Lipedema, also known as painful fat syndrome, is a chronic condition that is more common in women. It is very misunderstood and widely ignored.
Combined treatment of energy- and water-assisted liposuction on the legs below the knee
immediately after surgery, no skin excision, 20L removed
Unfortunately, most physicians are unaware that this is a medical condition and often attribute excessive pain and accumulation of fatty tissue in the lower body and extremities to obesity and often recommend weight loss and/or bariatric surgery. The latest studies show that lipoedema is actually a disease that requires treatment and does not improve with diet and exercise. Unfortunately, bariatric surgery does not significantly improve lipedema either.
The vast majority of patients suffering from lipedema are women, but occasionally men can also be affected. (Chen et al., 2004; Langendoen et al., 2009)
The exact frequency is not known, but it is estimated that up to 1% of American women can be affected by this condition. In the UK it is reported as 1 in 72,000. (Child et al., 2010). In Germany, the prevalence of lipedema in women and girls is estimated at 11% (Földi et al, 2006; Szél et al, 2014).
Power-assisted, water-assisted and ultrasound-assisted L: combined liposuction treatment of the legs below the knee
3 months no skin excision, 10L removed
The main symptoms of lipedema are abnormal or excessive accumulation of fatty tissue in the lower trunk, abdomen, hips, thighs, legs and occasionally arms. Feet and hands are usually spared and unaffected by lipoedema. Symptoms also include easy bruising, increased skin sensitivity when touched, feeling cold on the skin and an unusual uncomfortable feeling when someone touches the affected areas, and pain.The pain may be accompanied by an unusual texture of the fatty tissue. Fat can look like jelly or rice, peas or nuts under the skin's surface. Pain can also range from no pain to severe, be constant, come and go, or only occur when the affected areas are touched, squeezed, or pushed.
There is also a very significant psychological effect on the patient. They usually feel uncomfortable undressing or wearing more open clothing, which affects their self-esteem, raising a family, and many activities of daily living, such as certain public transportation, such as buses and planes, due to the inability to get on the seat to fit, or the associated pain. Some patients tire very easily and have difficulty finding or keeping a job. Some patients report difficulty getting in and out of vehicles.
Lipedema Cuff. THIS IS NOT A BEFORE AND AFTER PICTURE. THIS IS THE CUFING DEGREE
There is a social stigma associated with having a large lower body where laypeople can associate lipedema sufferers with laziness, uncontrolled eating habits, etc.
Weil
The cause of lipedema is currently unknown. It was first described in 1940 as an incurable chronic condition characterized by abnormal accumulation of adipose tissue (Allen and Hines). The word lipedema means "fat swelling". It is also known by other names such as Adiposalgia, Adiopoalgesia, Lipalgia, Lipohyperplasia, Lipohypertrophy Pain, Lipomatosis Painful Legs, Painful Spinal Legs, Painful Fat Syndrome, Jodhpur Syndrome and Stove Legs.
Most doctors assume that a combination of genetic and hormonal factors are involved in the development of lipedema. Many patients report that several family members also have maternal legs. Studies also show that up to 64% of patients report family members with the condition. Most of our patients report that lipoedema usually begins at the time of significant hormonal stress such as puberty, use of oral contraceptives, pregnancy or menopause. It's also common for lipedema symptoms to worsen with age.
I believe that most laypeople and physicians underestimate the complexity of diagnosing lipedema.
Lipedema is not just excessive fat accumulation. Most patients also show abnormal lymphatic vessel formation in the affected areas. No amount of diet, exercise, or bariatric surgery can fix that.
Nutrients and oxygen are transported to the lower extremities via the arteries. As the body uses all of the nutrients and oxygen for its daily functions, waste products are returned to the body through two systems - veins and lymphatics. The liver and kidneys then filter the blood.
Many of our patients with lymphedema have abnormal function of the veins and lymphatics, along with an accumulation of adipose tissue.
