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Lipedema diagnosis

One of Dr. Wright’s newer patients, Crystal, was diagnosed with Lipedema for the first time just 3 months ago, and she’s already feeling the joy and relief that comes with an official Lipedema diagnosis

“I felt a sense of relief and joy come over me instantly,” she says. 

Crystal was diagnosed by Dr. Wright with Stage 3, Type 3, and 4 Lipo-Lymphedema. Over the next 90 days post-diagnosis, she’s undergone two Lipedema surgeries and overcome a lifetime of challenges when it came to “her relationship with gravity”, as she calls it. She lost just over 70 pounds after the two surgeries and is relieved to be on a path of healing. 

Lipedema diagnosis

What is Lipedema?

Lipedema is a fat disorder, mainly affecting women, that causes an enlargement of both legs due to deposits of fat under the skin. It’s characterized as a “progressive disorder,” meaning it generally gets worse over time. In severe and more progressive cases, the trunk and upper body may also be affected, including the arms and upper back, and it’s often misdiagnosed and incorrectly treated as general obesity.

 

Nearly 17 million women in the U.S. and nearly 370 million women across the globe suffer from 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.

Troubling Signs and Symptoms

Women suffering from this disease often report the association with lipedema pain 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 diagnosis

Living with Lipedema Diagnosis

Lipedema is often misdiagnosed as standard obesity, leaving patients to deal with an endless cycle of disappointment and ongoing, painful lipedema symptoms. As they continue, their weight refuses to fall off. Unfortunately, Lipedema does not respond to a simple calorie restriction or increased exercise and ultimately requires surgical intervention in order to alleviate the appearance and pain of symptoms. 

Lipedema diagnosis

Patients often report that the road to their initial Lipedema 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.

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 one of the most effective forms 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.

Getting Help & Lipedema Treatment

Just like Crystal, many women search for answers for years before getting an official diagnosis and validation for their struggles. “My body really needed this healing,” Crystal says. “I needed answers and I was craving [an] explanation why my body was fighting me.” While she contributes 15 pounds lost directly to her surgeries, she says she’s done the non-surgical work to get rid of additional lipedema swelling and fluid alongside surgery. She says she monitors what she eats and when, and eliminated a few types of foods that directly increase swelling, helping her lose more than 50 pounds on her own, and improving the outcomes of both her surgeries tenfold. 

She encourages other women who think they may have Lipedema to contact Dr. Wright and his team to get the same help she’s received. “If you have lipedema or lipo lymphedema like I do, go easy on yourself,” she says. “There isn’t anything you could have done to prevent it, but I’m living proof there are things you can do to live better and have a higher quality of life.”

Before tackling the issues and symptoms associated with lipedema, it is important to assess your vein health by working closely with a vein specialist. Vein issues and lipedema, both can cause painful, heavy legs, and tenderness, so it can be difficult to know if your symptoms are related to veins or solely to lipedema. An experienced vein specialist can get you on the right path to a diagnosis and treatment plan.

Common Vein Issues

Understanding the limits of vein treatment in lipedema

Many women with lipedema require lifelong use of compression garments, so the advantages of treating vein issues are somewhat limited. Plus, unfortunately, edema in the legs of lipedema patients generally does not significantly improve after vein treatment. However, lipedema reduction surgery can at least temporarily treat venous insufficiency. Vein issues and issues with the lymphatic system are connected.

3 Reasons to Treat Vein Issues before Lipedema

  1. Cross-over in symptoms of between vein issues and lipedema.
  2. Vein issues stress the lymphatic system.
  3. Always treat varicose veins before leg liposuction to prevent complications during the liposuction procedure.

Learn more about their relationship.

What is Lipedema?

Lipedema is a fat disorder, mainly affecting women, that causes an enlargement of both legs due to deposits of fat under the skin. It’s characterized as a “progressive disorder,” meaning it generally gets worse over time. Sufferers living with lipedema experience easy bruising and tenderness, pain in the affected areas, and significant disability in daily life. In severe and more progressive cases, the trunk and upper body may also be affected, including the arms and upper back. Little is known about the disorder, and it’s often misdiagnosed and incorrectly treated as general obesity.

