Lipoedema: Information & lipoedema doctors

Leading Medicine Guide Editors
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Leading Medicine Guide Editors

Lipoedema is a genetic or hormonal fat distribution disorder. Around 8 to 14 percent of all women suffer from it. As conservative therapies do not promise lasting success, lipoedema is usually treated surgically by means of liposuction.

You can find further information and qualified lipoedema specialists here.

ICD codes for this diseases: E88.20, E88.21, E88.22, E88.28

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Article overview

What is lipoedema?

Lipoedema is a chronic disease of the fatty tissue. It results in a disturbed fat distribution with abnormally enlarged and deformed fat cells. It mostly affects women. Lipoedema rarely occurs in men. Most sufferers are between 30 and 40 years old.

Preferred areas of excessive fat storage in the tissue are

  • Buttocks,
  • thighs (breeches syndrome) and
  • hips.

In severe cases, it can even lead to thickened upper arms and lower legs.

Lipoedema cannot be cured, but can be treated well with conservative methods or surgery. If the accumulation of fat cells spreads from the buttocks to the ankles, doctors refer to this as "columnar leg".

In the early stages, lipoedema is difficult to distinguish diagnostically from obesity. More than 50 percent of patients are also obese at the same time. Many patients also have depression requiring treatment due to the disproportion between their upper and lower body.

People with lipoedema are often accused of not having their eating habits under control. However, an unhealthy diet and the resulting excess weight are not the cause of lipoedema. However, excessive body weight can have a negative impact on the course of the fatty tissue disorder.

The fat distribution disorder is genetic and occurs as a result of hormonal changes in the body, e.g. due to

The extent to which hormones influence the disease has not yet been sufficiently clarified scientifically.

Specialists who offer competent help with lipoedema are vascular specialists(angiologists, phlebologists) and cosmetic surgeons.

How can you recognize lipoedema?

Lipoedema always develops symmetrically. At first, only the outer sides of the hips, buttocks and thighs are affected.

Doctors assume that the disease is associated with damage to the small blood vessels in the affected areas of the body: the vessel walls become permeable, which in turn impairs the lymphatic system. It has to remove too much fluid from the tissue.

As the condition progresses, even the legs become thicker and thicker - even though many patients exercise regularly. At higher outside temperatures and after prolonged periods of sitting and standing, the fat cells store even more water than usual.

Other lipoedema symptoms are

  • Cellulite (orange peel skin)
  • Localized, sometimes severe pain
  • Sensitivity to pressure in the affected areas
  • Increased tendency to bruise without strong pressure
  • Swollen "heavy" legs
  • appearance of spider veins
  • Cold skin surface
  • bow legs due to the voluminous thighs
  • Premature osteoarthritis due to the leg misalignment
  • Reduced mobility due to joint complaints
  • Tissue injuries (wound eczema) on the inner thighs

How is lipoedema diagnosed?

Lipoedema is diagnosed on the basis of visual and tactile findings (palpation) and an ultrasound examination. In contrast to lymphoedema, lipoedema does not leave dents when pressure is applied to the surface of the skin. The specialist must also differentiate the fat distribution disorder from clinical pictures with similar symptoms (lymphoedema, obesity).

Due to the typical distribution pattern, the disease is clearly recognizable at an advanced stage at the latest. It starts from the hips and buttocks and spreads in large fat lobes to the ankles and wrists. The ultrasound image shows changes in the fatty tissue reminiscent of snow flurries.

Lipoedema can usually be easily diagnosed on the basis of clear symptoms:

  • Time of onset: lipoedema almost always occurs as part of a hormonal change such as the onset of puberty, pregnancy or the menopause.
  • Severe fat accumulation: The fat deposits accumulated in the subcutaneous fatty tissue are distributed symmetrically, for example on both legs or both upper arms.
  • Disproportion: There is a striking difference to the rest of the body. The upper body and waist are often slim, while the hips and thighs increase their volume uncontrollably.
  • Exercise and dieting: Even with a healthy diet, strict diets and plenty of exercise, the excess fatty tissue cannot be reduced.
  • Edema and tendency to hematoma: Even slight pressure can cause pain in affected women, who tend to develop edema and bruising at the slightest bump.
  • Skin structure: As the disease progresses, the surface of the skin loses its smoothness and becomes "pitted" with ever larger lumps in the subcutaneous fatty tissue. This is known as the mattress phenomenon.

