Lipedema Treatment
Have you been diagnosed with lipedema and want to know which treatment is right for you?
Are you suffering from the physical and emotional strain that comes with a diagnosis of lipedema?
Perhaps you are afraid of surgery or concerned about the associated costs?
Then the following lines should serve to give you a comprehensive overview of both conservative and surgical treatment for lipedema.
Lipedema is a condition—unfortunately still often misunderstood—characterized by a symmetrical increase in subcutaneous fat tissue on the legs or arms, accompanied by symptoms such as pain or a feeling of heaviness in the affected limb.
The diagnosis is usually made based on the symptoms and the results of a physical examination (e.g., a positive pinch test). There are no specific laboratory parameters or imaging diagnostics (ultrasound, MRI) for lipedema; these are used instead to rule out other differential diagnoses.
What can you expect at my practice?
In my private practice, an initial consultation lasting approximately one hour involves a detailed medical history and physical examination, including ultrasound if necessary, to rule out vascular disease as the cause of your symptoms.
Based on the examination results, we will then discuss whether lipedema may be present and explain the various treatment options with their specific advantages and disadvantages. Together, we will then develop the most suitable treatment plan for you.
What treatment options are available for lipedema?
In principle, conservative and surgical treatment options are available for every stage of lipedema. Both approaches have advantages and disadvantages, which will be presented here.
Conservative therapy:
The basis of any conservative treatment for lipedema is proper nutrition and what is known as "complex physical decongestive therapy" (CPT), consisting of:
1. Compression therapy (flat knit),
2. Manual lymphatic drainage (MLD),
3. Exercise therapy and
4. Skin care.
1. Compression garments
The aim of compression therapy is to relieve pain in the affected limb. Based on the assumption that inflammation is the cause of pain in the affected limb, compression reduces inflammation and thus alleviates the pain.
For effective compression, flat-knit corsets are used first and foremost, as circular-knit compression garments often do not provide sufficient rigidity to reduce pain. Circular-knit compression is mainly used in the treatment of varicose veins.
If wearing flat-knit compression garments during the day does not improve your symptoms, it is usually not advisable to continue with compression therapy. Compression garments cannot remove excess fatty tissue under any circumstances.
Compression garments are now available in a wide variety of colors and as multi-piece sets for flexible combinations. A good medical supply store will familiarize you with the features of your specific compression garment and provide you with various tips and tricks for using it. They will also help you if you encounter any problems with the garment in everyday use.
2. Manual lymphatic drainage (MLD)
Manual lymphatic drainage (MLD) for lipedema is increasingly controversial among experts. Why? To date, neither ultrasound nor magnetic resonance imaging (MRI) has been able to detect free fluid in the soft tissue of the affected limb in cases of pure lipedema. Consequently, it does not seem sensible to remove fluid that is not present through lymphatic drainage.
Furthermore, lymphatic drainage—similar to compression garments—cannot massage or press away fatty tissue. However, there is much evidence to suggest that manual lymphatic drainage, with its gentle stroking movements, has a pain-relieving effect and therefore has a place in the treatment of lipedema.
MLD can be supplemented by intermittent pneumatic compression (IPC) at home, in which cuffs applied to the legs or arms are mechanically filled with air. The gentle compression generated reduces pain in the fatty tissue according to the same principle as compression garments.
3. Exercise therapy
As a lipedema patient, you should ensure that you get sufficient exercise in your everyday life. On the one hand, exercise supports your mental well-being and thus your mental attitude towards lipedema. On the other hand, it promotes the stabilization of your body weight and can thus protect you from progressing to a higher stage—especially stage III.
In this context, a few words about exercise and lipedema: In principle, any form of exercise is good, but muscle-building exercises are always preferable to pure endurance training, as increasing muscle mass raises your daily basal metabolic rate, which in turn burns more calories per day. You don't even need to go to the gym to do this. There are wonderful exercises you can do at home or outdoors to train highly effectively using your own body weight and build muscle.
This can of course be supplemented by endurance training such as jogging or similar activities, but with this form of training, the body can quickly become accustomed to the strain and may end up burning only a few calories.
Find the sport you enjoy most, because only then will you stick with it in the long term.
4. Skin care
Good skin care is always important when increased fatty tissue causes skin folds, which can lead to infections or fungal infections due to sweating. You should ensure that the skin environment is acidic and not alkaline, as is unfortunately caused by many soaps.
The increased fatty tissue can also cause the thighs to rub together in the crotch area, which can affect the skin, especially in summer. If you have skin problems, I recommend consulting a dermatologist.
