250.

[4] C.A. Harwood, R.H. Bull, J. Evans, P.S. Mortimer, Lymphatic and Venous Function in Lipedema. (Br J Dermatol) 1996; 134: 1-6.

[5] Herpertz U. Krankheitsspektrum, des Lipödems an einer Lymphologischen, Fachklinik – Erscheinungsformen, Mischbilder und Behandlungsmöglichkeiten, vasomed 1997; 5: 301-307.

[6] A. Frick, J.N. Hoffmann, R.G.H. Baumeister, R. Putz, Liposuction Technique and Lymphatic Lesions in Lower Legs:  Anatomic Study to Reduce Risks, (Plast Reconstr Surg) 1999; 103: 1868-1873.

[7] J.N. Hoffmann, J.P. Fertmann, R.G. Baumeister, R. Putz, A. Frick, Tumescent and Dry Liposuction of Lower Extremities:  Differences in Lymph Vessel Injury, (Plast Reconstr Sur) 2004; 113: 718-724; discussion 725-726.

[8] S. Rapprich, A. Dingler, M. Podda, Liposuction is an Effective Treatment for Lipedema Results of a Study with 25 Patients, Department of Dermatology, Darmstadt Hospital, Germany, (JDDG Journal of the German Society of Dermatology) 20011; 9.33-40 DOI: 10.1111/j.1610-0387.2010.07504.x

 

My experience with Dr. Wright and his staff was exceptional. I have had two liposuction procedures performed by Dr. Wright and both were very successful. I would recommend Dr. Wright and his staff highly. The staff was professional and helpful with after care and follow-up appointments. If I had any other needs they would be on the top of my list.

– D.H.