Lipoedema

The legs, hips and arms are most frequently affected. Lipoedema in the chest and abdomen can be ruled out. The feet and hands also remain unchanged in most cases. As a result, there is a noticeable and visual difference in the proportions of the lower and upper body.

Those affected by lipoedema most commonly suffer from the following symptoms (which can vary in severity):

Physical complaints

• Irregular tissue structure (bilateral symmetrical fat deposits) on the affected areas of the body
• Spontaneous and/or dull pain, which usually increases during the course of the day and is further intensified by prolonged sitting or standing
• Strong sensitivity to touch in the affected body region
• more rapid occurrence of haematomas (bruising / bruises), e.g. after a slight impact, due to the very sensitive blood vessels in the tissue
• Nodular skin

Psychological complaints
Lipoedema sufferers usually also report concomitant psychological complaints, which are often associated with the altered appearance. As a result, psychological support is usually also recommended.

Lipoedema is most commonly diagnosed in women. However, lipoedema can also occur in men if they suffer from liver disease or a hormonal disorder (e.g. testosterone deficiency) or are undergoing hormone therapy (e.g. for prostate cancer).

Occasionally a familial clustering is observed. Parents and siblings of affected persons show similar symptoms in 30 to 60 % of cases. However, exact figures on the frequency are still lacking. There is also often a tendency to be overweight.

A physical examination can quickly determine whether lipoedema is present.

The earlier lipoedema is recognised, the quicker any long-term health consequences can be prevented by means of individually tailored treatment. It is also very important to rule out other causes in relation to the existing symptoms.

In the case of a lipoedema diagnosis, the type and stage of lipoedema are defined by means of a physical examination.

A total of five types are distinguished:

• Type 1: Hip
• Type 2: Hip and thigh
• Type 3: Hip, thigh and lower leg
• Type 4: Arms
• Type 5: Lower leg

There are three stages of lipoedema development:

• Stage 1: smooth skin, fine-knotted, soft subcutaneous fatty tissue, slightly thickened
• Stage 2: uneven skin structure, medium nodular thickening of subcutaneous fatty tissue
• Stage 3: coarse skin folds, coarse nodular subcutaneous fatty tissue, deformed leg contour and fat bulges

Important to understand: The complaints/symptoms of those affected can already be very advanced in stage 1. At the same time, some patients in stage 3 report very little pain. The symptoms (especially pain) and the stage do not necessarily have to run in parallel.

More precise research into the causes is still ongoing. However, experience has shown that the following influences can cause or exacerbate lipoedema:

Hormonal influences and genetic predisposition
There is a strong suspicion of hormonal influences, as the onset of the disease often occurs during phases of hormonal changes such as puberty, pregnancy or the menopause.

Influence of diet and exercise
The most common causes include an unfavourable diet and a simultaneous lack of exercise over a longer period of time.

As a result, body weight increases, the fat cells enlarge and the fatty tissue is no longer supplied with sufficient oxygen (as the fat cells form faster than the required blood vessels). This undesirable process can trigger inflammation, which causes the pain.

Influence of chronic stress, anxiety and depression
Anxiety, depression and chronic stress can fuel the pain via the so-called inflammatory mediators in the skin tissue.

It is important to differentiate between acute and chronic pain and to consider mental health within the treatment process.

The course of lipoedema is influenced by many factors and therefore varies greatly.

For a long time, it was assumed that the course of the disease would steadily worsen. Today, however, it is clear that this does not have to be the case - as long as lipoedema is treated early and in a medically correct manner.

The course of the disease can be positively influenced by constant weight control. Experience has shown that long-term professional nutritional counselling or support is required for this purpose.

Yes, weight gain or severe obesity exacerbates the symptoms of lipoedema. Therefore, those affected need to maintain a healthy, stable weight and exercise regularly.

Being very overweight can cause lymphoedema to develop. This causes swelling in the affected area of the body due to the lymph that can no longer be drained.

The progression of lymphoedema is usually not linear, but causes more and more symptoms over time, such as tissue hardening. As a result, the local immune defence is also weakened, which increases the local risk of inflammation.

