Despite affecting an estimated 11% of women around the world, Lipedema is not yet widely known. Fat tissue, (also referred to as adipose tissue) provide the human body with both cushioning and insulation. Lipedema affects the accumulation of these fat cells and ajoining connective tissue in the body, resulting in bulging, irregular fat in the affected areas. The legs are the most commonly affected area, but sometimes spreading occurs in the torso, and in many cases, excessive clustering of fat cells is noticed in the arms as well. Regardless of the affected area, the symptoms are equally debilitating, and unfortunately, these fat cells are equally resistant to both diet and exercise programs. 

Unlike Lymphedema or general obesity,  Lipedema has a tendency to affect both limbs equally and generally becomes more apparent over the course of time. Lipedema’s progressive nature makes getting a proper diagnosis and treatment imperative and extremely time-sensitive – as the disorder progresses so does the pain, immobility, and discomfort and appearence of Lipedema nodules.

3 Stages of Lipedema

Stage 1: The patient’s skin is flat and stretched over pearl-sized nodules.

Stage 2: The patient’s skin is indented, covering a layer of fat cells that look like a pearl to apple-sized masses. 

Stage 3: Skin is indented, sometimes with much larger bulges, and skin covers pearl-sized nodules in combination with excessively large fat masses, causing lobules along the legs, hips, and thighs and frequently extending to the torso or upper arms.

If one of these stages sounds like you, and you checked off multiple items on the list above, you may have Lipedema, but it’s impossible to say for sure. The only way to know for sure is to get a proper Lipedema diagnosis, which in itself is an important process. 

Lipedema Nodules and Fat

Lipedema is categorized as lipomatosis, also known as a subcutaneous fat disease that is characterized by abnormal fibrosis of the subcutaneous fat tissue. Fibrosis (also known as fibrotic scarring), is a pathological wound healing in which connective tissue replaces normal tissue, eventually leading to the formation of permanent scar tissue. The fibrosis of Lipedema fat tissue gives it a hard, nodular feeling when touched. 

How to Determine If You Have Lipedema Nodules

Early-stage Lipedema (Stage 1) has small nodules the size of small seeds or peas, which often appear pearl-size. Middle stage Lipedema (Stage 2) has larger nodules that feel like the size of walnuts or a gumball. Later stage Lipedema (Stage 3)  is characterized by the presence of lobules. The  nodules in Stage may be the same size as the nodules in Stage 2, or they may have be larger nodules up to the size of a plum.

The Lipedema nodules felt on the skin are important criteria for diagnosing Lipedema. Nodular or bumpy subcutaneous fat occurs with other conditions or diseases such as cellulite or obesity and other fat disorders, however, subcutaneous nodules must be present to diagnose lipedema. These nodules represent excess and slightly disorganized fibrosis of the subcutaneous tissue. Inflammation of the adipose tissue in lipedema is likely the cause of this fibrosis.

In these cases, fibrosis tissue in Lipedema patients swirls around the adipose tissue, but it usually won’t completely encapsulate it. If the adipose tissue is completely encapsulated by fibrous tissue, eventually it leads to a lipoma. Women with lipedema have an increased number of lipomas, but most of the bumps felt on the skin are nodules, rather than lipomas. 

There are other lipomatosis diseases that cause similar side effects as Lipedema to be aware of through the diagnosis process. Dercum’s disease, for example, is characterized by multiple painful subcutaneous lipomas. Madelung’s Disease also has subcutaneous nodules (but not many lipomas), however, these cases occur more in the upper half of the body. Overall, subcutaneous nodules are present in all patients with lipedema but they also occur in other subcutaneous fat diseases or lipomatosis.

Removing Lipomatosis Nodules

In the earlier stages of Lipedema (Stage 1 and most patients in Stage 2), the subcutaneous nodules are removed with lipedema reduction surgery, which involves modification of cosmetic liposuction using tools and techniques which minimize harm to the lymphatics. In lipedema patients with larger or more adherent nodules, the nodules have to be manually extracted.

 

In these cases, a small incision is made over the nodules that resist removal with a suction cannula and are gently milked out of the skin. Obviously, surgeons don’t want to cause any more trauma than is absolutely necessary, however, there are instances where this method is the only way to get larger, more adherent nodules removed. Dr. Wright has several videos of the extraction process you can view here.

Think you have Lipedema nodules?

Below are the different tests you may experience during this time, and it’s important to keep them in mind as you select your doctor. Moving forward, thoroughness will be your best friend; we highly recommend “interviewing” different Lipedema experts to find someone you trust, someone who can provide at least some of these diagnostic tests, and someone who is well versed in treatment options.

 

Note: There is no single test to diagnose Lipedema. Tests, however, are important to rule out a related disorder.

Stemmer’s Sign Test

The Stemmer’s Sign is the inability to pinch the skin between the toes or fingers. As mentioned in our last section, Lipedema in advanced stages can be complicated by secondary Lymphedema and may have a stemmer’s sign. This test can help Lipedema experts determine if this is the case for you. 

Venous Doppler Ultrasound 

A Venous Doppler Ultrasound is a very useful test for the diagnosis of Lipedema and to locate potential nodules. Lipedema has many similarities to venous insufficiency, so this can also help rule out or confirm venous insufficiency.  The Venous Doppler Ultrasound can readily detect venous insufficiency if done properly and by having the patient stand while completing it. A standing venous Doppler ultrasound is a painless, non-invasive, and inexpensive test that provides a lot of useful information about venous circulation. The Doppler ultrasound not only helps determine the presence of underlying venous problems, but it also gives critical information for managing Lipedema. If venous insufficiency is present, it is important that treatment is given as the resulting increased venous pressures can greatly aggravate Lipedema.

Lymphoscintigraphy

This is generally only used in complicated cases, where clinical diagnosis is not clear. This is a nuclear scan that assesses the lymph system. It may come back as normal in patients with Lipedema and may show the characteristic “corkscrew” changes with Lymphedema. In most cases of Lymphedema, lymphoscintigraphy shows delayed uptake. So lymphoscintigraphy can be very helpful to determine if and how significant a role lymphedema is playing in an individual’s symptoms, especially when there are widespread issues of swelling in the body.

We’re here to help!

Now that you’ve reviewed the signs and symptoms of Lipedema, determined that you identify with at least some of them, and you’ve familiarized yourself with other commonly related diagnoses, it’s time for the final step – finding a Lipedema specialist who can perform one of the diagnostic methods above. Each Lipedema doctor will have their own preferred method of diagnosing their patients and typically will include a physical exam, patient questionnaires, and then additional testing and ultrasounds to further support the physical exam. 

A treatment plan should be discussed and developed between you and your Lipedema doctor, but you can read more about the non-surgical and surgical options that we recommend to our patients. While these will always depend on specific cases and patient needs, it can give you an idea of what options may be available to you. Our hope for all women with Lipedema, whether they are our patients or not, is that we can provide valuable tools and knowledge so that more women can make it to this point and take the next step in living a more mobile, healthy, and enjoyable life. 

Through efforts led by LE&RN (the Lymphatic Education & Research Network), the Senate has passed a bill for the LD Commission (Lymphatic Disease Commission) to increase research and lymphatic education. The bill passed in the Senate last month, with a vote of 68-31. Now that it’s passed in both houses of Congress, it is now on President Biden’s desk to be signed into law. This is exciting and unprecedented news for men and women suffering from lymphatic diseases!

Video: LE&RN’s Appeal to Congress video here.

Lymphatic Disease

The following language is taken directly out of the recently passed bill and is a direct reflection of the hard work and dedication of advocates in this community. NHLBI refers to the National Heart, Lung, and Blood Institute and NIH refers to the National Institute of Health, two of the nation’s medical research agencies that support scientific studies for advancing knowledge and discovery in health.

Lymphedema (LE)—The agreement directs NHLBI to increase support for research on LE and to establish a Research Condition Disease Categorization category for research related to lymphedema.

National Commission on Lymphatic Diseases—The agreement directs NIH to establish a National Commission on Lymphatic Diseases and to engage with relevant Institutes, Centers, and external stakeholders in establishing this Commission. The agreement directs NIH to provide an update on progress to establish the Commission within 60 days of the enactment of this Act.