Nutrition for lipedema
Nutrition is a central pillar in the treatment of lipedema.
Proper nutrition for lipedema is a complex topic, and there is no single diet that is suitable for every patient.
Some patients prefer intermittent fasting, others swear by low-carb diets or follow the frequently recommended ketogenic diet, which involves consuming only a few carbohydrates, thereby permanently changing the metabolism and breaking down the body's own fat reserves.
I recommend consulting the relevant specialist literature to further deepen your knowledge of the individual diets.
Important: Always remember to consider the beverages you consume, as these are often overlooked. We unconsciously drink many calories, and unfortunately, calories in liquid form do not contribute to a feeling of fullness.
Unfortunately, light or zero-calorie drinks are not the solution either, because even though they are low in calories, they can still trigger the brain's sweet stimulus, leading to increased insulin release in the blood. Insulin is the fat-storing hormone and causes our bodies to build up excess fatty tissue.
It is helpful and sensible to consult a professional in the field of nutrition. A good nutrition therapist can guide you on your individual path to proper nutrition and work with you to find the diet that really suits you and, above all, your metabolism.
In summary, conservative therapy has the potential to slow down or even completely prevent the progression of lipedema. By reducing pain, it can lead to a significant improvement in quality of life.
Surgical treatment: Liposuction:
Surgery involving the removal of excess and painful fatty tissue—known as liposuction—offers the prospect of lifelong freedom from symptoms.
However, liposuction does not guarantee permanent relief from symptoms. Here too, the focus after liposuction is on sufficient exercise and proper nutrition.
In liposuction, the affected fatty tissue is first soaked with fluid (known as tumescent solution) and then suctioned out using various techniques—nowadays either water-assisted liposuction (WAL) or vibration-assisted liposuction (PAL)—with a thin cannula through small incisions in the skin.
The procedure can be performed under local anesthesia or under partial or general anesthesia—on an outpatient or inpatient basis.
Liposuction is currently the most commonly performed cosmetic procedure worldwide, with a very low complication rate.
Who is suitable for liposuction?
In principle, any patient without serious pre-existing conditions and any area of the body affected by lipedema can undergo liposuction. Only the fatty tissue directly under the skin is removed; liposuction of the abdominal cavity, for example, is not possible—only the abdominal wall.
Not too much fat should be removed during each surgical session, as although the incisions are very small, the wound area under the skin is large and the removal of fatty tissue means a loss of organ tissue for the body.
In most cases, up to 3 liters of pure fat are removed in one session on an outpatient basis, and in some cases even more. This always depends on the patient's circulatory condition during the operation.
Under inpatient conditions, more fatty tissue can be removed, but this also places greater strain on the body.
What is the goal of liposuction for lipedema?
The aim is to consistently remove all painful fatty tissue through suction in order to achieve lifelong freedom from symptoms.
Of course, an appealing cosmetic result should also be achieved. However, the focus is always on eliminating pain. If there are larger amounts of fat, irregularities in the skin texture may remain after liposuction.
What preparations are required for liposuction?
If you decide to undergo liposuction, you will receive detailed information about the procedure, including possible complications and post-operative care. All questions will be discussed at length. Always allow yourself sufficient time to consider your decision before undergoing surgery.
If you already have a compression garment, please wear it during the day in the days leading up to the procedure. This can optimize the soft tissue conditions for the procedure. Significant weight loss prior to the procedure is not recommended, as this can worsen the cosmetic result due to increased sagging of the skin.
If the patient's medical history is unremarkable, no further tests such as laboratory tests, ECG, or X-rays are necessary. In the case of anesthesia, the anesthesiologist decides on an individual basis whether further preliminary examinations are necessary—as a rule, they are not.
The operation
On the day of the operation, photos of the areas of the body to be treated are taken again so that a comparison can be made later. Many patients quickly forget what their body silhouette once looked like. The areas to be treated are marked, and you then put on the surgical clothing provided by us.
In the operating room, you will be asked to lie down on the operating table, and the areas of your body to be treated will be thoroughly disinfected and covered with sterile drapes.
After administering a local anesthetic, several small incisions approximately 0.5 cm in length are made and a cannula is used to inject tumescent local anesthetic into the fatty tissue to be removed. After a short period of time to allow the fat tissue to soak, it is then suctioned off using a cannula with a diameter of approx. 4 mm and a water-jet assisted liposuction (WAL) technique. During the suctioning process, you will be awake if you have had a local anesthetic and can eat, drink, or listen to music.
