People suffering from lipoedema face many challenges. Many are not recognized by healthcare professionals as having the condition, or are misdiagnosed. Awareness of lipoedema among healthcare practitioners is low, and little clinical research is focused on the condition. To date, no quality guidelines for disease management have been published, resulting in inconsistent and often inappropriate care for people with lipoedema.
Multidisciplinary management of lipoedema: therapeutic and preventive approaches
Lipoedema management requires a multidisciplinary approach to manage symptoms, facilitate patient care, optimize health and prevent disease progression. The main components of lipoedema management are: psychological support and education, healthy diet, weight management, physical activity, skin care, compression therapy and pain management.
Although attempts to lose weight may have no impact on the adipose tissue involved, preventing or reducing obesity through a healthy diet and regular physical activity would help avoid lipeodema deterioration. There is no clinical evidence to support the use of a specific diet. Patients should be encouraged to adopt a balanced, healthy diet that suits their needs and lifestyle.
The symptoms of lipoedema can be treated to maintain and improve quality of life, including pain, edema and mobility: early treatment gives the best results. Medication use should focus on reducing tissue inflammation, fibrosis, swelling and pain. Drugs that increase edema and promote weight gain should be avoided in people with lipoedema.
People with lipoedema should be assessed for this condition, as well as for lymphedema, arch position, balance, muscle strength, gait and joint hypermobility by a therapist certified in lipoedema or lymphedema. Standard conservative therapy for lipoedema includes nutritional counseling, manual therapy, compression garments, and recommendations for home exercise.
In addition to managing physical condition, psychological support is also important for lipoedema patients. Their quality of life can be severely affected by the social stigma associated with their physical appearance. Cognitive and behavioral therapies can help patients better manage stress and anxiety, and improve their self-esteem. Local French-speaking support groups can also provide a supportive community for patients and their families. By working closely with healthcare professionals, lipoedema patients can learn to manage their disease proactively, improving their overall quality of life.
Affected body parts may be softer in consistency, with a mattress-like or dimpled skin texture. The presence of scooping edema in affected areas indicates lipolymphoedema. Routine blood tests can be useful in ruling out or identifying other conditions, but heavy imaging investigations (CT scan, MRI) are not routinely used.
Patients with lipolymphoedema have an increased risk of cellulite.
Liposuction to treat lipoedema: techniques and precautions
The types of liposuction recommended for people with lipedema are based on tumescent liposuction (TAL), which uses a solution injected into the tissue to reduce pain and bleeding. Other mechanical methods can also be used, such as water-assisted liposuction (WAL ) or power-assisted liposuction (PAL). To date, all studies showing clinical improvements for women with lipedema have used tumescence or water-assisted techniques.
Lipedema reduction surgery does not fit the traditional volume limits for liposuction. Prior to surgery, a certified lymphedema therapist can perform a preoperative screening to guide preparation exercises, perform manual therapies (drainages) and recommend compression garments for the patient. If the patient has lipolymphoedema, comprehensive decongestion therapy prior to surgery should include an intensive volume-reduction phase, ideally 3-4 treatments per week.
Preoperative venous Doppler ultrasound and/or treatment of chronic venous disease should be considered, particularly in patients with lipolymphoedema, prior to lipoedema reduction surgery. Lipoedema reduction surgery can be performed safely under local or general anesthesia. Foam cannulas of 2 to 4 mm should be used to avoid damaging lymphatic vessels, and a longitudinal technique should be employed to avoid damaging lymphatic vessels.
There is no evidence that liposuction cures lipoedema, but it can reduce limb size and improve functionality and mobility. Patients should be advised to try at least 6 to 12 months of non-surgical treatment before undergoing liposuction. A pre-operative consultation is important to ensure that patients understand the non-curative nature of liposuction, the long and often painful post-operative course and the need to wear compression therapy at all times. Bariatric surgery may be indicated for some patients with lipoedema who are also obese.
