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Lipoedema – a disease, not a question of discipline
In lipoedema, subcutaneous fat increases pathologically – and barely responds to diet or exercise. Liposuction is the only effective method of removing the diseased fatty tissue and can noticeably relieve symptoms.
Many women with lipoedema have come a long way: diets, exercise, the experience that their legs or arms still do not get slimmer – and often the accusation of not trying hard enough. Yet it is a distinct disease of the fatty tissue.
What is lipoedema?
In lipoedema, the subcutaneous fatty tissue increases pathologically, typically symmetrically on the legs and hips, and often on the arms as well. The hands and feet are usually spared. Almost exclusively women are affected; the disease often begins during phases of hormonal change such as puberty, pregnancy or the menopause.
Typical signs:
- a disproportion between a slim upper body and considerably fuller legs or arms
- tension and pressure pain in the affected tissue
- a marked tendency to bruise
- a feeling of heaviness that increases over the course of the day
- diet and exercise have hardly any effect on the affected areas
The diagnosis is made by a doctor after an examination. Not every full figure is lipoedema – and not every case of lipoedema needs surgery.
Lipoedema, lymphoedema or overweight?
The distinction is important because the treatment differs. Lipoedema is not caused by being overweight, but it can be made worse by it. In lymphoedema, tissue fluid accumulates; the backs of the feet and the toes are often swollen, and the skin over the toes is difficult to lift (Stemmer’s sign). In a pure fat distribution disorder, pain and tenderness to pressure are absent. The diagnosis is based on the medical history, examination and palpation findings.
Stages
| Stage | Skin surface | Subcutaneous fatty tissue |
|---|---|---|
| I | smooth | thickened with fine nodules |
| II | uneven, wavy | coarsely nodular |
| III | deforming lobes | greatly increased, overhanging |
The stages describe the appearance – not necessarily the severity of the symptoms.
Conservative treatment
Treatment generally begins with conservative therapy: made-to-measure flat-knit compression garments, manual lymphatic drainage, regular exercise – especially in water –, a stable weight and good skin care. It relieves symptoms but cannot remove the diseased fatty tissue.
Liposuction for lipoedema
Liposuction for medical reasons in lipoedema was already part of my training, just as aesthetic procedures were. I work under general anaesthesia combined with tumescent local anaesthesia, with vibration techniques and thin cannulas that are gentle on the tissue and especially on the lymphatic vessels. Suction is performed lengthwise, parallel to the lymphatic pathways. In pronounced cases, it is often advisable to treat in several sessions.
Health insurance
Whether your health insurer contributes to liposuction for lipoedema depends on the individual case – among other things on the findings and on the treatment to date. Please clarify the assumption of costs with your health insurer before treatment begins. Documents on the diagnosis and previous therapy help with this.
Process: preparation, procedure, aftercare
Lipoedema is not about correcting the figure but about treating a disease. That is why the diagnosis comes first and careful aftercare comes at the end. We decide on the place of the procedure during the consultation.
- 01weeks to months beforeDiagnosis and planning
Diagnosis, previous conservative therapy, planning of the areas and stages, clarification of costs.
- 02one day of surgery per stageProcedure
Liposuction under general anaesthesia with tumescence, performed gently along the lymphatic pathways.
- 03weeks to monthsAftercare
Compression, lymphatic drainage, exercise, check-ups.
- Diagnosis Symptoms, distribution of the fatty tissue and medical history are assessed by a doctor.
- Stages In pronounced cases, areas such as the legs and arms are often treated in separate sessions.
- Preparation Have your compression garments fitted in advance and schedule lymphatic drainage appointments for the period afterwards.
- Day of surgery The areas are marked while you are standing; compression is applied immediately after the suction. With larger volumes, careful monitoring is particularly important.
- Day 1–3swelling and a feeling of tension; compression day and night
- Week 1–2lymphatic drainage as prescribed; light movement
- Week 3–6continue compression as instructed; increase activity gradually
- Month 3–6check-up; planning of the next stage, if intended
- long termcompression can often be reduced depending on the findings; exercise remains important
Contact us immediately if you have fever, severe pain, shortness of breath, a leg that is badly swollen on one side or redness around an access point.
Risks
The risks are essentially the same as those of liposuction: bruising, seromas, infections, sensory disturbances and unevenness of the skin. With larger volumes, careful monitoring and aftercare are particularly important.
Frequently asked questions
Do I have to keep wearing compression after the operation?
Immediately after the procedure, yes, for several weeks. Whether and for how long compression is needed afterwards depends on the findings. Many patients are able to reduce it over time.
Can lipoedema come back?
The fatty tissue that has been removed does not grow back. Lipoedema is, however, a chronic disease; it can progress in untreated areas or with hormonal changes.
How many operations are needed?
That depends on the severity and extent. The legs and arms are often treated in separate sessions.
Is lipoedema the same as cellulite?
No. Cellulite is a harmless change in the skin surface. Lipoedema is a disease of the fatty tissue with pain and tenderness to pressure.
Can I get rid of lipoedema through exercise?
Exercise relieves symptoms and is very important. As a rule, however, the pathologically increased fat cells do not disappear as a result.