At the end of the suction procedure, depending on the condition of the skin, additional skin tightening with argon plasma or laser is performed to prevent sagging skin flaps at the suctioned areas.
Afterwards, the remaining tumescent fluid is manually removed from the tissue, the wounds are closed with Steristrips (adhesive strips), and then the compression garment that we provide is put on. You should wear the garment day and night for 6 weeks.
If you feel well at the end of the procedure and your circulation is stable, you may leave our practice accompanied by a relative or friend.
The post-operative phase:
You will usually still feel exhausted for the first few days after the procedure, and I recommend that you take it easy physically during this time. The wounds usually heal after 14 days, at which point the adhesive bandages can be removed. You should wear the compression garment day and night for 6 weeks.
Intensive post-operative lymphatic drainage by a physical therapist (physiotherapist) starting in the first few days after the procedure is important for the healing process during this phase. This removes wound fluid and accumulated lymph from the treated leg or arm and loosens the hardening that often occurs in the soft tissue.
In some cases, lymphatic drainage must be continued over a longer period of time, and the corresponding treatment appointments at the physiotherapy practice should already be scheduled at the time of the operation.
Light exercise can be resumed after approximately 4-6 weeks.
Often, after 3 weeks, the treated limb has swollen down enough that a tighter corset can be fitted. For this reason, the first scheduled follow-up examination takes place at this point in our practice.
You will see the final results of liposuction after approximately 6 months at the earliest. The skin needs up to 12 months to retract over the reduced fatty tissue and thereby tighten and smooth out.
Please make sure to maintain your body weight after the procedure, as otherwise new fat deposits may appear in other areas of the body.
Many women then think that the lipedema has returned elsewhere. However, your body has to store the excess energy that you may be feeding it back in some way, and it does this again in the form of new fatty tissue. This means that you also gain weight again in the areas where liposuction was performed, albeit significantly less. Since the number of fat cells has been reduced by the liposuction, the increase is much less visible here than in areas that have not been treated. At this point at the latest, I recommend professional nutritional counseling to improve your metabolism.
Sometimes psychological support is also useful in order to identify and eliminate unhealthy eating patterns.
Of course, we will also look after you in the period following your operation and will be happy to be your first point of contact should painful fatty tissue reappear.
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 5
Abdominal wall (upper and lower abdomen) 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.
Conclusion:
- Both conservative and surgical treatment options are available for lipedema. Both approaches have advantages and disadvantages. We will determine your individual treatment plan during a detailed personal consultation.
- Conservative treatment is based on proper nutrition and complex physical decongestive therapy (CPT). This primarily involves wearing a flat-knit compression garment and manual lymphatic drainage.
- All treatment methods—both conservative and surgical—focus on optimizing dietary habits and ensuring sufficient physical activity, preferably with muscle building.
- The operation (liposuction) offers the potential of permanent relief from symptoms. However, it is an invasive procedure and involves costs that usually have to be borne by the patient.
- Liposuction is now a standard procedure with a very low complication rate and is the most commonly performed cosmetic procedure worldwide.
- At Dr. Kusenack's vascular practice in Düsseldorf, we advise and support you in the treatment of your lipedema. We treat you conservatively or perform stage-appropriate liposuction on an outpatient basis, preferably under local anesthesia (tumescent local anesthesia).
FAQ | Frequently asked questions about lipedema treatment:
According to current knowledge—although research in this area is still in its infancy—lipedema is incurable.
However, a higher stage can regress to a lower stage (e.g., stage II after stage I) if appropriate conservative or surgical treatment is performed.
It is also conceivable that treatment of simultaneous obesity could lead to a regression from stage III to a lower stage II.
Lipedema is incurable. The best chance of lasting relief from symptoms is offered by surgical intervention in the form of liposuction. However, purely conservative therapy can also lead to relief from symptoms.
In principle, any form of exercise is good. Both endurance and strength training can help to keep lipedema under control.
Many patients combine different types of exercise. However, endurance sports usually do not lead to a loss of fat tissue beyond a certain point, as the body becomes accustomed to the strain.
Muscle-building exercises lead to an increase in daily basal metabolic rate per se through muscle growth.
Hormonal changes are discussed as triggers for a lipedema flare-up, i.e., the onset of puberty or menopause, as well as pregnancy.
However, prolonged stressful situations are also possible, which can lead to increased fat storage due to persistently high cortisol levels in the blood.
Unfortunately, the exact triggers of a lipedema flare-up are still unknown, and research in this area is still in its infancy.
