Lipedema is playing an increasingly important role in public perception. Social media certainly plays a large part in this, as more and more celebrities are "coming out" and making their lipedema diagnosis public. They also talk about the treatment they have chosen, providing many sufferers with initial inspiration and assistance.
Lipedema therapy can be conservative or surgical.
Conservative lipedema therapy – what is it?
Conservative lipedema therapy aims to reduce pain in the subcutaneous fatty tissue by wearing compression garments and undergoing regular manual lymphatic drainage (MLD). It is believed that the pain associated with lipedema results from a mild inflammatory reaction in the subcutaneous fatty tissue. The application of compression can counteract inflammation in general. Wearing compression garments, which is an essential pillar of conservative lipedema therapy, can reduce pain in the fatty tissue via this mechanism of action.
Manual lymphatic drainage is the second essential pillar of conservative lipedema therapy. However, lymphatic drainage is not about the actual purpose of lymphatic drainage—the removal of fluid from the extremities or their "decongestion." Rather, the gentle, stroking movements of the lymph therapist are intended to stimulate the calming parasympathetic nervous system, thereby reducing lipedema pain.
In addition, proper skin care is an essential part of conservative lipedema therapy: certain areas of skin can rub against each other due to the increased fatty tissue—the inner thighs are a particularly common example. Proper skin care—especially in warm temperatures—prevents irritation of the affected areas of skin.
Last but not least, everyone affected should ensure they get enough exercise in their daily routine, as good mobility improves overall quality of life and can help to distance oneself from the pain. In addition to a balanced diet, exercise helps to burn calories and improve body weight and physical well-being.
Surgical lipedema treatment – often a permanent solution.
If conservative treatment does not lead to an improvement in quality of life, there is always the option of surgery to remove the painful fatty tissue—known as liposuction. In this procedure, the excess and painful subcutaneous fatty tissue is suctioned out through small incisions in the skin (approx. 0.5 cm long) using a thin suction cannula. This procedure usually leads to the elimination of symptoms and thus to a rapid improvement in quality of life. The procedure can be performed under local anesthesia or, at the patient's request, under general anesthesia with an anesthesiologist. However, the procedure is also associated with possible complications, although these occur very rarely.
Another advantage of surgical lipedema treatment using liposuction over conservative treatment is the improvement in body shape and thus in physical appearance.
Many patients have undergone prolonged conservative treatment before deciding to undergo surgical treatment for lipedema.
However, there are also patients who primarily opt for surgical lipedema treatment. It is always an individual decision on the part of the patient as to which path she would like to take initially. This often depends on her current circumstances and financial situation, as conservative lipedema treatment is usually covered by health insurance, but surgery almost always has to be paid for by the patient herself.
Advantages and disadvantages of lipedema therapies:
The advantage of conservative lipedema therapy is that it is covered by health insurance and preserves the integrity of the patient's body. The disadvantage of conservative lipedema therapy is that it often does not lead to complete relief of symptoms and, in particular, wearing compression garments can be uncomfortable in warm temperatures. Conservative therapy also does not change the patient's appearance.
In contrast, surgical lipedema therapy can sometimes lead to rapid and permanent relief from symptoms. The disadvantage of surgery is its invasive nature, with the possibility of complications from liposuction—albeit rare—and the fact that the procedure is usually a self-pay service.
Comprehensive information about both methods of lipedema therapy is essential.
It makes perfect sense for those affected to obtain detailed information about both options for lipedema treatment in order to be able to make an informed and self-determined decision about the right path for them.
During my consultation hours, many patients come to me wanting to know whether they are suffering from lipedema in the first place. Once the diagnosis has been made, I always advise the patient on both treatment options and recommend that they take sufficient time to consider their options.
However, many patients also want to find out directly about the exact procedure of an operation and what they need to do after the procedure. This is important in order to be able to plan the right time for surgery in lipedema therapy.
Is there "the" right way to treat lipedema?
