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Although liposuction of lipoedema is a well-established therapeutic option in plastic and reconstructive surgery, the commonly known operative protocols vary widely between clinics. A precise summary of all described protocols and a critical evaluation have not been published to date. This review aims to create a basic structure for future Standard Operative Protocols (SOPs) in the surgical treatment of lipoedema. For that purpose, 140 publications on therapeutic approaches concerning lipoedema have been reviewed and systematically categorized. The results indicate fundamental differences in treatment strategies as well as minor differences in organizational management.

Lipoedema is painful nodular subcutaneous adipose tissue (SAT) on legs and arms of women sparing the trunk. People with Dercum disease (DD) have painful SAT masses. Lipoedema and DD fat resists loss by diet and exercise. Treatments other than surgery are needed. Six women with lipoedema and one with DD underwent twelve 90-min sessions over 4 weeks. Body composition by dual X-ray absorptiometry scan, leg volume, weight, pain, bioimpedance, tissue size by caliper and ultrasound were analysed before and after SAT therapy by paired t-tests. There was a significant decrease from baseline to end of treatment in weight, 87.6 ± 21 to 86.1 ± 20.5 kg (P = 0.03), leg fat mass 17.8 ± 7.7 to 17.4 ± 7.6 kg (P = 0.008), total leg volume 12.9 ± 4 to 12 ± 3.5 L (P = 0.007), six of 20 calliper sites and tissue oedema. Pain scores did not change significantly. By ultrasound, six women had 22 hyperechoic masses in leg fat that resolved after treatment; five women developed seven new masses. Fascia improved by ultrasound after treatment. SAT therapy reduced amount and structure of fat in women with lipoedema and Dercum disease; studies are needed to compare SAT therapy to other therapies.

BACKGROUND: Tape measures continue to be used for the diagnosis and evaluation of lipoedema and lymphoedema in the clinical routine. Extremity volumes are calculated based on standardised circumferential measurements. Other volume measurements such as water displacement are not applied on a regular basis. This study aimed to evaluate a 3D scanner as an alternative and reproducible tool to objectively measure the volumes of the lower extremity. PATIENTS, MATERIALS AND METHOD: We used a commercially available 3D scanner, the Artec Eva(®), to perform 3D scans of the lower extremities on 20 subjects and calculated the volume using the appropriate software. In addition, limb volume was determined with standardised methods using the circumferential method (cone method and disc method) and the water displacement technique. The results and the time taken to perform the three measurement methods were documented and statistically evaluated. RESULTS: There were no significant deviations between the results from 3D volumetry and water displacement (p > 0.05). The cone method significantly overestimated the volume measured by water displacement and 3D volumetry. The disc method revealed no statistically significant differences, but clinically relevant differences with a high variance in the 95 % confidence interval. All methods demonstrated high positive correlations with each other. Water displacement was the most timeconsuming method. CONCLUSION: Our findings obtained from the examination of 40 lower extremities show that 3D scans and software-based volumetric calculations can achieve objective and reproducible measurements in a relatively short time. The deviation from the gold-standard method of water displacement is small. Compared with the cone and disc method, however, we observed clinically relevant deviations with a high variance. We therefore recommend the 3D scan procedure for the objective documentation of conservative and surgical treatments for lipoedema or lymphoedema and have incorporated it into our clinical routine.

Lipoedema is a rare painful disorder of the adipose tissue. It essentially affects females and is often misdiagnosed as lymphoedema or obesity. It is globally misdiagnosed or underdiagnosed, and the literature is lacking appropriate guidance to assist clinicians towards this diagnosis. However, the need to recognise this disorder as a unique entity has important implications to establish proper treatment and, therefore, its tremendous effect on patients. Early diagnosis and treatment can turn these patients' lives upside down. The aim of this review is to focus on the clinical guidance, differential diagnosis, and management strategies. In addition, other aspects of lipoedema, including epidemiology and pathogenesis, are also being discussed here. Lipoedema is distinct from obesity and distinct from lymphoedema, although it might progress to involve the venous and lymphatic system (venolipedema or lympholipedema or both). Late diagnosis can leave the patient debilitated. Management of lipoedema includes weight loss, control of oedema, complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. However; there are increasing reports on tumescent liposuction as the preferred surgical option with long-lasting results. The role of more randomised controlled studies to further explore the management of this clinical entity remains promising.

