What is Lipedema?

What is Lipedema?

Lipedema is a condition characterized by the abnormal accumulation of fat in the legs, leading to both aesthetic concerns and functional impairments.

This disorder has a genetic origin. It arises from genetic factors passed down through heredity, which can lead to complications.

Notably, hormonal imbalances, particularly involving estrogen, contribute to the uneven fat distribution in the legs. In this context, lipedema can be classified as a hormonal-metabolic disorder.

Also known as painful legs syndrome, lipedema presents with pronounced swelling, predominantly around the hips and legs. This swelling does not extend to the feet but is accompanied by fluid retention and fat buildup in the affected areas.

Lipedema, a chronic disease;

• On the legs,
• On the hips and
• In the calves

It is a fatty tissue disease that causes abnormal swelling.

Lipedema, a rare disease, is more common in women, but also in men.

Lipedema, typically emerging during periods of hormonal changes, can lead to skin pain and increased susceptibility to bruising.

What Causes Lipedema?

Lipodema is a condition that predominantly affects women, and many people wonder about its underlying causes.

Despite the increasing interest, a definitive scientific explanation for its origin remains unclear.

However, researchers suggest that various factors may contribute to its development, with genetics playing a significant role.

Scientific studies show that lipedema often has a hereditary component, with many cases occurring within families.

For example:

15% of individuals with lipedema report having relatives with the same condition.

Beyond genetic predisposition, hormonal imbalances are also considered potential contributing factors.

This belief arises from the observation that lipedema frequently manifests during adolescence or later stages of life, often coinciding with periods of significant hormonal changes.

Additionally, estrogen is known to influence fat metabolism, potentially impacting the distribution and buildup of fat in the body.

Another contributing factor may be vascular abnormalities, particularly involving capillaries and lymphatic vessels.

Damage to these small blood vessels can lead to symptoms such as bleeding, bruising, and impaired fluid circulation.

In some cases, excessive permeability in the vessel walls can lead to protein loss and edema formation.

Additionally, some individuals may experience an unexpected increase in the number of fat stem cells.

This unusual growth may cause an excessive buildup of fat in specific areas of the body, potentially worsening the progression of the condition.

Who Gets Lipedema?

Those who wear tight clothing for extended periods,

Those experiencing intense stress and anxiety or mental health problems,

Those experiencing weight problems related to adolescence

What are the Symptoms of Lipedema?

The onset of lipedema occurs especially during periods when women experience hormonal changes and progresses over time.

These periods include:

• Adolescence,
• Pregnancy and menopause.

It can also occur in situations that disrupt the patient’s hormonal balance, such as trauma, major surgeries, and serious illnesses.

Lipodema is a slowly progressing disease. It is accompanied by varying degrees of obesity.

The presence of obesity causes the disease to worsen. While treating obesity helps reduce the severity of the disease, the swelling in the legs does not fully subside.

In patients with lipedema, the legs are thicker in proportion to the torso due to increased fat tissue.

Swelling and an increase in circumference have been noted in the hips, thighs, and calves. In other words, there is a disproportion between the legs and the torso.

Symptoms include:

• Disproportionate thickening and swelling in the legs compared to the torso,
• Absence of swelling in the feet and hands,
• Thickening, irregularities, and sagging in the subcutaneous tissue in the affected areas,
• Palpable round swellings (nodules) under the skin,
• Swelling in the legs not decreasing with weight loss,
• Tenderness in the affected areas,
• Prominent capillaries in the skin and a tendency to bruise,
• Pain and bruising in the legs,
• Restricted joint movement,
• Difficulty walking,
• Worsening of symptoms with weight gain,
• Swelling or tightness in the legs and calves during the summer months.

What Orthopedic Problems Occur in Lipedema?

Patients with lipedema may face many orthopedic problems.

One of these is postural deformities in the spine due to the disruption of the patients’ body balance.

Due to lipedema, patients experience postural deformities, followed by straightening of the neck.

As a result, a hump-like protrusion forms at the base of the neck. Many patients even consult a doctor thinking they have a mass in their neck.

Another orthopedic issue arising from lipedema is the accentuation of the lumbar curve and increased prominence of the hips, caused by an altered spinal balance.

This imbalance affects the distribution of weight on the hips and knees, potentially leading to conditions such as clubfoot, also referred to as “X” leg deformity.

Additionally, outward ankle rotation and flat feet may occur. These developments are likely linked to the connective tissue characteristics often observed in individuals with this condition.sue disorders, problems such as joint dislocation and ligament injuries are more common.

Orthopedic problems include:

• Posture disorders,
• Straightening of the neck and resulting swelling at the base of the neck,
• Spinal disorders, spinal curvatures, and postural disorders throughout the spine due to increased leg weight,
• Increased lumbar curve,
• Disruption of load balance in the hips and knees,
• Bowed legs (X-legs) deformity,
• Susceptibility to ligament injuries,
• Outward displacement of the ankle,
• Flat feet (falling arches).

What are The Stages of Lipedema?

Lipedema is divided into stages according to the amount of fat accumulation.

1. Stage 1:

Skin is normal and soft, increase in subcutaneous adipose tissue

2. Stage 2:

The skin is rough, there are nodules of fat that are the size of a pearl to the touch.

3. Stage 3:

Large fat masses caused curvature and deformities around the knee and upper part of the leg.

