Lipoedema
Lipoedema is a chronic and often underestimated fat distribution disorder that occurs almost exclusively in women. With the right treatment and care, those affected can achieve a significantly improved quality of life.
Lipoedema
Introduction
Patients with lipoedema are affected by a serious condition that can cause considerable suffering. The clinical picture of lipoedema is complex and cannot be limited to merely painful extremities. It is by no means synonymous with just “fat legs” or “fat arms”, and not all cases of oversized limbs are due to lipoedema. For this reason, it is crucial to make a precise diagnosis and clearly differentiate lipedema from other conditions, despite its nuances and gray areas. Clarification by specialists and experts in lipoedema is necessary to ensure appropriate treatment and support.
With us, you and your lipoedema are in the best of hands. Our experienced team of lipoedema specialists understand the complexity of this condition and will provide you with the individualized care and tailored treatment approaches you need. We specialize in assisting you with accurate diagnosis, planning appropriate treatment options and providing support throughout the course of your treatment. Your health and well-being are our top priority.
Further information
Lipoedema
What exactly is lipoedema
When we begin to deal with the topic, we must first bear in mind the word lipoedema. This contains the word stems “lip” and “oedema”, and therefore incorrectly suggests classic oedema in the sense of water retention. However, this is simply wrong, as lipoedema is not usually associated with water retention.
In fact, lipoedema is a fat distribution disorder in which there is a disproportionate increase in fatty tissue in certain areas of the body. In a few cases, there is actual oedema in the form of lipo-lymphoedema in addition to lipoedema.
You can find out more about this in this video.
Lipoedema
Causes
To date, the trigger mechanism for lipoedema has not been clarified. From our everyday clinical practice, we know that there is a familial clustering; the literature speaks of a clustering of up to 60 % in first-degree relatives. In addition, there are factors such as hormonal balance, including a congenital or acquired hormone receptor distribution disorder and lifestyle.
In addition to familial clustering, a multifactorial genesis also appears to be very certain. This means that several factors come together to cause lipoedema.
But one thing is certain: lipoedema occurs in or around the fatty tissue. I am also curious to see what science will reveal in the future.
Lipoedema
The pathomechanism
When we look at the course of lipoedema, we come across numerous different theories that are discussed as possible explanations. You will find a lot of information on this in my book. At this point I would like to discuss the theory of hormone receptor distribution disorders. Oestrogens are recognized by two different receptors of the fat cell, oestrogen receptor α (alpha) and oestrogen receptor β (beta)
Their distribution determines how a fat cell reacts to a calorie surplus. Many of these conclusions have emerged from animal studies. If these theories are transferable to humans, then this theory would be a plausible explanation as to why some women develop lipoedema and others do not.
If the α receptor on a fat cell were increased and the β receptor decreased, fatty tissue would be broken down, whereas the other way round there would be an increase in fat.
A pathomechanism that explains the pain, bruising and tissue scarring is shown in the diagram on the right. The fat cells increase in volume (hormone receptors) and the existing blood vessels are unable to meet the increased oxygen demand. This leads to the formation of new blood vessels. However, the newly formed vessels are fragile and burst quickly (bruising), while at the same time an inflammatory reaction takes place in the tissue, resulting in scarring / connective tissue remodeling.
Lipoedema
Type and stages of lipedema
Lipoedema is defined as a painful fat distribution disorder affecting the extremities (including the hips). If there is no pain, we speak of lipohypertrophy without manifest disease value, but often with a disturbing aesthetic component.
Lipoedema is divided into stages and types. It cannot be diagnosed on the basis of images; a thorough medical history and physical examination are essential.
The type merely describes the areas of the body affected, i.e. which body regions are affected by lipoedema, regardless of the extent. Both classifications are purely a description of the external form.
In contrast to the type, the stage is intended to reflect the progress or severity of the disease. Depending on the user, a distinction is made between three or four stages. Classically, we speak of three stages.
Lipoedema
Type classification
Type I
- Hip-thigh region
- including buttocks if necessary
- depending on the interpretation
Type II
- Hip-thigh region
- including buttocks if necessary
- Inclusion of the knee joint region
Type III
- Hip-thigh region
- including buttocks if necessary
- Inclusion of the knee joint region
- with conduction to the ankle region
Type IV
- Hip-thigh region
- including buttocks if necessary
- Inclusion of the knee joint region
- with conduction to the ankle region
- plus arms
Lipoedema
The classic three stages of lipoedema
Stage 1: Smooth skin surface with uniformly thickened, homogeneously impressive subcutis.