Lipoedema is a painful, chronic progressive disorder of adipose tissue, characterised by symmetrical swelling of the lower and/or upper limbs. Due to a lack of awareness, lipoedema is frequently misdiagnosed. However, accurate diagnosis and treatment are essential since they determine the patient's prognosis. There is no known causal therapy because the exact aetiology of the disease is not fully understood at this time. Familial aggregation is common, which suggests a genetic disorder. Since lipoedema is almost exclusively found in women and manifests around hormonal changes (puberty, pregnancy, menopause), oestrogen is believed to play a decisive role in its pathogenesis. This review aims to summarise the symptoms and clinical features of lipoedema, its differential diagnosis, treatment options, and current theories on the pathogenesis of lipoedema.

Lipoedema is a progressive disease, which predominantly affects women. It is characterised by circumferential growth, with increase in fat tissue of the extremities, and can lead to oedema. In contrast, the lymphoedema is defined by a specific lymphatic drainage disorder and can lead to fibrosis of the surrounding connective tissue. While lipoedema is diagnosed through clinical symptoms and diagnostic imaging can usually only be used to rule out comorbidities, lymphatic drainage disorder can be visualised using imaging methods. Ultrasound is a basis diagnostic tool to show retained interstitial fluid in lip- and lymphoedema. Lymphoscintigraphy is considered to be the gold standard to demonstrate a lymphatic drainage disorder, which can be combined with computed tomography. Indocyanine green(ICG) lymphography is a dynamic imaging tool, which is of increasing significance due to its possible intraoperative use. Magnetic resonance imaging (MRI) lymphography has the ability to visualise a lymphoedema and a lymphatic drainage disorder in three dimensions and is therefore considered to be a meaningful supplement. Therapy of lip- and lymphoedema should always be based on a combination of conservative and surgical strategies. While liposuction and other resection procedures can lead to symptom relief in lipedoema or advanced lymphoedema, newer reconstructive procedures such as lymph node transplantation or lymphovenous anastomoses are modern techniques to treat lymphoedema. A long lasting volume reduction can be achieved by creating new lymphatic pathways leading to improved quality of life and reduced symptoms.

Lipedema is a symmetrical disorder of the subcutaneous adipose tissue that affects almost exclusively women in postpubescent age. The trinity of disfiguring hyperplastic adipose tissue of the proximal extremities, increasing pain over time and bruising is characteristic. Lymphedema can occur in both sexes and is differentiated into primary and secondary subtypes. Symmetry is not a prerequisite for diagnosis. Characteristic for lymphedema is the disproportion between lymphatic fluid and the capacity of lymphatic vessels. The most distal body parts are always more severely affected than proximal parts. In the initial phases lymphedema is painless but in advanced stages tension pain can occur. The combination of both disorders has been described; however, lipedema is not responsible for subsequent lymphedema in contrast to central obesity, which significantly increases the risk of lymphedema. The differential diagnosis is of utmost importance for a meaningful management.

Dr Herbst and colleagues of University of Arizona explain fat tissue disorders, lipomas, and who should see a physician

Lipedema is a chronic, progressive adipose tissue disorder that may impact the quality of life of women who suffer from it. The main aim of this study was to asses the role of perceived symptom severity, physical and psychological functioning with the disease in predicting quality of life in patients with lipedema. We conducted an online study with 329 participants who responded to five questionnaires measuring quality of life (World Health Organization Quality of Life BREF), lipedema symptom severity, mobility (Lower Extremity Functional Scale), depression (Patients Health Questionnaire-9), and appearance-related distress (Derriford Appearance Scale 24). Multiple hierarchical regression analyses showed that appearance-related distress and depression explained significantly more variance in quality of life when added to the symptom severity and mobility. Lower quality of life was predicted by higher symptom severity, lower mobility, higher appearance-related distress and higher depression severity. Appearance-related distress and depression constitute important aspects of psychological functioning in women with lipedema. Considering their relationship with quality of life, their assessment should be included in lipedema treatment with appropriate interventions aimed at decreasing appearance-related distress, as well as preventing and addressing depression.

