Lipoedema (US spelling Lipedema) is a fat disorder characterized by symmetrical enlargement of the legs, buttocks and sometimes arms, as a result of increased fat deposition.
Lipoedema is not caused by poor diet and sedentary lifestyle and indeed, the excess fat is largely diet and exercise resistant. Nevertheless, many sufferers are incorrectly advised to lose weight and aim for weight loss that is completely unachievable. In an effort to lose weight from their legs, some patients inappropriately undergo weight loss (bariatric) surgery and are left bitterly disappointed when the fat remains.
Lipoedema is not a new disease and was first described in the United Sates in 1940.
It is poorly recognised by the medical profession, allied health professionals, dieticians and the general public. As such, patients are left frustrated and subject to criticism from their doctors, family, friends and strangers.
Painful Fat Syndrome
To add to the confusion, lipoedema is also known by other names, these include;
Adiposalgia, Adiopoalgesia, Lipalgia, Lipohyperplasia dolorosa, Lipohypertrophy, Dolorosa, Lipomatosis dolorosa of the legs, Painful column legs, Painful fat syndrome, Riding breeches syndrome and Stovepipe legs.
Lipoedema is considered to be a disease within the spectrum of rare adipose disorders, which also includes familial multiple lipomatosis, Madelung’s disease and Dercum’s disease. However, it is not clear if each disease is truly unique or if they represent different manifestations of the same genetic disorder of fat cells.
Lipoedema almost exclusively affects females and is estimated to affect up to 11% of women. It is a progressive condition with the rate of progression varying between patients. Although the exact cause of lipoedema is unknown, it is recognised that hormones, genetics and diet have an influence on the disease.
For some lipoedema sufferers, the genetic component is clearly evident as there are multiple other women in their family tree with enlarged, painful legs.
Signs & Symptoms of Lipoedema
The symptoms of lipoedema vary between patients and are also related on the severity of the disease (known as stage). Typical symptoms include;
- Pain – originating from the excess fat. Some patients report the fat feels ‘under pressure’.
- Pressure hypersensitivity – light touch of the skin causes intense pain. This may prevent some patients from wearing compression garments.
- Tendency to bruise easily – possibly related to capillary fragility
- Cold skin – the skin in the affected areas feels cold to touch
- Joint hypermobility – patients may report previous dislocation of their patella (knee cap).
Typical signs include;
- Symmetrical enlargement of the legs with minimal involvement of the feet. The circumferential fat deposition extends from the buttocks down to the ankles (depending on the Type). The upper half of the body remains unaffected unless there is concurrent obesity.
- Ankle ‘pantaloon’ deformity – the excess fat on the legs stops abruptly at the ankle. This may be also present at the wrist if the arms are involved.
- Involvement of the arms
- Body disproportion – the lower half of the body is disproportionately larger than the upper half.
- Varicose veins & ‘spider’ veins
- Nodular consistency of the fat – as the disease progresses the fat may become nodular and feel ‘lumpy’. The skin subsequently becomes uneven and gives rise to the ‘mattress’ pattern.
Causes of Lipoedema
The cause of lipoedema is unknown but three factors are believed to be involved, notably female hormones, genetics and certain foodstuffs.
Female hormones are thought to play a significant role because lipoedema almost exclusively affects females and most commonly arises at times of hormonal change, such as puberty, start of oral contraceptive use, pregnancy and menopause.
Evidence for genetic influence comes from the fact that many sufferers report a positive family history of large, painful legs.
For some lipoedema patients, certain foods can exacerbate symptoms.
Diagnosis of Lipoedema
The difficulty with diagnosing lipoedema is that there are no definitive tests. The diagnosis is made on the history and examination findings and as such, it is essential the patient is assessed by a doctor who has expertise in lipoedema.
Certain investigations may be performed but their main purpose is to exclude other diagnoses or to help determine the best course of action for a particular patient.
Blood tests – although female hormones are thought to contribute to the development of lipoedema, hormone blood tests are unlikely to detect anything abnormal.
