In June 2017, international experts on liposuction for Lipedema joined together to discuss their findings on this under-diagnosed disorder, and to evaluate current European guidelines for treatment. The First International Consensus Conference on Lipedema sought to bring experts together to solidify the consensus that one specific surgery, Tumescent Liposuction, is the only proven and most promising treatment option to help millions of affected women. This article is a summary of their findings. Additional research and all sources can be found in the published paper via PDF by the American Society for Dermatologic Surgery, Inc.
A Background on Lipedema
An estimated 10% 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.
Signs of Lipedema
The easiest way to spot someone with Lipedema is to compare their top and bottom halves; the lower body is proportionally more massive than the upper body (think extremely pear-shaped), as seen in the photo here. Those suffering from the disorder experience a range of symptoms: Swollen, large legs proportionately more massive than the trunk.
- Unaffected, normal-sized feet with fat accumulation abruptly stopping at the ankle.
- “Cuffs” at the wrists and ankle.
- Easy bruising and tenderness to the touch in the affected areas.
- Decreased mobility due to pain.
- Secondary obesity.
- Difficulty finding clothing that fits appropriately due to disproportionate fat accumulation.
Types & Stages of Lipedema
We also know that this disorder is highly progressive and characterized into five types and four stages. If no treatment is implemented to stop the progression, patients will move through each stage and are likely to experience all types as well.
Lipedema Types by Area
|Type I||Buttocks and Saddlebags|
|Type II||Thighs, down to the knee|
|Type III||Legs, down to the ankle|
|Type V||Calves Only|
|Stage I||The skin is smooth and even but has an enlarged subcutaneous fat compartment.|
|Stage II||The skin surface is wavy with some indentations and elevations.|
|Stage III||Large nodules, hanging fat flaps (esp. on thigh and knees).|
|Stage IV||Progresses past prior stages and now includes lymphedema.|
What’s Happening in the Body to Cause Lipedema?
We all have adipocyte cells in our connective tissues, which specialize in storing our fat. These cells experience hypertrophy, an increase in the size of these cells. At the same time, the cells experience hyperplasia, an increase in the reproduction rate of these cells. Both processes cause the tissue to enlarge irregularly. The capillary glands (branch-like blood vessels) are not able to allow fluid to pass through smoothly, which then causes bruising and sensitivity. As time goes on, cells continue to enlarge the tissue and circulation slows down. Excess tissue continues to build up, and we see more significant deformities at the skin’s surface, causing the following:
- Forced spread of legs due to painful fat deposits on inner, upper thighs.
- Decreased mobility or ability to move around at all.
- “Bottleneck” fat pad on the outside of the leg, just below the knee
- Presence of Spheroids: Small, 5-10mm “bean-like” nodules at the surface of fatty, affected areas. The number of these spheroids increases as patients progress to new stages.
- Irregular fat accumulation in affected areas.
Nevertheless, despite everything we know, why are we only now finding solutions? This question is a difficult one to answer. First, the cause is still widely unknown. Second, frequently the symptoms are attributed to something else – usually general obesity. More than half of reported cases show a degree of family history of the disorder, but not all of them. Often patients report the early onset of symptoms at puberty, but sometimes it is triggered with pregnancy or menopause. Interestingly, one medical study found only 3 in 500 Lipedema patients suffered from Type II Diabetes, suggesting that Lipedema fat is not insulin-resistant like “normal” fat. This irregular fat may protect patients from developing diabetes and supports the diagnosis of Lipedema as something outside of general obesity.
Taking everything that we know and everything that’s still unclear, experts have broken down treatment into both surgical and non-surgical options. Both categories of treatment seek to improve the signs and symptoms of leg volume, pain, swelling, disproportionate limbs, and to prevent infection or further progression. However, because Lipedema is a progressive disorder, non-surgical options will only serve to try and eliminate further progression. Surgery via tumescent liposuction is the only way to remove lipedema fat that’s already developed – diet, exercise, and non-surgical treatment options have proved unsuccessful in removing this irregular fat. Yo-yo dieting and obesity have been shown to make Lipedema worse, so finding the right treatment as early as possible is imperative.
Non-Surgical Treatment Options
Much 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 also opt-in to Manual Lymph Drainage massage (MLD), a gentle skin massage used to stimulate 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.
Surgical Option: Tumescent Liposuction
Tumescent is a local anesthesia that puts the treated area in a numbed “state o
f tumescence.” Surgeons deliver the liquid to the treated area via IV tubes, causing a firm “watermelon” surface that remains firm for longer than half an hour. During this time, both limbs (arms or legs) are treated to ensure symmetry, and draining of the area may last for several weeks following the surgery.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, gentle on the lymphatic system, 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.
Post-Surgery Care & Recovery
Swelling may last for 4+ weeks after surgery; however, low-impact movements can begin relatively quickly, as soon as the incisions have closed and healed, usually within two weeks. While compression garments must be worn for at least four weeks following surgery, long-term results offset this requirement. One study of 85 patients checked in with each of them six months, four years, and eight years after their surgery. Each patient reported an increase in quality of life and skin appearance post-op and a decrease in pain, pressure, sensitivity, bruising, and mobility impairments at each check-up. This outcome suggests that the benefits of surgery are experienced both quickly after healing and long-term. ⅓ of the patients reported they were completely free of all symptoms, and ongoing non-surgical measures were no longer necessary.
Why Tumescent Liposuction is the Best Option
While non-surgical options will be less expensive and more accessible, it is crucial to remember that they are also solely for slowing the progression of the disorder. Not only will the patient be required to implement these lifestyle changes indefinitely, these changes will only work to ease their symptoms and slow down further growth. Side effects of lipedema may become less severe in some patients and have little or no effect for others in more progressed stages. However, tumescent liposuction has proven to not only slow progression but reverse the lipedema stages of patients to deliver a higher quality of life. Lymph-sparing liposuction using local tumescent anesthesia is the most promising and only effective treatment for patients with Lipedema.
Although it’s been a few years since the First International Consensus Conference on Lipedema, ongoing research has not slowed down. Stem cell research shows early indication that cells in lipedema may be different than cells in normal fat. Hematoxylin and eosin staining, a process using various dyes to help distinguish different cell parts from each other within tissue samples, reveals crown-like structures within lipedema fat cells that do not exist in normal fat. Both findings support the understanding that lipedema fat requires special consideration for patients seeking treatment. As research continues, lymph-sparing liposuction using tumescent local anesthesia is the only effective and permanent treatment for lipedema patients.
Kami Export - 2019-Sandhofer-et-al-Prevention_of_Progression_of_Lipedema_With_Liposuction_using_TLA-DermSurg-2019 (1)