Lipedema: treatment of fastenings

Definition of lipedema:

Lipedema, also called pole leg disease, is a congenital disorder of fat distribution that affects the legs and arms.

Very often the four limbs are affected, where we observe accumulations of fat not adapted to the morphology of women or men.

In this adipose tissue, there is a violation of the production of lymph and its excretion. Lymph production is excessive compared to what can be eliminated. This causes a delay in the lymph and an increase in pressure in the tissues. This is manifested by pain when touched.

However, the most striking symptom of lipedema is that fat in the legs and arms cannot be eliminated through weight loss.

This adipose tissue, located on the limbs, is not related to the fat that we gained during weight gain. This is a different kind of fat.

Many women have tried countless diets without success. They hide their legs, and sometimes face reproaches from others. Then they are very happy when they meet a doctor who considers lipedema a pathology.

lipedema of the hand

It is often stated in medical journals that the hands are also affected in 30% or 60% of patients with lipedema. In fact, the hands are also affected in most cases. But since women seek medical attention primarily for leg pain and then are usually examined for possible vein disease, the arms are not considered. The distribution of fat in the arms is generally similar to lipedema in the legs.

Lipedema, lymphedema or lipolymphedema?

Lymphedema develops due to a violation of the passage in the lymphatic system. The fabric is saturated with substances such as water and proteins that cannot be properly removed due to turbidity. This leads to progressive chronic inflammation and long-term damage to the connective tissue. There are primary lymphedema and secondary lymphedema.

• Primary lymphedema is a congenital underdevelopment of the lymphatic and vascular system. Symptoms usually appear before the age of 35. 
• Secondary lymphedema is caused by external influences such as trauma, burns, or inflammation. Lymphedema can also develop after surgery.

An experienced doctor can determine whether it is lipedema or lymphedema. The differences are easy to recognize for him:

• In the case of lymphedema, the legs are affected as well as the forefoot. The skin is smooth and elastic, there is no orange peel. Palpation reveals edema and mild swelling, leaving traces. The thickness of the skin fold is more than two centimeters. The patient usually does not feel pain.
• On the other hand, in the case of lipedema, the forefoot is never affected. The skin is soft, wavy and knotty. Orange peel skin is usually visible. On palpation, the affected areas are oily. The thickness of the skin folds is normal. Patients experience pain, especially pain when pressed.
• A reliable classification criterion is the so-called Stemmer sign. Here the doctor is trying to lift the fold of skin over the second or third toe. If this fails, it is a case of lymphedema. On the other hand, in the case of lipedema, the skin fold can be grasped without difficulty.

Why such a disproportion in adipose tissue, where do hematomas come from and why do patients feel pain?

Lipedema is a pathological disorder of fat distribution of unknown cause that occurs in women symmetrically on the thighs, buttocks and both legs, and usually also on the arms.

The typical first signs of lipedema are a feeling of tension, pain and fatigue in the legs. They start when you stand or sit for a long time, increase during the day and can reach intolerable levels. The pain is especially excruciating at high temperatures, as well as at low atmospheric pressure (air travel). The pain does not decrease significantly even when the legs are elevated. In some women, it is especially pronounced a few days before menstruation.

These symptoms are not due to lack of discipline or due to the fact that some people with lipedema of the legs, the so-called pole legs, eat immoderately, but simply because they have health problems. That it's not their fault. 

Sometimes it is a relief for patients when they know what it is and are able to be treated properly.

Lipedema tends to get worse. However, this "progression" varies greatly from person to person and is unpredictable in individual cases. In some women, the progression of adipose tissue reaches a certain intensity and remains in this state throughout life. In others, on the other hand, the lipedema increases rapidly from the start. And sometimes it stays constant for years before gradually getting worse. The vast majority of lipedema occurs between the ages of 20 and 30.

Depending on the severity, there are three stages of lipedema:

Stage I: stage I leg lipedema 

A tendency to the shape of a “saddle” is visible, the skin is smooth and even, if you press on it (with subcutaneous tissue!) (pinch test), you can see the consistency of “orange peel”, the subcutaneous tissue is dense and soft. Sometimes (especially on the inside of the thighs and knees) you can palpate formations that look like balls.