Lymphedema

Why is passing the Lymphatic Disease Education bill so important? 

This is the latest step in pushing for resources for deeper research into the causes, best treatment practices, and even genetic dispositions for lymphatic diseases that are not yet clearly identified across healthcare. A National Commission on Lymphatic Diseases pushes Lymphatic Diseases to the forefront of national research as a priority, and ultimately this gives experts in this field a seat at the table to tell Congress what we need in order to provide the best care to patients. Most exciting, the bill now directs NIH to establish this Commission within the next two months after President Biden signs! 

Takeaways from the bill: 

Understanding Lymphedema Diseases

Lymphedema is a condition that occurs when lymphatic fluid, a transparent liquid composed of fat, water, salts, and proteins, begins to pool and accumulate in the arms and the legs. The initial and most predominant symptom indicating the presence of Lymphedema is significant swelling of these extremities. Medical experts point to damaged lymph vessels as the cause of fluid retention leading to Lymphedema. When lymphatic fluid isn’t able to properly circulate through the human bloodstream via lymph nodes and vessels, retention quickly occurs. Other potential causes for fluid retention are linked to infections, genetics or underlying medical conditions especially cancer and its treatment. Keep reading to learn more about the treatment of Lymphedema in St Louis.

Lymphatic Disease

Types of Lymphedema

It is widely understood and accepted that Lymphedema can be an inherited medical condition and as a result, is recognized under three distinct categories. Congenital Lymphedema refers to symptoms that develop in early childhood. Lymphedema Praecox refers to symptom development that occurs during adolescence, while Lymphedema Tarda refers to symptoms that show up in patients later in life. Lymphedema quite commonly develops in patients as a result of a traumatic injury damaging lymphatics. This type of trauma is generally linked to the removal of lymph nodes during surgical procedures related to cancer treatment or radiation. Infection is a second factor closely linked to the development of Lymphedema.

Skin Lymphostatic Fibrosis 

This is a widespread side effect in patients with lymphedema, where the skin hardens over time. In the early stages of lymphedema, swelling is soft to the touch. However, over time, the swelling hardens the skin due to the development of connective tissue fibers underneath the skin of the affected areas.

Papillomatosis

The growth of numerous papillomas, more commonly referred to as warts.

Dermal Sclerosis

Hardening and tightening of the skin and connective tissues.

Leg Swelling

Leg swelling is one of the most common symptoms of lymphedema and prompts patients to seek treatment.

Lymphedema

Lymphedema is a progressive condition that can quickly transform into a more serious medical issue. The risks of leaving Lymphedema untreated can include a heightened vulnerability to infection leading to lymphangitis and cellulitis. Similarly, Lymphedema can commonly lead to fibrosis or hardening and scarring of the skin and subcutaneous fat cells. This condition has the potential to impede the overall circulation of lymph fluid causing physical movement to become a painful task. These conditions comprehensively increase the pressure put on veins working to move blood through the body towards the heart.

Diagnosis Prior to Treatment

A physical exam will be carried out and the results compared to the patient’s medical history and profile. A venous doppler ultrasound is commonly utilized to assess the potential for venous insufficiency which can also lead to increased swelling of the limbs. To verify the presence of Lymphedema, a physician may choose to perform a Lymphoscintigraphy. This procedure involves the injection of a radioactive solution into the potentially affected area of the body to decisively map the path of lymphatic fluids in a targeted region. The option for the physician to perform a Lymphangiography involves the replacement of the radioactive solution with a medicinal dye.

Home Care Strategies

Patients suffering from Lymphedema are at a greater risk of developing infections and there are some simple home care strategies that help diminish the overall risk factor. Those suffering from Lymphedema should always completely dry affected limbs after showering or swimming. Wearing protective shoes and clothing reduces the risk of cuts or injuries while the addition of compression garments is highly recommended in the promotion of healthy blood circulation. Sitting with the legs uncrossed is another simple strategy towards promoting improved lymphatic flow. Maintaining a dedicated exercise routine along with a healthy diet has been shown to help reduce the risk of injury or infection related to Lymphedema.

Seeking Lymphedema Treatment

While there is no permanent cure for Lymphedema, complications, and progression of the disease can be managed effectively with a combination of Lymphedema treatment St Louis options. Compression garments are the primary method recommended for managing Lymphedema. Compression stockings, sleeves, leggings, and gauntlets provide the first line of defense when it comes to promoting healthy blood circulation. Manual lymphatic drainage or massage can aid in the management of Lymphedema as well. This technique works to manually move the lymph out of congested areas. When this type of massage is combined with compression bandages the treatment method may be referred to as Complete Decongestive Therapy.

For patients with more severe cases of Lymphedema, intermittent compression pump lymphedema therapy may prove effective. These compression pumps actively work to move trapped lymphatic fluid through the lymphatic circulatory system.

March is Lymphedema Awareness month, a time to put on your light blue ribbon and find creative ways to participate in educating the world on lymphatic diseases. The highlight of the month, World Lymphedema Day, falls on March 6th this year. The Lymphatic Network hosts a wide range of events all around the world for the community to participate in, both digitally and in person. Sign up for events and presentations on their home page, or use their guide to getting involved and participating on World Lymphedema Day. All month long, the clinical, patient, and advocacy communities, as well as the private sector, join forces to increase awareness of this chronic condition.

World Lymphedema Day was established by the United States Senate in 2016 in response to a Senate bill written by the Lymphatic Education & Research network. Advocates celebrate annually each March, with the primary focus on educating the world on all lymphatic diseases: primary and secondary lymphedema (LE), lipedema (LI), lymphatic filariasis (LF), lymphatic malformations (LM), and the full lymphatic continuum (LC) of diseases impacted by the lymphatic system.

World Lymphedema Day

Understanding Lymphedema

Lymphedema is a condition that occurs when lymphatic fluid, a transparent liquid composed of fat, water, salts, and proteins, begins to pool and accumulate in the arms and the legs. The initial and most predominant symptom indicating the presence of Lymphedema is significant swelling of these extremities. Medical experts point to damaged lymph vessels as the cause behind fluid retention leading to Lymphedema. When lymphatic fluid isn’t able to properly circulate through the human bloodstream via lymph nodes and vessels, retention quickly occurs. Other potential causes for fluid retention are linked to infections, genetics or underlying medical conditions especially cancer and its treatment. Keep reading to learn more about the treatment of Lymphedema in St Louis.

World Lymphedema Day

Significant Symptoms Associated with Lymphedema

Individuals suffering from Lymphedema often report experiencing swelling of the limbs which tends to be more significant on one side of the body as compared to the other. Additionally, those struggling with Lymphedema may experience fatigue, heaviness, tightness, or lack of flexibility affecting the limbs that are swollen. Inflammation and redness of the arms and legs are common symptoms associated with Lymphedema.

Types of Lymphedema

It is widely understood and accepted that Lymphedema can be an inherited medical condition and as a result, is recognized under three distinct categories. Congenital Lymphedema refers to symptoms that develop in early childhood. Lymphedema Praecox refers to symptom development that occurs during adolescence, while Lymphedema Tarda refers to symptoms that show up in patients later in life. Lymphedema quite commonly develops in patients as a result of a traumatic injury damaging lymphatics. This type of trauma is generally linked to the removal of lymph nodes during surgical procedures related to cancer treatment or radiation. Infection is a second factor closely linked to the development of Lymphedema.

Reasons for Seeking Treatment

Lymphedema is a progressive condition that can quickly transform into a more serious medical issue. The risks of leaving Lymphedema untreated can include a heightened vulnerability to infection leading to lymphangitis and cellulitis. Similarly, Lymphedema can commonly lead to fibrosis or hardening and scarring of the skin and subcutaneous fat cells. This condition has the potential to impede the overall circulation of lymph fluid causing physical movement to become a painful task. These conditions comprehensively increase the pressure put on veins working to move blood through the body towards the heart.

Diagnosis Prior to Treatment

A physical exam will be carried out and the results compared to the patient’s medical history and profile. A venous doppler ultrasound is commonly utilized to assess the potential for venous insufficiency which can also lead to increased swelling of the limbs. To verify the presence of Lymphedema, a physician may choose to perform a Lymphoscintigraphy. This procedure involves the injection of a radioactive solution into the potentially affected area of the body to decisively map the path of lymphatic fluids in a targeted region. The option for the physician to perform a Lymphangiography involves the replacement of the radioactive solution with a medicinal dye.

