Lipoedema can be a painful and debilitating disorder. It predominantly affects women and may appear following a fluctuation in hormones, such as puberty, pregnancy, or menopause. Once diagnosed, patients wonder if lipoedema will continue to worsen. The answer is, yes, it often does without management. It is typically a progressive condition and may become more severe with symptoms growing worse as time passes. The key to slowing its progression is management of the condition.
Lipoedema is characterised by excessive deposits of fat cells (adipose tissue enlargement) which disproportionately develop on legs, thighs, and buttocks, and may also affect the arms. The fat does not develop on hands or feet, and this collar or braceleting of fat that stops at the hands or feet is a telltale sign of lipoedema. The condition causes bruising without apparent cause, pain, and sensitivity to touch. Patients may have difficulty standing for long periods or have mobility difficulties and muscle weakness.
There are 3 different ways of classifying lipoedema. Type by the area affected, type by the shape and appearance of the fat, and the stage, which describes the severity of the condition.
Type I – Pelvis, buttocks, hips.
Type II – Buttocks to knees, with the formation of fat folds around the inner knees.
Type III – Buttocks to ankles
Type IV – Arms
Type V – Lower legs
Columnar – Enlargement of limbs so they look column- or cylinder-like in shape. A loss of definition around the ankles and knees.
Lobar – Large bulges of fat or lobes of fat, limbs lower extremities, hips, and upper arms.
Stage 1 – Skin appears smooth. When pressed firmly with the fingers, small nodules (firm lumps) can be felt beneath the skin.
Stage 2 – Skin has an irregular texture similar to orange peel. When skin is pressed with the fingers, nodules of varying sizes can be detected, from the size of a walnut to an apple.
Stage 3 – The lumps beneath the skin are larger and more prominent than in Stage 2. Lobes of fat tissue form around thighs and knees and may make the silhouette of the leg significantly change.
Stage 4 – Lipoedema with lymphoedema (known as lipolymphoedema)
As lipoedema patients age, it is likely the condition will progress through the different stages, and that symptoms will become increasingly debilitating. There is no cure for lipoedema, however, management of the disease can alleviate symptoms and greatly improve the quality of life for sufferers.
There is a range of symptoms and consequences for the patient because of the disease. It may affect anything from their mental wellness to their walking gait and ability to care for themselves at home. Management of the condition is often undertaken by a range of medical professionals to get the symptoms under control. Patients may find support with a lipoedema/lymphoedema specialist, physiotherapist, podiatrist, occupational therapist, dietitian, pain clinics, phlebologist, plastic or cosmetic surgeon, bariatric surgeon, with each able to treat a different aspect of the condition.
Although there is no silver bullet cure, addressing symptoms can bring a lot of benefits including pain reduction, improved limb shape, and reduction of mass. This eases joint pain and mobility challenges. When the size of the tissue is reduced, the pressure placed on the lymphatic system is also diminished, making a progression to lipolymphoedema much less likely.
Tumescent liposuction reduces the size of lipoedema of the legs, hips, buttocks, and arms. Under tumescent anaesthetic (a local anaesthetic), the surgeon inserts a cannula containing a suction tube, below the skin surface. A combination of the tumescent solution and gentle movement of the cannula is enough to dislodge the deposits of lipoedema fat and is suctioned out of the body. The patient is awake during the tumescent liposuction, and recovery is faster and less painful than more invasive forms of the technique, like mechanical liposuction under general anesthetic.