Stage II: stage II leg lipedema 

Pronounced "saddle" shape, uneven surface of the skin with large tubercles and bumps the size of a walnut or apple, subcutaneous tissue is thicker, but still soft.

Stage III: stage III leg lipedema 

pronounced increase in circumference, strongly thickened and compacted subcutaneous tissue,

rough and deforming accumulations of fat (formation of large skin accumulations) on the inner sides of the thighs and knee joints (friction ulcers), fatty rollers, partially hanging down on the ankles.

Important note: the severity of symptoms, especially pain, is not necessarily related to stage classification!

Secondary lymphedema, transforming lipedema into lipolymphedema, can occur at all stages of lipoedema! Concomitant obesity may contribute to this phenomenon.

Treatment of lipedema

People with this pathology should be aware that there are 2 different methods of treatment lipedema of the legs :

People with this pathology should be aware that there are 2 different methods of treatment: conservative treatment and surgery. They choose the way that suits them. For the treatment of lipedema, coverage depends on the condition and type of treatment.

Classic conservative method:

This method serves to move the lymphatic flow towards the center towards the heart. For this, the attending physician prescribes manual lymphatic drainage.

This treatment is aimed at positively influencing the time interval between lymph production and excretion. It's for pain relief, but it's a lifelong cure. In the worst case, this means 1 hour / 3 times a week. And if you refuse treatment, the problem appears again.

For lipedema, natural treatment consists of a balanced diet and regular exercise.

2nd solution: lymphological liposculpture:

This method was first applied in 1997 after many years of research.

The only possibility of a long-term solution lipedema of the legs consists in removing the adipose tissue surgically, of course avoiding any damage to the lymphatic vessels and thus correcting the disproportion between the production of lymph in the adipose tissue and its excretion by the vessels and restoring it to its normal state.

However, it is not ordinary, as in . It should be known that the purpose of this operation is not to harmonize the silhouette, but obviously the surgeon must take into account the aesthetic aspect when he operates, but the decisive element is the lymphological cure of the pathology.

That is why removal of lipedema fat can be performed by a specialist in the field of lymphology.

The diagnosis of lipedema is mainly made on the basis of history taking, examination and palpation.

Stages of lipedema surgery

Surgical treatment is carried out in several stages. 

During the first operation, the surgeon removes fatty tissue from the outside of the legs. During the second on the arms and during the third on the inside of the legs. 

These interventions should be carried out at intervals of four weeks.

Why does lipedema need to be treated in several stages?

If we imagine that during the operation the surgeon removes up to 5 liters of tissue even more, then this is a huge disappeared volume, which means that the body needs to get used to it. This is a major operation, but the key to success also lies in postoperative care.

Postoperative treatment of lipedema

In postoperative treatment, the patient is given manual lymphatic drainage immediately after surgery. From the operating table, it goes straight into the hands of the physiotherapist. This lymphatic drainage is aimed at eliminating the injected fluids, as well as preparing the lymphatic vessels for normal functioning, after which a tight bandage is applied. The patient is then transferred to the hospital, where he spends the night, to ensure postoperative control, as this is a major intervention. 

Then the patient who returns home must wear compression shorts for a week, day and night, and the next 3 weeks for another 12 hours a day. This compression is very important after surgery to ensure skin tightening.

Four weeks after the operation, all side effects subside, and the skin, stretched with excess fatty tissue, returns to its normal size within the first six months. 

Rarely, a surgeon is required to remove excess skin. And this is not necessary, because with this method of operation, the surgeon proceeds to some kind of preliminary stretching by inflating with liquid. And then it's a kind of elastic reaction to regain its shape.

After six months or a year, the patient should go to her surgeon for the last examination.

During this final examination, the attending surgeon decides whether an island of lipedemic fat remains here or there, which can lead to localized pain. And if so, then he explicitly removes it.

And now patients can finally classify the subject of lipedema. 

Lipedema disease is curable. Of course, there is the possibility of conservative treatment. But if you want to be cured, you will have to operate. It won't come back because it's innate.

The lipedema is removed, the disease is cured and the treatment is completed.

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