Lipoedema

What is lipoedema?

Lipoedema is a chronic, progressive fat distribution disorder in which the subcutaneous fatty tissue in certain areas of the body increases disproportionately.

The additional tissue presses on other structures such as the lymphatic channels. The accumulated fluid then causes the limbs to swell even more.

The swelling and the unnatural-looking body proportions can be a major restriction in everyday life and a heavy psychological burden for those affected.

In the long term and without targeted, early treatment, lymphoedema can also develop due to lipoedema or a build-up of lymph fluid.

Which areas of the body are affected?

The legs, hips and arms are most commonly 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.

Who is most frequently affected by lipoedema?

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

The types of lipoedema

There are a total of five different types:

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

What stages of lipoedema are there?

There are three stages of lipoedema development:

• Stage 1: smooth skin, fine-knotted, soft subcutaneous fatty tissue, slightly thickened
• Stage 2: uneven skin structure, subcutaneous fatty tissue medium-nodular thickened
• 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.

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

The types of lipoedema

There are a total of five different types:

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

What stages of lipoedema are there?

There are three stages of lipoedema development:

• Stage 1: smooth skin, fine-knotted, soft subcutaneous fatty tissue, slightly thickened
• Stage 2: uneven skin structure, subcutaneous fatty tissue medium-nodular thickened
• 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.

Lymphological physiotherapy

In cases 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.

Physiotherapeutic and psychosocial therapy

On the one hand, a referral to physiotherapy is ensured; 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 therapy has been carried out for at least six months and the symptoms have not been satisfactorily
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 making a large incision in the skin and without damaging 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.

What follow-up treatment is required (self-management and weight management)?

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.