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

bilateral, symmetrical enlargement of limbs, both in legs (with buttocks involved) or in both legs and/or arms (excluding the feet and hands); often the appearance is described as "saddlebags" on buttocks, hips and inside the knees; if the disease spreads further downwards, it is known as "Suaven trousers" (the fat hangs over the ankles) ; typically women with lipoedema have very slim upper bodies

Different types of lipoedema

Sensitivity to touch and pain on pressure is common, especially on thighs and base of spine. When the disease progresses even the lightest pressure can cause pain.

Tendency to easy bruising due to an increased fragility of blood capillaries (often without remembering the event that may have caused the bruise)

Dependent oedema at the end of the day (during early stages of lipoedema), pressure will not cause pitting; however, acquisition of lymphoedema is possible (in later stages), which further complicates lipoedema

Skin elasticy is reduced and usually has an "orange peel" appearance; limbs may feel cold

Stemmer's sign is negative, i.e. the skin on the second toe, when pinched, can be lifted up (if lymphoedema is present it cannot)

There is little or no loss of weight (in lipoedemic fat areas) with rigorous diet and exercise; lipoedema sufferers tend to gain weight in the lipoedemic fat areas and can only lose it in the non-lipoedemic areas of the body (lipoedema can occur in those who are anorexic or obese)

There maybe joint pain (particularly knees), "pins and needles" sensation and flat feet; in later stages restricted mobility and further complications (e.g. osteoarthritis in hips or knees)

Lipoedema sufferers may have developed low moods or depression due to the cosmetic appearance of their legs as they may have been "teased" about their legs since childhood or young adulthood. Often it takes a long time to be diagnosed with lipoedema (as the medical profession is not well informed about the disease) and therefore patients may have been falsely diagnosed as being obese. Recommendations such as "keeping up the diet" or "exercising a lot", despite being unable to lose weight in lipoedemic areas, may have lead to further frustation and disappointment (not only in one self, but also the medical profession).

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, Dr. Frambach/Dr. Baumgartner at the Hanse-Klinik in Lübeck, Germany and Dr von Lukowicz at Lipocura in Munich, 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, water aerobics and water cycling is highly recommended (and a great sport for lipoedema patients as it improves skin tissues); 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.