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.

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 the 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 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 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. 

Recovery

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 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.

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. 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 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

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!

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

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. 

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!

Lipedema Standard of Care

As of May 28, 2021, Dr. Wright and nearly two dozen other Lipedema experts led by Dr. Karen Herbst published 85 consensus statements making up the first ever Standard of Care Guidelines for Lipedema in the United States. Prior to it’s publication, other countries such as Germany, Spain, the United Kingdom and The Netherlands have documented and published Standards of Care for women with Lipedema, but the United States continued to lag behind it’s international colleagues. Ultimately, this resulted in American women with Lipedema being underdiagnosed, misdiagnosed, dismissed, and underserved. This publication is the first of many steps in the right direction to increasing awareness and proper treatment for women with this disease.

What are “Standard of Care” guidelines, and why are they important?

A standard Lipedema care typically refers to the formal guidelines that are generally accepted in the medical community for the treatment of a specific disease, condition, or ailment of some kind. These guidelines include important information including how to properly recognize and diagnose the condition in question, followed by the treatment process a medical provider should follow for patients with symptoms of the medical issue. The standard of care provides “best practices” developed by experts in the field who have come to a consensus of what is the most appropriate way to treat the condition at hand. 

The importance of having a standard of Lipedema care in place can be best understood by highlighting what happens when a standard is not in place, as we’ve seen in Lipedema prior to today. Clinical practice guidelines are compiled by the National Guideline Clearinghouse, which provides medical providers the ability to stay up-to-date on what the standard of care is in areas of treatment. When Lipedema is not included in these national guidelines, there are no resources for physicians to refer to. 

Without guidelines to the disease, symptoms checklists, or treatment plans, medical providers are unlikely to understand the disease or recognize it when they see it in their patients. Most women with Lipedema discover the disease on their own and bring it to their doctor to discuss a report being dismissed by their providers, who are unaware of the disease and have no medical expert guides as resources to refer to. This publication is a very important and exciting step to ending this cycle. 

A Background on Lipedema

An estimated 11% of the world’s female population, and 16 million women in the United States alone, are affected by Lipedema, a chronic, progressive, and disruptive fat disorder. Also referred to as Lipoedema in European countries, this disorder has a variety of symptoms, ranging from generally irritating to aggressively painful. Patients suffer from swollen, sensitive areas, unsightly, bulging and indented skin, and a disproportionately larger lower body. Without answers or solutions, patients often also suffer from secondary obesity. By the time they make it to a Lipedema specialist, they report similar stories; their primary doctors had not heard of Lipedema or dismissed it as unfounded. These medical professionals’ lack of knowledge leads to improper diagnoses such as general obesity, prescribing diet and exercise as a cure, and sometimes extraordinarily invasive and dangerous weight-loss surgeries. The journey towards diagnosis and treatment takes both a mental and physical toll of those it touches, a problem that the Standard of Lipedema Care guidelines seek to alleviate. 

11 Highlights from Lipedema’s Standard of Care Lipedema Guidelines

The Standard of Care for Lipedema guideline explains the following in far greater depth and should be the go-to resource for everyone in the Lipedema community, from providers to patients and their families. Below are only a few examples of action items provided, and the full standard should be consulted here for a comprehensive guide to understanding Lipedema, diagnosing it, and treating it across patients. 

 

