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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. Obesity

Unlike common obesity, Lipedema is comprised of fat deposits and swelling that typically does not affect the feet or hands; it’s as if patients are wearing a tight bracelet or rope at their wrists or ankles that causes every above to swell and everything below to remain unaffected. At more progressive stages, the swelling increases and leads to a diagnosis of lymphedema, which makes it even less likely Lipedema is diagnosed and treated promptly and adequately.

Despite the strong impact of Lipedema on millions of women across the world, only limited research exists to determine its cause. In many cases, the genetic background can provide some context, but enough research has yet to offer a comprehensive understanding of the disease. 

Dr. Wright and his team at St. Louis Laser Lipo & Vein Center have put together a helpful list of Lipedema Do’s and Don’ts for living with this difficult disease.

DO: Take This Cold Medication Regularly

Guaifenesin, best known by the brand name Mucinex©, and often prescribed as an over-the-counter expectorant to treat the common cold, may help reduce lipedema swelling and inflammation.

To our knowledge, there are no published, controlled studies showing the use of Guaifenisn to treat lipedema or lymphedema. However, there are abundant reports from clinicians and lipedema patients stating Guaifenisn helps lipedema. In our limited clinical experience, about 20 – 30 % of lipedema patients report reduced pain and/or swelling when taking this medication. Plus, there are reports of Guaifenisn being used for pain relief to treat other diseases. Guaifenesin has shown modest but significant analgesic and anti-inflammatory effects in neck and back pain and some other conditions. It is thought guaifenesin may be working as a  muscle relaxant effect that occurs in these conditions. Mucinex / guaifenesin may help pain or it may work as an expectorant in lipedema tissue and thin out extracellular proteins. However, there are no studies to support these theories in lipedema.

Guaifenesin for Lipedema: Dose and Use

Guaifenesin is approved for safe use at 600 mg twice a day (or 1,200 mg twice a day) for no more than 2,400 mg per day. Studies in the use of Mucinex for other medical conditions report it takes a least a week to see effects. I recommend lipedema suffers try this medication for two weeks to see if they notice any positive changes in addition to their consistent treatment plans including compression, supplements, and a healthy diet as prescribed. May not be suitable for people with a persistent cough due to asthma, bronchitis, emphysema, or smoking, or who have a cough that is producing excessive amounts of phlegm. Talk with your doctor first before using Mucinex if you are pregnant or breastfeeding.

DO: Use Diosmin to Combat Lipedema

Diosmin is a flavonoid extract made from orange peels used to treat vein disease. Diosmin helps reduce inflammation along vein walls in people with chronic venous insufficiency and it can also have very positive results for people with lipedema and lymphedema.

Benefits

In a recent case study, Diosmin had positive results when used in combination with other supplements, diet, compression, and other anti-inflammatory measures to non-surgically manage lipedema. Based on these studies, and my experience prescribing Diosmin to patients, I recommend Diosmin as part of an overall conservative management treatment plan for lipedema and lymphedema.

Where to Get Diosmin for Lipedema

In the United States, Diosmin is sold under the brand name Vasculera, which is available in pharmacies by prescription from a physician. Vasculera is approved by the FDA as a medical food.

Diosmin is also available as a supplement without a prescription. We recommend Vein Formula, as we trust its formulation. Be sure to order any supplements from a reputable website for the best safety and quality. Link https://vitasupportmd.com/products/vein-formula-1000

DON’T: Treat Lipedema with Fat Freezing 

Fat freezing—also known as cryolipolysis (or Cool Sculpting) uses cold temperature to reduce fat deposits in certain areas of the body. The procedure is designed to reduce localized fat deposits that do not respond to diet and exercise. It is not intended for people who are obese or significantly overweight. Currently, there is no published research on cryolipolysis for lipedema. Most lipedema fat is not the type of localized fat deposit for which this procedure is intended. Cryolipolysis can cause Paradoxical Adipose Hyperplasia (PAH). This condition can aggravate symptoms, and lead to worsening of lipedema.

DO: Adopt a Mediterranean Diet & Active Lifestyle (Instead of Keto!)

Researchers from Stanford University found both diets improved blood glucose and led to comparable weight loss. However, this study shows keto may elevate LDL cholesterol, lacks essential nutrients, and is more difficult to maintain over time.

Study: During the study, 30 adults with prediabetes or type 2 diabetes followed the Mediterranean diet and the keto diet for 12 weeks each. Both diets served non-starchy vegetables and avoid added sugars and refined grains, but there are three key differences between them: the Mediterranean diet incorporates legumes, fruits, and whole grains – keto does not.

Results:

Note: Please work with a doctor or nutritionist to choose a dietary pattern that fits your needs and preferences. The potential harms of higher LDL associated with keto cannot be dismissed.

Exercising can help to activate the lymphatic drainage system in a patient’s limbs through the foot and calf muscle pump. Workouts that aren’t too strenuous help to move the excess fluids out of affected limbs, as well as reduce additional fat buildup.

The lymphatic system differs from the blood circulatory system in that it does not have a muscle “pump” to move fluids into the lymphatic system and eventually return back into circulation. Because of this, good lymph flow depends on proper joint and muscle activity. This is especially true if the lymphatic system is compromised. Individuals suffering from lipedema can receive a great benefit when engaging in diaphragmatic breathing exercises. These exercises are especially beneficial when they are combined together with other parts of a decongestive regimen.

Because fat disorders and lymphedema can often feed into one another, exercise is a great option to help combat both. With its dual purpose of clearing out excess lymph fluid and burning fat, exercise offers exactly what patients need to deal with these disorders.

Types of Exercise

The best types of exercise to help treat lipedema and lymphedema are low-impact exercises and aren’t too strenuous, as strain can increase fatigue and pain levels. Low impact exercises help protect joints. Workouts should also focus on exercises that do not increase lactic acid build-up. 

The types of exercise used should be focused on the individual patient’s needs and ability. Additionally, it is important to use compression garments when exercising whenever possible. Compression garments help to promote blood circulation and lymph fluid flow, which can be severely inhibited in patients who suffer from fat disorders and lymphedema.

Living with Lipedema? 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!

References

Albert-Adrien Ramelet, MD, Pharmacologic Aspects of a Phlebotropic Drug in CVI-Associated Edema

First Published January 1, 2000 Research Article https://doi.org/10.1177/000331970005100105

https://scholar.google.com/scholar?q=diosmin+effect+on+lymphatic+function&hl=en&as_sdt=0&as_vis=1&oi=scholart

https://www.ncbi.nlm.nih.gov/pubmed/8919263

Int Angiol. A lymphatic function of Daflon 500mg., 1995 Sep; 14(3 Suppl 1):36-8

Recommended Sources of Diosmin: https://vitasupportmd.com/

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.

Learn More About Lipedema Here!
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.

Find More Non-Surgical Treatment Options Here!

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!


After receiving the diagnosis of Lipedema, all heads turn to the Internet for the glory answers of what, how, and the why. And of course, who else? You view minimal reporting from doctors and remind yourself, “That’s probably why my family doctor thought I had painful cellulite.” Yes, you are shocked, and agree to never return to a doctor who believes in such falseness. By the way, we did our research and indeed, there is no such thing as painful cellulite.

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