Just one or two of these symptoms can indicate lipoedema. If you are affected, you should consult a specialist, such as a phlebologist. He or she will clarify the symptoms and suggest a treatment.

How is lipoedema categorized?

Doctors differentiate between 3 stages of the progressive disease:

  • 1st stage: formation of orange peel skin (smaller dimples) - In the initial stage, the skin surface is still relatively smooth with soft and fine-knotted subcutaneous tissue. The overall harmony of the body is hardly disturbed.
  • Stage 2: Development of larger dents (mattress skin) - As the disease progresses, nodules increasingly form in the fatty tissue. The skin surface becomes more uneven, the fat deposits larger and more asymmetrical. The difference to the rest of the body is clearly visible.
  • Stage 3: Large, harder skin flaps and skin bulges that even cover the hand and back of the foot - The subcutaneous fatty tissue is very thickened and hardened with large lumps and a pitted skin surface. The affected parts are very swollen. The disproportion to the other half of the body is very pronounced, especially on the thighs and hips with sometimes large flaps of fat.

There are also 5 types, depending on the degree of severity:

  • I. Type: limited to the buttock-hip region
  • II. type: up to the knees and fat flaps on the inside of the knees
  • III. type: up to the ankles
  • IV. Type: only hands and feet are not affected
  • V. Type: water retention (edema) even in the hands and back of the feet, fingers and toes (lipolymphedema). Damage to the larger lymph vessels

Lipödem-Typen
Different types of lipoedema © vanillya / Fotolia

Lipoedema is also referred to as:

  • Thigh type,
  • Lower leg type,
  • calf type or whole leg type,
  • as well as upper arm type, whole arm type or forearm type.

How is lipoedema treated?

There are several therapeutic options for treating this hereditary fatty tissue disorder:

  • Manual (by hand) lymphatic drainage by a physiotherapist (usually lifelong conservative therapy)
  • Compression treatment (compression bandages, support stockings)
  • sport
  • Liposuction(liposuction) by an aesthetic and plastic surgeon (usually performed several times)

Regular lymphatic drainage

Lymphatic drainage is often used in the later stages of lipoedema. It is intended to reduce the swelling (oedema) caused by the additional accumulation of water in the tissue.

Certain manual techniques are used to decongest the lymph trapped between the fat cells: Pressure and traction activate the lymph vessels, allowing the lymph fluid to drain from the affected area. The mechanical stimulus also has a pain-relieving effect.

During the decongestion therapy at the beginning of the treatment, lymphatic drainage is planned 5 to 7 times a week. In the subsequent maintenance phase, only once or twice a week.

The affected areas of the body are additionally wrapped with compression bandages.

Support stockings

Thanks to their special manufacturing method and firm material, support stockings exert increased pressure on the leg veins. They are used in maintenance therapy.

Compression stockings are available in three strengths - depending on how intense the pressure exerted should be. As people with lipoedema often have a larger leg circumference, the doctor prescribes flat-knit support stockings. They must be worn daily - even during exercise if possible - and prevent venous blood from backing up into the legs. The accumulation of water in the fatty tissue is reduced. The legs become slimmer.

Sport

Patients with lipoedema who also suffer from obesity should lose excess weight if possible. This alleviates their pain and helps them to become more mobile again. Not only a moderate and healthy diet (no reduction diet!) contributes to this, but also sport.

All types of water sports are well suited, including

  • Aqua gymnastics,
  • swimming and
  • aqua jogging.

These sports are particularly easy on the joints and support the effect of manual lymphatic drainage. Vascular specialists also recommend

  • Cross-country skiing,
  • walking and
  • walks.

Liposuction

The suction of fat cells and lymphatic fluid (liposuction) is the only method that also helps those affected in the long term. It not only removes excess tissue fluid, but also reduces fatty tissue. The treatment is also permanent: fat can no longer accumulate in the treated areas.

