Lipedema

What is Lipedema?

Lipedema is a disorder of fatty tissue that generally affects the legs. In most cases, lipedema causes the legs and sometimes arms (but not the feet) to accumulate fatty tissue. Puberty usually triggers lipedema, but it can worsen during or after pregnancy, menopause and following gynecologic surgery. Extremely stressful situations such as death in the family or divorce can also trigger the condition. Stressful situations cause cortisol (the key stress hormone) to increase and inflammation cascades. This almost always is misdiagnosed as weight gain or obesity. Early diagnosis and lipedema treatment can prevent a significant expansion of lipedemic fat cells, and alert patients to their heightened risk for obesity. However, early diagnosis is currently very rare because of the limited number of trained specialists. Estimates of the occurrence rate of lipedema vary widely. Studies range as high as 11% of the post-puberty female population, with more conservative estimates of 17 million women in the US, and 370 million women worldwide affected. Dercum’s Disease is also a fat disorder that causes abnormal accumulations of fat. Dercum’s disease and lipedema were previously thought to be due to “bad genetics” or “obesity”. We now know now that this is not the case.

Lipedema is Distinguishable by Five Characteristics

1. It can be inherited.
2. It occurs almost exclusively in women.
3. Can occur in women of all sizes, from the seriously underweight to the morbidly obese.
4. Involves the excess deposit and expansion of fat cells in an unusual and particular pattern. This pattern of abnormal fat is bilateral and symmetrical and usually from the waist to a distinct line just above the ankles.
5. Lipedemic fat generally cannot be lost through diet and exercise (unlike the typical fat of obesity). Surgery is often a solution.

What Causes Lipedema?

The cause is unknown, although most people with lipedema have a significant hormonal imbalance. In women with lipedema, the times of exacerbation coincide with periods of hormonal disturbance, puberty, pregnancy and peri-menopause, so it seemingly is hormonal in nature.

Symptoms of Lipedema

Symptoms of lipedema include disproportionately large, column-like legs that bruise easily, legs that are unusually large to the knees, and disproportionate hips, stomach or buttocks. As the condition progresses, patients become increasingly heavy in the lower body. Those with lipedema tend to gain weight in lipedemic areas and lose it in non-lipedemic areas. There are, however, cases where weight loss resulted in improvement of the condition. Obese patients who undergo bariatric surgery lose fat primarily from the waist up, while the legs keep the fatty tissue. While the condition presents itself in various ways, diagnosis is possible as early as pre-puberty when inner thigh pads develop. The disease can also present itself at any age when fat gathers and drapes at knees. The additional, expanding fat cells of lipedema interfere with the pathways of lymphatic vessels and patients can develop secondary lymphedema, or lipo-lymphedema. Many patients cannot tolerate the compression garments used in conventional lymphedema treatment because the underlying fat is very painful. Without these garments, patients are at risk for the side effects of uncontrolled lymphedema, including recurring blood infections and fibrosis. If not kept in check through healthy lifestyle, the condition can worsen and patients will become progressively less mobile.

Lipedema Treatment

Non Surgical Lipedema Treatment Options

Non-surgical conservative treatment is largely ineffective. It often includes a course of manual lymphatic drainage and bandaging by a lymphedema therapist, followed by the wearing of custom-fitted compression garments or devices — usually stockings and sometimes biker shorts. Compression prevents recurrence of lymphedema, and in some lipedema patients can reduce the pain of the excess fat. There is currently no known uniform medical procedure to cure lipedema but the condition can be successfully managed.  A variety of techniques can improve the health of the legs and prevent the condition from returning in more difficult to manage levels. Some ways to manage the condition include

• Reducing salt intake
• Frequent, gentle exercise to promote circulation in the legs
• Maintaining a healthy circulation to reduce inflammation

Often because of the higher pressure from the affected areas, vein disease and lymphatic problems occur simultaneously. We can assess your circulation in our non-invasive cutting edge vascular lab as part of your workup to ensure that any issues with blood flow can be addressed, and it is part of your workup at our centers. It should be remembered that lipedema is a genetic disease that progresses throughout adulthood. Early diagnosis and control is the best treatment.

Lipedema Surgery Treatment Options

Current research and clinical practice support surgical intervention with specialized micro cannula liposuction for lipedema. Surgeons have been successfully treating patients with specialized liposuction for over 15 years, mostly in Europe. We are also investigating these results at City Surgical Care to ensure that the findings in our New York and New Jersey lipedema centers match or exceed those abroad. Prior to performing therapeutic water assisted liposuction, your circulation should be assessed by a specialist. Your surgeon must ensure you have a healthy blood supply for appropriate healing and minimize risk to the procedure from abnormal blood vessels that often are present in the diseased areas. No patient has the same anatomy, and in general each patient should have a customized approach specific to their problem. Prior to any surgical intervention, our specialists will discuss the procedure plan and rationale. We will also discuss non-surgical options to get help each patient achieve the best results for their specific needs.

Research & More Information

Lipedema was first identified in the United States at the Mayo Clinic in 1940. It is a relatively unknown disease in the USA both to physicians and the patients who have the disease. The limited understanding of lipedema often leads it to be confused with obesity. In fact, a significant number of patients diagnosed as obese may have the condition, either instead of, or in addition to obesity. In November 2012 the UK’s Health service the NHS first listed lipedema as the abnormal build-up of fat cells in the legs, thighs and buttocks. The NHS listed a procedure called micro cannula tumescent liposuction as the only treatment that appears to be effective for the condition. Tumescent liposuction is now routinely performed in Holland and Germany. For decades, surgeons in Germany, the Netherlands and the U.K. have been achieving excellent documented success with medically indicated therapeutic micro-liposuction. This specialized form of liposuction, usually performed with tumescent local anesthesia and one of the core issues is to ensure preservation of the lymphatic system while removing the diseased adipose tissue.

Lipedema Surgery Cost New York & New Jersey

City Surgical Care is committed to helping our patients receive the best care possible. That journey always begins with a medical consultation. No two lipedema patients are exactly alike, so consultations enable our doctors to better understand each patient’s unique case, and determine what kind of treatment will be required to help you. Prior to booking a lipedema consultation with our surgical practice, our team will collect your insurance information to determine if our providers accept your specific insurance plan. If we do not accept your medical insurance, we will inform you of any out of pocket costs associated with a lipedema consultation and help you weigh your options. Either way, a doctor must see you before we can tell you what treatment for your condition will entail, from both a medical and cost standpoint.