Lipedema and Lipedema Reconstruction

What is lipedema?

Lipedema (or lipoedema) was first described as a disease by Allen and Hines in 1940. It is characterized by congenital enlargement of the adipose tissue, or fat, of the legs and upper extremities, with associated pain to touch and easy bruising. It is almost exclusively seen in women by the third decade and most commonly involves the lower extremities, excluding the feet.

How many people are affected with lipedema?

An epidemiologic study by Földi estimates that 11% of the female population is affected with lipedema. It is also estimated that between 8–17% of women with lymphedema also have lipedema.  

How is lipedema diagnosed?

Lipedema is diagnosed with clinical examination and history. The original diagnostic criteria were developed in 1951 and include:
  • Female gender
  • Bilateral symmetrical swelling/adiposity, with minimal involvement of the feet
  • Minimal pitting edema
  • Ability to “pinch” the skin of the top of the foot
  • Pain and tenderness to touch, and with pressure
  • Increased vascular fragility and easy bruising
  • Persistent enlargement of extremities and fat pockets despite weight loss and elevation

Dr. Karen Herbst, an international expert in lipedema and other fat disorders has also added the following criteria:

  • Hypothermia of the involved skin
  • Involvement of the upper extremities/arms in 30% of patients
  • Worsened swelling with orthostasis in the summer
  • Swelling is unaffected by diet and/or calorie restriction
  • Presence of telangiectasias of the skin

Dr. Donald Buck II has added the following:

  • Column-like, or tree trunk appearance, of the legs
  • Disproportionate lower extremity swelling and fat/adiposity compared to the trunk and upper extremities

What is the cause of lipedema?

At this time, the exact cause or etiology of lipedema is unknown. We believe there is a hereditary or genetic aspect to the disease as many women recall similar symptoms in female relatives. We think that there is a relationship between the fat cells and the lymphatic channels within the extremities, such that early lymphatic dysfunction and/or inflammation may result in hypertrophy, or abnormal size, of the fat cells. As the fat cells increase in size, they swell with fluid and can secondarily affect lymphatic flow by creating small aneurysms in the lymphatic channels and stretching these channels out until they leak lymph fluid. There is also a fibrosis of the small capillaries just beneath the skin in the involved areas,, which can lead to capillary fragility, leakage and easy bruising. 

How can lipedema be treated?

The current treatment of lipedema largely consists of conservative therapies, similar to lymphedema, to manage the excess fluid and suction lipectomy, or liposuction, to remove the diseased fat. 

Conservative treatment for lipedema:

  • Complete decongestive therapy
  • Extremity compression garments
  • Dr. Herbst recommends several dietary supplements to help support the immune system, as well as assist with edema control. Please see her website for more details.

Liposuction for lipedema

Currently, liposuction is the only method we have to effectively remove the diseased lipedema fat. Although diet, exercise and bariatric surgery can remove the “normal” fat of obesity, these methods do not remove lipedema fat.  Liposuction for lipedema requires a special technique and protocol that is different than that used for traditional cosmetic liposuction. These liposuction techniques promote removal of diseased fat with sparing of the lymphatics and have been popularized by surgeons in Germany, including Dr. Josef Stutz and Dr. Stefan Rapprich. Research has shown that lymph-sparing liposuction is effective at removal of diseased fat, reduction in pain, slowing of the progression of disease, and improving quality of life. Although there currently are no long-term studies, Dr. Rapprich has published on 5-10 year results, which show great control of disease.

In similar fashion to Dr. Stutz and Dr. Rapprich, Dr. Buck uses their lymph-sparing liposuction techniques, along with a specialized protocol, to treat lipedema and maximize the removal of diseased fat with the least risk to lymphatic injury.  

For an appointment:

As of October 1, 2016 we have changed our appointment policy.  Prior to scheduling an appointment, we ask that your medical records be faxed to our office for review.  The records may include lymphedema therapy notes, primary care notes, diagnostic testing, medication and allergy lists, medical and surgical history and lipedema diagnosis notes.  Our fax number is (314) 653-5828.  Please contact us today to learn more about our protocol and how we can help you fight this disease!

For more information, feel free visit the following sites and support groups: