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Lipoedema

In lipoedema, abnormal fat cells are deposited in certain parts of the body. The tissue at the affected parts is sensitive to pressure and painful to the touch with a tendency toward bruising (haematomas). Particularly in the early part of the disorder, fat accumulations are mainly found below the navel, i.e. on the buttocks, hips and the legs. They can also appear on the arms at a later stage. Lipoedema that extends over the thigh and hip area is also referred to as a “saddle bag phenomenon.”

Self-check

Lymphoedema or lipoedema?

To illustrate the differences between the two conditions, lymphoedema and lipoedema, we have drawn up a comparison of the most important distinguishing criteria.

LYMPHOEDEMALIPOEDEMA

Appearance of the oedema

asymmetricalsymmetrical
Painful sensitivity to pressurenoyes
Bruises (haematoma)noyes
Erysipelascommonno

Swelling on

back of the foot and/or hand

yesno

Important: This self-check is not a replacement for seeing a medical specialist. It is crucial that you consult a medical specialist to obtain a correct diagnosis.

Lipoedema

Lipoedema (Greek: lip = fat) is a dysfunction of fat distribution. Lipoedema mainly affects women as their tissues are of a different structure than men’s tissues. The predisposition to lipoedema is probably already present in the genes of affected people. The triggers for this chronic condition are mainly hormonal changes in the body as can be found during puberty, pregnancy or menopause. If the condition is already established, these changes can contribute to a worsening of the symptoms. 

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Symptoms

Unfortunately, it can often take some time until a lipoedema diagnosis is made. In many cases it is wrongly confused with obesity, as both frequently happen together, making differentiation more difficult. You can use the following signs to identify whether you potentially suffer from lipoedema. 

Diagram Lipoedema symptoms

Symptoms that are visible on the outside
There are certain signs that make it very easy to spot lipoedema from its appearance: 

  • Both legs and/or arms are of disproportionate size, feet and hands are slim and not swollen.
  • The body looks as if put together the wrong way. The upper body is relatively slender, but buttocks, hips and legs and/or arms are significantly more voluminous.
  • Clothing sizes for upper and lower body differ significantly.
  • There is an increased susceptibility to bruising.
  • Exercise, healthy eating or diets make little difference to the affected parts; this will result no or only a slight decrease in circumference.


Internally experienced symptoms
In addition to the visible signs, there are also lipoedema symptoms that can be felt. These can be aggravated after sitting or standing for long periods throughout the course of the day but are also worsened by heat:

  • Extreme sensitivity of the tissues
  • Tenderness
  • Heavy feeling in the legs due to increased fatty tissue and accumulation of tissue fluids

If you notice one or more of the following signs, please consult a medical specialist. Early diagnosis is important to ensure an optimum therapy process and counteract any deterioration of the condition. 

Stages

A distinction is made between different stages of lipoedema. If lipoedema is not treated, the circumference of the affected body parts will continually increase over the years. Early diagnosis by a medical specialist and starting the appropriate treatment are of utmost importance in counteracting the progression of the disease.

Diagram showing the stages of lipoedema


Stage I

  • Smooth, uniformly thickened skin surface


Stage II

  • Uneven, predominantly wavy skin surface, so-called “orange peel skin”
  • Coarse, nodular tissue structure (nodules are approx. the size of a walnut or fist)


Stage III  

  • Pronounced increase in circumference
  • Very coarse and hardened skin surface
  • Tissue forms large folds on the legs and/or arms
Diagram showing the types of lipoedema

Type classification


Proper identification of lipoedema is not always that easy as it can have different outward appearances and vary from patient to patient. Depending on which parts of the legs and/or arms are affected, different types can be distinguished.

 

Treatment concept

Dearly diagnosis can prevent deterioration of lipoedema. As lipoedema is a chronic condition, it will accompany you all your life. Consistent treatment can positively influence the extent and potential consequences of lipoedema and alleviate symptoms. It is important that you accept yourself and your condition and start any treatment options as early as possible, consistently adhere to the treatment and become the “manager” of your condition.