Stage 2: Uneven, predominantly undulating skin surface, nodular structures in the thickened subcutaneous area.
Stage 3: Pronounced increase in circumference with overhanging tissue.
The staging and type classification does not ask about pain and/or restriction of movement. It is purely descriptive. However, the classifications assume the presence of lipoedema (with pain).
Lipoedema
My comment on the staging of lipoedema
As we have established, the classification of types and stages is merely descriptive. Neither the severity of pain nor the extent of movement restriction nor the psychological burden (excluding manifest mental illness) are taken into account, and it is precisely these aspects with the actual disease value that are important for treatment. A descriptive classification neither helps those affected nor does it meet the needs of the patient. And it is even less in line with the requirements and quality standards of evidence-based medicine. Unfortunately, this aspect is being ignored by all sides – practitioners, politicians and health insurance companies. The result is unequal treatment of those affected, which in itself is contrary to the principle of equal rights.
The fact is, however, that in Germany a medical justification for surgical treatment is determined on the basis of staging. This is a major problem. It is also difficult that in this classification a stage applies to the entire body. However, it is possible that the progression of the disease in the thigh area corresponds to stage III, but in the lower leg area to stage II or vice versa.
We can therefore see that the classification is not quite as simple as it seems at first glance. As with many other diseases, lipoedema is not just black and white, but also gray, sometimes even light gray and dark gray.
It is precisely this gray area that poses a major challenge in the treatment of lipedema. The many intermediate and special forms must be treated individually.
Lipoedema
General information on treatment
There is no cure for lipoedema. However, a significant improvement in quality of life can be achieved, including freedom from pain and no need for compression garments. The extent to which a significant improvement in your symptoms is possible depends on many factors.
What does our treatment for lipoedema look like in detail? Conservative treatment is often, but not necessarily, carried out in advance, for example for 6 months. If your parameters and body constitution indicate the existence of significant obesity (also taking into account the Waist-to-Hip Ratio = WHR and Waist to Height Ratio = WHtR), the treatment of lipoedema is preceded by weight reduction after consultation. We cannot and do not want to rely on BMI values for patients with lipoedema, but must differentiate on a case-by-case basis.
For patients with mild to moderate obesity and lipoedema, regardless of its severity, we recommend a nutritional analysis and, if necessary, dietary adjustments as well as an activity-enhancing change in general lifestyle.
For lipoedema patients with mild, moderate or severe disproportion without a significant obesity component, we recommend only conservative or surgical lipoedema treatment.
Das Lipödem
Konservative Therapie
The conservative treatment of lipoedema is therefore based on several pillars. In the presence of morbid obesity, as explained in the previous section, weight reduction is a key factor. In general, the lower the obesity and the more pronounced the disproportion, the lower the effect of weight loss on the areas affected by lipoedema. In normal-weight lipoedema sufferers, weight loss will therefore only bring about a small change that is sometimes only visible at second glance.
In addition to weight reduction (if necessary), complex physical therapy is the most important pillar of conservative treatment.
Conservative treatment
The complex physical treatment
Complex physical therapy for lipedema consists of the following components:
- Compression treatment (in all stages)
- Manual lymphatic drainage (only if edema is present)
- Apparative lymphatic drainage (only if edema is present)
- Exercise therapy
- Rehabilitation treatment
Complex physical therapy is an important component of treatment. Lifestyle changes with appropriate dietary changes and exercise in combination with complex physical therapy can lead to an improvement in the situation. We have not yet been able to observe long-term results that can be achieved without lifelong compression therapy. If compression is an acceptable alternative for you, the conservative approach makes perfect sense.
Lipoedema
Surgical therapy
Our main goal with surgical therapy is to give you freedom from pain and quality of life. Of course, we also want you to be satisfied with your external appearance and body contour. We always keep this aspect in mind during the surgical treatment of lipoedema. This also means that we not only remove unwanted fatty tissue, but also treat any excess skin that may result from large-volume liposuction. It makes no sense to remove unwanted and painful fatty tissue and then leave you with excess and sagging skin. Unfortunately, we see this problem very often because many doctors who are not trained in plastic surgery do not offer tightening. Each of us is different. There is a huge variety of body shapes and equally different forms of lipoedema. This is why we create an individual treatment plan for each person affected.