Recommended Home Care Strategies

Patients suffering from Lymphedema are at a greater risk of developing infections and there are some simple home care strategies that help diminish the overall risk factor. Those suffering from Lymphedema should always completely dry affected limbs after showering or swimming. Wearing protective shoes and clothing reduces the risk of cuts or injuries while the addition of compression garments is highly recommended in the promotion of healthy blood circulation. Sitting with the legs uncrossed is another simple strategy towards promoting improved lymphatic flow. Maintaining a dedicated exercise routine along with a healthy diet has been shown to help reduce the risk of injury or infection related to Lymphedema.

World Lymphedema Day

Seeking Lymphedema Treatment

While there is no permanent cure for Lymphedema, complications, and progression of the disease can be managed effectively with a combination of Lymphedema treatment St Louis options. Compression garments are the primary method recommended for managing Lymphedema. Compression stockings, sleeves, leggings, and gauntlets provide the first line of defense when it comes to promoting healthy blood circulation. Manual lymphatic drainage or massage can aid in the management of Lymphedema as well. This technique works to manually move the lymph out of congested areas. When this type of massage is combined with compression bandages the treatment method may be referred to as Complete Decongestive Therapy.

For patients with more severe cases of Lymphedema, intermittent compression pump lymphedema therapy may prove effective. These compression pumps actively work to move trapped lymphatic fluid through the lymphatic circulatory system.

Learn More During the World Lymphedema Day

Swelling of the arms and legs is generally the first symptom of Lymphedema but can also be linked to underlying venous insufficiency. When this is the case, seeking vein treatment options can significantly improve symptoms associated with Lymphedema. Dr. Wright and his team at the St. Louis Laser Lipo and Vein Center provide comprehensive Lymphedema therapy plans that take a patient’s full medical profile into consideration. When you’re looking for solutions to treat symptoms of Lymphedema of underlying vein disease, make sure to contact us to set up an initial consultation.

Chronic swelling (also referred to as “edema”) in the legs is a risk factor for eventually developing cellulitis, venous insufficiency, and is one of the primary symptoms of lipedema. A recent study showed that swelling of the legs from any cause leads to an increased risk for leg skin infections or cellulitis. For women suffering from Lipedema, this can add insult to injury in an already debilitating disease accompanied by sensitive and easily bruised skin. If left untreated, cellulitis can move into the lymph nodes and bloodstream and require more serious medical treatment, and is one of many reasons why compression therapy for lipedema patients has more than one benefit!

Benefits of Compression Therapy

  1. Helps smooth lobules and thereby improved mobility
  2. Helps with pain
  3. Garments have anti-inflammatory properties
  4. Compression should be helpful with all types of edema 
  5. Helps maintain benefits after MLD, pumps, or surgery.

Today, most doctors recommend conservative and preventative measures, such as daily washing of wounds or cuts that could be infiltrated by bacteria, and the application of protective creams, ointments, and bandages when necessary to surface wounds or extremely dry, flaky skin. Preventative medications, such as antibiotics, may be recommended in some instances where patients experience several recurrences of cellulitis.

Learn More About Compression Therapy Here!

Symptoms of Cellulitis May Include the Following:

For people with poor circulation – such as diabetics or women with Lipedema or Lymphedema, additional precautions for avoiding skin injury are recommended, but overall are still conservative and focus on healthy and consistent skincare. For example, the health providers at the Mayo Clinic recommend you inspect your feet daily, check for signs of injury or infection early on, moisturize skin regularly to avoid dryness or cracks, trim finger and toenails with great care to avoid injuring the skin and wear clean and protective footwear and gloves often.

Like Lipedema, there’s a lot we still don’t know about cellulitis; we know it can be caused by several types of bacteria infecting deeper layers of the skin, we know that it causes swollen, red, painful areas in the skin, and we know it commonly affects the feet and lower legs. But we don’t know how the bacteria get into the body for many people affected. And new studies suggest something else we did not know previously – compression therapy may help prevent this painful condition.

A recent study by the New England Journal of Medicine divided 84 patients into two groups. Participants in each group experienced chronic swelling in their legs, and also suffered from cellulitis on an ongoing basis. In the first group, participants received compression therapy and were provided education on how to prevent their cellulitis from returning. In the second group, participants received the same education but did not undergo compression therapy. The groups returned for follow-up therapy and education every six months, for up to three years, until the entire trial experienced a total of 45 cases of cellulitis. When someone in group two experienced a return of their cellulitis, they were moved to group one to under compression therapy. 

Overall, the quality of life in both groups was the same, and there weren’t drastically different experiences between group one and group two. However, the group who received both therapy and cellulitis prevention education experienced only 6 new cases of cellulitis, while the second group experienced 17 cases. While the study was small, and additional studies are needed, early indications suggest compression therapy will result in a lower recurrence of cellulitis than education and conservative treatments alone. We have known for years that people with lymphedema have an increased risk for cellulitis and they benefit from compression. However, this study showed leg swelling from any cause puts affected individuals at risk for infections, and compression helps reduce this risk. 

Not Sure if You Have Lipedema? Click Here to Find Out!

What Is the Goal of Compression Therapy?

For patients with Lipedema, there are many reasons to consider using compression garments or compression pumps. From clinical experience, it’s been noted that Lipedema and Lymphedema patients show faster and less complicated healing after surgery when patients are undergoing MLD/pump treatment before surgery. For individuals who have lipedema, lymphedema, or lipo-lymphedema, compression garments are often used to assist lymph circulation by increasing the pressure in the tissue to propel lymph fluid through the body. Lymphedema causes excess fluid to become trapped in the extremities, especially the legs, and compression garments put pressure on the skin and veins, helping them clear lymph and decongest. If we can utilize the garments to decrease the levels of chronic edema, we may also decrease the chances of developing cellulitis. 

Compression garments can help reduce pain and heaviness felt in the limbs from fat disorders (such as lipedema) by decreasing swelling in the fat and throughout the limbs. Compression may also reduce the rate at which the fat cells grow, and help to prevent fat disorders from progressing to more serious stages. In other words, compression can be one of the best treatments for lipo-lymphedema or fat caused by lymphatic diseases, in addition to cellulitis prevention.

Another option patients have to manage their own symptoms at home is pneumatic compression pumps. Pneumatic compression pumps are a great at-home solution for patients suffering from lipedema or lymphedema, and potentially for cellulitis prevention. Compression pumps are devices that mimic the massage techniques used in manual lymphatic drainage. An intermittent pneumatic compression device (IPC) is worn on the affected limb and activated to help push retained fluids back towards the core of the body. These devices let patients who may have difficulty or are unable to visit a doctor’s office often still find relief from their symptoms.

If you have compression stockings but aren’t providing enough relief, an intermittent pneumatic compression device can help you get daily treatment.  These treatments are very effective at treating extreme levels of swelling, and IPC devices help patients to continue their treatment at home and keep their lymph fluid from rebuilding in the affected limbs. As we continue to monitor the development and new studies related to how these practices may help prevent the recurrence of cellulitis, we will update the data here as well. Contact us today!

Click Here to Learn More About Lymph Drainge & Massage

As we ring in the new year, the world continues to create find new normals in a pandemic as the coronavirus variants keep us on our toes. As we now well know, people of any age and gender can be infected with COVID-19, but there are a number of conditions that make individuals more likely to get severely ill from the virus. New research has shown that the risk of severe COVID-19 increases as the number of underlying medical conditions increases in a person and that individuals with an increased amount of fat in their bodies are at an increased risk of contracting the coronavirus, and may also suffer from a severe illness and side effects than those with lower body fat. 

Severe illness means that a person with COVID-19 may:

As a result, women with lipedema – who are prone to hold higher levels of fat on their bodies – are highly encouraged to take all precautions against COVID-19, especially by getting both vaccinated and boosted. 

What is Lipedema?