Instead of normally functioning lymph vessels, patients with lipedema often have enlarged, loose, leaky, or small sacs (like aneurysms) in which protein-rich lymph accumulates.
With increased pressure in the lymphatic system, the lymphatic valves stop working normally, and the relaxed and dilated lymphatic vessels release some of the lymph into the surrounding tissues, which accumulates mainly in the fat cells. This is why the fat in patients with lipedema and lymphedema does not look normal. It looks fluffy, watery, gelatinous, and noticeably whiter than regular yellow fat. Other structures such as muscles, bones, tendons, and ligaments cannot accumulate lymph easily and are generally unaffected. However, the nerves are affected directly or indirectly when the swollen fat presses on them, leading to increased sensitivity and pain.
The abnormal accumulation of fat and lymph leads to tissue inflammation and increased sensitivity. Blood vessels also become more fragile and can contribute to easy bruising.
When the patient accumulates extra fat in the lower extremities due to genetic and hormonal changes, the fat cells become progressively larger and also produce more waste products. At the same time, the pressure increases in the main lymphatic channels in the groin area, where it becomes increasingly difficult to drain the lymph from the legs.
Essentially, it becomes a vicious cycle where fat cells accumulate more fat and
more lymph, produces even more lymph fluid and causes stagnation, increased pressure, lymph leakage and impedes the ability of the lymphatic vessels to further evacuate lymph.
When the amount of waste products increases, they can only be removed via the venous system. Patients with lipedema often have abnormal venous function, which also leads to venous insufficiency. The mechanism is similar to the lymphatic system.
In my opinion, lipoedema is not just a painful fat condition, but a combination of impaired function of the veins, the lymphatic system and painful fat accumulation.
Diagnose
Most of the diagnosis is based on the patient's symptoms and clinical examination. Other tests such as ultrasound, magnetic resonance imaging, lymphangiography, and lymphoscincigraphy may also be useful.
Classic symptoms for the diagnosis of lipedema are female patients, bilateral and mostly symmetrical accumulation of fatty tissue below the waist, minimal indentable edema, pain, pressure sensitivity, hypersensitivity of the skin, easy bruising and a feeling of coldness on the skin. Typically, the feet are spared. The junction between the ankles and the feet can have an excessive accumulation of fatty tissue known as the ankle cuff.
In our practice, I often ask patients to have a vascular ultrasound to rule out simultaneous insufficiency of the venous and lymphatic systems. I approach the treatment of lipoedema holistically. The diagnosis of venous insufficiency is challenging in patients with lipedema. Due to the increased size of the leg, a little experience is required to fully assess superficial vein function and miss improperly functioning venous valves. Performing a venous ablation procedure (vein procedure) also requires additional skills and more advanced equipment than ordinary patients. That's why I prefer to diagnose and treat vein problems in lipoedema patients in our practice, as we often have to repeat interventions by other doctors.
treatment of lipoedema
Traditional treatments for lipedema have had very limited success. Common recommendations include diet, exercise, nutritional modification, emotional support, biological feedback, treatment of co-existing medical conditions that may also cause leg swelling, and full decongestive therapy.
Complete decongestive therapy, or CDT, typically involves a combination of manual lymphatic drainage, compression therapy, wearing custom-made compression garments, physical mobilization, and mechanical compression equipment such as the Lymphapress used on a daily or continuous basis. Unfortunately, despite all of the above remedies, most patients experience only very limited and temporary improvement.
Surgical options generally yield longer-lasting results. Studies have shown the effectiveness of energy-assisted liposuction, waterjet-assisted liposuction, and ultrasound-assisted liposuction in reducing adipose tissue accumulation.
Removal of the affected skin with or without removal of underlying fatty tissue is also used.
Some surgeons use manual extraction of painful nodules in addition to liposuction and excision.
Abortion from Dr. Wolshteyn
Any form of liposuction that reduces the number of fat cells in the lower extremities and other affected areas also reduces the metabolic stress on the tissue. It decreases the ability to store excess lymph and generally decreases the amount of lymph moving through tissues.
