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Lipoedema

Lipoedema is a fat storage disorder that mainly affects women. It is also known as painful fat syndrome. It has been shown to affect up to 11% of Australian women. It is a genetic fat disorder. It usually affects the thighs but the arms may also be involved.

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Introduction:

Lipoedema is a fat storage disorder that mainly affects women.

It is also known as painful fat syndrome.

It has been shown to affect up to 11% of Australian women.

It is a genetic fat disorder.

It usually affects the thighs but the arms may also be involved.

Investigations:

There is no simple blood test or scan to diagnose lipoedema and the diagnosis is made on taking a full history and examination.

Classic Patient History:

It generally affects women usually with a strong family history of lipoedema.

There have been some rare cases with males being affected.

It is possible to inherit this from either the maternal or paternal side of your family.

The signs of fat deposition to the thighs usually occur during hormonal changes.

This classically first emerges during puberty but can also occur during pregnancy and menopause where significant fat deposition and worsening of symptoms is noted.

The legs classically bruise easily and feel heavy at the end of the day.

Diet and exercise may have little or no affect in reducing the fat and lipoedema, which is a source of public confusion and frustration.

Lipoedema can also cause knock knees and flat feet as well as joint problems, which can make walking difficult.

Other conditions which may be confused with lipoedema:

Lymphoedema:

If the skin of your legs is hard and tight but does not hurt when touched it could be lymphoedema.

This is caused primarily by a problem in the lymphatic system.

This is a network of vessels and glands that help fight infection and drain excess fluid from the tissues.

The classic difference between these is whether the feet and hands become swollen.

This is classically the case in lymphoedema and oedema but in lipoedema the feet and hands are usually not affected.

Physical Signs/Characteristics of Lipoedema:

  • The legs are classically enlarged symmetrically and bilaterally.
  • The arms can also be affected
  • The torso, most notably the waist, is usually normal. The thighs appear out of proportion to the rest of the body
  • Classically fat deposits are seen in the thighs and the lower leg with no involvement to the feet
  • The arms and forearm can be involved in up to 30% of patients but there is no involvement of the hands
  • There is classically a family history or genetic predisposition
  • There appears to be a ‘cuff’ around the ankles and a round fat pad just below the knees
  • The waist and hip region may be small and in proportion to the hips but out of proportion to the thighs, buttocks and legs
  • Changes associated with significant hormonal events such as puberty, pregnancy and menopause
  • Diet and exercise may have minimal or no effect
  • The legs may be cold and painful to touch
  • The fat is soft to touch, wobbly and cold
  • The skin is always involved in lipoedema and may have a cellulite type appearance
  • Evidence of dilated veins which are sensitive to touch
  • Bruising is commonly seen, can occur spontaneously and often unexplained
  • Swelling of the hands and feet may create the appearance of a bracelet of cuff just appearing above the ankles and wrists
  • The upper body is often smaller than the lower body
  • Deep throbbing pain in the legs with pain in the knee joints
  • Legs feel heavy and swell throughout the day but resolve overnight

Treatment of Lipoedema:

Lipoedema cannot be cured, however it can be managed.

Conservative/Non-Surgical Treatment:

The better long-term results can usually be obtained with maximising conservative and non-surgical treatment before, during and after potential surgical options.

The conservative methods include a calorie controlled low inflammation diet, maintenance of a healty weight/BMI, skin care (e.g. regular moisturising cream) regular low impact daily exercise (such as yoga, aqua aerobics, walking and vibration plates), MLD therapy (manual lymphatic drainage), customised lipoedema compression garments and also the use of sequential intermittent pneumatic devices.

MLD therapy is a light skin stretching massage that helps promote the movement of lymphatic fluid out of the swollen limb. MLD should not be confused with a traditional massage but is specifically focused on the lymph vessels to help the flow of lymphatic fluid.

Therapies applied to the unaffected areas first making it possible for the fluid to move out of the affected area. MLD helps open the remaining lymphatic lymph channels and move protein fluid into them as well as help hasten the flow of lymphatic fluid through the lymphatic vessels.

Surgical Treatment:

This method is the only method that will remove fat.

Liposuction is the main stay of treatment to remove stubborn fat, limit disability and slow the degree of progression as well as to reduce the risk of permanent lymphatic dysfunction and it may assist in reducing painful symptoms.

At present liposuction is the only proven method to remove lipoedema fat. It should be noted that liposuction will provide a form of control and slowing the disease progression but is not a definitive cure.

Many modalities of liposuction have been employed for lipoedema including tumescent (this is where fluid is first injected to create an inflated area to facilitate liposuction and reduce bleeding and pain).  The solution contains a psychological salt-water solution, adrenaline as well as local anaesthetic.

Other forms of mechanical, power assisted laser and water-assisted liposuction have also been used.

All of these modalities aim to cause minimum collateral damage to the lymphatics, nerves, blood vessels and other vital structures whilst removing the adjacent fat.

Dr Belt has been using liposuction to treat lipoedema as well as other conditions since 2005.

Other references/support networks:

Talk Lipoedema www.talklipoedema.org

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