Lipedema is a rather common, yet often painful disorder that affects the accumulation of fat cells in the body. While fat cells, otherwise referred to as adipose tissue, are an important feature in providing the human body with both cushioning and insulation. Lipedema causes the excessive congregation of these cells, particularly around the legs. Sometimes, spreading occurs in the torso, and in many cases, excessive clustering of fat cells is noticed in the arms as well. It’s estimated that arms are affected in nearly 80% of Lipedema cases reported.

Who is Affected by Lipedema?

Women tend to be the vast majority of individuals affected by Lipedema. It is estimated that at least 11% of women worldwide suffer from this disorder. Because Lipedema is highly resistant to both diet and exercise regimens, it’s not uncommon for women suffering from Lipedema to be misdiagnosed with either traditional obesity or lymphedema.

Symptoms and Stages of Lipedema

Lipedema can be noticeably characterized by the excessive and disproportionate appearance of nodular fat accumulations across the legs, hips, thighs, and often arms. Unlike Lymphedema, Lipedema has a tendency to affect both limbs equally and generally becomes more apparent over the course of time. It’s common for those who suffer from Lipedema to bruise rather easily as well. 

 

Overall, Lipedema appears in a series of three stages. Stage 1 presents in patients as skin that is flat stretched over pearl-sized nodules that show up within a layer of fat showing increased cell size. Stage 2 presents as indented skin that’s covering a layer of fat cells presenting as a pearl to apple-sized masses. Stage 3 presents as pearl-sized nodules in combination with excessively large fat masses causing lobules along the legs, hips, and thighs and frequently extending to the torso or upper arms.

 

Lipedema & COVID-19

The Center for Disease Control has determined that as an individual’s BMI increases, so do their chances of a more severe case of COVID-19 if contracted. Overweight (defined as a body mass index (BMI) ≥ 25 kg/m2 but < 30 kg/m2), obesity (BMI ≥ 30 kg/m2 but < 40 kg/m2), or severe obesity (BMI of ≥ 40 kg/m2), can make you more likely to get severely ill from COVID-19. 

Body Mass Index (BMI) is a calculation that illustrations the relationship between a person’s weight and height, and equips healthcare providers with one tool in evaluating a patient’s overall health. Specifically, these ranges are used to categorize whether a person is underweight, in a normal weight range, overweight, or obese. While BMI does not provide the full picture of a patient’s health or the full body composition breakdown, it is a commonly used factor in diagnosing numerous diseases. 

The risk of severe COVID-19 illness increases sharply with elevated BMI. 

A study of COVID-19 cases suggests that risks of hospitalization, intensive care unit admission, invasive mechanical ventilation, and death are higher with increasing BMI. The increased risk for hospitalization or death was particularly pronounced in those under age 65. More than 900,000 adult COVID-19 hospitalizations occurred in the United States between the beginning of the pandemic and November 18, 2020. Models estimate that 271,800 (30.2%) of these hospitalizations were attributed to obesity.

Lipedema vs. Obesity

While Lipedema is metabolically the opposite of obesity – both are associated with excess fat accumulation, and as a result, hold the same danger for patients who may contract COVID-19. Obesity presents with fat accumulated in the central area of the body, primarily in the abdomen, and is associated with diseases such as diabetes, high blood pressure, high cholesterol, and cardiovascular disease. However, lipedema presents with peripheral fat in the extremities, while the abdomen and/or waist are typically unaffected. But because both diseases increase a patient’s BMI, misdiagnoses are common and destructive. This illustrates one reason why BMI is not a biologically valid way to diagnose obesity or lipedema, but all the while makes women with Lipedema at high risk for becoming severely ill from COVID-19. 

Take Every Precaution

COVID-19 vaccines (initial doses and boosters) and preventive measures for COVID-19 are important, especially if you are older,  have multiple or severe health conditions, and/or carry excess fat on your body, such as individuals with Lipedema are known to suffer from. Learn more about CDC’s COVID-19 vaccination recommendations, including how medical conditions and other factors inform recommendations. If you have a medical condition, learn more about Actions You Can Take

Questions about Lipedema?

Even with all the challenges presented by lipedema, there are those who you can trust. Dr. Wright continues to strive for better education, research, and coverage for the lipedema community. Do not let these challenges bring you down even further; let Dr. Wright and his expert team help you to reduce the symptoms of lipedema and live your life. Dr. Wright can help find the right procedure to help manage your lipedema symptoms, such as lymphatic drainage massage. Don’t let lipedema take over your life; contact us today!

 

Kompaniyets L, Goodman AB, Belay B, et al. Body Mass Index and Risk for COVID-19–Related Hospitalization, Intensive Care Unit Admission, Invasive Mechanical Ventilation, and Death — United States, March–December 2020. (2021). MMWR Morb Mortal Wkly Rep 2021;70:355–361.

 

O’Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. (2021). Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. Journal of the American Heart Association. 2021 Feb;10(5):e019259.

 

An estimated 17-million women in the U.S. and nearly 370 million women across the globe suffer from a condition known as Lipedema. What is regularly associated with rapid and uncontrollable weight gain in its initial stages can quickly spiral out of control if left undiagnosed.

Lipedema is a disease that leads to the excessive buildup of fat cells, primarily in the arms and legs. Going far beyond the appearance of extra pounds, those who suffer from Lipedema often have large pockets of fat on their limbs that appear disproportionate in comparison to the rest of the body.

Lipedema is often misdiagnosed and dismissed by medical professionals as simple obesity, leaving affected women to deal with an endless cycle of disappointment, frustration, and pain. Lipedema does not respond to a diet and exercise routine, yo-yo dieting, or juice cleanses. Ultimately, effective treatment will require cosmetic intervention in order to alleviate the appearance and pain of symptoms. Liposuction performed on the affected limbs is generally the most effective form of treatment. Removing fat deposits that are diseased not only helps reduce swelling of the limbs but alleviates the pain that holds patients back from everyday activities.

One of the top recommended treatments for dealing with lipedema is lymph sparing liposuction. This surgical treatment is able to provide a variety of benefits and relieve the symptoms you are experiencing from lipedema. Dealing with lipedema can be difficult, especially if you are just now starting to take control of it.

Women suffering from Lipedema often report the disease in association with painful symptoms that trigger difficulties dealing with everyday life activities. Excessive swelling often comes with pain, numbness, and bruising. In its advanced stages, Lipedema can impact mobility and provoke vascular and lymphatic swelling which can lead to further medical complications.

Click Here to Learn More About Lipedema!

Why Do We Call It “Lymph-Sparing?”

Lipedema reduction surgery is different from cosmetic liposuction. Studies have shown that women with Lipedema have impaired lymphatic function. Lymphatic fluid promotes the collection of fat cells, which can cause the obstruction of lymphatic capillaries (branch-like blood vessels). Extra care must be taken to avoid injuring the lymphatic system and making an already stressed system worse. Using blunt cannulas generous and special surgical techniques, studies have shown that lymphatic function can actually improve after this type of liposuction in women with Lipedema. The goal of lipedema reduction surgery is to remove the fibrous tissue and maximally reduce the lipedema tissue. It is a debulking surgery, not a cosmetic surgery.

There are two specialized liposuction techniques that have been shown in studies to benefit individuals with lipedema: water-assisted and tumescent liposuction. In addition to the surgical equipment used, it is important to choose a surgeon with experience and one that is cautious when performing lipedema surgery. These factors can have an important influence on protecting lymphatic flow and function.

1 – No General Anesthesia

One of the most beneficial aspects of lymph sparing liposuction is that the treatment does not rely on general anesthesia. While general anesthesia is used for a variety of treatments, it can cause complications for individuals with lipedema. In fact, it can cause complications in as high as 0.3% of liposuction treatments when used. Instead, lymph sparing liposuction uses tumescent anesthesia to avoid these unwanted complications. In fact, general anesthesia can cause serious complications even death in up to 0.3% of liposuction treatments when used. Patients are conscious for the duration of treatment, while the tumescent liquid acts as a local anesthetic to the treatment area. Patients take pain kills ahead of time to help with discomfort, and through the process feel little pain, and if anything, pressure in the area being treated. 

