What is Lipedema?
Lipedema is a chronic, progressive, painful fat disorder. The typical physical symptoms are a large lower body and column shaped legs as the fatty tissue accumulates and is deposited in a pant-like distribution that begins at the hips and extends downwards, ending in a cuff like appearance around the ankles. Lipedema fat distributes itself completely symmetrically on both extremities. In some cases, the arms are also involved. Chronic inflammation leads to hardened fibrotic tissue and fat accumulation that can over time interfere with mobility. The accumulation of fat can also lead to skin rashes and serious infections. Weight loss seems practically impossible and over time, the physical symptoms of Lipedema can effect mental and emotional systems as well.
There are conditions that seem to co-habitate with Lipedema. Sometimes those affected with Lipedema may have auto-immune conditions, Dercums Disease, POS, EDS, or Lymphedema. Lymphedema and Lipedema are often confused because of the similarities of the two. Both are frequently misdiagnosed and treated as generalized edema or obesity.
|Spares the feet||Feet involved|
|No pitting edema||Pitting Edema|
|Stemmed sign negative||Stemmer sign positive|
|Tender to touch, painful||Non-tender, not painful|
|Bruises easily||No bruising|
|Primarily effects women||Effects men and women almost equally|
Vein disease in no way contributes to the development or progression of Lipedema, but Lipedema can exacerbate vein disease and the combination of the two can predispose patients to lymph edema. Venous insufficiency in association with Lipedema should be treated to avoid swelling and decrease the chances of lymphedema.
Ten percent of women worldwide suffer from Lipedema. Despite being described over 75 years ago by doctors Allen and Hines at the Mayo clinic, many patients are still misdiagnosed with obesity, lymphatic or other soft tissue disorders. The cause is still elusive but there are many researchers now committed to finding out what specifically creates this condition. There is a definite genetic component that has been found. Lipedema runs in families, predominantly effects women, and appears to be triggered by hormonal changes, stress and trauma. Although Lipedema may start at puberty, patients typically present after their second decade of life and describe painful, symmetric weight gain, preferentially in the legs with difficulty losing with diet and exercise.DiagnosisLipedema patients experience a broad range of symptoms, but the most common symptoms are pain in the legs, unexplained weight gain, muscle weakness and shortness of breath.There are 4 stages of Lipedema:
- Stage I – Smooth skin, increased fat primarily around the hips, thighs, calves and ankles, pear shaped figure
- Stage II – Uneven skin, lipomas, rashes, fat deposits around the knees, ankle swelling, larger arms
- Stage III – “Orange Peel” skin deformity, tissue forms folds and ridges, ankle swelling folds over the feet, tissue begins to harden and becomes fibrotic
- Stage IV – Lipo-Lymphedema, impaired mobility, fat and scarring obstructs lymphatic system and results in generalized edema and leakage of lymphatic fluid, ulcers, massive overhanging masses of soft tissue.
Initial treatment involves a complete blood work-up, this helps to determine whether or not medications or supplements need to be recommended to correct hormonal imbalances that may help weight loss, pain and anxiety. Complete Decongestive Therapy that includes graded compression bandaging, custom tailored compression garments, manual lymphatic drainage and specialized lymphatic exercises. Lymphatic sparing micro cannula, tumescent liposuction is by far the most effective of all the treatment options. It has the best results in decreasing pain, reducing swelling and improving quality of life.
Dr. Neinstein believes that ultrasound based VASER liposuction is more fat specific than water based liposuction and is currently performing clinical research with a large number of patients to prove it is the best form of liposuction for Lipedema. Our complete treatment begins with procedures to fix refluxing veins that lead to edema in the legs. This treatment is followed by liposuction of the extremities and finally we perform body contouring plastic surgery procedures to reduce excess skin. Surgical treatment is the only known modality at this date that can safely remove Lipedema fat.