Treatment for Lipoedema

What is Lipoedema?

Lipoedema is a chronic, progredient disorder that affects almost exclusively women and is characterized by bilateral, symmetrical abnormal fatty tissue accumulation mainly in the hip region and upper and lower legs (and sometimes the arms, but never the feet and hands). Lipoedema sufferers have a tendency to orthostatic oedema, which can lead to lipo-lymphoedema or lipo-lymph-phleboedema.

The cause of lipoedema is unknown. A genetic and hormonal involvment is suspected. The times of onset or exacerbation coincides with times of hormonal disturbance such as puberty, pregnancy and peri-menopause.

In males lipoedema is extremely rare (if it occurs, it is accompanied by a massive hormonal disorder).

Sign and Symptoms

        Different types of lipoedema

       

Stages of lipoedema

Stage I: has a normal skin surface.The subcutanous fatty tissue has a soft consistency but multiple small nodules can be palpated ("orange-peel skin"). This stage can last for several years.

Stage II: the skin surface becomes uneven and harder due to the increasing nodular structure (big nodules) of the subcutaneous fatty tissue ("mattress skin")

Stage III: lobular deformation due to increased fatty tissue; palpable nodules varying in size from a walnut up to a fist; large, deforming folds of fat

Different stages (I, II, III) of lipoedema

 

Treatment of Lipoedema

There is currently no known cure for lipoedema. However, lipoedema can be successfully managed with a variety of consistent techniques and therapies, which help to alleviate oedema, pain and delay the progressive nature of lipoedema. 

This includes the following techniques and therapies:

Liposuction

Lipoedema patients may consider liposcution as a way of reducing fat tissue. However, only liposuction using tumescent local anesthesia with a vibrating micro cannula is recommended. The surgeon needs to be experienced in the surgical reduction of fat tissue in lipoedema patients!  However, only very few are. We like to recommend Dr Stefan Rapprich at the Hautklinik Bad Soden, Germany, Dr Stutz at his private clinic in Schwarzenbach am Wald, Germany and Prof. Schmeller at the Hanse-Klinik in Lübeck, Germany.  Often several procedures are needed to get the desired result.

We HIGHLY recommend that you do your research before going to have liposuction.

Diet and Exercise

An anti-inflammatory diet high in anti-oxidants will help to minimise oedema by strengthing the vascular system. It will also help to not gain additional weight in lipoedemic fat areas.

Regular exercise, particular power walking, walking, cycling etc, helps to increase the lymph flow (the lymphatic system has no pump and depends mainly on muscular activity). Compression tights should be worn when exercising to support the lymphatic system and connective tissue.

Swimming is often recommended (and a great sport for lipoedema patients); however, often women with lipoedema are very self-conscious about their legs and may therefore not choose this type of sport.

Patients who have become immobile (later stages of lipoedema) may use the rebounder on a daily basis (only 5 mins per day already increases lymph flow).

Manual Lymphatic Drainage

Regular manual lymphatic drainage (MLD) helps to reduce dependent oedema (early stages) and lymphoedema (later stages). MLD is particularly recommended for lipoedema sufferers who are sensitive to touch or experience pain when touched. Usually other types of massage (e.g. holistic - or sports massage) are not tolerated. Furthermore, several studies on the effectiveness of manual lymphatic drainage in the treatment of fibromyalgia (a condition where sufferers experience soft tissue pain allover their bodies) and sports injuries (sprains and strains) have shown that MLD has a pain relieving and anti-inflammatory effect.

The frequency and duration of manual lymphatic drainage sessions depends on the serverity of the lipoedema and if, additionally, lymphoedema is present.

Compression garments

Ideally compression tights or stockings should be worn daily to assist the lymph flow and support lose connective tissue. What type of compression garment (i.e. round-or flat knit) or what compression class is needed, depends very much on the severity of the lipoedema and if lymphoedema is present.

However, some lipoedema sufferers may not tolerate compression garments at all (due to experiencing pain when pressure is applied). In such cases, kinesio taping may provide a solution.

Bandaging (as part of a Combined Decongestive Therapy) 

Combined decongestive therapy (CDT) is an intensive type treatment, which combines MLD and bandaging to reduce oedema and therefore reduce the allover volume of the limbs. Frequency and duration of a CDT treatment depends on the severity of the lipoedema and the presence of lymphoedema. Obviously, those of have developed lymphoedema alongside lipoedema, would greatly benefit from CDT.

 

The Lymphoedema Clinic London

Practices in Central and South London

For appointments please call 0790 22 33 747