What is lipedema reduction surgery?

Lipedema reduction surgery is a spin-off of liposuction focused on the reduction of lipedema tissues including fibrous tissue, fat, and extracellular contents. It is possible for lymphatics to be injured by a suction cannula during lipedema reduction surgery and/or cosmetic liposuction. Some argue whether this is possible, but studies show it can, and unfortunately, may happen for some. So, it is important if you have lipedema, or suspect you may have lipedema that you get a proper diagnosis and work closely with skilled surgeons well-versed in lipedema, lymphatics and lymphedema for the best possible outcomes and treatment plan before you proceed with any type of liposuction.

According to a study by Wright and Herbst, in patients with normal lymphatic function, and no severe injury to the lymphatic collectors, the lymphatic system almost always recovers and returns to a normal state. Suction lipectomy with small blunt cannulas and surgical techniques that focus on avoiding lymphatic damage have been reported to halt lipedema progression. A modification of suction lipectomy can result in alleviating or at least improving the swelling, leg heaviness and fatigue, the need for limb compression, and the need for lymphatic massage in women with lipedema. In patients with an impaired lymphatic function such as chronic lymphedema (or lipedema), careful suction lipectomy using techniques to avoid lymphatic injury can result in improved lymphatic function and a decreased rate of secondary infection or cellulitis in the affected limbs.

Lymphatics and Lipedema

There are well-documented changes in the lymphatics of women with lipedema. The lymphatics are dilated and tortuous. Here are the differences between lipedema and lymphedema:

What are measures that may protect lymphatics?

Protective measures to lessen risk of lymphatic injury include:

Effective techniques to lower the risk of lymphatic injury

The short answer is this issue is hard to study as it is not possible to examine on live patients. There is one study by Hoffman which showed a longitudinal cannula technique and tumescent solution caused less injury to the lymphatics post-mortem. There is some evidence that the preoperative mapping of venous and lymphatic structures can lower the risk of lymphatic injury. While there is clear evidence lymphatic injury can occur, there is no definitive proof of what surgical techniques can prevent lymphatic injury from liposuction or lipedema reduction surgery. Lymphatic injury complications are poorly recognized after suction lipectomy surgeries and therefore are less likely to be reported in the literature for both lymphedema and lipedema.

References

Crescenzi R, Marton A, Donahue PMC, Tissue sodium content is elevated in the skin and subcutaneous adipose tissue in women with lipedema: Obesity (Silver Spring), 2018; 26(2); 310-17.

Hoffmann JN, Fertmann JP, Baumeister RG, Putz R, Frick A. Tumescent and dry liposuction of lower extremities: differences in lymph vessel injury. Plast Reconstr Surg. 2004 Feb;113(2):718-24; discussion 725-6. doi: 10.1097/01.PRS.0000101506.84361.C9. PMID: 14758241.

Iker E, Mayfield CK, Gould DJ, Patel KM, Characterizing lower extremity lymphedema and lipedema with cutaneous ultrasonography and an objective computer-assisted measurement of dermal echogenicity: Lymphat Res Biol, 2019; 7(10); 525-30.

Peprah K, MacDougall D: Liposuction for the treatment of lipedema: A review of clinical effectiveness and guidelines, 2019, Ottawa (ON), Canadian Agency for Drugs and Technologies in Health.

Rasmussen 2022.[https://pubmed.ncbi.nlm.nih.gov/35707862/]  It also well reported that higher stages of lipedema are associated with impaired lymphatic functioning. ,7–9].

The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology: Lymphology, 2016; 49(4); 170-84.

Wright TF, Herbst KL. A Case Series of Lymphatic Injuries After Suction Lipectomy in Women with Lipedema. Am J Case Rep. 2022 Jul 11;23:e935016. doi: 10.12659/AJCR.935016. PMID: 35811389; PMCID: PMC9284075.\
https://my.clevelandclinic.org/health/diseases/16872-chronic-venous-insufficiency-cvi
 https://www.mayoclinic.org/diseases-conditions/varicose-veins/symptoms-causes/syc-20350643#:~:text=Varicose%20veins%20may%20be%20caused,(superficial)%20can%20become%20varicosed.