2 – Reduces Fat Tissue

Perhaps the most noticeable benefit to lymph sparing liposuction is how it is able to reduce the amount of subcutaneous fat tissue in the body. Lipedema reduction surgery not only significantly reduces fat tissue, but also removes fibrous tissue, making the limbs lighter, smaller, less tender, and smoother. It is critical to follow your physician’s guidelines to reduce any swelling and inflammation before the treatment. This is done by wearing compression garments and wraps along with receiving manual lymph drainage for several weeks following lipedema surgery and beyond. Patients wear medical-grade compression clothing for at least 8 weeks, and manual lymph drainage and massage are typically recommended as an ongoing and regular treatment. 

Your tissue will be decongested, allowing your liposuction treatment to be as successful as possible. Some slight swelling and bruising may return immediately following the procedure, but this is expected and should subside over time. Some patients also report numbness as their nerves in the treated areas respond to treatment. Numbness may last for several months and up to one year, but when compared with the reduction in fat tissue, patients still see this as a huge improvement. Compression is critical to be maintained after the lipedema surgery as well, as the lymphatics are reestablished. The lymphatic function is often improved.

3 – Reduces Pain Associated with Lipedema

By reducing the amount of subcutaneous fat tissue, you can reduce any pain that is associated with lipedema. Lipedema reduction surgery, which is sometimes referred to as Lymph sparing liposuction, will be able to help you increase mobility without having the pain you have been feeling with lipedema since it started. This is huge for women with lipedema, especially because the pain and bruising is the leading symptom of seeking treatment. Women report a significant improvement in their ability to move around more freely, exercise more regularly and enjoy day-to-day activities that were previously off-limits. Bumping into a chair or a corner no longer causes large bruises, playing with the family dog doesn’t cause pain when they jump, and everyday activities are no longer considered out of reach. 

4 – No Additional Risks Included

Lipedema reduction surgery also makes sure to avoid any additional risks for the treatment. This type of liposuction procedure limits the amount of fat tissue that will be removed at once, and a follow-up appointment is scheduled for the day following the procedure to ensure the treatment and recovery are going as planned. While that may not seem like a benefit at first, it will actually make sure your body does not take any additional trauma than what is needed. The general amount of fat tissue that can be safely removed is around 5.0 liters. Smaller cannulas are also used to also keep down the risk of trauma to the body and an already compromised lymphatic system.

5 – Quality of Life

While the recovery can get painful, especially in more heavily used areas such as the arms and calves, patients will report that the payoff is well worth it. Lipedema fat more often accumulates around the lower body, including the thighs and buttocks. Women will often see the majority of their Lipedema fat in these areas. However, they can also commonly find Lipedema fat accumulation around the inner knee and backside of their leg. After the removal of lipedema tissue in these areas, patients are not only more mobile and can get around more easily, but they experience far less pain in their daily lives.

This procedure allows for a more active and healthy lifestyle, which many patients have experienced in years (and in some instances, it’s been decades). If paired with proper compression therapy, a healthy diet, tons of water for hydration, and responsible maintenance, women with lipedema are afforded a much higher quality of life and more enjoyable day-to-day. The reduction of irregular and heavy fat can improve joint function, making everyday tasks such as walking, climbing stairs, tying shoes, or even getting up from a chair much easier than before. Normal tasks that many take for granted are daunting and painful for women with lipedema, and lymph sparing liposuction can help reset the clock by several years to help provide a higher quality of life for those who have missed it for years. 

Learn About Life with Lipedema Here!

Recovery from Lipedema Surgery

While lymph sparing liposuction for lipedema is generally safe in healthy individuals, risks such as infection, bleeding, and trauma to the area may occur. Post-operative swelling in the limbs after surgery, which occurs with any liposuction procedure, is more prolonged in individuals with lipedema. The swelling typically worsens for a few months before it gets better, and the full benefit may not be realized for six months to a year. However, overall, most patients with lipedema experience significant improvement of many or all of their symptoms, with varying individual results. It’s not uncommon for Dr. Wright and his team to complete the procedure, and their patient notices a change before they leave the office, especially when large amounts of fat tissue are removed. 

Although some people who have lipedema in one specific area may need only one procedure, most people undergo multiple lymph sparing liposuction procedures to address all the different areas affected by lipedema. The multiple liposuction procedures need to be staged, or separated, to be done safely. The timing of the procedures depends on multiple factors, including the clinical stage of lipedema in the patient, the amount of fat being removed, the patient’s health and mobility, and other logistical factors. Generally, each procedure should be spaced out by at least three months to allow for proper recovery. After the lipedema surgery, patients go home the same day but should be sent home already in their compression garments. The first afternoon after surgery should be spent resting, and it’s likely patients are extremely drowsy from the procedure and medications. The following day post-op check-in should be completed before returning home. Patients will be sore and will continue to experience drainage of tumescent fluids. Padding around the incision points is required for several weeks, and compression garments are worn around the lock for the first several weeks, then worn during the daytime hours only, before eventually tapering off after 12 weeks. 

Schedule Your Lymph Sparing Liposuction Today

As you can see, there are plenty of exciting benefits to lymph-sparing liposuction. This procedure can make it easier to live with unwanted symptoms such as difficulty with mobility, pain, and tenderness. Physicians such as Dr. Wright can provide you with the needed treatment that it takes to reduce your lipedema symptoms. Contact us today!

Click Here to Learn About Insurance Coverage for Your Surgery!

Fall has arrived and with the cold weather looming you may be wondering what you can eat that can be both fulfilling and anti-inflammatory for your lipedema care. It’s easy to learn what you should and shouldn’t eat but sometimes hard to stick to it without the background knowledge of why. Knowing the why can help you make the best decisions for yourself and maybe incorporate some things that you may not have thought of before.   

Follow an Anti-Inflammatory Diet

It is recommended to follow the RAD diet (or Rare Adipose Disorder diet). The RAD diet is basically a modified Mediterranean diet that helps maintain a low glycemic index. The goal is to keep your insulin levels low by avoiding refined or processed starches and sugars that are found in pasta, rice, bread, corn, and potatoes. Avoiding processed carbs and processed food, in general, will help keep your inflammation at bay and in turn reduce your lipedema symptoms. Along with reducing starches, avoiding gluten(found in wheat, rye, and barley) all together may be necessary to limit flare-ups. 

For a healthy lipedema care meal plan, you will want a nutrition plan that is high in omega 3’s. Mainstream health organizations recommend a minimum of 250-300 mg of omega-3s per day, the FDA recommends not to exceed 3000 mg of omega-3, but European Food Safety Authority (EFSA) says up to 5000 mg of omega-3s per day is safe. 

Why Are Omega-3s so Important if You Have Lipedema 

Omega-3s reduce the production of some substances (eicosanoids and cytokines) released during an inflammatory response in the body, reducing inflammation will help reduce lipedema flare-ups. Some added bonuses of increasing your omega-3 consumption are; it may help fight auto-immune diseases, decrease symptoms of anxiety and depression, improve eye health, promote brain health during pregnancy, improve risk factors of heart disease, reduce symptoms of metabolic syndrome, improve mental disorders, fight age-related mental decline, reduce fat in your liver, improve bone and joint health, alleviate menstrual pain, and improve sleep. 

Obviously incorporating more omega-3s into your diet will reduce inflammation and other symptoms that may arise from lipedema but what foods and supplements are best? Fish is high in omega-3s such as Mackerel (4,107mg per serving), salmon (4,123 mg per serving), herring (946mg per serving), oysters (370mg per serving-about 6 raw oysters), sardines(2,205mg per serving), anchovies(951 mg per serving), caviar(1,086 mg per serving). Now if you’re not crazy about fish, there are other options, flaxseeds, chia seeds, walnuts, and soybeans all have a similar amount of omega-3s per serving to their fish counterparts. 

**It should be noted that soybeans are high in omega-6s which can cause inflammation so you may want to leave the soybeans out of your diet.

Along with omega-3s, there should be a heavy focus on fiber in your diet plan. It is recommended that men get 38 grams of fiber a day and women 25 grams of fiber per day. Fiber can be split into soluble fiber(metabolized by good bacteria in the gut, water-soluble) and insoluble fiber(does not dissolve in water). Fiber feeds the good gut bacteria and works with our bodies in symbiosis by breaking down what we cannot on our own. By consuming fiber, we are feeding our gut bacteria “prebiotics” which the bacteria break down to produce necessary nutrients, short-chain fatty acids. Short-chain fatty acids feed the cells in the colon which can reduce gut inflammation. Fiber is also a necessary element to help you feel full and stay full longer! Also, it slows down digestion by absorbing water and in turn, increases the number of vitamins and nutrients the body can absorb. 