  1. Knowing the barriers to treatment for women with Lipedema. It will be no surprise to women with this disease that patients have difficulty in self-care, limited mobility, experience a social stigma attached to their increased body size, experience anxiety and/or depression, and face a lack of knowledge in their healthcare providers. Plus, there are little to no affordable treatment options, and limited non-surgical options that offer any meaningful solutions. 
  2. There are no known medications that specifically treat Lipedema. Any use of medications or supplements should focus on reducing inflammation in the tissue, fibrosis, swelling, and pain. Medications that increase edema (swelling) or weight gain should be avoided and/or replaced with medications that are weight neutral or promote weight loss. 
  3. Lipedema tissue is resistant to diet, exercise, or bariatric surgery. This is likely due to the fibrotic component of loose connective tissues. While weight reduction of non-lipedema obesity is beneficial to reduce metabolic complications, the difference between Lipedema and non-Lipedema weight is imperative to successful treatment. 
  4. People with lipedema should be assessed for lipedema, lymphedema, posture, balance, muscle strength, gait and joint hypermobility. People with lipedema may benefit from postural and core exercises, muscle strengthening exercises, gait training, neuromuscular re-education, and deep abdominal breathing to increase lymphatic flow and stimulate the parasympathetic system. 
  5. Conservative (non-surgical) therapies or lipedema may help slow progression and possibly relieve symptoms, but at present there is little evidence on their effectiveness. Standard conservative therapy for lipedema includes nutritional guidance, manual therapy, compression garments, recommendations for a pneumatic compression device (external pump) and a home exercise plan.
  6. Lipedema reduction surgery is currently the only available technique for removing abnormal lipedema tissue. Adipocytes, nodules, fibrotic extracellular matrix, and other non-adipocyte components cannot be removed without lipedema reduction surgery, which utilizes suction lipectomy (liposuction), excision and manual extraction that spares blood and lymphatic vessels. Lipedema reduction surgery significantly improves symptoms,mobility, stance, gait, valgus rotation/deformity of the knee and ankle, quality of life, and redistributes and restores the plantar arch. It also improves lymphatic symptoms, reducing the need for compression and manual therapy and can improve lymphatic function as shown by radionucleotide lymphangioscintigraphy.
  7. Most people with lipedema have leg pain, all have leg swelling, either pitting or non-pitting, and many have underlying chronic venous disease. The physical examination should include inspection and palpation of pulses in the limbs. Pulse palpation in people with lipedema may be difficult and painful due to limb size. Common venous conditions seen in people with lipedema include increased risk for venous thromboembolism and conditions associated with chronic venous disease: varicose veins, chronic venous insufficiency, and telangiectasias (spider veins).
  8. Updated Definition of Lipedema: While lipedema is still considered a fat disorder, new evidence further clarifies that all of the components loose connective tissue in the subcutaneous space maybe affected by lipedema these include adipose tissue,  fibrous tissue lymphatic , veins and arteries of the subcutaneous space. Therefore lipedema should be considered a loose connective tissue disorder not merely a fat disorder even though abnormal fat accumulation is a principal characteristic of lipedema.
  9. The clinical criteria for the diagnosis of lipedema was agreed on.
  10. Stages and Types of Lipedema was agreed on. Lipedema was divided into stages 1 through 3 stage 1. Stage one is typified by small nodules in the subcutaneous fat stage 2 is characterized by larger nodules and visible indents in the surface of the fat in stage 3 is characterized by lobules in the skin. Some authors have described a 4th stage for lipedema and called it lipolymphedema. The proposed 4th stage would be when lymphatics are affected and cause a secondary lymphedema from the lipedema. Our current understanding of lipedema is that lymphatics are affected at all stages of lipedema. While stage 2 and 3 more often show lymphatic impairment than stage 1 there is no clear stage of lipedema where lymphatic are affected. 

 

TABLE 1: Classification of lipedema severity according to Stößenreuther (2001).

STAGE SKIN SURFACE SUBCUTANEOUS ADIPOSE TISSUE
STAGE 1 NORMAL SMALL NODULES
STAGE 2 UNEVEN BIGGER NODULES
STAGE 3 LOBULAR DEFORMATION LARGE NODULES & DEFORMITIES

 

TABLE 2: Types of lipedema, used to describe the location of lipedema fat

TYPE LOCATION
TYPE I BUTTOCKS, HIPS (“SADDLEBAGS”)
TYPE II BUTTOCKS TO KNEES, WITH FOLDS OF FAT AROUND THE INNER KNEE
TYPE III BUTTOCKS TO ANKLES
TYPE IV ARMS
TYPE V LOWER LEGS

 

  1. Common  Diseases Associated with Lipedema Diagnosis.

Common complications of lipedema including lymphedema non lipedema obesity venous disease and hypermobile joints were described.