Although none of these surgeries restore normal lymphatic function, the vast majority of patients experience significant improvement in their symptoms and overall well-being.
Many of the patients we see have very serious illnesses. It's not uncommon for me to remove over 20 pounds (or 10 liters) of fat tissue in a single session. Removing the traditional 5 liters recommended for cosmetic liposuction patients does not result in any significant visible improvement. There are patients whose lower legs I have lost around 80 kilograms in several operations.
One-time puncture of a patient with lipedema - one session at a time.
I use power liposuction to remove volume, waterjet liposuction to spare the lymphatics, and ultrasonic liposuction to promote skin tightening after the procedure. The younger the patient, the better the skin tightening can be expected.
I used to remove the skin at the same time as the original procedure. Now I do it later and only when needed. I have found that many of my patients experience impressive skin tightening when I use ultrasound assisted liposuction (vaser) which promotes skin tightening. After about six or nine months, many of our patients do not require skin removal, especially below the knees.
Depending on the extent and severity of the condition, most patients will require two or more surgeries separated by three months of recovery and rehabilitation. During this time, I recommend continuous lymphatic massage, tailored clothing, and the use of mechanical lymphatic devices such as the Lymphapress.
Patients with venous insufficiency who are also treated with foam, laser, radiofrequency devices, or a combination of techniques to occlude defective superficial veins.
Vein procedures can be performed in our treatment room.
Click here to viewPOWER ASSISTED LIPOSUCTION PROCESS
For safety reasons, I do not perform high-volume lipedema surgeries in practice. I usually perform them at the accredited licensed outpatient surgery center or hospital outpatient clinic.
Liposuction is usually performed under general anesthesia or sedation. Patients do not remember anything and do not feel any pain during the procedure. My procedures may take longer as I use multiple technologies at the same time to get the best possible result.
After the procedure, a compression bandage is applied and the patient resumes mechanical massage 7-10 days after the procedure according to my protocol.
Skin removal is usually combined with one of the additional sessions.
insurance coverage
Many private tariffs cover lipoedema operations based on the latest scientific findings. Aetna, Cigna and Blue Cross and others offer coverage for liposuction and excision surgery based on their internal policies. The approval process is lengthy and requires reports from the treating physician or endocrinologist and, where appropriate, an assessment of viability.Despite this, my office managed to approve many of them.
usefull links
Lipedema basicshttps://www.lipedema.org/
Fat Disease Resource Societyhttps://www.fatdisorders.org/
Great Britainhttps://www.lipoedema.co.uk/
American Board of Venous and Lymphatic Medicinehttps://www.abvlm.org/search_instructions.php
Call us today to schedule your appointment at 732-641-3350
FAQs
Why is lipedema not covered by insurance? ›
Since there is no specific ICD-10 code for lipedema disease, most medical insurers chose not to recognize Lipedema as a medical disease. Medical insurance providers in the United States are critical of published research on lymph sparing liposuction for Lipedema.
How does mucinex help lipedema? ›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.
Is lipedema surgery covered by Medicare? ›Cost. Lipedema is not currently recognised by Medicare as a rebatable medical condition, so surgery attracts no Medicare or private health insurance support and is very expensive.
Is lipedema covered under insurance? ›For your lipedema surgery to be covered by insurance, there must be a medical reason to do so. This reason can be the presence of swelling, pain or problems with mobility and other activities of daily living.
Can I get disability for lipedema? ›If the lymphedema severely impairs your ability to use your arms or legs, you may qualify for SSD under listing 1.02, Major Dysfunction of a Joint, which includes chronic joint pain and stiffness with either limitation of motion or abnormal motion as one of its criteria.
What makes lipedema worse? ›However, lipedema frequently does worsen with time due to the general trend toward increasing body weight and obesity (which is itself a progressive disease) with age. Psychological distress is often also a progressive disorder, one that typically amplifies feelings of pain and diminishes willpower and general health.