No, there is of course no single "right" way to treat lipedema. This approach may also change over time, with an initially conservative approach ultimately giving way to surgical treatment. Many patients who come to my clinic have already undergone several years of conservative lipedema therapy involving the wearing of compression garments and manual lymphatic drainage, and are now ready for liposuction due to the severity of their symptoms.
Please bear in mind, however, that liposuction in lipedema therapy primarily serves to relieve you of your pain. Liposuction naturally changes the body's silhouette, but the appearance of uneven skin texture cannot be ruled out even after liposuction. However, an experienced surgeon will do everything possible to ensure that the cosmetic result after liposuction is appealing.
Frequently asked questions about lipedema therapy:
There are both conservative and surgical treatments for lipedema. Both methods have their specific advantages and disadvantages and are discussed in detail during a consultation with a doctor who is experienced in treating lipedema.
Conservative lipedema therapy consists of four elements: 1. wearing compression garments, 2. manual lymphatic drainage, 3. good skin care, and 4. sufficient exercise and improved eating habits.
During liposuction (technical term: liposuction), a fine suction cannula is inserted under the skin through small incisions, and the excess and painful fatty tissue is sucked out and thus surgically removed. This can achieve complete and permanent relief from symptoms in a very high percentage of cases.
The advantages and disadvantages of both treatment methods will be discussed with you in a detailed consultation with a doctor who is experienced in treating lipedema. Many patients initially begin with conservative lipedema treatment and decide to have surgery if the conservative treatment does not improve their symptoms. However, there are also patients who receive long-term conservative treatment and patients who decide to have surgery right from the start.
The effectiveness of purely conservative lipedema therapy without surgery, involving dietary changes, wearing compression garments, manual lymphatic drainage, and sufficient physical activity, can be good in the long term and lead to a significant improvement in symptoms. However, many patients do not want to go down this route, and surgery offers the prospect of lifelong freedom from symptoms, even if this cannot be guaranteed and a cure is not possible at the current stage of research.
The right time for lipedema surgery is always when conservative therapy fails to relieve symptoms or when the patient wishes to achieve symptom relief quickly. Significant excess weight may be a reason to postpone surgery initially. However, in some cases, particularly in patients who are overweight, it may be beneficial to improve the patient's quality of life through liposuction, thereby paving the way for weight loss through lifestyle changes (diet, exercise).
Nutrition and exercise are fundamental pillars of lipedema therapy, regardless of whether the patient opts for surgical or conservative treatment. Even with lipedema, you can only gain weight if you eat poorly, don't get enough exercise, or have a metabolic disorder (e.g., hypothyroidism), because the body always converts excess energy into fat—it can't do anything else. There is no such thing as self-growing fatty tissue, as is often claimed about lipedema fat, because this is not possible according to the laws of physics (law of conservation of energy). Even with lipedema, you can gain or lose weight depending on your diet, exercise, and metabolism. This is very important to understand, because it means that you are not helplessly at the mercy of the disease, as is so often claimed on social media. If diet and exercise are not taken into account sufficiently after lipedema surgery, this can quickly lead to renewed weight gain and thus a recurrence of lipedema symptoms.
Holistic therapy planning for lipedema begins with taking the patient's medical history—particularly their symptoms—and performing a physical examination. Depending on the symptoms, a supplementary ultrasound examination of the legs is useful and indicated. The advantages and disadvantages of conservative or surgical treatment are then discussed and a personalized treatment plan is drawn up based on the patient's level of suffering and treatment preferences. We reserve a time slot of approximately 1 hour for the initial consultation with each new patient, even if this is not always necessary.
The costs for conservative lipedema treatment are generally always covered by statutory (only for doctors registered with the health insurance system) and private health insurance companies. The situation is different if surgery (liposuction) is planned. In this case, you can try to obtain partial or even full financing from your private health insurance company in advance by submitting a cost estimate. With statutory health insurance companies, this is currently only possible in stage III lipedema. However, this may change in the future once the results of the recently completed LipLeg study (liposuction for lipedema in all stages) have been evaluated and implemented by the G-BA.
