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Your expert for lipedema

I have dealt extensively with the condition of lipedema in recent years. If patients suspect they may be suffering from lipedema, I conduct a thorough examination in my practice. If lipedema is confirmed, I accompany them on their journey—either conservatively or surgically.

What is "lipedema"?

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Lipedema is a disorder of fat distribution in the adipose tissue, affecting mainly the upper and lower legs, hips, and occasionally the arms. The subcutaneous adipose tissue is painful and sensitive to touch. A hormonal trigger is suspected to be responsible for the development of lipedema. For example, lipedema can develop during the first menstrual periods, after pregnancy, or with the onset of menopause.

In 1940, two American physicians, Allen and Hines, first described the typical appearance of increased fatty tissue on the legs, which occurs almost exclusively in women, and gave it the name "lipedema." Unfortunately, this term is misleading, as lipedema does not involve edema in the true sense of the word—i.e., water retention in the fatty tissue.

In very rare cases, men can also be affected by lipedema.

Diagnostics

The physical appearance is characterized by an increase in subcutaneous fatty tissue on the legs and hips or even on the arms, combined with a slim waist or upper body. There is often a difference in clothing size between the upper and lower body of up to two sizes. However, there are also patients who do not have any major fat distribution disorders but still suffer from lipedema because they complain of pain in the subcutaneous fatty tissue of the extremities. Even women of normal weight with a normal BMI can develop lipedema.

The presence of pain in the subcutaneous fatty tissue is important for the diagnosis of lipedema. If there is no pain, it is a simple fat distribution disorder of the subcutaneous fatty tissue, known as lipohypertrophy. The fat distribution pattern is often hereditary. Bruises may occur spontaneously, but this is not always the case. According to current research, the pain in the subcutaneous fatty tissue in lipedema results from an inflammatory reaction in the fatty tissue. Histological examinations of the liposuctioned fatty tissue of lipedema patients have shown an increase in inflammatory cells between the fat cells.

Lipedema is often classified into stages I-III :
Stage I: smooth skin surface
Stage II: uneven skin surface
Stage III: overhanging fat deposits

However, this classification is very subjective and often does not reflect the patient's symptoms. For example, there are patients with advanced stage III lipedema (fat aprons) who experience very little pain, and on the other hand, there are patients with only slightly elevated body weight (stage I) but significant symptoms.

Can imaging tests detect lipedema?

No. Whether it is lipedema or simply excess weight, the fatty tissue always looks the same on ultrasound or MRI scans. Neither of these examinations is therefore helpful in diagnosing lipedema. Furthermore, to date, no water retention in the fatty tissue in the sense of an "edema" has been detected in pure lipedema, either on ultrasound or MRI scans.

However, ultrasound is still important: it can be used to rule out deeper vein insufficiency or varicose veins as further causes of swollen and painful legs. Ultrasound examination of the leg veins is therefore a standard part of lipedema diagnosis and is also performed regularly during my consultations.

Lipedema symptoms

Lipedema is always accompanied by symptoms, but these can vary from person to person, which often makes it difficult for doctors to diagnose. In most cases, there is spontaneous pain in the affected limb or pain when touched, e.g., by a partner. Even children or pets sitting on the lap can cause discomfort.

Treatment options for lipedema

There is currently a shift in the way lipedema and its treatment are viewed.

The lack of evidence to date regarding fluid accumulation in lipedema means that manual lymphatic drainage to remove fluid from fatty tissue, as is often prescribed, does not appear to be effective.

The situation is different when it comes to wearing compression garments: although these cannot "push away" the excess fatty tissue, they can significantly alleviate the patient's symptoms, as compression reduces inflammation and thus relieves pain. This also supports the theory that inflammation of the subcutaneous fatty tissue is the cause of pain in lipedema.

The main treatment for lipedema is controlling body weight by monitoring calorie intake and getting sufficient physical exercise. Diets are counterproductive, as they usually lead to permanent weight gain due to the yo-yo effect. A sustainable change in diet is advisable, with nutritional counseling if necessary.

Plenty of physical activity and exercise —preferably to build muscle and increase your daily basal metabolic rate—are also important. Muscle building and exercise do not necessarily have to take place in a gym; training with your own body weight at home or outdoors also builds muscle.

If these measures do not lead to an improvement in the symptoms or if stubborn problem areas of fat distribution remain, these can be eliminated by liposuction (fat removal) with very good prospects of success.

Liposuction

What happens during liposuction?

Liposuction is a surgical procedure that targets areas with excess and painful subcutaneous fat tissue. The fat inside the abdominal cavity cannot be removed by suction; only the fat tissue under the skin can be suctioned out. During liposuction, a thin suction cannula is inserted under the skin at the desired location through a small incision of just under 0.5 cm in length, and the excess fatty tissue is suctioned out. There are various surgical techniques; water-jet-assisted liposuction (WAL) is currently the gentlest method for removing excess fatty tissue under the skin.

I also use water jet assisted liposuction for fat removal.