Um das Lipödem ranken sich zahlreiche Mythen! In dieser kleinen Übersichtsreihe über die Mythen des Lipödems werfen wir einen kritischen Blick auf populäre Statements zum Lipödem; Statements, die vor Jahrzehnten schon Eingang in wissenschaftliche Publikationen gefunden haben und seither unkritisch und stetig wiederholt werden; Statements, die dadurch inzwischen zum selbstverständlichen Wissensallgemeingut von Lipödempatientinnen und vor allem auch von Lipödem-Selbsthilfegruppen geworden sind. Im ersten Teil unserer Darstellung haben wir uns kritisch mit zwei populären Mythen über das Lipödem auseinandergesetzt. Hierbei haben wir festgestellt, dass sowohl für das Statement „Das Lipödem ist eine progrediente Erkrankung” als auch für das Statement „Ein Lipödem macht psychisch krank” keine wissenschaftliche Evidenz vorliegt. In einem zweiten Beitrag über die Mythen des Lipödems fokussierten wir uns auf den Ödemaspekt, auf das „Ödem im Lipödem” und die hieraus erfolgende therapeutische Konsequenz: die Manuelle Lymphdrainage. Wir konnten darlegen, dass für das populäre Statement „Das Lipödem ist in erster Linie ein „Ödem-Problem”, daher ist die Manuelle Lymphdrainage essenzielle und regelmäßig durchzuführende Standardtherapie” ebenfalls keine wissenschaftliche Evidenz existiert. Der regelmäßigen und dauerhaften Verordnung von Manuellen Lymphdrainagen mit dem Ziel der „Ödembeseitigung” fehlt daher jede Grundlage. In diesem dritten Teil der Auseinandersetzung über bekannte und oft zitierte” Lipödem-Statements” beschäftigen wir uns mit zwei weiteren Mythen: 4. „Das Lipödem macht dick” und 5. „Gewicht abnehmen hat keinen Effekt auf das Lipödem”. Für beide Statements gibt es weder ein sinnvolles physiologisches bzw. pathophysiologisches Konstrukt noch eine sich in der Literatur findende wissenschaftliche Evidenz. Darüber hinaus widersprechen beide Statements in hohem Maße unserer seit Jahren bestehenden täglichen klinischen Erfahrung mit Lipödempatientinnen. Tatsächlich scheint das Gegenteil richtig: Gewichtszunahme wirkt als entscheidender Trigger, um – bei entsprechend genetischer Disposition für ein Lipödem – dieses überhaupt erst zu entwickeln. Lipödem und Adipositas sind zwei unterschiedliche Erkrankungen, die jedoch in den meisten Fällen gemeinsam auftreten. Fast täglich sehen wir Lipödempatientinnen, die sich aufgrund ihrer morbiden Adipositas einer bariatrischen Operation unterzogen und dadurch effektiv – auch im Bereich der Extremitäten – Gewicht verloren haben. Patientinnen mit Lipödem erfahren durch diese meist nachhaltige Gewichtsabnahme regelhaft eine deutliche Besserung ihrer lipödemtypischen Schmerzen. Häufig sind die Patienten dann beschwerdefrei, sodass wir dann von einem Lipödem in Remission sprechen können. In einem vierten Beitrag werden wir uns mit dem Stellenwert der Liposuktion beim Lipödem beschäftigen, um dann in unserer letzten Darstellung ein therapeutisches Konzept vorzustellen, das nicht nur wissenschaftlich fundiert ist, sondern auch zu einer nachhaltigeren und umfassenderen Beschwerdebesserung unserer Lipödempatientinnen beitragen soll.