Good news, these conditions are not life-threatening on their own. However, if undiagnosed or untreated, they will worsen over time and may contribute to several other secondary ailments and complications. If you have signs of swelling, and pain in your body, especially in your legs and arms, seek treatment starting with your primary care physician. Ongoing care of lipedema and lymphedema with a vascular expert lessens the risk of other serious problems.

Hearing the terms lipedema and lymphedema sound strange and Googling them can be downright scary.

For instance:

Remember, you are in control of how you manage your health and well-being. Educate yourself and do not hesitate tol ask for help. A great resource for emotional support from the comfort of your home is https://www.mind-diagnostics.org. A study by researchers at the University of California, Berkeley found online counseling can be just as effective as face-to-face therapy while being more convenient, affordable, and accessible.

Sources:
https://www.healthgrades.com/right-care/symptoms-and-conditions/lymphedema
https://my.clevelandclinic.org/health/diseases/8353-lymphedema
https://www.nhs.uk/conditions/postural-tachycardia-
syndrome/#:~:text=Postural%20tachycardia%20syndrome%20(PoTS)%20is,as%20postural%20orthostati
c%20tachycardia%20syndrome
https://www.aapmr.org/about-physiatry/conditions-treatments/pain-neuromuscular-medicine-
rehabilitation/degenerative-joint-disease
https://www.nhs.uk/mental-health/conditions/body-
dysmorphia/#:~:text=Body%20dysmorphic%20disorder%20(BDD)%2C,affects%20both%20men%20and%
20women.
https://www.betterhelp.com/study/Study_of_BetterHelp_eCounseling.pdf

In celebration of Lipedema Awareness month back in June, Dr. Wright and Dr. Herbst updated the world on the latest insights and understandings on Lipedema vs normal fat. Sponsored by Lipedema UK and Lipedema LIO ITALIA, we’ve summarized the key learnings and helpful information below. Don’t miss updates in the future on our “Lipedema in the News” section, and feel free to watch the full 1.5-hour webinar here.

What is Lipedema?

Lipedema is a fat disorder, mainly affecting women, that causes an enlargement of both legs due to deposits of fat under the skin. It’s characterized as a “progressive disorder,” meaning it generally gets worse over time. Sufferers living with lipedema experience easy bruising and tenderness, pain in the affected areas, and significant disability in daily life. In severe and more progressive cases, the trunk and upper body may also be affected, including the arms and upper back. Little is known about the disorder, and it’s often misdiagnosed and incorrectly treated as general obesity.

For anyone affected, diet and exercise alone aren’t effective ways to get rid of Lipedema fat; Lipedema fat has proved relatively immune to these lifestyle changes and won’t budge. While women are likely to experience some weight loss with a healthy diet and regular exercise routines, weight loss is usually mostly loss of non-Lipedema fat. In these instances, the painful, stubborn fat remains. This cycle becomes a difficult one to break for those with the disorder: Yo-yo dieting leads to more weight gain. More weight gain leads to increased pain and disability. Increased pain and disability make it more challenging to manage mobility and secondary obesity increases. Lipedema fat also appears to be relatively resistant to bariatric surgery, meaning many women are undergoing dangerous surgeries without experiencing the intended benefit of significant loss of lipedema fat.

Lipedema vs Normal Fat: What We Already Know

Lipedema adipose fat tissue is different from normal adipose tissue. When looking at this fat tissue in lipedema patients, we find a more fibrous, nodular, tender adipose tissue than in patients without lipedema. The look and feel of lipedema fat tissue can be physically seen when performing lipedema surgery in addition to under a microscope when analyzing the tissue components. It’s clearly a different type of fatty tissue, explaining why lipedema patients experience different side effects and symptoms than those with traditional obesity. 

A study published in the International Journal of Obesity in November 2021 (Ishaq et al) highlighted the cellular differences that signaled the differences in lipedema fat than traditional adipose tissue. 