Omega-3s and fiber are incredibly important to reduce lipedema inflammation but what does that mean for what you should eat? Think of the standard food pyramid, instead of the high consumption of grains, it’s recommended to consume high levels of low-carb vegetables, herbs, and spices, such as cabbage, eggplant, carrots, cauliflower, Bok choy, peppers, broccoli, cucumbers, asparagus, etc. Here are some herbs for an extra boost of anti-inflammatory action: ginger, garlic, turmeric(with black pepper for absorption), cardamom, green tea, rosemary, and cinnamon. 

Next on the pyramid, you should consume a smaller amount of healthy fats like nuts- Peanuts, almonds, Brazil nuts, macadamia nuts, hazelnuts, pecans, avocados, coconut oil, and olive oil. Brazil nuts in particular have a large amount of selenium, a necessary nutrient that helps reduce the painful swelling that lipedema causes. It should be noted that only two brazil nuts a day can make a difference!

The next part of our pyramid is healthy protein. We’ve touched on a few fish for your omega-3s but you could also include eggs, chicken, turkey, tofu, shrimp, and tuna. Protein is another important component to help you feel full and stay full longer which helps reduce cravings. 

Lastly, we have lower-carb fruits, beans and legumes, and moderate-carb vegetables. Some lower-carb fruits include berries, melons, kiwis, mangos, and raisins. It is best to try to eat the rainbow! Each color has different nutrients and antioxidants necessary for a long-term healthy body and it’s much easier to track the colors you’re eating versus every nutrient each fruit/vegetable has in it. 

Patients with lipedema often have low levels of vitamin D3 so supplementing with four times the daily recommended dose of vitamin D is helpful along with Diosmin, and selenium if you are not able to eat brazil nuts. Fish and krill oil are great supplements to take on days you are not consuming high amounts of omega-3s

Now that we’ve covered food, what else can you do to keep lipedema symptoms aways?  There are multiple ways to keep your lymphatic fluids flowing such as yoga, dry brushing, massage, and compression garments. 

Yoga & Deep Breathing

Yoga is all around great for your whole body by lengthening, strengthening, and deep breathing, it can improve your health and mental wellbeing. Lymphatic yoga is even better for lipedema! Lymphatic Yoga can help move the stagnant fluid in the lymph system through the body and to the heart. Dynamic yoga such as sun salutations is great because it keeps you moving from one pose to another and encourages the movement of fluids. Any inversion poses and backbends will help fight gravity that keeps fluids in the lower part of your body from moving to the upper parts. Twists help with stimulating organs and stretching the spine. 

The lymphatic system lies just below the surface of the skin so dry brushing has been shown to stimulate the lymph system and help move venous blood. Dry brushing should be done with long firm strokes towards the heart. Start from your feet to the legs and groin and then hand to your armpits. An added bonus is your skin will be exfoliated and feel amazing! 

Massage & Deep Breathing for Lipedema Care

Lymphatic massage is a great way to reduce swelling and improve lymphatic circulation. You can go to a professional massage therapist who specializes in lymphatic massage or you can learn how to do it on yourself at home! When performing these techniques you should make sure you are relaxed, don’t perform this if it is too painful, and it should only affect your skin, so deep pressure is not needed.

Start by connecting to your deep breaths, slowly inhaling from your nose and out through the mouth. Try to make these breaths as long as possible with a pause between each breath. Like the dry brushing, you start from your feet and pull the skin up towards your heart with light pressure, so the skin stretches. Continue this all around the ankles, then calves and thighs. 

Compression

Last but not least, you can use compression garments! Luckily it will be getting colder so it won’t feel so hot and restricting to adding in an extra layer of clothes. It is best to use medical-grade garments because fluid flows from higher pressure to lower pressure and medical-grade compression garments have graduated compression. The compression at the lower part of the garment will force lymphatic fluid from the lower part of your body up through your body back towards your heart. Again, we’re fighting gravity so compression garments will need to be tighter for the legs versus your arms.

You Got This

Now you have all the options to keep your lipedema symptoms low over the winter months, from eating the rainbow to yoga, massage, and compression garments. It’s a difficult disease to battle but you’re not alone, and now you have a few extra tools that can help you along the way. Contact us today!

Before you start looking for more invasive treatments to help reduce the symptoms of your lipedema, there are a few tools you have right at home, and every little bit helps! Your nutrition plays a key factor in how and when your body experiences edema (swelling), and a large player in this experience is in response to the food you eat. Learn how to reduce lipedema swelling below!

Reduce Discomfort with Compression Garments! Click Here!

The Rare Adipose Disorder Diet (AKA RAD Diet)

Dr. Wright recommends following a Rare Adipose Disorder (RAD) diet, a modification to a standard Mediterranean diet that helps you maintain a low glycemic index to limit the number of occurrences and levels your blood sugar spikes through the day. In order to do this, it is recommended that you avoid any refined or processed starches and sugars. These are usually found in pasta, rice, bread, corn, and potatoes. Avoiding processed food – especially processed carbohydrates – will keep your insulin levels low and provide you the best chance at limiting inflammation. 

lipedema swelling

Interestingly, Lipedema experts also report that avoiding starches alone will not prevent symptoms from flaring up. It is also recommended that individuals with lipedema may want to reduce their gluten intake as much as possible. Gluten is typically found in wheat, rye, and barley. Instead of gluten, make sure your diet focuses on foods high in omega-3 fatty acids and are also high in fiber to assist your body in burning fat and fighting inflammation.  Focus on colorful foods like nuts, beans, fish, and whole grains. 

Lipedema Diet: Anti-Inflammatory Meal Plan

Need some recipe inspiration for how to follow the RAD diet plan and still enjoy whole, nutritious food? It’s easier than you think! Try the examples below, which use the following methods. 

lipedema swelling

Breakfast: Add something different to a slice of toasted, whole-wheat bread each day, so you’re following the plan but mixing it up enough that it doesn’t get boring! The following pairs well with a freshly toasted piece of bread: 

Lunch: Try keeping lunch to different versions of a salad. It’s easy to prep, light and fresh, and there are numerous versions of salads to make! 

Snack: Homemade trail mix is an easy on-the-go snack that also allows a wide variety of items to be included depending on what you’re craving. 

Any variety of the following meet the RAD Diet suggestions:

Dinner: 1 protein, 1 veggie, 1 grain or potato

Click Here to Learn More About Diet & Supplements for Lipedema!

Supplements for Fighting Lipedema Swelling

Another tool in your toolbox to help the fight against edema is ensuring you have a regular and robust vitamin supplement alongside the RAD diet. These vitamins and supplements can be found at your local drug store and are an inexpensive way to help. 

Vitamin D3: Lipedema patients are typically deficient in Vitamin D, an essential supplement that plays a critical role in your immune system. It also helps your bone, muscle, and nervous system health. It is recommended that lipedema patients who are deficient in Vitamin D take up to 4 times the Recommended Daily Allowance, or RDA.

Selenium: A supplement that can aid with your daily metabolism is Selenium. It has been known to help reduce lipedema swelling that is often painful and continuous. While supplemental pills can be hard to find you can find them in brazil nuts; eating just 2 of these nuts per day should be enough to notice a difference.

Diosmin: Perhaps the most effective supplement to take is Diosmin, a bioflavonoid that is commonly found in citrus fruits. They can have anti-inflammatory, antioxidant, and lymph-tonic properties that will help with your symptoms of lipedema.

How to Tell Lipedema Apart from Regular Fat?

Lipedema fat is an abnormal accumulation of fat in specific areas – usually in the lower body, though fat accumulation is symmetrical, it’s painful and easily bruises. You can read more about the difference here. 