 

Put Criteria for EDS hs .  Beighton Criteria.

Table 2: Beighton’s joint hypermobility score.

The ability to Right   Left
(1) Passively dorsiflex the fifth metacarpophalangeal joint to ≥90◦ 1   1
(2) Oppose the thumb to the volar aspect of the ipsilateral forearm 1   1
(3) Hyperextend the elbow to ≥10◦ 1   1
(4) Hyperextend the knee to ≥10◦ 1   1
(5) Place hands flat on the floor without bending the knees   1  
Total possible score   9  

One point can be gained for each side for maneuvers 1–4 so that the hypermobility score will have a maximum of 9 points if all are positive. (12)  12. Vounotrypidis P, Efremidou E, Zezos P, et al. Prevalence of joint hypermobility and patterns of articular manifestations in patients with inflammatory bowel disease. Gastroenterol Res Pract. 2009;2009:924138. doi:10.1155/2009/92413

References:

https://journals.sagepub.com/doi/10.1177/02683555211015887

https://pubmed.ncbi.nlm.nih.gov/34049453/

https://www.lipedema.com/us-lipedema-soc#join

June is Lipedema Awareness month, one in which the Lipedema community focuses (even more than usual) on how to reach women who have lived with this painful and distressing disease. While we’ve seen great strides in awareness, insurance coverage, and slightly greater recognition of this disease in the medical community, we continue to fight an uphill battle as women are underdiagnosed or completely dismissed when discussing their struggles and side effects with their providers. As a result, our team has put together some of the most important and most impactful information for all of you! 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! 

An illustration of Cartoon Women with Lipedema jumping into the air

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. 

Three woman in their underwear in a line

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 Lipedema 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:

Signs and Symptoms of Lipedema

3 Stages of Lipedema

Overall, Lipedema appears in a series of three stages. Do any of these sounds like you?

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.

Lipedema Infographic displaying the stages of lipedema

Below are conditions that can be confused with and can affect people with Lipedema. Because there can be so much overlap in appearance and symptoms, only clinicians with the training and experience to diagnose and treat these conditions can differentiate them. If you’re diagnosed with one of these conditions but you feel strongly that the diagnosis is incorrect, these summaries can help highlight why. 

Lymphedema

While Lipedema typically does not have to swell in the patient’s feet and hands, Lymphedema will always have swelling in these areas. Lipedema symmetrically affects both legs equally, but Lymphedema usually affects one leg or arm and leaves the other leg or arm unaffected. There may be overlap in these two diseases and treatments can be similar, but some patients only experience Lymphedema after their Lipedema progresses into later stages. 

Obesity

Obesity is much more common than Lipedema, and the most common misdiagnosis for it. While obesity is the accumulation of excess fat, stored centrally inside the abdomen or belly, Lipedema is the excess accumulation of fat out of proportion on the extremities, and typically not in the abdomen or belly. There may be overlap in these two conditions, too. In fact, sometimes obesity develops as a secondary condition due to the mobility problems caused by the Lipedema. So, not only is lipedema often misidentified as just obesity, but obesity can also complicate Lipedema, and be a symptom of it. 

Venous Insufficiency and 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.

Getting a Lipedema Diagnosis & Next Steps

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. 

Life After Lipedema 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. 

Woman in a light blue sweater jumping in front of a pink background

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 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. Good luck! 

 

It’s not uncommon for women with Lipedema to either be misdiagnosed with severe obesity, or diagnosed with both Lipedema and obesity. In either scenario, it can be difficult to know what the next step should be. And if your doctor is recommending a serious surgery, such as bariatric surgery, to address obesity, it can be even more difficult to understand the relationship that has with lipedema, and how treatments should work so that both issues are addressed. 