The surgical procedure can reduce the thigh circumference by a maximum of 3 trouser sizes. The treatment also reduces the oedema in the legs so that the patient will hardly experience any pain in future.

The cosmetic surgeon first marks the surgical area and makes several incisions about 4 millimetres long. He then injects a saline solution into these incisions. It also contains adrenaline and a local anaesthetic.

The solution

  • stops the bleeding that occurs during suction,
  • relieves the patient's pain and
  • swells the fat cells stored there so that they can be removed more easily.

The doctor then uses a narrow cannula to suction up to 9 liters of fat cells, lymph and blood from the subcutaneous fatty tissue.

After liposuction, the patient must wear a special compression garment for around 4 weeks. It shapes the areas of the body that have been worked on and helps the skin to grow well.

If the operation goes well, the patient may be able to do without lymphatic drainage in the future.

Preparation and form of anesthesia for liposuction

In most cases of lipoedema, large amounts of fat are suctioned out. Tumescent solution continues to leak out even hours after the operation. For this reason, practically every liposuction is performed under general anesthesia.

In preparation for the procedure, the team carries out the usual anesthetic pre-examinations. In the case of lipoedema, lymphatic drainage shortly before the procedure is also helpful and improves the result.

In the case of liposuction under general anesthesia, the local anesthetic in the tumescent solution can be dispensed with. This allows patients to recover more quickly after the operation and maintain a stable circulation.

Complications and risks of liposuction

Every surgical procedure carries potential risks, regardless of the clinical picture. However, they can be greatly reduced by thorough preparation.

The patient should therefore inform her doctor comprehensively about possible

  • allergies,
  • intolerances and
  • other health problems

health problems. The necessary precautions can then be taken to ensure a smooth procedure.

In the case of lipoedema, venous disorders are a possible side effect. In this case, a vein specialist must be involved in the treatment.

Aftercare following liposuction

The compression pants are put on while the patient is still under anesthesia and should then be worn for 6 weeks. The girdle can be removed for a few hours for washing.

An inpatient stay of one to two days is recommended.

The first lymphatic drainage is programmed for the day after the operation. Two to three lymph drainage sessions per week should follow in the initial period. After two weeks, this can be reduced to one or two lymphatic drainages per week.

You will notice a significant reduction in pain shortly after the procedure. Once the swelling has subsided after a few weeks, you can lead a normal life again, do sport and enjoy new clothes.

Treatment costs for liposuction

Since January 1, 2020 and initially limited until December 31, 2024, statutory health insurance may cover liposuction under certain circumstances.

The prerequisites are

  • The presence of lipoedema from stage 3,
  • previous conservative treatment for at least six months that has not been successful, and
  • a maximum BMI of 35

Before deciding on liposuction, please consult your health insurance provider in detail to ensure that the costs are covered.

Billing with private health insurance companies is sometimes easier, but the costs are often not covered here either. Clarify this directly with your private health insurance company.

In any case, the treatment costs can be declared as a special expense for tax reduction.

The right doctor for lipoedema treatment

General practitioners and family doctors are often the first point of contact for complaints that can be explained by lipoedema. However, the initial characteristics and symptoms of this condition are usually very unspecific, so that the family doctor or general practitioner then refers those affected to a specialist. These include phlebologists, lymphologists and plastic and aesthetic surgeons.

The best results in lipoedema treatment can be achieved with interdisciplinary therapy. This means that different treatment methods from different medical specialties work together in the treatment.

Conclusion on lipoedema treatment with liposuction

With the right preparation and aftercare, liposuction can achieve very pleasing results . They fundamentally change and improve the patient's life.

With the right lipoedema treatment, lipoedema rarely recurs (recurrences). Good results can be expected in the following areas:

  • Pain and symptoms of the disease: the discomfort associated with lipoedema, such as sensitivity to pressure and a tendency to hematoma and oedema, often disappears completely.
  • Body harmony: The immediate reduction in volume restores body proportions.
  • Mobility: The weight reduction results in greater freedom of movement, even sport becomes possible again after many years.
  • Aesthetics: Even in severe cases, the skin is visibly smoothed and becomes elastic again.
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