Overview of Lipedema Seminar
- What is Lipedema?
- What are the Symptoms of Lipedema?
- How is Lipedema Diagnosed?
- What are the Stages and Types of Lipedema?
- Conservative Treatment Options
- Surgical Treatment Options
What is Lipedema?
Lipedema is a chronic disease that occurs almost exclusively in females. It affects the adipose (fatty/fat) tissues and is characterized by bilateral, symmetrical fatty tissue excess, mainly in the hip area, upper and lower legs, and sometimes the arms. The condition is characterized by the following:
- It is an inherited condition
- It occurs in females of all sizes – Obese to underweight
- It presents as excess deposit of fat in unusual and particular patterns
- Unlike regular fat, lipedema fat cannot be eliminated through exercise and diet
Signs and Symptoms of Lipedema
- Age of onset is usually puberty, pregnancy, menopause
- Upper body slender with large lower body – 2 body syndrome
- Symmetrical Presentation
- Pain in soft tissue; hypersensitivity to touch
- Pain when walking or sitting
- Easy bruising
- Accumulation of lipedemic fat from waist to knees or fat pads above, inside and below knees, outer thigh, and inside and outside of ankle
- Distinct ankle cuff
- Impaired gait
- Loss of skin elasticity
- Feet and hands are spared
- Non-pitting edema (initially)
- Skin Texture – mattressing
Pathophysiology of Swelling
How is Lipedema Diagnosed
- Clinical Exam
- Rule out competing Dx
- Venous Doppler Ultrasound
- Check deep system
- Check for venous insufficiency
- Check lymphatic system
Stages of Lipedema
What are the 5 Types of Lipedema?
- Compression / Wraps
- Complete Decongestive Therapy (CDT)
- PT / OT Manual Lymph Drainage
- Intermittent Compression Pumps (Tactical – Flexitouch)
- Diosmin (Vasculara) 500-1000mg/day
- Selenium 400 mcg/daily
- Vitamin D 3000 – 5000 IU/daily
- Anti-Inflammatory Diet
- Modified Mediterranean Diet
- Keto Diet
- Water Therapy
- Walking (start 5 minutes / day)
Lymph Sparing Liposuction
- Removal of the “Sick Fat”
- Patients must complete MLD and CDT with compression prior to surgery to complete decongestion of lipedema tissue
- The majority of patients have a significant reduction of clinical symptoms and experience immediate relief of pain, edema, bruising, improved mobility, improved quality of life
- Reduced need for conservative treatment after liposuction
Patients with lipedema often have other medical conditions that put them at higher risk for complications. Therefore, all efforts must be made to minimize the risk of complications.
- Lymph sparing liposuction with generous tumescent technique that avoids general anesthesia
- Generally not more than 5.0 liters of total volume aspirate should be removed in one surgical procedure
- Generally not more than 5% – 8% of total body surface area should be treated in one surgical procedure
- Small liposuction cannulas should be used
- Surgical technique is very important. Intimate knowledge of the locations and anatomic variations of the lymphatic drainage in the limb or body area that is being treated is crucial
- Patients with varicose veins greater than 4.0mm in the treatment area, or with significant underlying venous reflux, should be treated before having lymph sparing liposuction.
Reasons why your insurance provider usually does not pay for liposuction:
- Lipedema does not have its own ICD-10 diagnosis code
- Research for lymph sparing liposuction for lipedema has been performed outside of the US, which is not recognized by most insurance companies
- Insurance companies are not convinced liposuction is an effective treatment for lipedema – considered experimental.
- The Liposuction Procedure is considered cosmetic and therefore an exclusion on the policy.
Procedure is not a covered benefit for any reason – administrative exclusion.
Very long process of rejection and appeals that requires diligence and dedication:
- Must prove medical necessity and evidence as to why the exclusion of liposuction should be overturned
- Obtain letters of medical necessity from all physicians
- Obtain medical records from all providers
- Write a letter explaining in great detail how lipedema affects your quality of life, ability to carry out daily tasks, ability to work, and the
– If your insurance is through an employer that is self‐insured work with the HR department to obtain approval.
Research in Which We are Participating:
Funded by the Lipedema Foundation to study lipedema and Dercum’s Disease
T: Development treatment regimens
R: Research on SAT disorders
E: Develop educational materials
AT: Focus on adipose tissue disorders
The purpose of this study is to assess body fat composition and metabolic function in women with lipedema before and after weight loss.