What vitamins help lipedema? ›Vitamin D3: Lipedema patients are typically deficient with Vitamin D, an essential supplement that plays a critical role with your immune system. It also helps your bone, muscle, and nervous system health.
What over the counter medication can I take for lipedema? ›Mucinex / guaifenesin may help pain or it may work as an expectorant in lipedema tissue and thin out extracellular proteins.
What supplements help lipedema? ›Diosmin: Perhaps the most effective supplement to take is Diosmin, a bioflavonoid that is commonly found in citrus fruits. They can have anti-inflammatory, antioxidant, and lymph-tonic properties that will help with your symptoms of lipedema.
Does lipedema fat come back after surgery? ›Wright: Lipedema reduction surgery reduces the amount lipedema tissue. It will not completely eliminate it. In most cases, lipedema pain, swelling and bulk stays reduced for many years (and possibly your whole life). However, it is possible lipedema can become worse.
Can you get rid of lipedema without surgery? ›
Treatment for Lipedema
Lipedema is a chronic condition with no cure. At Stanford, we offer therapies and surgery to improve symptoms, reduce leg size, and provide ongoing care and management. Surgical treatment (tumescent liposuction and reductive surgery) is the most effective treatment to remove the fatty tissue.
A patient's recovery varies by how many target areas are treated and the severity of each plus how fast a patient's body heals after surgical procedures. Most patients can return to work in 2 weeks and fully get back to normal activities in 4-6 weeks. Dr. Schwartz will give detailed, aftercare instructions.
Does lipedema show on MRI? ›Computed tomography and MRI images in patients with lipedema, on the other hand, typically demonstrate diffuse fatty hypertrophy throughout the bilateral lower extremities without skin abnormalities (Figure 4).
Does walking help lipedema? ›Aerobic exercises such as swimming, walking and cycling are especially recommended because they increase lymphatic drainage and improve blood flow through the affected limbs.
Does lipedema go away with weight loss? ›Unfortunately, Lipedema fat is far more stubborn than regular fat, and will not respond to diet or exercise. Those with this disorder may workout regularly and practice healthy and balanced nutrition but will continue to gain weight.
Do compression leggings help lipedema? ›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 limb. Also compression potentially reduces the rate at which the fat cells grow and help to prevent fat disorders from progressing to more serious stages.
Is lipedema autoimmune? ›For some women it is impossible to lose weight because of an under-diagnosed autoimmune disorder many people have never heard of called lipedema. Los Angeles-based surgeon Dr. Jaime Schwartz diagnosed Cruz with the condition. As many as 1 in 9 women may suffer from the condition, according to Dr.
How do you stop lipedema getting worse? ›- Manual Lymphatic Drainage Massage (referred to as MLD).
- Adopting a diet focused on low levels of carbohydrates and limited refined foods.
- Beginning and maintaining regular exercise activity that's low impact, such as water exercise.
Liposuction is the only treatment available to lipedema patients that eliminates the troublesome fat deposits from the legs, hips, buttocks, stomach, and/or arms. Liposuction enables doctors to improve the look of the legs and restore better mobility for the long-term.
How do you break down lipedema? ›- Managing co-existing health conditions that may cause leg-swelling such as peripheral vascular or cardiac issues.
- Getting Emotional Support.
- Reducing Inflammation.
- Improving Lymphatic Flow with use of Complex Decongestive Therapy.
- Light to moderate exercise.
- Surgical Options: Liposuction.
What diseases are associated with lipedema? ›
Women with lipedema are at risk for developing lymphedema, which may happens in lipedema Stage 3 > Stage 2 > Stage 1 (26). The presence of lymphatic disease or lymphedema increases the risk of cellulitis and wounds, which can be difficult to manage and disfiguring.
How do I slim my lipedema legs? ›- manual lymph drainage therapists who gently open lymphatic channels and move the lymphatic fluid using hands-on techniques.