Take a Look at Normal Vs. Lipedema Fat Here!
References:

1 Micke, O., Bruns, F., Schäfer, U., Kisters, K., Hesselmann, S., and Willich, N. (2000) Selenium in the treatment of acute and chronic lymphedema. Trace Elements and Electrolytes 17, 206-209 www.ncbi.nlm.nih.gov/pubmed/12694822

2 Kasseroller, R. G., and Schrauzer, G. N. (2000) Treatment of secondary lymphedema of the arm with physical decongestive therapy and sodium selenite: a review. Am J Ther 7, 273-279 https://www.ncbi.nlm.nih.gov/pubmed/11486162

3 [ http://www.ncbi.nlm.nih.gov/pubmed/10667641] shows the effectiveness of Diosmin Diosmin significantly improved symptoms such as leg pain, heaviness, and cramps. Diosmin also improved leg edema or swelling and decreased leg circumference. Other studies have shown Diosmin improved venous ulcer healing, hemorrhoids, and lymphedema. [Citationhttp://europepmc.org/abstract/MED/16014984]

DiCorleto, P. (2014). Why you should pay attention to chronic inflammation. Cleveland Clinic. Retrieved from https://health.clevelandclinic.org/2014/10/why-you-should-pay-attention-to-chronic-inflammation/

Doheny, K., & Chang, L. (2008). Anti-inflammatory Diet: Road to Good Health? Retrieved July 19, 2016, from http://www.webmd.com/food-recipes/anti-inflammatory-diet-road-to-good-health?page=3

Erlich, S.D. (2015). Omega-3 fatty acids. University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/altmed/supplement/omega3-fatty-acids

When dealing with the effects of lipedema, your body can also feel the repercussions of direct impact on your lymphatic and venous circulation system. Both systems together help the body create lymph. Venous disorders like venous hypertension and venous reflux impact these combined systems to create excess lymph production. Having an overwhelmed production can lead to overloaded lymphatic circulation. Both the venous system and our lymphatic circulation utilize passive contractions to clear this fluid from our limbs.

As a result, our team has put together some of the most important and most impactful information about Lipedema, how it can affect your veins, and how to get a proper diagnosis. Read it, re-read it, and share it with the women in your life. Some of the pain we’ve lived with for decades may actually have a life-changing solution! 

venous insufficiency

What is Lipedema?

Despite affecting an estimated 11% of women around the world, Lipedema is not yet widely known. Fat cells, (also referred to as adipose tissue) provide the human body with both cushioning and insulation. Lipedema affects the accumulation of these fat cells in the body, resulting in bulging, irregular fat in the affected areas. The legs are the most commonly affected area, but sometimes spreading occurs in the torso, and in many cases, excessive clustering of fat cells is noticed in the arms as well. Regardless of the affected area, the symptoms are equally debilitating, and unfortunately, these fat cells are equally resistant to both diet and exercise programs. 

Unlike Lymphedema or general obesity,  Lipedema has a tendency to affect both limbs equally and generally becomes more apparent over the course of time. Lipedema’s progressive nature makes getting a proper diagnosis and treatment imperative and extremely time-sensitive – as the disorder progresses so does the pain, immobility, and discomfort.

In addition to the characteristic disproportionate fat accumulation, there are specific physical signs and symptoms of Lipedema. Do any of the following Lipedema symptoms sound like something you regularly experience?

Lipedema Symptoms Checklist:

☑Tender skin that is sensitive to the touch, feels pressure when walking or climbing stairs, crossing your legs, or sitting for long periods of time.

☑Skin’s surface feels nodular and firm, like beans in a bean bag or rubber balls. 

☑Skin’s surface is uneven, with large bulges and valleys up and down. Areas that were traditionally thought of as cellulite are much more dramatic and bulging. 

☑Skin’s temperature is relatively cool.

☑Legs feel heavy and tired.

☑Swelling in the affected area (legs, arms), worsening during the day, and better at night after you’re able to elevate your limbs (such as laying in bed). 

☑Easy bruising.

☑Visible veins.

☑Disproportionate fat accumulation, not affected by calorie restriction. Think extreme “pear-shaped” body. 

☑Feet and hands are unaffected by weight gain or swelling. As a result, there’s often a “cuff” at the ankles or wrists.

Lymphatic Issues Occurring with Lipedema

Our lymphatic system has several key jobs to help our body function properly. First, it drains our body cells of any debris that needs to be removed. It also drains any excess fluid our tissues have built up. The lymphatic system also transports any clean fluid back to our blood that needs it. With such an important job for our body, it is critical to understand how lipedema can cause additional lymphatic issues. Individuals with lipedema will notice that their lymph fluids are not properly draining, causing a buildup in the legs. This fluid building can be painful and cause additional swelling.

venous insufficiency

Venous Issues Occurring with Lipedema

Our venous system is made up of deep venous pumps and veins located throughout the legs. These pumps when properly working pump 90% of the blood from the legs. The other 10% of the blood is pumped through a superficial venous system. While this system is typically less important than the deep venous pumps, they are at more risk when lipedema is involved. Blood flow may reverse and flow in the opposite direction; healthy vein valves ensure our blood is flowing in one direction for a healthy system.

Venous Insufficiency & Veno-Lipo-Lymphedema

The symptoms of Lipedema and venous insufficiency are similar. They both cause heaviness, tenderness, fatigue, and swelling. They often both have discoloration in the shins, easy bruising, and prominent veins. In more advanced cases of venous insufficiency, not only does venous lymphedema develop, but a secondary Veno- Lipo- Lymphedema develops. With the overwhelmed lymph circulation, the ability to clear fatty acids from the affected tissue is compromised and a secondary fat accumulation occurs. In many cases, the best way to differentiate between lipedema and venous insufficiency and veno- lipo-lymphedema is to have a specialized standing venous Doppler ultrasound to check for venous reflux.

venous insufficiency

Getting a Lipedema Diagnosis & Treating Vein Issues

Now that you’ve reviewed the signs and symptoms of Lipedema, determined that you identify with at least some of them, and you’ve familiarized yourself with other commonly related diagnoses, it’s time to find a Lipedema specialist and get tested! Each Lipedema doctor will have their own preferred method of diagnosing their patients and typically will include a physical exam, patient questionnaires, and then additional testing and ultrasounds to further support the physical exam. 

Below are the different tests you may experience during this time, and it’s important to keep them in mind as you select your doctor. Moving forward, thoroughness will be your best friend; we highly recommend “interviewing” different Lipedema experts to find someone you trust, someone who can provide at least some of these diagnostic tests, and someone who is well versed in treatment options.

Note: There is no single test to diagnose Lipedema. Tests, however, are important to rule out a related disorder.

Stemmer’s Sign Test

The Stemmer’s Sign is the inability to pinch the skin between the toes or fingers. As mentioned in our last section, Lipedema in advanced stages can be complicated by secondary Lymphedema and may have a stemmer’s sign. This test can help Lipedema experts determine if this is the case for you. 

Venous Doppler Ultrasound

A Venous Doppler Ultrasound is a very useful test for the diagnosis of Lipedema. Lipedema has many similarities to venous insufficiency (as explained above), so this can help rule out or confirm venous insufficiency.  The Venous Doppler Ultrasound can readily detect venous insufficiency if done properly and by having the patient stand while completing it. Unfortunately, most hospital vascular labs complete Venous Doppler Ultrasounds with the patient lying down, While this is the typical way to find Deep Vein Thrombosis (DVT), it is definitely not a successful method to detect venous insufficiency. A standing venous Doppler ultrasound is a painless, non-invasive, and inexpensive test that provides a lot of useful information about venous circulation. The Doppler ultrasound not only helps determine the presence of underlying venous problems, but it also gives critical information for managing Lipedema. If venous insufficiency is present, it is important that treatment is given as the resulting increased venous pressures can greatly aggravate Lipedema.

Lymphoscintigraphy

This is generally only used in complicated cases, where clinical diagnosis is not clear. This is a nuclear scan that assesses the lymph system. It may come back as normal in patients with Lipedema and may show the characteristic “corkscrew” changes with Lymphedema. In most cases of Lymphedema, lymphoscintigraphy shows delayed uptake. So lymphoscintigraphy can be very helpful to determine if and how significant a role lymphedema is playing in an individual’s symptoms, especially when there are widespread issues of swelling in the body. 