4. Stage 4:

Lymphedema is added to the table, and lipolymphedema, in which large tissue sagging occurs, develops.

What are Lipedema Types?

A classification system has been introduced according to the regions where lipoedema is involved in the leg.

1. Type 1. Involvement is mostly in the hip region.
2. Type 2. Involvement is seen in the hip and thigh region.
3. Type 3. There is involvement of the whole leg.
4. Type 4. There is involvement in the arm region.
5. Type 5. Involvement is seen in the calves.

How is Lipedema Diagnosed?

Lipoedema does not have a definitive diagnostic test. Diagnosis is primarily based on patient examination, clinical evaluation, and ruling out other potential conditions.

Various diagnostic criteria for lipoedema have been outlined by different experts in the field. The condition predominantly affects women.

Key characteristics include symmetrical fat deposits in both legs while sparing the feet. When pressure is applied to the swollen area of the leg, it leaves minimal, temporary indentation.

Stemmer’s sign, typically associated with lymphedema, is absent in lipoedema. The skin is sensitive to touch, with pain and tenderness occurring when pressed.

Bruising is common and occurs easily on the legs. Even with weight loss or leg elevation, the swelling and thickening of the legs remain persistent.

In about 30% of cases, the arms are also affected. The skin frequently feels cold to the touch. Swelling tends to worsen during summer months.

Despite lower calorie intake, there is typically no improvement in symptoms or the clinical condition. In some cases, capillary varicose veins may also develop.

Lipedema Treatment

Lipedema is a chronic disease with limited treatment options. Today’s treatment options are aimed at reducing the complaints of the patients and maintaining the general health level.

1. Conservative Treatment

• Exercise:

It is recommended to reduce body weight, strengthen muscles, increase blood and lymph flow, and support mental health.
Low-intensity exercise types such as walking, lymphatic yoga, cycling, pilates are often used.
It is also recommended to exercise in the pool.

• Diet and Healthy Eating:

Although the appropriate diet varies from patient to patient, it is important to have a healthy diet with regular exercise.

• Psychological Support:

Psychosocial problems such as depression, isolation and eating disorders are frequently observed in patients with lipoedema.

Individual or group therapy sessions led by a psychologist offer essential mental and emotional support to patients. Counseling and support groups play a crucial role, especially in addressing the psychological challenges linked to lipedema.

• Orthopedic Support:

An increase in body weight and a disproportionate increase in leg mass cause disorders in the joints and walking axis. Flat feet are common.

• Compression Therapy:

Specialized compression garments are designed to provide support to body areas affected by lipoedema.

For added convenience, materials like non-stretchable Velcro bandages are available, which are easy to put on and remove.

Compression therapy helps by applying pressure to the impacted legs, stimulating lymphatic flow, and alleviating swelling and discomfort.

• Manual Lymphatic Drainage:

• Complex Decongestive Treatment:

The program encompasses a variety of treatment methods designed by the Physical Therapy and Rehabilitation unit to alleviate swelling and edema in the legs.

A special treatment program is applied to the patient by a physiotherapist.

And it includes manual lymphatic drainage or intermittent pneumatic compression, personalized bandage, compression garments, and therapeutic exercises.

• Breathing Exercises:

Deep breathing exercises are helpful as they activate the diaphragm and promote lymphatic flow.

• Food Support Products:

Cokina (Christmas Flower) herb extract and selenium supplementation have been noted to alleviate symptoms in individuals with lipedema. These supplements are often suggested for patients within lipedema support communities.

2. Surgical Treatment

Surgery is the only possible method to correct abnormal adipose tissue. Two types of operations applied for this purpose are liposuction and reduction surgery.

• Liposuction:

It is a method of removing adipose tissue under general or local (tumescent and water-assisted) anesthesia and through a cannula.

One end of the cannula connects to a vacuum device, while the other is inserted through a skin incision into the adipose tissue.

Reports indicate that liposuction is an effective method for treating lipoedema. It helps alleviate issues like pain, sensitivity to touch, and bruising, enhances cosmetic appearance, and significantly improves overall quality of life.

In addition, the Dutch scientific guidelines emphasize considerations before performing liposuction on patients;

• Edema,
• Obesity,
• Unhealthy lifestyle,
• Lack of physical activity
• And recommends conservative treatment for psychosocial problems accompanying lipoedema.

• Reduction Surgery:

This procedure is performed on patients in the later stages of the condition.

Things to Consider After Lipedema Surgery

Liposuction for the treatment of lipoedema requires diligent post-operative care, particularly during the initial recovery phase, which lasts about six weeks.

Following surgery, wearing compression garments is essential, as they aid in reducing swelling and supporting your recovery. Typically, you can take a shower two days after the procedure.

To promote more efficient healing, specialized skin treatments like lymphatic drainage or endermology may be beneficial.

However, these additional treatments should be undertaken only under a doctor’s guidance. While movement is possible after surgery, swelling and discomfort may temporarily limit your physical activities.

It is generally advised to refrain from sports and strenuous activities targeting the treated areas until noticeable improvement in symptoms occurs. Most patients can return to their regular routines around the six-week mark.

Throughout your recovery, adhering strictly to medical guidance, properly administering prescribed medications, and avoiding overexertion are key for optimal results.

The measures taken after lipoedema surgery are just as critical as the procedure itself. Consistent and attentive post-operative care greatly enhances the effectiveness and enduring success of the treatment.