The study had the following key findings:

 

Finding #1: Adipose Tissues Show Distinct Gene Signatures

This means that lipedema fat actually causes the body to turn on a different gene than we see in non-lipedema patients. Fat tissue from lipedema was compared to location, gender and age-matched tissue from non-lipedema patients. In the photo below, we see a heatmap gene expression of adipose tissue by Z-score fold-change value: red indicates upregulation and blue indicates downregulation.

Finding #2: The difference in lipid composition includes significantly increased lipids in lipedema

What does this mean? Lipedema fat has a different metabolism, characterized by a differing production of phospholipid production compared to normal fat.  Lipedema adipocytes are shown on the left half [Header Bright Red] and non-lipedema adipocytes are shown on the right side of the hierarchal plot of lipid composition [Green Header over columns]. 

Finding #3: Lipedema Fat has more stem cells than non-lipedema fat

In this study, stem cells [ADSCs] from lipedema fat were compared to stem cells of matched people without lipedema.  The stems in lipedema are increased in number.

Note: ADSCs are stem cells. They can continuously divide and renew themselves. The ADSCs stem cells can also become mature fat cells or other types of cells to sustain or grow fat tissue. This means that lipedema fat replicates their cells more than regular fat, increasing the growth of this painful, fibrous fat tissue in lipedema patients!

Additionally, Lipedema Stem Cells contain Fat Droplets and have More Fat Droplets per cell than non-lipedema fat cells. The number of fat droplets, percentage of fat-positive cells, and the number of fat droplets per cell were significantly increased in lipedema adipocytes compared to controls. Lipedema fat cells had more fat in them, and the presence of fat droplets in stem cells (ASCDs) indicates maturation toward an adipocyte. 

Finding #4: Cell Cycle Gene like Bub1 are upregulated in Lipedema

Cell-cycle genes involved in regulating cell growth and proliferation are dysregulated in lipedema ADSCs and may contribute to the increased adipocyte number, and maldistribution and accumulation of dystrophic fat in lipedema. Because of the lack of regulation, lipedema cells again are able to replicate and grow at a higher speed and frequency than non-lipedema fat.

For example, Bub1, which is one of the cell cycle genes, is turned on more or upregulated in lipedema.

What does all of this mean?

First, and most validating for people with lipedema, these findings prove that lipedema fat and normal fat are not the same. Adipocytes and stem cells from individuals with lipedema are structurally different and behave differently from cells of normal fat tissue. Second, diet and general nutrition do not affect lipedema fat in the same way it does for non-lipedema fat. Given the same nutritional support, lipedema-derived stem cells proliferated compared to normal fat-derived stem cells. And third, the faster growth of lipedema fat compared to non-lipedema fat can be explained at a cellular level. The different cell biology of the lipedema cells that leads to hyperproliferation of fat tissue may explain disproportionate growth compared to other adipose tissue.

Nature vs. Nurture

While these lipedema vs normal fat findings are exciting for lipedema providers, and even more validating for patients seeking insights and treatment options, one question still remains: Is the biology of lipedema fat different because of genetic differences or is the difference in the fat cell biology of lipedema a product of an altered environment? 

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 DISEASE LINKED TO FAMILY HISTORY

3 independent studies find lipedema is an inherited condition.

As reported by The Cleveland Clinic [#} on its website, the exact cause of lipedema is unknown, but the condition runs in families and may be inherited. This statement is supported by three independent studies conducted by leading research teams in Europe who validated lipedema is a genetic condition. Lipedema appears to primarily affect females, presumably driven by estrogen as it usually manifests at puberty. Lipedema disease is different from obesity and is often misdiagnosed as primary obesity because these conditions commonly overlap.

Researchers hope to continue to study as many families as possible with multiple cases of lipedema to create a stronger genetic linkage and determine the biochemical makeup of this disorder. Having this data may help researchers identify the gene that causes lipedema to increase understanding and improve treatment for this painful condition.

Fig 1. Bauer and etal. study reaffirms relatives of lipedema patients also suffer with lipedema. In most cases, grandmothers and mothers were affected the most, followed by aunts, sisters, and cousins.