- Lymphoscintigraphy – a specialist test that images the lymphatic system may be performed to exclude lymphoedema.
- Ultrasound – ultrasound measurement of dermal thickness may help to differentiate lymphoedema and lipoedema
- Venous duplex scan – may be performed if the patient is suspected of chronic venous insufficiency.
The European Lymphology Society (ELS) has identified 5 types of lipoedema, based the distribution of abnormal fat.
Type 1. Buttock & hips (saddle bag phenomenon)
Type I lipoedema may be confused with ‘female-pattern gluteofemoral obesity’ or ‘steatopygia’ which are different conditions to lipoedema.
Patients who have female-pattern gluteofemoral obesity have a recognised natural history and report fat loss during lactation. Steatopygia is characterised by excessive fat on the buttocks and thighs and is particularly prevalent in women of African origin.
Type II. Buttocks to knees
Type III. Buttocks to ankles
Type IV. Arms & legs affected
Type V. Lipo-lymphoedema
Three stages of lipoedema have been described, based on changes in the texture of the limb and development of skin folds.
Stage 1. Has a normal skin surface. The subcutaneous fatty tissue has a soft consistency but multiple small nodules can be palpated (“orange-peel skin”). This stage can last for several years.
Stage 2. The skin surface becomes uneven and harder due to the increasing nodular structure (big nodules) of the subcutaneous fatty tissue (“mattress skin”)
Stage 3. Lobular deformation due to increased fatty tissue; palpable nodules varying in size from a walnut up to a fist; large, deforming folds of fat. Skin bulges are most common around the medial knee.
Liposuction for lipoedema
Liposuction (also known as suction lipectomy) is now recognised as a definitive treatment for lipoedema. Liposuction serves to permanently removes fat cells, thereby reducing the volume of the treated limb or area.
Of the different liposuction techniques, Mr Vasu Karri particularly favours water-assisted liposuction (WAL) which he considers state-of-the-art for lipoedema liposuction. He is the only Plastic Surgeon in the United Kingdom that uses WAL to treat lipoedema and has successfully treated hundreds of patients.
Water-assisted liposuction uses a high-pressure jet of water to separate fat from the surrounding tissue, which is then suctioned out through the cannula. Research has shown this liposuction technique causes little damage to the lymphatic system. It is therefore considered to be ‘lymph-sparing’.
For some lipoedema patients, the arms can be more problematic than the legs. In addition to the heavy weight, patients have great difficulty wearing tops with sleeves and receive unwanted attention from strangers because of their ‘bingo wings’.
As a result, some lipoedema women choose to have lipoedema liposuction of their arms, particularly the posterior arm. The surgery may be combined with a simultaneous arm lift if the posterior arm skin is thin and has poor elasticity.
Recovery following posterior arm liposuction is much quicker than that following leg liposuction and the results can be dramatic.
Real Life Examples from our Clients
Lipoedema Liposuction – 15 minutes after treatment – Kinvara Hospital – Mr Karri
Lower Limb Lipoedema Liposuction – Stage 3 Lipoedema
Consultants who do this treatment
Mr Vasu Karri is a Consultant Plastic Surgeon in full time private practice in East Yorkshire. He is on the General Medical Council (GMC) specialist register for plastic surgery, certified by the Royal College of Surgeons of England in plastic surgery and a member of British Association of Plastic Reconstructive & Aesthetic Surgeons (BAPRAS).
Listen to interviews by Mr Vasu Karri on the subject Lipoedema
Interview with Mr Vasu Karri
Why should you choose Kinvara Private Hospital for lymphoedema surgery?
All lymphoedema surgery at Kinvara Private Hospital is performed by Mr Vasu Karri, a highly skilled and experienced lymphoedema surgeon. Mr Karri was one of the first UK surgeons to have performed vascularised lymph node transplant (VLNT) for the treatment of lymphoedema.
There are very few other private hospitals to offer the range of lymphoedema surgery procedures available at Kinvara.