Neither diets nor fasting or exercise will bring the desired success for lipoedema as a fat reduction in the affected parts will not be achieved. You will only lose weight in the “healthy” parts of your body. That is why these methods are not an option treating lipoedema. Nevertheless, you should still pay attention to a healthy eating regime, an active lifestyle and exercise in compression garments. Lipoedema cannot be cured by medication. Lipoedema treatment consists of combined decongestive therapy (CDT) with manual lymphatic drainage (MLD) and supporting compression therapy (non-surgical method), potentially with intermittent compression treatment (IPC). This is divided into two phases (phase 1: decongestion phase, phase 2: maintenance/optimisation phase).

Surgical methods

  • For some female patients, surgical procedures liposuction and plastic surgery that may sometimes consequently be necessary can also be an option. This will have to be decided on a case by case basis by the treating physician and is subject to consistent prior treatment with a non-surgical method.

Liposuction – another option in lipoedema therapy
Liposuction is the only way of removing excess fatty tissue. This should be carried out only after consistent non-surgical therapy.
However, a guaranteed healing of the lipoedema through liposuction is not possible either, what can be achieved is a temporary relief and reduction in symptoms.
If you are considering liposuction, it is essential that you consult one or more medical experts to find out about the possibilities, risks and side effects as well as expected costs and long-term results. It is rare that health insurers bear the cost for the liposuction. They do however pay for compression garments in most cases.

Outpatient or inpatient care?
Whether you receive inpatient or outpatient treatment for your lymphoedema or lipoedema will depend first and foremost on the stage of the oedema and any accompanying illness. There are a number of reasons why it might make sense to receive inpatient treatment for oedema:

  • symptoms can only improve if treatment in the decongestion phase (CDT phase 1) is complete and continuous without interruptions, i.e. ideally on a daily basis. If treatment is interrupted, this could exacerbate both the condition and symptoms. 
  • More intensive measures may be required, especially in the more advanced stage of lymphoedema or lipoedema, to significantly reduce circumferences. Patients can sometimes be busy with treatments for the majority of their day. In such cases, outpatient care is not always possible.
  • The treatment success will only be evident and maintainable over the long term with daily wear of the compression bandages during the decongestion phase, and compression garments during the maintenance phase. Motivation levels often drop, particularly in the maintenance phase of treatment. A hospital stay with consistent decongestive therapy and the resulting reductions in circumference and pain can provide additional support to motivate patients to persevere in consistently wearing their compression garments.
  • Furthermore, inpatient treatment comprises other important supportive measures such as skincare, advice on nutrition, pain therapy, fitness training, psychological care or instructions for self-management after discharge. The intensive decongestive phase and training in proper self-management can also be carried out in specialised lymphological practices on an outpatient basis.

Complications

Development of lipo-lymphoedema

Similarly to the explanation already provided for lymphoedema, so-called “lipo-lymphoedema” often develops, especially in the advanced stages of lipoedema.

In addition to the already existing lipoedema, a lymph drainage disorder also develops. This mixed form develops due to the extreme constriction of the lymphatic vessels by severe overgrowth of the fatty tissues. Lymph can no longer drain sufficiently and accumulates in the tissues.

In contrast to a typical one-sided formation, the lymphoedema that forms within the context of a lipoedema condition mostly develops symmetrically.


Orthopaedic consequences

Volume increases in the inner thighs can result in severe reduction of mobility and negatively affect the gait pattern. This can lead to misalignments in the area of the ankle, knee and hip joints.


Damage to the venous system

If you are diagnosed with lipoedema, a phlebological examination of the venous system is also recommended as the system can be impacted by this condition. Early detection of a venous dysfunction can prevent superficial varicose veins and damage to the deep vein system while also treating any existing venous conditions. 

You can find information on potential venous disorders on our Phlebology page.