KEY RESULTS / FINDINGS

The familial nature of the condition suggests that lipedema can demonstrate heritability[1]. The exact nature of the form of inheritance is difficult to determine.

Of lipedema patients who participated in a study, 73% reported they had one or suspected multiple family members also had lipedema. Most frequently affected was the mother (38%), followed by grandmother (17%), aunt (8%), sister (6%) and cousin (5%).

A study from 2010 showed that within six families of more than three generations with lipedema disease, a genetic autosomal-dominant hereditary pattern [2]was found.

Frequent studies of mother-to-daughter mode of inheritance led researchers to theorize lipedema is a genetic disorder.

Fig 2. The largest family pedigrees (with a minimum of three living affected members in at least two generations) are demonstrated in Figure 2.

Family clusters of lipedema where more than one family member has the condition indicates a genetic component with a possibly X-chromosome[3] dominance inheritance pattern.

All affected family members were female first- or second-degree relatives of female patients.

One family had six living affected members in three generations, two families had five affected members, two had four affected members, and one further family had three living affected members.

As lipedema appears to be most common at puberty, it is reasonable to assume that hormonal influence underlies the marked female limitation shown in studies to date.

Estrogen is also considered to play a key role in regulating the manner of development of the condition.

Study participants:

Between all three studies, women ages 16-83 (average age, late 30s)

Do you suspect you or a loved one may have lipedema? We can confirm your condition and start you on your journey to feeling better. Contact us to schedule an appointment, today.

References

Bauer AT, et al. Plast Reconstr Surg. 2019 Dec;144(6):1475-1484  https://pubmed.ncbi.nlm.nih.gov/31764671/

Ghods M, Georgiou I, Schmidt J, Kruppa P. Disease progression and comorbidities in lipedema patients: A 10-year retrospective analysis. Dermatologic Therapy. 2020;e14534. https://doi.org/10.1111/dtch.14534

Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S, Mortimer PS. 2010. Lipedema: An inherited condition. Am J Med Genet Part A 152A:970–976. https://pubmed.ncbi.nlm.nih.gov/20358611/  and https://www.researchgate.net/publication/346917917_Disease_progression_and_comorbidities_in_lipedema_patients_A_10-year_retrospective_analysis/figures

 

 # Cleveland Clinic Lipedema https://my.clevelandclinic.org/health/diseases/17175-lipedema

[1] Heritability is a measure of how well differences in people’s genes account for differences in their traits

[2] Autosomal dominant inheritance is a way a genetic trait or condition can be passed down from parent to child.

[3] The X chromosome is one of two sex chromosomes. Humans have two sex chromosomes, the X and Y. Females have two X chromosomes in their cells, while males have X and Y chromosomes in their cells.

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 impactful information for all of you, and we’re kicking off the month with a webinar from a team of lipedema experts.

Join us on Tuesday, June 7th, 2022 at 8 pm ET to listen to our panel discuss Recognizing Lipedema and Treatment Options. This is a FREE event! 

Register here, or listen to the recording following the webinar at tactilemedical.com/education.

Drs. Steve Dean, Thomas Wright, and Tony Gasparis with Julie Green, OTR/L CLT-LANA, WCC, CLWT discuss lipedema – the pathophysiology, association with vein disease, conservative treatments, and surgical options available for patients. 

What Is Lipedema Reduction Surgery?

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

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

Who Is an Ideal Candidate for Lipedema Surgery?

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 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?

3 Stages of Lipedema

Overall, Lipedema appears in a series of three stages. Do any of these sound 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 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.

Photo credit: Linda Anne Kahn at Integrative Treatment 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. 

When is the best time to get lipedema surgery?

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!).

Learn More About Stages of Lipedema Here!

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 improving 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.

Learn More About the Risks and Safety of Lymph-Sparing Liposuction Here!

What Results Can I Expect from Lipedema Surgery?

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

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

Lipedema Reduction Surgery Risks

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 and 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 in 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. 

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.

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!