- exercise including whole body vibration and swimming, exercises that have been proven to move lymphatic fluid.
Lipedema is a painful fat disorder which predominantly affects women and develops during times of hormonal fluctuation including, but not limited to, puberty, pregnancy, and menopause [1,6].
How do you treat lipedema naturally? ›- Choose a Healthy Way of Life.
- Opt for a Healthy Skincare Routine.
- Make Healthy Dietary Changes.
- Regular Exercise.
- Lifestyle Changes.
- Decongestive Therapy and Compression Therapy.
- Invasive Therapies.
Furthermore, clinicians recommend supplements such as bioflavonoids, turmeric and selenium to lipedema patients, as these act as antioxidants which might help in reducing inflammation, improving blood vessels and removing free radicals [2].
How do you get rid of lipedema fat without surgery? ›- Treatment for Lipedema.
- At present, there are two courses of treatment for lipedema. ...
- Manual Lymphatic Drainage (MLD) ...
- Compression Garments. ...
- Pneumatic Compression Device. ...
- Diet/Food Management. ...
- Supplements. ...
- Exercise/Movement.
Symptoms of lipedema include: Fat build-up in buttocks, thighs, calves, and sometimes the upper arms. Diuretics, elevating your legs and support stockings do not help the affected areas.
Does acupuncture help lipedema? ›Traditioal Chinese Medicine (TCM) and Acupuncture can treat lymphedema by not only addressing the lymphatic system, but also by targeting the specific areas in the body where are driving a chronic state of inflammation while aiding in detoxification.
Is lipedema surgery worth it? ›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.
What are the side effects of lipedema surgery? ›Complications reported by women after lipedema reduction surgery. Anemia, wrinkles, sagging skin, and asymmetry were the most common complications.
What are the risks of lipedema surgery? ›
- Scar – scars are very small and hidden in a skin crease. ...
- Bruising and swelling – this happens in every patient and will be marked. ...
- Blood loss – patients with lipoedema have leaky blood vessels, varicose veins and sometimes anaemia before surgery.
If you're living with lymphedema, lipedema, or a similar condition, you can take steps to get relief from pain and the other symptoms at home. Lymphatic massage can be used to relieve the swelling in your arms, legs, or other affected areas. The technique works by helping to promote lymphatic drainage.
How do you stimulate lymphatic drainage in your legs? ›Place one hand on your shin and the other hand on the back of your lower leg, just below your knee. Gently stretch the skin towards your upper leg and release. Shift your hands down and repeat this upward motion until you reach your ankle. Remember to stretch and release the skin up towards your knee.
Can lipedema be drained? ›If you have lymphedema or lipedema or are experiencing symptoms associated with these disorders, you may experience similar or better lymphatic drainage massage benefits from Complete Decongestive Therapy. This non-invasive medical technique has helped countless patients manage and reverse their symptoms.
What is the most painful cosmetic surgery recovery list? ›Many patients suggest that the Brazilian butt lift is the most painful surgery. This is followed by the tummy tuck, breast implants, liposuction, breast lifts and reductions, and jaw surgery. Dental implants can also cause much pain, as you still need to eat in the healing process.
How long to wear compression after lipedema surgery? ›After liposuction for lipedema, you should initially consistently wear compression garments on the treated areas for about 6 weeks. You can usually shower after two days; of course the compression garments can be removed for this.
How successful is liposuction for lipedema? ›For the large majority of people, liposuction is permanent when used to help treat lipedema. There are a very small number of cases where the fat cells have returned, due to a genetic issue with the patient, but overwhelmingly once the surgery is performed the fatty cells are gone forever.
What kind of doctor would diagnose lipedema? ›Vascular surgeons, in fact, are one of the few medical professions where you can find Lipedema diagnosis and management as a core requirement of their advanced medical training programs. A vascular medicine specialist will carefully consider differentiating Lipedema vs lymphedema and also from other conditions.