Treating Vein Issues

Vein insufficiency and other venous issues can cause your lipedema symptoms to worsen over time. Significant vein insufficiency can cause venous issues that are not superficial such as ulcers. If you are looking into surgical treatment for lipedema, you will need your vein issues to be treated first. Vein issues can cause problems during surgery if blood flow is not working correctly. It can also lead to poor wound healing after the procedure has been completed. The increased risk of blood clots is one factor any surgeon will want to avoid.

Life After Diagnosis

First – congratulations! We know the road to diagnosis is emotionally draining, physically painful, and it can feel lonely and discouraging. The time and research it takes to make it to this point are huge, and you should be proud of yourself and the courage it takes to be your own advocate. Our hope for all women with Lipedema, whether they are our patients or not, is that we can provide valuable tools and knowledge so that more women can make it to this point and take the next step in living a more mobile, healthy, and enjoyable life. 

venous insufficiency

After going through the diagnosis process and receiving a positive Lipedema diagnosis, most patients are relieved, overjoyed, and validated by their endless search. After years of living with the private struggle and knowledge that “something just isn’t right” in their body, putting a name to the issues is a huge win. And after an official diagnosis, there are many different treatment paths available to you! A treatment plan should be discussed and developed between you and your Lipedema doctor, but you can read more about the non-surgical and surgical options that we recommend to our patients. While these will always depend on specific cases and patient needs, they can give you an idea of what options may be available to you. Good luck! 

 

There’s nothing more satisfying and exciting for Dr. Wright and his team at Laser Lipo & Vein Center than celebrating patient wins! One of our favorite patients, Rita, spent her time in quarantine focused on getting through her lipedema surgeries, recovering safely at home, and both she and our team couldn’t be happier with her results! Rita’s experience is proof that Lipedema surgery can transform patient experiences as they walk through life (literally!) from pain and immobility to pain-free progress! 

lipedema surgery

Rita has undergone three Lipedema surgeries on her legs and has seen dramatically positive results. She’s continued to follow a generally healthy diet both before and after her surgeries but did not implement any form of diet changes, so these results are primarily the outcome of her lipedema surgeries! She’s gone from a size 24 to a size 14 in jean size, lost 30 pounds, and is now more easily active and mobile day-in and day-out. 

There are so many day-to-day activities that those without Lipedema wouldn’t think twice about, but patients with Lipedema struggle with and dread. Post-surgery, Rita has reported back to our office that after losing 10 pants sizes and removing the irregular lipedema fat in her lower body, she has no problems fitting into those frustrating chairs with arms on either side, she has enjoyed walking around the amusement park with her 10-year-old daughter without having to take breaks, and overall has enjoyed her active lifestyle, without the pain that used to accompany it! 
lipedema surgery

What is Lipedema?

Lipedema is a subcutaneous fat disease that primarily affects women. When we reference the “subcutaneous” tissue and fat, we’re referencing the layer of tissue directly under the skin. 

Shockingly, Lipedema affects an estimated 17 million women across the globe. This disease affects a huge number of women, the majority of whom are still walking through their world in a lot of physical and mental pain. Lipedema is a disease that leads to the excessive build-up of fat cells, primarily in the arms and legs. Women suffering from it often have “pockets” of fat on their limbs that appear disproportionate in comparison to the rest of their bodies. This disease causes an enlargement of the legs due to deposits of fat under the skin, and typically gets worse over time, making diagnosis and treatment essential.

It’s common for women with Lipedema to have a small upper body, while their lower body is disproportionately larger (kind of like an extreme pear-shaped body). Pockets of fat develop in the affected areas and appear to bulge in and out of the top layer of the skin. This is often mischaracterized as cellulite, rather than painful lipomas.

These pockets of Lipedema fat are accompanied by painful symptoms, such as excessive swelling, pain to the touch, numbness, and very easy bruising. If my dog jumped up on my legs, it was excruciating. Everyday occurrences that most people don’t think twice about, like accidentally bumping into a table or chair, can cause deep, painful bruises. 

lipedema surgery

As Lipedema progresses over time, these symptoms will continue to get worse as more Lipedema fat accumulates, and many women report that they are less and less mobile or active as time goes on. As a result, these women are stuck in a terrible cycle; they are less mobile, so they often gain weight, then it’s even more difficult and painful to be active, and the cycle goes on and on.

With Lipedema, we experience fat accumulation in specific areas, which may help indicate if your weight gain is normal or not. If you’re gaining pockets of fat that are out of proportion to other areas, this may be a tip-off that you have Lipedema.

While many women also see weight gain in their arms, it’s common that the following areas are greatly affected:

lipedema surgery

What Causes Lipedema?

We know that Lipedema is inherited in about 60% of women, and early studies show a genetic component is definitely at play (read more about that here!) and is the result of a malfunction of the Lymphatic System. The lymphatic system is a network of tissues and organs that help rid the body of toxins, waste, and other unwanted materials. This system transports lymph fluid throughout the body and is important for maintaining a healthy immune system. This disease affects the lymphatic system’s tiny vessels (microvessels) that cause a build-up of excess fluid around the body’s tissue cells. These tissue cells (located in the subcutaneous layers we discussed above) are then full of excess fluid, causing the swelling, soreness, bruising, and pain that many women with Lipedema report.

As researchers continue to gain understanding and genetic proof of Lipedema and differentiate it genetically from other diseases that they’re commonly misdiagnosed with, it will only become easier for women with Lipedema to get a proper diagnosis. Then, as the disease is more widely known and understood, treatments will become better and better, it will be more difficult for insurance providers to refuse coverage for treatments. Hopefully from there, more doctors will be trained in treating women with Lipedema properly, so treatments will become more accessible across the country! Read more about the first-ever Standard of Care Guidelines for Lipedema here!

How do you treat Lipedema?

There are two categories of treatment, surgical and non-surgical. Insurance providers require patients first try non-surgical treatment options before they’ll consider approving lipedema surgery, and Lipedema providers should be able to walk patients through this. While Lymph-sparing liposuction is the only treatment option that can provide permanent results by removing the lipedema fat, non-surgical options can help slow progression and are also necessary post-surgery (so it’s still important to practice them!).

Non-Surgical Treatment Options

To the dismay of patients, wearing medical-grade, tight compression garments 24-hours per day, seven days per week, is the key to improve circulation for the lymphatic system, making this a go-to prescription from Lipedema experts. Compression garments come in a variety of strengths and will be prescribed based on the stage and type of affected areas. The tighter the compression, the better.

A healthy and consistent lifestyle of clean eating and low-impact exercise to address obesity will also help with Lipedema. A diet focused on low-carb and low-sugar has proven successful. Low-impact exercise such as walking, water aerobics, yoga, or gymnastics has also reported success. Patients must avoid yo-yo dieting while also permanently losing or, at the very least, maintaining their weight. What works for one patient may not work for another. Diet and exercise recommendations and healthy practices are essential, but ultimately should be based on the individual with the understanding that weight gain is not an option. 

Some patients opt-in to Manual Lymph Drainage massage (MLD), a gentle skin massage used to stimulate the circulation of the lymphatic system. While experts have yet to find significant evidence that MLD helps with Lipedema directly, some patients prefer it for its “hands-on” nature to addressing their symptoms.

Lymph-Sparing Liposuction for Lipedema

For patients in the later stages of Lipedema, the pain and disruption to daily life are not permanently addressed with compression garments, diet, and exercise alone. Traditional liposuction that uses general anesthesia, radio frequencies, ultrasound, or lasers are possibly damaging to the lymphatic vessels, and as such are not an option for Lipedema patients, either. However, Lymph-sparing liposuction is safe, using surgical techniques that avoid lymphatic injury, and the use of local tumescent anesthesia reduces the risk of complications. Generally, the most painful areas should be treated first, starting high on the legs and then moving downward in future surgeries.

lipedema surgery

Start Your Life-Changing Journey 

Even with all the challenges presented by lipedema, there are those who you can trust. Dr. Wright continues to strive for better education, research, and coverage for the lipedema community. Do not let these challenges bring you down even further; let Dr. Wright and his expert team help you to reduce the symptoms of lipedema and live your life fully! Dr. Wright can help find the right procedure to help manage your lipedema symptoms. Don’t let lipedema take over your life; contact us today!