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

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

 

3 Stages of Lipedema

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

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

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

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

Learn More About Lipedema Stages Here!

What is a lipedema lobule

In stage 3 lipedema, lobules develop in the skin.  The presence of a lobule is one of the most important physical changes to occur in the skin that differentiates stage 2 and stage 3 lipedema.  Originally described by Dr. Schmeller, a lobule is defined as a “hanging flap of skin,” also called an “extrusion of skin that protrudes or sticks out from the expected smooth contour of the skin.” Lobules can be seen from a distance.  The lobules can occur in many areas on the body in lipedema patients, but the classic areas are just below the knees, or subpatellar lobules, lobules that hang over the knees, Inner thigh lobules, lateral thigh lobules, and upper arm lobules. Some lipedema expert thinks these lobules are diagnostic of lipedema. [1, 2 ].  

 
 
This original definition was put forth in Dr. Schmeller and Dr. Meier-Vollrath’s 2008 paper, “Pain with Lipedema: An Attempt to Approximate” and was published in German the Journal LymphForsch. Similar to nodules, they describe lobules as characteristic of lipedema – and especially stage 3 lipedema. The lobules can occur in many areas of the body, but the classic areas are just below the knees (subpatellar lobules), lobules that hang over the knees, inner thigh lobules, lateral thigh lobules, and upper arm lobules. Some lipedema experts think these lobules are diagnostic of lipedema. [1, 2].
 

Lipedema Nodules and Fat

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

How to Determine If You Have Lipedema Nodules

Lipedema nodules are felt and not usually seen. In lipedema, the skin surface is soft, but just below the surface, the nodules can be felt as harder areas. Early-stage Lipedema (Stage 1) has small nodules the size of small seeds or peas, which often appear pearl-size. Middle-stage Lipedema (Stage 2) has larger nodules that feel the size of walnuts or gumballs. Later stage Lipedema (Stage 3)  is characterized by the presence of lobules. The nodules in Stage may be the same size as the nodules in Stage 2, or they may be larger nodules up to the size of a plum.

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

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

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

Removing Lipomatosis Nodules

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

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

Think you have Lipedema nodules?

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

 

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

Find Out More About Lipedema Nodules Here!

Stemmer’s Sign Test

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

Venous Doppler Ultrasound 

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

Lymphoscintigraphy

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

We’re here to help!

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

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

 

 

Sources
1. Pain with lipoedema Attempt to approximate W. Schmeller, I. Meier-Vollrath Capio Hanse-Klinik, Department of Liposuction and Operational-Aesthetic Dermatology, Lübeck, Germany LymphForsch 12 (1) 2008; 8-12
link https://pubmed.ncbi.nlm.nih.gov/28677175/  
2.
Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia; Results of an International Consensus Conference Matthias Sandhofer, MD. DermSurg-2019. link https://pubmed.ncbi.nlm.nih.gov/31356433/

Meet Dr. Thomas Wright!

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

Benefits of Compression Therapy

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

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

Learn More About Compression Therapy Here!

Symptoms of Cellulitis May Include the Following:

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

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

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

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

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

What Is the Goal of Compression Therapy?

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

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

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

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

Click Here to Learn More About Lymph Drainge & Massage

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

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

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

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

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

Click Here to Learn More About Lipedema!

Why Do We Call It “Lymph-Sparing?”

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

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

1 – No General Anesthesia

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

2 – Reduces Fat Tissue

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

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

3 – Reduces Pain Associated with Lipedema

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

4 – No Additional Risks Included

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

5 – Quality of Life

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

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

Learn About Life with Lipedema Here!

Recovery from Lipedema Surgery

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

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

Schedule Your Lymph Sparing Liposuction Today

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

Click Here to Learn About Insurance Coverage for Your Surgery!

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

Follow an Anti-Inflammatory Diet

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

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

Click Here for More Diet and Supplement Recommendations!

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

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

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

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

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

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

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

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

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

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

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

Yoga & Deep Breathing

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

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

Massage & Deep Breathing for Lipedema Care

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

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

Compression

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

Learn More About Compression Garments Here!

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!