Does lipedema show up on blood test? ›There is no specific blood test or imaging test widely available to diagnose lipedema. The diagnosis of Lipedema is made based on a clinical evaluation using the below criteria by a physician knowledgeable and experienced in the diagnosis of the disease and with supporting tests that rule out other diagnoses.
Can lipedema cause belly fat? ›Patients with lipedema (or lipoedema) can experience an abnormal buildup of body fat in different areas of the body. While this accumulation of lipedema fat occurs most in the legs, thighs, and arms, areas such as the stomach and the hips are possible too.
Can coolsculpting help lipedema? ›
Answer: SculpSure and Coolsculpting in Lipedema
These noninvasive body contouring devices are not as effective as power-assisted liposuction for the treatment of lipedema.
For your lipedema surgery to be covered by insurance, there must be a medical reason to do so. This reason can be the presence of swelling, pain or problems with mobility and other activities of daily living. A FCE can help you demonstrate issues you have with sitting, standing, carrying, bending, etc.
What happens if you don't treat lipedema? ›If left undiagnosed, it leads to more risk of health concerns and in most cases, emotional issues. Although Lipedema starts off as a cosmetic concern for women, if left untreated, it can have life-threatening consequences. Affecting up to 11% of women, Lipedema becomes a painful and, in some cases, crippling disorder.
Can intermittent fasting help with lipedema? ›Neither diets nor fasting or exercise will bring the desired success for lipoedema as a fat reduction in the affected parts will not be achieved. You will only lose weight in the “healthy” parts of your body. That is why these methods are not an option treating lipoedema.
Is lipedema considered a disease? ›Lipedema is a chronic disease of lipid metabolism marked by a bilateral and symmetrical swelling of the lower extremities caused by impairment of symmetrical fatty tissue distribution and storage combined with hyperplasia of individual fat cells. It can be diagnosed using clinical features rather than diagnostic tests.
Does Medicare pay for lipedema liposuction? ›Medicare does not generally pay for liposuction. However, the program may pay for the procedure when it is medically necessary to restore function after an incident or illness.
How do you break up lipedema fat? ›Complete decongestive therapy (CDT): is used to treat both lymphedema and lipedema. CDT consists of manual lymphatic drainage (MLD), exercise, compression bandaging, compression garments, and skin care. CDT helps lipedema by decongesting swelling, encouraging normal lymphatic vessel pumping, and decreasing pain.
Does lipedema fat return after liposuction? ›It will not completely eliminate it. In most cases, lipedema pain, swelling and bulk stays reduced for many years (and possibly your whole life). However, it is possible lipedema can become worse.
Can you see lipedema on an MRI? ›Soft tissue imaging: Common imaging platforms such as MRI, Ultrasound, DEXA, and CT scans are being used to measure characteristic differences in Lipedema between tissue thickness, or ratios of elements like fat to muscle.
Can lipedema go away with weight loss? ›Unfortunately, Lipedema fat is far more stubborn than regular fat, and will not respond to diet or exercise. Those with this disorder may workout regularly and practice healthy and balanced nutrition but will continue to gain weight.
What is the best exercise for lipedema? ›
Aerobic exercises such as swimming, walking and cycling are especially recommended because they increase lymphatic drainage and improve blood flow through the affected limbs. High impact exercising (i.e. jogging, step-aerobics) or contact sports are better avoided as they may exacerbate join pain and lead to bruising.
What type of liposuction is best for lipedema? ›Commonly used liposuction methods for lipedema are tumescent anesthesia (TA) liposuction, and water assisted liposuction (WAL). In TA liposuction, tumescent is infused in the subcutaneous tissues to cause the fat cells to swell and vessels to constrict; then blunt micro-cannulas are used to suction the fat.
Does liposuction make lipedema worse? ›We do know that traditional liposuction, without special care of the lymphatics or proper tumescent technique, can cause lymphatic damage and possibly worsen lipedema symptoms.