Lipoedema

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Lipoedema is an inherited disorder characterized by symmetrical increased fat accumulation below the waist that mainly affects women and results in hips, buttocks and legs that are out of proportion with the upper body. The ankles and feet are usually spared, causing a distinct contrast between the lower leg and foot.

Lipoedema in Hamburg

This condition is usually associated with migrating pains often referred to as “painful lipodystrophy”, lumpiness and a tendency to easy bruising. Lipoedema can occur in patients of all sizes from slim to morbidly obese women. Lipoedema fat, unlike normal fat, generally cannot be lost through diet and exercise.

The first symptoms typically start at puberty, and worsen during or after pregnancy and menopause. It is a very common condition that has an immense psychological impact.

However few patients ever receive a correct diagnosis and often feel rejected when they seek medical advice, especially when they are stigmatized as being obese.

Presentation of Lipoedema

There are five distinct types of lipoedema that present clinically.

  • Type 1: Increased adipose tissue localized in the buttocks and thighs.
  • Type 2: Adipose tissue extends to the knee with formation of fat pads on the inner side of the knees.
  • Type 3: Lipoedema extends from the hips to the ankles.
  • Type 4: Lipoedema involves the arms as well as the legs.
  • Type 5: Lipolymphedema.

Clinical Stages of Lipoedema

The progression of lipoedema can be divided into three stages according to skin conditions and the sizes of the fat nodules.

  • Stage 1: The skin surface is normal and the subcutaneous fatty tissue has a soft consistency but multiple small nodules can be palpated under the skin.
  • Stage 2: The skin develops an uneven surface and becomes harder to touch due to the formation of bigger fat nodules under the skin.
  • Stage 3: The subcutaneous fat nodular formations become larger which gives an orange peel-like appearance “Peau d’orange” and causes the subcutaneous fat to project outside of the skin and bulge particularly in the knees or thighs, which hinders mobility.

Treatment

Standard therapy includes manual lymphatic massage, physical exercise, multilayered compression garments and meticulous skin care all combined to help relief pain and according to the most recent clinical studies, it can also help to reduce up to 10% of limb circumference with best patient compliance.

However, these conservative measures do not reduce or take away the fat deposits.

In such cases tumescent liposuction to the legs is possible and results in the most benefit provided the patient is not morbidly obese. Liposuction can remove the excess localized fat and create a more harmonious balance between the upper and lower body and in some cases it can even help the patient to mobilize better.

According to the latest studies constant compression garments or therapies needed to treat the symptoms of lipoedema can be either stopped or reduced considerably after liposuction. Any deep vein insufficiency or varicose veins should be investigated before consideration for liposuction.