Although lipedema as a disease was discovered in the middle of the 20th century, it still causes controversy, unknowns, and is insufficiently represented and researched in our wider area. Lipedema is a disease defined as a painful disorder in the distribution of fat tissue, which occurs almost exclusively in women. Such a disorder of fat distribution occurs in the area of the upper and/or lower extremities, including the area of the hips and buttocks. The cause of the disease is still unknown, but there are possible hereditary factors, as well as environmental and hormonal influences. The diagnosis of lipedema is made clinically, since there is still no laboratory, imaging or other parameter that could reliably diagnose the disease. The clinical experience of the specialist is important, as well as a thorough clinical examination and conversation with the patient. The diagnosis of the disease is often reached by excluding other diseases.
Symptoms of the disease include an increase in adipose tissue, disproportionate to adipose tissue on unaffected parts of the body, except for the appearance of the disease on the hands and feet (unless there is a lymphedema component in addition to lipedema), different levels of pain (sensitivity to superficial and/or deep pressure, feeling of tension in the extremities ), easy accumulation of fat on the skin in the case of mild injuries, the appearance of bumps under the skin, in the later stages wavy skin through the various accumulation of fat deposits and the accumulation of so-called fat bags (depots), which can cover the joints and thus cause movement disorders. As the disease progresses, changes occur in the small lymphatic vessels, and patients experience various forms of swelling of the extremities. The symptoms of the disease often increase after standing for a long time, physical activity, heat (sometimes cold temperatures), significant hormonal changes such as puberty, pregnancy, menopause, hormone replacement therapy. Sometimes certain foods can lead to a temporary worsening of symptoms. Since some of the symptoms can be caused by other diseases and conditions, a clinical assessment and possible further diagnostic tests are essential in order to rule out other causes of the symptoms. The disease often develops after puberty, and progresses at different speeds. In some patients, the progression of the disease is slow, while in others it is relatively fast.
According to the experience of Dr. Dozan, many patients face misunderstanding and stigmatization. One of the possible concomitant diagnoses of lipedema is obesity itself, so patients often come across advice on how to solve their problem with a balanced diet and sports. If there is increased body weight or obesity along with lipedema, all conditions should be treated. Lipedema itself is refractory to attempts at diet and sports, and such painful fatty tissue is successfully removed surgically (liposuction). It is important to emphasize that currently there is no medical or surgical treatment that could completely cure the disease, but with the adequate application of the currently available methods, the quality of life can be significantly improved and the symptoms reduced.
Not all patients are ideal candidates for surgical treatment, so talking to a specialist is extremely important. In addition to specialists in plastic, reconstructive and aesthetic surgery, specialists from other fields such as internists, phlebologists, lymphologists, vascular surgeons, orthopaedists also participate in the diagnosis of lipedema. Since the surgical therapy of lipedema is performed by liposuction, a specialist in plastic, reconstructive and aesthetic surgery has been trained to perform such procedures through many years of education. Lipedema is not only an aesthetic problem, it is a complex disease that affects patients on several levels, and a specialist with extensive experience in treating such patients should be selected for treatment. In liposuction of lipedema, the radicality of fat tissue removal is important, in order to improve the quality of life of patients and slow down the progression of the disease. Through an experienced surgical technique, significant aesthetic improvement is possible. In patients with advanced stages of the disease, skin tightening procedures can be performed in addition to liposuction itself. Such skin tightening includes skin tightening by laser, plasma or similar methods during the liposuction itself. If the problem of excess skin is large and causes functional and/or aesthetic problems for the patient, then the excess skin is surgically removed after the recovery phase after liposuction. The ideal time for surgical removal of excess skin is at least 12 months after the last liposuction. It is important to emphasize that in most cases, more than one liposuction must be performed, since such procedures are limited by the maximum volume of fat tissue that can be removed during one procedure, and the surface area of the part of the body that is operated on. Along with surgical treatment, conservative lipedema therapy is a very important part of treatment. Conservative treatment includes wearing special compression clothing, manual lymphatic drainage, treatment of possible existing diseases such as obesity, diseases of blood and lymphatic vessels, and other conditions. Supportive psychosocial support is also of great importance for patients. The treatment of lipedema does not end with liposuction, but it is a big step in improving or stopping the symptoms, and improving the quality of life.
Mirko Dozan, MD, PhD
Specialist in plastic, reconstructive and aesthetic surgery