Typically, BMI plays a large role in the starting point for obesity diagnosis, even if patient’s are certain they have lipedema. But what many don’t realize is that both can be true! The longer your lipedema goes untreated, the more it progresses. And the more lipedema progresses, the more likely it is that you develop obesity as a side effect. For example, while Lipedema fat accumulation can contribute and lead to a Body Mass Index (BMI), of up to 35, obesity in addition to lipedema can lead to higher BMIs, ranging from 45 to 50+. In these cases, it’s imperative to first address and treat obesity prior to putting together a treatment option for lipedema, and the most successful obesity treatment is Bariatric surgery. 

What Does BMI have to do with Lipedema?

Body Mass Index (BMI) = weight in pounds (or kilograms) divided by height in feet squared (or meters squared). 

Body Mass Index (BMI) is simply an overall numerical score (like height and weight) which is not a biological representation of a person’s overall health. While the World Health Organization (WHO) defines a BMI over 25 as overweight and over 30 as obese, this is actually an inaccurate and incomplete assessment. Overall, obesity is a condition where fat mass affects patients metabolically, chemically, and mechanically (for example, in your joints).

 

In many cases, BMI is actually a very flawed number that leads doctors to misdiagnose women with Lipedema with obesity instead. The Body Mass Index (BMI) calculation is an unfortunate oversimplification of a person’s health, and ignores extremely important factors that are imperative for accurate diagnosis and treatment plans. Family history and genetics, general lifestyle and activity levels, age, gender, and body composition (muscle mass, water content, bone mass) are all essential parts of our health profile, all of which are ignored by the BMI calculation. Despite all of this, it continues to be used worldwide to aid in diagnosing (or misdiagnosing and oversimplifying) patient health profiles.

As mentioned above, lipedema can lead to a BMI of 35 simply due to the disproportionate fat it creates. At this point, it’s unlikely that patients have metabolic fat accumulations, because lipedema fat is somewhat cardiac protective. At this point, patients can likely manage it well enough with an anti-inflammatory diet and regular exercise. 

This helps treat lipedema, and is associated with weight loss because low inflammation means patients also have low insulin excretion, which, in itself, helps patients feel better, improve health, and manage their lipedema. 

However, once a BMI over 35 is reached, patients are considered to have both lipedema and obesity. At this point, weight loss is CRITICAL. You must address that first, because the increased weight puts additional pressure on your lymphatics, further aggravates the existing lipedema, and continues to negatively affect venous return. All of this leads to more serious medical issues. 

The metabolic issues that develop from obesity are extremely serious, especially high blood sugar and increased levels of triglycerides which can aggravate and increase BMI even more. Ultimately, patients find themselves in a disastrous cycle, starting with increased BMI and fat accumulation, leading to the metabolic issues, and then to further increases in obesity and lipedema. 

The best part about addressing obesity with Bariatric surgery? It increases the odds of significant and long-term weight loss. 

One study showed that 95% of people who lose 20+ lbs (without surgery) ultimately regain it, and only 5% keep it off. Patients who undergo Bariatric surgery, on the other hand, experience a weight loss of 65-70 lbs on average, and are 10X more likely to keep it off in comparison to traditional weight loss diets. In fact, over 60% of patients who undergo this surgery are able to keep this off for 15+ years, and they lose, on average, 70% of their excess weight.  Meanwhile, only 3.4% of patients regained the weight within 10 years post surgery! 

Obesity in lipedema patients should be addressed prior to liposuction for lipedema, because about 10% of patients regain their fat in the treated areas – especially those who have the higher BMI. Lipedema and obesity experts are finding that post surgical growth of lipedema tissue can affect a staggarting 30% of patients, so ultimately patients are more likely to have recurrence of lipedema fat if treated prior to addressing their obesity. And Bariatric surgery is the most successful treatment for obesity in these patients by far. 