Treatment overview
The complex surgical treatment of lipedema
Our surgical treatment process is therefore based on the following three pillars:
- Weight reduction or stabilization if necessary (conservative or surgical)
- Determination of the liposuction regions
- Tissue tightening of the skin if required
We will create an individual treatment plan for you based on the points “Liposuction of the treatment areas and tissue tightening”. You can find further information on the individual treatment plan in the corresponding category.
About Lipold
Procedure for a presentation at LIPOLD
For concerns that fall within the scope of statutory or private health insurance, please coordinate an appointment by e-mail to info@lipold.de or give us a call. LIPOLD is part of the Augusta Practice for Plastic, Aesthetic and Hand Surgery Oldenburg.
Contact:
Augusta Praxis für Plastische, Ästhetische und Handchirurgie Oldenburg
Gemeinschaftspraxis Dr. Jandali und Dr. Jiga
Auguststr. 22
26121 Oldenburg
Phone: 0441-18131550
WhatsApp: 01719992280
Prepare all your documents for your appointment with us. Bring all previous reports and examination findings as well as your medication list with you to the appointment. Fill out the “Lipoedema” questionnaire in advance. You can find the questionnaire here and in the download area.
Address:
LIPOLD in der Augusta Praxis für Plastische, Ästhetische und Handchirurgie Oldenburg
Gemeinschaftspraxis Dr. Jandali und Dr. Jiga
Auguststr. 22
26161 Oldenburg
You will find a parking garage right next to the practice (50m).
During the consultation, we will first take your medical history and perform an examination. We will draw up a treatment plan for you and, if necessary, a certificate for submission to the health insurance company. Our therapy includes both conservative and surgical treatments. For self-pay services, we will provide you with an individual cost estimate.
You will find a parking garage right next to the practice (50m).
If you have any follow-up questions, you are welcome to contact us again via WhatsApp 01719992280 or visit us again during consultation hours.
Have you opted for surgical lipedema treatment? Then you can make an appointment for surgery via WhatsApp 01719992280 or at info@lipold.de.
VAPP+
The costs of VAPP+ treatment are not covered by health insurance and are therefore self-pay services.
We will be happy to draw up an individual treatment plan for you, including the costs incurred, during your visit to our consultation.
Option Upgrade
Are you covered by your health insurance? But would you like an upgrade to VAPP+? Sprechen Sie uns gerne an auch diese Kombinationsmöglichkeiten sind im Rahmen einer Zuzahlungsoption möglich.
Assumption of costs in stage III
If the patient has stage III lipoedema, the costs for treatment can be applied for in advance from the health insurance company. Treatment is only possible with a written declaration of assumption of costs.
Downloads
General documents on lipoedema
Download your lipoedema questionnaire here. Our patients fill it out before and 6 months after treatment to track their progress. For your application to the health insurance company, we offer a statement on staging for download. Our clinic meets quality standards, which you can view here. Furthermore, instructions for photo documentation for the health insurance company are available here. Your satisfaction is our goal and we are happy to support you every step of the way.
Lipedema questionnaire
Statement on staging
Liposuction quality standard
Photo documentation health insurance
We introduce
Our patient guides for those affected
The lipoedema book “The Lipoedema Patient Guide” is the result of many years of experience in dealing with affected women and families. Our aim with this book is to shed light on all aspects of lipoedema and to help you decide on your own treatment.
In doing so, we dispel many half-truths and myths. We explain the theories about the cause of lipoedema, the clinical picture itself and how it manifests itself in a structured way, before finally looking at the consequences and supposedly similar diseases such as pure lymphoedema and obesity. We will also discuss the current classification and how we would like it to be.
We are sure that you will benefit from this guide and that you will be able to ask very specific questions about your treatment at your next visit to the doctor. At the end, we will of course give you our personal conclusion with a recommendation for treatment.
Lipedema (DE) (ISBN 9783662624142), Lipedema (EN) (ISBN 9783030867164)
Contact us
Would you like a consultation appointment?
We are happy to help you by phone, email or WhatsApp chat. You can rely on our in-depth medical expertise and many years of experience. You are in safe hands with us.