Lipoedema is a long-term condition that causes an abnormal, diseased fat buildup on both sides of your body, usually in your legs. However, it can sometimes occur in your arms. It does not respond to diet and exercise like ordinary fat and can cause significant pain and make daily activities difficult.
The cause of lipoedema is often unknown, and although there is no cure, you can manage symptoms with compression garments, medications, an anti-inflammatory diet and maintaining a healthy weight. Water-assisted liposuction surgery can also help.
Lipoedema in summary
Lipoedema:
- Mostly affects women
- Does not respond to diet and exercise like ordinary fat
- Tends to start or worsen during hormonal changes, e.g., puberty, pregnancy and menopause
- It can make walking and other daily activities difficult
- It is managed with compression garments and some anti-inflammatory measures
- It can be reduced through water-assisted liposuction surgery
Lipoedema comes from the words ‘lipo’ (meaning fat) and ‘oedema’ (meaning swelling). It is estimated to affect approximately 11 per cent of women worldwide. Although the condition can affect both men and women, it is far more common in women. Typically, it causes abnormal fat buildup in the lower body, often affecting the buttocks, thighs and calves. Some people also have it in their hips or upper arms. However, it doesn’t affect the hands or feet.
Lipoedema sounds a lot like lymphoedema, but they are two very separate conditions. (Lymphoedema is due to damaged or blocked lymphatic vessels.) However, lipoedema can lead to lymphoedema by compromising the lymphatic system.
Symptoms of lipoedema
If you have lipoedema, you may find that although you have a small waist and upper body, your lower body is swollen, and doesn’t respond to diet and exercise the way the rest of your body does.
Other common symptoms of lipoedema include:
- Bruising easily
- Swelling
- Pain or tenderness in the areas affected by swelling
- Increased discomfort in hot weather
- A feeling of heaviness in the swollen areas
- Bumps inside the fat that feel like there is something under the skin
- An orange peel texture to the affected skin
- Spider or varicose veins in the affected areas
- Reduced hair growth in affected areas
- The appearance of lumpy, nodular fat in other areas of the body, including the abdomen, groin, breasts and scalp
- A distinct ‘bracelet’ or ‘cuffing’ effect at the ankles or wrists, as the feet and hands are usually not affected
Types of lipoedema
Lipoedema is categorised into types, from I to V. You can have more than one type of lipoedema at a time. They are as follows:
- Type I: Fat is between your belly button and hips.
- Type II: Fat is between your pelvis and knees.
- Type III: Fat is between your pelvis and ankles.
- Type IV: Fat is between your shoulders and wrists.
- Type V: Fat is between your knees and ankles.
What causes lipoedema?
The cause of lipoedema is often unknown; however, a genetic component may be present. This means that you are more likely to have the condition if a close family member has it.
It is also thought that hormonal changes can cause lipoedema, such as during:
- puberty
- pregnancy
- menopause
- times of stress
Lipoedema is not caused by being overweight or obese. Individuals at a healthy weight can still get lipoedema, and losing weight does not make lipoedema go away.
How to diagnose lipoedema
If you suspect you may have lipoedema, you should visit your GP, as early diagnosis is important. Lipoedema is a progressive disease, so without treatment, it will often get worse over time.
Your GP will examine the affected areas to confirm that you have lipoedema, not lymphoedema, or swelling due to other causes. When your fat in the affected area is touched, it will feel like round peas in a plastic bag. You may also notice larger nodules. Currently, there are no known blood or urine biomarkers, and no specific diagnostic tests for the condition.
During your consultation, your doctor will ask you numerous questions about your family history, prior surgical and medical history and current medications, as this can help them determine a more accurate ‘differential’ diagnosis. (‘Differential’ diagnosis is telling the difference between conditions that have similar signs and symptoms.)
Some health professionals may find it difficult to make a clear diagnosis through the consultation alone and may order further tests, such as an MRI scan or CT scan.
Stages of lipoedema
As we’ve mentioned, lipoedema is progressive and slowly worsens over time. The stages are as follows:
- Stage 1: Your skin looks normal, but you can feel something like pebbles under your skin. This may be accompanied by pain and bruising.
- Stage 2: Your skin surface is uneven. It may have dimpling that looks like quilted stitching, a walnut-shell or cottage-cheese texture.
- Stage 3: Your legs can look like inflated rectangular balloons and have large folds of skin and fat. This fat may stick out, making it difficult to walk.
- Stage 4: In addition to lipoedema, you now have lymphoedema, where your lymphatic vessels are damaged or blocked.
Management and treatment
Lipoedema is a serious condition that can cause significant emotional distress. Although there is no cure for the condition, several things you can do can help you feel better by reducing pain and inflammation.
Initially, you should start with simple, non-invasive treatments. However, it’s recommended that you manage your condition under the guidance of your GP. If simple treatments are not enough to manage symptoms, you may want to discuss more complex treatments with your doctor.
Simple lipoedema treatments include:
- Exercise – This can help improve mobility and reduce swelling. Exercising in a pool can also help reduce stress on your joints.
- An anti-inflammatory diet – To help stem inflammation
- A heart-healthy diet – This may slow the progression of lipoedema, especially if you address the condition early. However, it cannot cure the condition.
- Compression stockings – Compression will help alleviate pain and make it easier to be mobile.
- Skin moisturiser – As the condition affects the connective tissue and lymphatics, the skin can become dry and sensitive. Regular moisturising can help maintain skin health and prevent infections.
- Medications or supplements – Various prescription medications and supplements may help with inflammation, swelling and other issues.
- Psychological support – Including social connectedness and management of expectations
Non-invasive lipoedema treatments include:
- Lymphatic drainage massage – This can help alleviate the lymphatic system, which can be compromised by lipoedema.
- Complex decongestant therapy – A massage that concludes with a compression wrap
- Pneumatic compression devices – That can be worn on the legs
A more invasive therapy for lipoedema is water-assisted liposuction (WAL).
WAL is a specialised, advanced treatment that is considered the premier treatment for lipoedema. It aims to reduce damaged, diseased, and inflammatory fat to preserve lymphatic health and leg circulation, and to reduce pain and swelling. By doing so, it avoids long-term dependence on compression garments and manual lymphatic drainage, allowing the individual to preserve their mobility and reduce the risk of degenerative conditions such as arthritis in the hips, knees, and ankles.
Lipoedema fat is fibrotic and difficult to remove with traditional liposuction. Waterjet-assisted liposuction specifically targets these fat cells while preserving healthy tissues.
During surgery, a local anaesthetic is used to minimise discomfort. Then, the waterjet technology gently dislodges and removes fat with precision. The patient is then fitted with a compression garment. Recovery takes 1-2 weeks, with the exact time depending on the extent of WAL performed and the individual’s healing response.
Initial Consultation
If you’d like to find out more about water-assisted liposuction, the first step is to book an appointment with Dr Mark Attalla in his Melbourne-based rooms.
During your consultation, Dr Attalla will review your concerns and examine the areas you would like addressed. This may include assessing your lipoedema, taking measurements, and recording photographs for medical planning.
Your overall health and medical history will also be reviewed, including any medications, vitamins, or supplements you are taking. This information helps in identifying any factors that could influence the procedure or recovery.
If Dr Attalla determines that you are suitable for water-assisted liposuction, he will carefully explain the procedure, recovery, risks, complications and all costs to you.
References
- Lipoedema Australia https://www.lipoedema.org.au/
- HealthDirect https://www.healthdirect.gov.au/lipoedema
- HealthEd: Mythbusting a mysterious condition https://www.healthed.com.au/clinical_articles/lipoedema-mythbusting-a-mysterious-condition/