I’ve recovered from bariatric surgery. Now what?

After fully recovering from your bariatric surgery, it’s important to do two things. First, maintain a healthy diet and exercise routine, following the anti-inflammation based diet mentioned below, and exercising daily for about 30 minutes a day. Below is an example of what a daily meal plan should look like. 

While continuing this practice, you should also start working towards your official lipedema diagnosis, if you don’t already have one. As you continue your post-bariatric surgery lifestyle, you’ll want to start working towards a lipedema treatment plan. Now that you’ve freed your body of the obesity-related fat, it means you’ll have greater success in ridding your body of the painful, swollen, stubborn lipedema fat. Check out these resources for how to best address the next steps of diagnosis, non-surgical treatment options while you wait for lipedema surgery, and what to expect from lipedema surgery as well. 

Contact Dr. Wright today if you have questions or would like to set up a consultation – his team is available to help guide you wherever they can!

There’s nothing more frustrating than sticking closely to an exercise routine and never deviating from a diet without any results to show for it. While some may attribute this scenario to a subpar attempt at fighting fat, for many, there is an underlying medical reason that weight isn’t being lost despite a concentrated effort. When diet and exercise aren’t doing the trick and in some cases, weight continues to accumulate over time, it’s time to look more closely at what could be causing this to happen, as seen in this medical study. 

Woman in sports bra and leggings sitting on wall

Nearly 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 unruly weight gain in its initial stages can quickly spiral out of control if left undiagnosed. Often striking in a woman’s mid-20s, 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 present with pockets of fat on the limbs that appear disproportionate in comparison to the rest of the body.

Lipedema Symptoms and Signs

Woman with Lipedema posing in her underwear

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 provokes vascular and lymphatic swelling which can lead to further medical complications.

Lipedema is often misdiagnosed as standard obesity, leaving patients to deal with an endless cycle of disappointment and ongoing pain as symptoms continue and weight refuse to fall off. Unfortunately, Lipedema does not respond to an altered diet or increased exercise and ultimately requires cosmetic intervention in order to alleviate the appearance and pain of symptoms. Patients often report that the road to their initial diagnosis is an uphill battle. Women with Lipedema are typically diagnosed by their primary care provider with traditional obesity, and all treatment methods follow this diagnosis.

Examples of Lipedema Signs & Symptoms:

Ball and Chain on Leg

Woman checking legs on couch

Unfortunately, as any Lipedema specialist will tell you, this treatment proves ineffective, and leaves women with Lipedema without answers, without a solution, and with continued pain and continued frustration as their, Lipedema continues to progress. 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. But before women with Lipedema and even consider these procedures and treatment options, they must first find a doctor who is an expert in this field and start with a proper diagnosis of the disease.

Selecting Expert Care

When it comes to liposuction specific to treating women with Lipedema, an experienced physician is required to perform the procedure successfully. While 93% of doctors and nurses are not aware of Lipedema or the symptoms it causes, experts in this field are working diligently to advance the field and continue finding the best methods of care. Advanced technique and precision planning are both required to remove diseased fat deposits and achieve long-term results, and as a result, the best way to find solutions is to partner with an experienced Lipedema healthcare provider.

Doctor discussing procedure to Patient

Women suffering from Lipedema should always take the time to ensure they are under the care of a physician who specializes in Lipedema treatment and is willing to work closely with their patients to create customized treatment options.

Stages & Progression of Lipedema

As patients work through getting an official lipedema diagnosis, experts will first need to determine what stage the lipedema is currently at. There are three different stages, or levels of progression used to evaluate how far the disease has progressed in the affected areas of the body – the first stage being the earliest onset, and the third stage the most progressed.

As lipedema progresses through these three stages, the level of pain, tenderness, swelling, and fat accumulation may increase. Depending on the person, different parts of the body can be affected in different ways at each stage.

