CLINICAL

UNDERSTANDING LIPODEMA: HOW TO HELP PATIENTS NON-SURGICALLY

What exactly is lipoedema and how can clinics help patients manage it without surgery? Kezia Parkins investigates...

WHAT IS LIPOEDEMA?

Lipoedema is a chronic fat disorder that primarily affects women, often developing and progressing during periods of hormonal change such as puberty, pregnancy or menopause. It is often confused with cellulite in early stages. Unlike regular fat accumulation, lipoedema fat is pathologically different – it is painful and resistant to diet and exercise.

“Surgery is not the only answer to lipoedema. It is one piece in the jigsaw, and it is one treatment method that is great for certain patients, not all patients.„

“Lipoedema is one disorder in a family of fat disorders whereby there’s abnormal deposition of fat, typically on the lower limbs, and in some patients on the upper limbs,” says Vasu Karri, one of the few specialist lipoedema surgeons in the UK and owner of The Karri Clinic in Hull.

The condition spares the hands and feet and affects both sides of the body, which helps differentiate it from lymphoedema.

“Lipoedema sufferers have a very specific presentation,” continues Dr Karri. “What I would look for is the ankle cuff, whether the feet are involved, whether they have a pre-tibial fat pad, whether they have fat over the Achilles tendon, whether they have medial knee fat pad, super patella fullness, anterior bowing of the thighs, and mattressing.”

Despite these generally accepted presentations among lipoedema doctors and specialists, the condition is still widely misunderstood and misdiagnosed. Many women who have lipoedema are incorrectly told they simply have obesity, to “just lose weight” or that it is lymphedema, leading to feelings of frustration, shame and isolation.

Research suggests a genetic component, as it often runs in families, and estimates that up to 11% of women may be affected to some degree.

“Always ask a client if their mother or grandmother suffers from lipoedema, because that is often a big factor,” says manual lymphatic drainage specialist and wood therapist Jasmina Connelly.

HOW LIPOEDEMA AFFECTS SUFFERERS

Beyond the visible differences, lipoedema brings a host of physical and emotional challenges including:

Tenderness and pain: “In lipoedema sufferers the fat can be really painful. Even light touch can cause pain and bruising, or a pet jumping up on the lap of a lipoedema sufferer can cause significant pain,” says Connelly.

“If untreated, over time lipoedema can progress and lead to serious mobility limitations and secondary lymphedema, making awareness and early recognition and management really important.„

Easy bruising: Due to fragile blood vessels within the fatty tissue.

Fatigue: Carrying extra weight that’s unaffected by standard weight-loss methods can lead to exhaustion and mobility issues, especially in later stages of the disease.

Emotional distress: Many women report low self-esteem and anxiety related to their body image and the chronic, misunderstood nature of the disease. “We know that lipoedema can cause depression and affect interpersonal relationships. It can have effects on intimacy, getting a job, mobilisation and general happiness and wellbeing,” says Karri.

“If untreated, over time lipoedema can progress and lead to serious mobility limitations and secondary lymphedema, making awareness and early recognition and management really important,” says Connelly.

NON-SURGICAL TREATMENTS

While liposuction (specifically tumescent or water-assisted liposuction) remains a leading medical intervention to remove lipoedema fat, many individuals seek non-surgical options either before surgery, instead of surgery, or as maintenance afterwards. “Surgery is not the only answer to lipoedema. It is one piece in the jigsaw, and it is one treatment method that is great for certain patients, not all patients. There are other treatments that patients have found to be beneficial for symptom control but you can’t really reduce the size of the limb,” says Karri.

Manual lymphatic drainage

This specialised, gentle technique stimulates the lymphatic system to move excess fluid out of the tissues. Manual lymphatic drainage (MLD) can reduce swelling, discomfort and the “heavy” feeling associated with lipoedema.

Compression garments

“Medical-grade compression leggings, stockings or sleeves are one of the first things I advise for lipoedema sufferers to help manage swelling and support the tissue. I always advise my clients wear compression after their MLD to prolong results,” adds Connelly. By encouraging better lymphatic flow and reducing fluid accumulation, compression can potentially help slow disease progression and improve mobility.

Diet and exercise

Although diet alone won’t cure lipoedema or significantly reduce its fat, an anti-inflammatory diet can bring down overall inflammation in the body, which can reduce some of the pain and swelling associated with the condition. Avoiding processed foods, sugar and excess salt are also said to be important in managing the progression of the disease. “Plenty of fluid is needed to support the lymphatic system and I advise clients to cut out alcohol because it causes inflammation and dehydration,” says Connelly.

When it comes to exercise, traditional weight-loss and workouts won’t shrink lipoedema fat. “But staying active is still essential to prevent progression and support lymphatic flow,” Connelly adds. “I recommend rebounding on the trampoline, vibration plate therapy and low-impact exercises like swimming, aqua aerobics, walking or cycling.”

Aesthetic devices

There are a number of aesthetic devices that have been studied in the management of lipoedema. Pneumatic compression devices like Body Ballancer are essentially massaging suits that inflate and deflate to assist lymphatic drainage. Smaller, at-home versions can be prescribed for daily use and to help control swelling and pain. Other technologies and devices that can help with the pain, swelling and eventual tissue fibrosis of lipoedema include Icoone, LPG’s Endermologie, Endospheres micro-vibration and Karri’s recommendation of deep oscillation therapy (DOT) such as Physio Pod.

Supplements and skincare

Some patients incorporate natural supplements like diosmin (a flavonoid) or horse chestnut extract to support vascular health. Targeted skincare with ingredients that promote circulation and collagen health can help support the skin and make it appear firmer. Extra moisturising lotions that can support the inflation and deflation of the skin, including caffeine or retinol, are also a good shout.

WHY AWARENESS MATTERS

For aesthetic practitioners, awareness of lipoedema is critical because a patient coming to you for a treatment for cellulite may actually be suffering from lipoedema as it can appear as mid-severe cellulite in early stages. “This is actually ‘mattressing of the tissue’,” explains Karri.

Plus, with it being such an underserved and misdiagnosed condition in the general medical field, aesthetic practitioners have the chance to fill a void in the lives of lipoedema sufferers by providing non-surgical treatment, advice and even referral for diagnosis. Understanding that persistent lower body fat might be a medical issue, not a personal failure, can be life-changing.