There are many patients who suffer from three diseases at the same time: Lipoedema, obesity and lymphoedema. All three conditions need to be treated.

As lipoedema cannot be cured, the aims of treatment are as follows:

• Control/contain the growth of lipoedema
• Improve the functionality of the affected areas of the body
• Prevent complications
• Provide support in terms of psychological stability and nutrition

In a personal consultation, we address the following key questions:

• Which (physical and psychological) complaints do you suffer from the most?
• What should the treatment improve?

On the other hand, a thorough physical examination is carried out, which includes the following:

• Determination of the volume of the affected body regions
• Measuring your body weight and the ratio of your abdominal circumference to your height
• Assessment of pain intensity, activity level, fatigue as well as quality of life and stress level
• Thematisation of overweight

Our therapy concept covers the following areas:

• Compression therapy
• Physiotherapy/exercise therapy
• Liposuction (liposuction by means of a surgical procedure)
• Weight control
• Psychosocial therapy
• Self-management

Lymphological physiotherapy
In the case of severe pain, manual lymphatic drainage can be effective at the beginning. The soft fibrosis grips during the treatment can alleviate the acute pain so that the subsequent permanent compression can be used successfully.

Of central importance is compression therapy, which is implemented using modern compression bandages.

The intervals between treatments are gradually extended over time.

Towards the end of the intensive phase, the affected areas of the body are measured and the orthopaedic technicians produce customised compression stockings.

The intensive phase is followed by the maintenance phase, during which the patient wears compression stockings and takes part in a training programme.

The constant use of compression stockings in combination with regular physical exercise and the control and maintenance of body weight are decisive factors in conservative treatment.

Physiotherapy and psychosocial therapy
On the one hand, a referral to physiotherapy is ensured, and on the other hand, the option of talking to a specialist about the psychological effects of the disease is offered.

We issue medical prescriptions for both forms of therapy.

Drug treatment
No medication is used to treat lipoedema. Conservative therapy focuses on compression therapy in combination with targeted physiotherapy.

As soon as complete conservative treatment has been carried out for at least six months and the symptoms have not been satisfactorily reduced, surgical treatment may be considered.

Liposuction
Thanks to state-of-the-art infrastructure and our many years of experience, we can remove large volumes of fat without a large incision in a way that is gentle on the tissue.

The treatment of lipoedema is carried out using the water-jet assisted liposuction procedure, which differs fundamentally from a purely aesthetically motivated treatment.

The fat cells are simply flushed out, whereby the blood vessels and lymphatic channels are spared considerably. Another advantage of this procedure is the faster recovery after the operation.

Even if large amounts of fatty tissue can be removed in a single procedure, several operations are usually necessary. As a result, an individualised treatment plan and personal, close care are of central importance.

After the operation, it is still necessary to ensure weight stability (through diet and exercise) and, if necessary, the use of support/compression stockings, as the chronic fat distribution disorder cannot be eliminated with liposuction. It may also be necessary to continue physiotherapy in many cases. Increasing muscle strength and endurance can have a positive effect on inflammatory processes in the tissue.

Sophisticated procedures such as lipoedema treatment should always be carried out by experienced specialists. This allows the complication rate to be reduced to an absolute minimum.

Our specialist for lipoedema treatments, Prof. Dr Mario Scaglioni, has many years of experience and a high level of expertise in lymphatic surgery.

He will take care of you and your concerns competently, comprehensively and personally. Arrange your individual appointment - directly online or by telephone.

Sports that are easy on the joints or do not put too much strain on them are particularly recommended: swimming, cycling, yoga exercises and fast walking. If you are affected by lipoedema, regular exercise is of central importance.

It is important to wear compression stockings to relieve the pressure on the tissue and alleviate any pain. Tight-fitting clothing should be avoided to prevent unnecessary pain and swelling.

In general, a healthy and balanced diet that can be integrated into everyday life in the long term is important.

The following recommendations should be taken into account:

• Drink enough water (no sweet drinks)
• A healthy intake of carbohydrates (as little simple sugars as possible)
• A high-fibre diet (lots of vegetables and unprocessed foods)
• Focus on unsaturated, healthier fatty acids

Individual nutritional counselling is highly recommended in any case.