The Only Way To Reset Lipedema Progression: Lymph Sparing Liposuction

Once you’ve been properly diagnosed by a doctor specializing in Lipedema, patients are advised to start with conservative and non-surgical treatment methods. While lymph-sparing liposuction for Lipedema is the only effective way to stall or stop the progression of Lipedema, non-surgical methods allow the patient and their doctor to first determine what their specific symptoms may be responsive to.

Examples of Conservative Lipedema Practices:

Woman in a lake, legs visible

However, in reality, lymph sparing liposuction will be the most effective and long-lasting treatment option for women with Lipedema. After regular practice of the available conservative Lipedema treatments, Lipedema experts may recommend a surgical plan for addressing the affected areas based on their patient’s specific needs. Lymph sparing liposuction has been shown to improve the quality of life of patients post-surgery, improve their pain long-term, increase mobility, and provide access to a new, more active lifestyle than they’ve previously known.

Modified liposuction surgery is the only available technique to correct and remove the abnormal adipose tissue of lipedema. Liposuction is a surgical treatment that involves the application of local (tumescent and water-assisted) anesthesia, and subsequent removal of adipose tissue through a straw-like device called a cannula. One end of the cannula is connected to a vacuum device, and the other end is inserted through a small incision of the skin and removes.

Lipedema Procedure Tools

There are two techniques of liposuction that can be safely used to treat lipedema, provided the surgeon has experience in techniques to avoid injury to the lymphatics. Note: Lipedema patients often have impaired lymphatic function, so great care must be taken to avoid further damage. The two liposuction techniques that are safest and most effectively used by surgeons with a great deal of experience with the treatment of lipedema are tumescent liposuction and water-assisted liposuction. These two are the only research-backed surgical treatment plans for lipedema

Tumescent liposuction for Lipedema

involves the introduction of large volumes of tumescent solution into the fat below the skin space to tumesce (or swell) the area. This solution contains lidocaine anesthetic, which causes local numbness; epinephrine, which causes constriction of blood vessels to reduce the risk of bleeding; and saline, which causes swelling of the adipose tissue and protects the vascular structures from trauma. The solution is allowed to infiltrate the tissue, and its salinity causes the adipose tissue and cells to swell and separate from the connective tissue, at which point the cannula is used to aspirate the fat.

Water-Assisted Liposuction

This type of liposuction treatment for Lipedema does not involve over-swelling [tumescence] of the adipose tissue. Instead, small amounts of tumescent solution and water are introduced into the adipose tissue. Once sufficient numbing occurs, a modified cannula with an attached fan-shaped and slightly pressurized saltwater jet is inserted into the subcutaneous space and applied to separate the adipose cells from the tissue, while simultaneously aspirating the solution and detached cells.

Trust the Professionals in the Field

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!

Hi everyone – it’s Cat again!

If you haven’t read my story or seen any of my videos before, I’m a long-time patient of Dr. Wright and am working towards completing a total of five Lipedema liposuction surgeries with him. I’ve put together some helpful tips and a bit about my story, and you can find all my videos on Dr. Wrights YouTube channel.

My Lipedema Experience infographic featuring Cat

At the end of February, I hit the one-year mark since undergoing my second Lipedema surgery. My initial goal was to get all five surgeries completed within one year of being diagnosed (in October 2019). However, thanks to COVID-19 and life and money and insurance unhelpful companies, here I am; It’s already March of 2021, and I’m praying I can get a third surgery done soon! Until then, I want to continue helping women like me who are struggling with Lipedema, in the hopes that I can show you the light at the end of the tunnel, and help make the journey a little less overwhelming! In the video below and through this post, I’ll take you through what my life has been like since recovering from my 2nd surgery, and what it’s like being half-healed; I’m living in the in-between of some areas being treated while others are still in the midst of the struggle.