During liposuction using tumescent local anesthesia, one of the distinguishing features is the tumescent state. This is characterized by a whitening of the skin and a firm, smooth surface that persists for more than 30 minutes. This indicates that the right amount of tumescent local anesthetic has been delivered to the target tissue.
It is recommended to treat both limbs in the same session to maximize symmetry and improvement. Patients with lipedema treated with TAL or WAL liposuction may have lymphatic fluid to drain for several weeks after the procedure. Swelling of the treated area may last 4 weeks or more.
Some European surgeons use low-dose heparin prophylaxis to prevent deep vein thrombosis. Post-operative antibiotics are often given for 1-2 weeks after surgery. Compression stockings are worn for 2 to 4 weeks after the operation to prevent the formation of lymph pockets in the treated areas. After the first 4 weeks, patients may prefer to wear compression bands daily for added comfort and support. Manual lymph drainage can be administered for 4 to 5 weeks after the operation.
Compression in the treatment of lipoedema
People with early-stage lipedema need to wear a post-operative compression garment for at least 2 to 3 months to manage post-operative edema. People with advanced lipedema and/or lipolymphoedema may need to wear compression garments for life to relieve the pain and heaviness caused by the disease.
If people find it difficult to put on and take off compression garments, two garments with a lower level of compression can be layered to achieve adequate compression.
To improve their quality of life, people with lipoedema need to adopt new habits and be vigilant.
For the milder stages of lipedema, we recommend self-management, including the wearing of compression garments, long-term modification of eating habits and increased physical activity.
For moderate stages, patients may benefit from multilayer bandaging or intermittent compression sessions before receiving compression stockings.
For advanced stages, an endocrinologist can be consulted to manage metabolic syndrome and achieve weight control. We also recommend aquatic physical activity to avoid joint damage in cases of obesity, as well as psychological support.
It should be noted that compression, physical activity and diet improve the quality of life of sufferers by reducing the symptoms of lipoedema, but are by no means a long-term treatment.
Liposedema reduction surgery
Lipoedema reduction surgery (primarily TAL and WAL liposuction) is currently the only technique available to remove abnormal lipoedema tissues such as adipocytes, nodules, fibrotic extracellular matrix and other non-adipose components. It is also the only treatment that can slow the progression of lipoedema and, ideally, should be performed before the complications and disabilities associated with lipoedema develop.
It’s worth pointing out that lipoedema reduction surgery includes not only the TAL (Tumescent Anaesthesia Liposuction) and WAL (Water Jet-Assisted Liposuction) liposuction techniques mentioned above, but also thigh or arm lifts. A thigh or arm lift is a surgical procedure that removes excess skin and reshapes body contours after significant weight loss through liposuction. This procedure is often recommended for patients with advanced lipoedema, where a large amount of adipose tissue needs to be removed.
While lipoedema reduction surgery can provide significant symptom relief and improve patients’ quality of life, it’s important to remember that this surgical procedure carries risks and side effects, such as post-operative pain, bruising and swelling. Patients should therefore be well informed about the pros and cons of lipoedema reduction surgery before making an informed decision about the procedure.
In conclusion, lipoedema is an often unrecognized and misdiagnosed chronic disease that requires a multidisciplinary approach for effective symptom management. It is important that patients receive an accurate diagnosis and are assessed for this and other associated conditions. Healthcare professionals need to be better informed about lipoedema in order to provide consistent care tailored to each patient’s needs.
Patients can be encouraged to adopt a healthy lifestyle that includes a balanced diet, regular exercise and appropriate skin care, in addition to standard conservative therapies such as compression and therapeutic exercise. Lipoedema reduction surgery is considered the safest and most effective treatment for reducing the abnormal fatty tissue associated with lipoedema. However, it should be seen as an adjunct to other treatments, and should only be considered after discussing the potential benefits and risks with a qualified and experienced surgeon.
In addition, psychological support is important to help patients better manage their disease and their overall quality of life.
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