With this method, a fine jet of water emerges from the cannula, breaking down the fatty tissue into smaller particles and protecting the surrounding lymphatic vessels, nerves, and blood vessels. The shredded fat tissue is then suctioned out through the cannula ..

The procedure can be performed very well under local anesthesia, with the anesthetic being added to the water jet. At the patient's request, the procedure can of course also be performed under general anesthesia with an anesthesiologist. In order to achieve a quick recovery after liposuction, it is often advisable to spread the total amount of fat tissue to be removed over several sessions and to only remove fat from 1-2 different areas per procedure. Further information: Liposuction Düsseldorf

What happens to the extracted fatty tissue?

If desired, the extracted fatty tissue can also be transplanted to other areas of the body, such as the breasts or buttocks (known as fat transfer or lipofilling). Fat transfer to the face is also possible. To enable the fat cells to grow in their new location, only up to 250 ml of fat cells should generally be transferred per area of the body.

What is the recovery process like after liposuction?

Depending on the area of the body treated, you should wear compression garments day and night for approximately 6 weeks. You will be mobile immediately after the procedure and can usually resume your daily routine within the first few days. You can shower the day after the procedure. The skin incisions are closed with adhesive strips. They usually heal without any problems within the following 2-3 weeks and leave only very small scars, which are often no longer noticeable.

When and who benefits from liposuction?

Liposuction is not a cure-all for obesity. In cases of severe obesity, it is advisable to first reduce body weight through dietary changes and physical exercise. If there are still areas that remain painful or visually unsightly (so-called "problem areas"), these can be specifically targeted and removed through liposuction.

The weight loss process can often be supported by liposuction in its various phases to make it easier for the patient to lose weight.

Liposuction is therefore part of an overall concept, the central components of which are a change in eating habits and sufficient physical exercise.

Treatment of lipedema in my practice

During an initial consultation, we will take your medical history, examine the affected area and, if necessary, perform an ultrasound examination of your legs. Based on this information, we will work with you to determine a diagnosis and treatment plan. This can range from conservative treatment (dietary changes, exercise and, if necessary, compression therapy) to stage-appropriate liposuction (fat removal). The cost of liposuction depends on the number of areas to be treated. Even after the procedure, I will remain your direct contact and accompany you during the recovery period.

Costs for liposuction according to GOÄ

consultation

We would like to point out that we are legally obliged to charge for our advice.

Liposuction 1 region

Water jet technology WAL

Liposuction 2 areas

Water jet technology WAL

Lower leg liposuction

Water jet technology WAL

Lipotransfer of one region

Fat transfer / lipofilling

Costs of liposuction

Since the amount of fat to be removed and the areas to be treated vary from patient to patient, only approximate prices can be given here. Invoicing is always transparent and comprehensible in accordance with the German Scale of Medical Fees (GOÄ).

Consultation
approx. €170 with ultrasound of the leg veins for lipedema and approx. €50 without ultrasound for lipohypertrophy.
We would like to point out that we are legally obliged to charge for the initial consultation.

Region 1

Front and inner thighs with knee joint on both legs under local anesthesia.

Region 2

Outer thighs (saddlebags) and back of both legs under local anesthesia.

Region 3

Lower leg circular on both sides under local anesthesia.

Region 4

Gynecomastia (male breasts) on both sides under local anesthesia.

Region 5

Abdominal wall (upper and lower abdomen) under local anesthesia.

Region 6

Upper arms on both sides under local anesthesia.

Other regions: Price on request

Fat transfer to a region

fat transfer

breasts
butt
Hip dips

plus costs for liposuction

Simultaneous skin tightening

With argon plasma or laser immediately after liposuction (recommended).

All prices are exclusive of VAT, as lipedema is a medically indicated procedure that is exempt from sales tax.

All prices apply to procedures performed under local anesthesia. If you would like an anesthesiologist, there will be additional costs for the anesthesia.

The respective price includes 1 compression garment. We will provide you with the garment based on your body measurements, which we will determine on the day of the operation.

As I work exclusively in private practice, the costs of surgery performed by me are not reimbursed by statutory health insurance companies in the case of statutory health insurance. If you have private insurance or are eligible for assistance, you should request coverage of the costs from your health insurance company or assistance provider in advance of the operation on the basis of a cost estimate, which I will be happy to provide.

Does health insurance cover the costs of liposuction?

The Joint Federal Committee (G-BA) decided in 2019 that a pilot study would first examine the costs of liposuction exclusively in stage III for selected patients by statutory health insurance companies. The basic requirement for inclusion in the study is a BMI of up to 40 kg/m2 and unsuccessful six-month conservative therapy. The indication for liposuction must be made by a specialist in plastic surgery or a specialist surgeon in order for the costs to be covered by statutory health insurance. If liposuction is performed by a private doctor, the costs of treatment are generally not covered by statutory health insurance.

Further information on lipedema

symptoms

Lipedema is a symmetrical increase in subcutaneous fat tissue in the extremities, primarily in the legs and sometimes also in the arms, always accompanied by symptoms.

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