Recovery after lipedema surgery varies from patient to patient. There is no generally applicable recovery time. As a rule, you will not be able to work during the first week and will need a certain amount of time to recover. I will provide you with a sick note for this period, and for longer if necessary. In most cases, however, you will be able to return to work in the second week. Pain is usually experienced in the first week and is comparable to severe muscle soreness in the areas where liposuction was performed. I will provide you with sufficient pain medication and my cell phone number, which you can use to reach me at any time (24/7). In this context, it is very important to wear a compression garment day and night for 6 weeks and to undergo regular manual lymphatic drainage by a physical therapist (2-3 times a week) to remove the lymph fluid and wound fluid that accumulates after the operation.
The risks of conservative lipedema therapy ultimately consist only of the possibility of the therapy failing. There are generally no side effects with conservative therapy. Liposuction is a surgical procedure and therefore carries the classic risks associated with surgery, such as the risk of thrombosis, infection, soft tissue swelling, or nerve damage. I will discuss and explain all risks during the preoperative consultation. However, serious complications do not usually occur, and postoperative pain is normal in the first few days and can be treated effectively with appropriate pain medication. From a cosmetic point of view, skin irregularities may remain after liposuction.
In preparation for liposuction (fat removal), please try to maintain a stable body weight. Significant weight loss prior to surgery is not advisable, as this can increase the risk of sagging skin after the procedure. It is also important that you prepare for the pre-operative consultation with your doctor by, for example, writing down any questions you may have in advance on a piece of paper, as you may forget them during the consultation due to nervousness. Be sure to ask any questions that are important to you. A responsible doctor will discuss all questions with you and try to leave no stone unturned. Ultimately, liposuction is, of course, a surgical procedure, but in the hands of an experienced colleague, it is very safe for you.
Weight loss in the areas of the body affected by lipedema is possible despite lipedema. However, this does not usually change the body silhouette with its different proportions.
Only liposuction can restore the correct proportions by selectively removing the excess fatty tissue (known as liposculpture).
The costs of conservative treatment of lipedema involving the wearing of compression garments and manual lymphatic drainage are normally covered by statutory and private health insurance companies. However, surgical intervention is still generally a self-pay service today.
For information on costs, please refer to the section "Costs of liposuction." The prices for liposuction at our practice are calculated transparently and comprehensibly in accordance with the German Scale of Medical Fees (GOÄ).
This question is currently being discussed very heatedly and critically among experts.
Since lipedema has been shown not to involve increased water retention in the soft tissue that could be drained, the positive effects of lymphatic drainage on reducing perceived pain appear to be concentrated in the gentle stroking movements.
It is not possible to massage or press away the excess fatty tissue using lymphatic drainage.
First, a medical history is taken during a consultation lasting just under an hour, during which the symptoms are identified and a physical examination is carried out. If necessary, an ultrasound examination of the legs is performed to rule out internal, non-visible varicose veins. An ultrasound examination of the arms is not useful even if symptoms are present, as varicose veins do not occur here. The best possible course of treatment is then determined together with the patient. In the case of conservative therapy, I accompany the patient with appropriate prescriptions for lymphatic drainage and compression stockings (for private patients). If you have statutory health insurance, I recommend that your family doctor prescribe the treatment so that the costs are covered by the statutory health insurance, as I can only issue a private prescription as a private doctor. If you decide to have surgery, I will explain the surgical procedure and further behavioral measures in detail during a comprehensive consultation. The operation is performed in my practice on an outpatient basis and preferably under local anesthesia—on request, also in conjunction with an anesthetist under general anesthesia or twilight sleep. Further postoperative check-ups are also carried out in my practice until the treatment is complete.
Lipedema surgery on the entire leg is usually performed in three sessions to minimize the strain on the circulatory system. In the first session, the increased and painful fatty tissue on the front and inside of the thighs and the knee region of the patient is suctioned off. In a second session, the outside and back of the thighs are treated, and finally, in a third operation, the lower legs are treated circularly. The order of the operations and the question of whether all three procedures are necessary depends, of course, on the individual findings and the patient's wishes. The procedure on the arms is usually performed in one session, and only one surgical session is required for the abdominal wall and/or flanks. A combination of several body regions should not be performed on an outpatient basis, as this would require the removal of excessive amounts of fat, placing an unnecessarily high and potentially dangerous strain on the circulatory system (fat loss is organ loss). Under inpatient conditions, slightly more fat can be removed on an individual basis.
Further information on lipedema
What is lipedema?
symptoms
Stadiums
Impressions from practice
