Lipoedema is an illness characterised by symmetrical swelling, pain and frequent hematomas in the lower limbs which unfortunately mainly affects women and the prevalence is estimated to be 11% being extremely rare in men. It is often misdiagnosed and currently under-researched disorder. Early-stage lipedema often cannot be distinguished from common cellulite.
Nethertheless it is very common and has an immense psychological impact on its sufferers. Patients often feel disheartened by the lack of understanding of this illness amongst medical staff, especially if they are stigmatised as being ‘overweight’.
Fat distribution involves lower extremities, upper arms, hips, buttocks, thighs sparing trunks, and feet. Lower extremities are characterised by pain, easy bruisability, firm subcutaneous nodules of adipose tissue, and resistance of fat to traditional diet and exercise. However, in some instances lipoedema and obesity can co-occur, unlike obesity, lipoedema usually targets the legs and thighs, without affecting the feet or hands, and the adipose tissue in lipoedema is swollen and painful. The lymphatic system remains unimpaired in the initial stages and can keep up with the increased amount of interstitial fluid, However, patients with lipoedema may develop secondary lymphedema (lipolymphoedema) if the fatty deposits compromise the lymphatic system.
Untreated lipoedema may result in secondary problems including osteoarthritis, reduced mobility, psychological impairment, and lowered self-esteem.
Unfortunately, as with many rare illnesses we still do not have a definite answer to this question.
Hormonal changes which occur during puberty or menopause can be the catalyst for this, however in most cases the illness develops in women between 30-40 years old. The theory here is that fatty tissue is receptive to the female hormones oestrogen and progesterone.
Depending on the severity, there are 3 stages of lipoedema:
STAGE I – The skin surface is smooth; the sub[1]cutaneous fat appears evenly dense and homogeneous.
STAGE II – The skin surface is wavy; the subcutaneous fat feels lumpy.
STAGE III – The skin surface has a cobble stone-like texture; the subcutaneous fat tissue has large lumps; there is a severe increase in circumference with overhanging tissue sections.
There is unfortunately no known curative therapy for lipoedema. The treatment for Lipoedema is always multidisciplinary.
The primarily focus of treatment is to reduce its related lower extremity symptoms, disability, and functional limitations to improve patients’ quality of life, as well as preventing disease progression. Treatment is divided into conservative therapy and surgical interventions.
The conservative therapy includes promotion of individually adjusted healthy lifestyle, combined decongestive therapy (CDT). CDT can be carried out in different ways and combine different techniques, manual lymphatic drainage (MLD) once or several times a week, compression bandages, intermittent pneumatic compression or flat knit compression garments (available in 3 different strength levels).
Conservative therapy can alleviate some lipoedema symptoms such as heaviness, pain, and secondary swelling. However, these benefits are short-lived, usually requiring repeat treatment within days.
Other supportive measures include such as psychosocial therapy and orthopaedic counselling, and nutritional education.
Liposuction is the main surgical interventions for lipoedema. Commonly used liposuction methods for lipoedema are tumescent anaesthesia (TA) liposuction, and water assisted liposuction (WAL).
Dr Brooks only uses water assisted liposuction which uses a pressure spray of tumescent fluid to dislodge the fat from the connective tissue, rather than utilising a cannula. The WAL procedure is carried out using the body-jet® device which is safe and effective, and is a gentle type of liposuction involving the use of water which involves little pain for the patient. Contusions and injury to the sensitive nerves directly underneath the skin are relatively rare when the water-jet liposuction technique is used. Like tree roots washed clean, the strands of connective tissue under the skin, which are important for keeping the skin tight, remain mostly intact
Following liposuction a strict use of compression garments is advised for up to 6 months. If liposuction is extensive, occasionally there will be pockets of excess skin which may benefit from subsequent excision at a later date. This is all discussed at the time of consultation.
Please do get in touch with our team about how we might be able to assist with lipoedema.
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