Lipedema
Lipedema is a congenital pathological chronic dysfunction and distribution disorder of the fatty tissue lying under the skin on the extremities, preferably on the legs and arms. Hands and feet are excluded
- mostly women
- Men are extremely rarely affected
| Lipedema is not a body shape variant but a recognized condition (ICD 10 E88.20 – 22), that requires medical treatment |
Lipedema occurs after puberty, after pregnancy or during menopause. The pathological change in the fat cells is probably caused by a genetic predisposition, but hormonal changes and weight gain are also suspected to be triggers. The edema is caused by increased permeability of the capillaries to fluid and an obstruction to lymphatic drainage.
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| Lipedema is frequent, nearly 11% of all women are affected by Lipedema |
The pathological change in the fat cells is probably caused by a genetic predisposition. The pathological change in the fat cells is probably caused by a genetic predisposition, but hormonal changes (Puberty, Pregnancy, Menopause) and weight gain are also suspected to be triggers.
The dysfunction is accompanied by increased vascular permeability and vascular fragility. This results in increased edema and bruising from minor injuries over the course of the day. The origin of the strong sensitivity to touch and pain in the edema area has not yet been completely elucidated. However, there is a clear connection with the edema, as decongestion (de-edematization) significantly reduces the pain.
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Lipedema is progressive, meaning it will continue to progress without treatment.
If lipedema has existed for years, the existing edema can cause overloading and ultimately damage to the lymphatic system. The lipedema then develops into lipo-lymphedema. Clinically, the previously extremely soft tissue is now becoming increasingly hard. In addition, all complications of lymphedema can occur.
From a clinical aspect (morphological) a distinction is made between 4 stages:
| I | II | III | IV |
Smooth skin surface with evenly thickened, homogeneously impressive subcutis (“orange peel”: cellulite with finely nodular skin surface) | Uneven, predominantly wave-like skin surface, knot-like structures in the thickened subcutaneous area (“Mattress skin”: cellulite with coarse, nodular skin surface) | Pronounced increase in circumference with overhanging parts of tissue (formation of dewlaps, coarse, deforming fat flaps).
| In (advanced stage III) stage IV, the tissue becomes increasingly hardened (lipo-lymphedema) |
What is characteristic of lipedema is that the pathological changes always occur symmetrically, i.e. on both legs and/or both arms. The fat accumulations can either be distributed homogeneously over the entire leg and/or arm (so-called pillar leg or pillar arm) or only affect either the upper or lower leg. In the later course, circumscribed bulges (dewlaps) are often found, which are located primarily on the inside of the thighs and knees, and more rarely in the ankle area
 | Lipedema leads to physical, functional, psychological and/or aesthetic impairment | |||
physical | functional | psychological | aesthetic | |
Feeling of heaviness and tension in the affected extremities
Painful on palpation or spontaneously – increasing as the day progresses
Edema – increasing throughout the day
Tendency to bruise (tendency to hematoma) | Chafing effects in the area of the inner thighs
Chronic skin inflammation in the area of deep skin folds. →This increases the risk of secondary lymphedema.
Orthopedic complications due to bulges on the inside of the thighs
| The women affected often suffer greatly from their illness
Severely reduced self-esteem | Disturbances of the body shape: ever-increasing circumference of the legs and the shifted proportions between trunk and extremities are increasingly becoming an aesthetic problem | |
 | There is no causal therapy for lipedema; only the symptoms can be treated | |
 | The therapy has two goals:
• The elimination or improvement of the findings and complaints (especially pain, edema and disproportion) • The prevention of complications. As the condition progresses with an increase in v. a. The risk of dermatological (e.g. macerations, infections), lymphatic (e.g. erysipelas, lymphedema) and orthopedic complications (gait disorders, axial misalignments) increases.
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Conservative and surgical procedures are available for therapy, which are used depending on the stage of lipedema and individually adapted to the patient.
Based on many years of research and clinical experience in the field of fat distribution disorders, we have developed a so-called “integrative therapy concept for lipedema according to HIERNER” for the efficient treatment of fat distribution disorders and have successfully used it in our daily practice.
Operative Treatment Goal of treatment
→ Correction of axial malalignement → Osteoarthritis Management (Knee, Hip, ….) | Correction of lipedema-associated pathological gait | ||
Plastic & Reconstructic Surgeries → Tissue Reduction by Body Lift procedures | Restoration of body contour after edema reduction | ||
| → Decompression by multiple-stage Liposucction | Improvement/elimination of symptoms through reduction of edema | ||
| Conservative Treatment | |||
| Improvement/elimination of symptoms through reduction of edema | ||
| Basic-Treatment | |||
| Avoiding the aggravation of fat distribution disorder | ||
| Weight loss and exercise have no direct influence on the severity of lipedema |
Goal: Avoiding the aggravation of fat distribution disorder | |
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| Conservative Treatment |  |
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Lymphatic drainage has no direct influence on Lipedema | |
| Goal: Improvement/elimination of symptoms through reduction of edema | ||
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| Operative Treatment |  | |
| | Careful preoperative preparation (chronic skin infection, Lymphedema) Careful operative planning with the patient standing | |
Goal:
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Liposuction: Depending of the stage of the Lipedema disease, decompression of Lipedema needs multiple stages → Need for a complete treatment plan (Number of treatments sessions depends on the initial findings) → Need for planning of the current surgery
NOTE: Therapy goals are depending on the initial findings (stage of disease)
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Body contouiring by skin Resection: → Tissue Separation Technique according to PASCAL | ||
Orthopedic surgeries: → Correction of axial malalignement → total joint replacement hip and knee | ||