My Treatment Plan

After being officially diagnosed and working on non-surgical treatments, I met with Dr. Wright and his team to determine what surgeries I would need and on what areas of my body. We determined that I had Lipedema swelling and fat in my legs, abdomen, and arms, and would need a total of five surgeries: My legs, abdomen, front of my thighs, back of my thighs + buttocks, and my calves. I completed the front of my thighs in December 2019 and the back of my thighs and buttocks in February 2020. I had about 8 liters of fat removed in the first Lipedema removal surgery, and 12 liters (INSANE) in my 2nd surgery. To give you an idea of this volume, 8 liters is about 2 gallons of fat. So between the two, I’m free of a huge amount of lippy fat and am about 35 pounds lighter.

The Liposuction Machine used for Cat's Procedure

Because I live in Austin and Dr. Wright’s office is in St. Louis, the COVID-19 pandemic has made continuing surgeries difficult. His expertise, kindness, and genuine passion for helping women like us make the travel well worth it under any other circumstances, but we’re trying to be extremely cautious with flights. Over the last year, my partner and I have even thought about making the 13-hour drive to his office rather than continuing to wait, but the thought of riding in a car post-surgery is daunting.

Picture illistrating Cat's progress through the procedure

In mid-march, I have a virtual consultation with Dr. Wright to touch base and make plans for my 3rd surgery, this time focused on my calves. I’m so excited to get the next phase rolling, and hoping that the world calms down and allows for safe travel soon!

Recovering from the Lipedema Removal Surgery

My first and second surgery recoveries were actually extremely different. While the overall process and the surgeries themselves were all the same, I needed a week to recover the first time, and about two weeks to recover the second time. My backside was a bit harder to recover from due to the large volume of fat that was taken, and simply because sitting and laying down was more uncomfortable. I was able to drive, work, and get back to most of my routine within a few days, but I preferred to take it easy for the full two weeks because I was still leaking tumescent fluid, and putting on those compression garments is tough for the first two weeks (more like the first 6 weeks, just to set your expectations…) – I preferred to do this in the comfort of my home for as long as possible.

Cat post procedure with a blanket

Interestingly, in the first surgery, I had a lot of numbness on the inside of my thighs, which lasted about a month. Numbness is completely normal after liposuction as your nerves start to heal, so it wasn’t necessarily worrisome, but it was uncomfortable. It made walking extremely uncomfortable and, to the delight of my friends and family, I waddled like a duck for several weeks. So even though I spent more time on the couch after my second surgery, I still “enjoyed” it far more than the first. It’s just proof that every area of the body and every patient is different. But I loved the end results of both!

Life After Lipedema Surgery

As I sit here today, I find myself in a funny limbo in regards to living with my lipedema. The already-treated areas of my legs are doing great! No bruising, no swelling, and no sensitivity at all. In fact, my thighs even feel different to the touch – the remaining fat (I’m no bodybuilder yet, haha) is soft and fluffy – something I’ve never experienced before. The only fat I’ve ever encountered has been dominated by my lipedema fat – firm or tight, bulging, and sore.

But because I’m mid-treatment overall, the remaining areas of my body are still very much experiencing the pain of lipedema. The tops of my legs are great, and the bottom of my legs are struggling. My arms and abdomen are progressing and gaining more fluid and lipedema fat. As I work out, I get excited to see small changes in my thighs and depressed seeing no changes in the other parts of my body. When I bump into something with my calf and I get a pang of pain, I get angry and then grateful when I realize I can’t remember the last time I felt that in my thighs. It’s so many mental and physical feelings and changes all at once!

Other Positive Changes Post Lipedema Removal

There are so many things that anyone outside of the lippy community wouldn’t think twice about but have had a profound and positive impact on my life post-surgery.

How Can I Help You?

As I move into my next three surgeries, I’m sure I’ll have more updates! But until then, what questions do you have about my lipedema journey or the general process for getting treatment? Leave a comment or contact Dr. Wright and his team, and we’d be more than happy to put together more resources for you! We’re all in this together!

All the best,

Cat