BACKGROUND: Implementation of guideline recommendations for the diagnosis and therapy of lipedema and lymphedema seems to be problematic in daily routine. Systematic data for Germany are missing. The aim of the study was data collection regarding diagnosis and therapy of lymphologic diseases in an outpatient setting. METHODS: Monocentric, prospective survey of patients from a lymphologic outpatient clinic using a standardized questionnaire focusing on diagnostics and therapy at the initial diagnosis. RESULTS: In all, 72 patients (83.3% women) with lymphedema (n = 26), lipedema (n = 14) or lipolymphedema (n = 32) were included; 44.4% had symptoms more than 5 years before the initial diagnosis. Main symptoms were swelling of the leg and foot (especially lymphedema) and feeling of heaviness (especially lipedema). In 75%, the initial diagnosis was made by a medical specialist. The basic diagnostics recommended by the guidelines-medical history (73.6%) and clinical examination (84.7%)-were done in most of the patients. After the initial diagnosis, 46% of the patients had decongestion therapy of different intensity and quality. A total of 58.3% of the patients were directly provided a prescription for a medical stocking. Only a few patients received instructions for breathing exercises (22.2%), self-performed lymphatic drainage (6.9%) or muscle exercises (8.3%). DISCUSSION: There are still deficits in the diagnosis and especially in the therapy of patients with lymphologic diseases in an outpatient setting. Further education and training are necessary for physicians, physiotherapists, medical supply businesses, and patients.

INTRODUCTION: Lipoedema is a chronic disorder in which excessive fat distribution occurs predominantly from the waist down, resulting in a disproportion between the lower extremities and upper torso. Lipoedema is often not recognized, while patients experience pain and easy bruising. As a long-term condition, lipoedema has a massive effect on patients' lives and mental health. The aim of this study is to explore patient characteristics, quality of life, physical complaints and comorbidities in patients with lipoedema. METHODS: A survey was conducted by email amongst lipoedema patients, consisting of informed consent and multiple questionnaires. The questionnaires included general patient characteristics, physical complaints, comorbidities, RAND-36 and EQ-5D-3L. Participants who responded to a message on the Dutch Lipoedema Association website were recruited. RESULTS: All lipoedema patients experience physical complaints, with pain (88.3 %) and easy bruising (85.9 %) as primary complaints. The diagnosis was mostly made by a dermatologist after visiting a mean of 2.8 doctors. Furthermore, mean time from onset until diagnosis was 18 years. Quality of life (59.3) was significantly lower than the Dutch female average (74.9; p < 0.001). Additionally, patients with comorbidities had significant lower quality of life (RAND 54.7, p < 0.001). CONCLUSIONS: Lipoedema patients often have severe complaints and experience lower quality of life regarding physical, emotional and social functioning. Additionally, comorbidities have a large impact on quality of life.

<p>In dieser kleinen Übersichtsreihe über die Mythen des Lipödems werfen wir einen kritischen Blick auf populäre Statements zum Lipödem; Statements, die vor Jahrzehnten schon Eingang in wissenschaftliche Publikationen gefunden haben und seither unkritisch und stetig wiederholt werden; Statements, die dadurch inzwischen zum selbstverständlichen Wissensallgemeingut von Lipödempatientinnen und vor allem auch von Lipödem-Selbsthilfegruppen geworden sind. Im ersten Teil unserer Darstellung haben wir uns kritisch mit zwei populären Mythen über das Lipödem auseinandergesetzt. Hierbei haben wir festgestellt, dass sowohl für das Statement „Das Lipödem ist eine progrediente Erkrankung” als auch für das Statement „Ein Lipödem macht psychisch krank” keine wissenschaftliche Evidenz vorliegt. In diesem zweiten Beitrag über die Mythen des Lipödems fokussieren wir uns auf den Ödemaspekt, auf das „Ödem im Lipödem” und die hieraus erfolgte therapeutische Konsequenz – die Manuelle Lymphdrainage. Daher: Mythos 3: Das Lipödem ist in erster Linie ein „Ödem-Problem”; daher ist die Manuelle Lymphdrainage essenzielle und regelmäßig durchzuführende Standardtherapie! Auch dieses Statement widerspricht in hohem Maße unserer seit Jahren bestehenden täglichen klinischen Erfahrung mit diesem speziellen Patientengut. Gleichzeitig haben wir im Rahmen unserer umfangreichen Literaturrecherche festgestellt, dass es keine Evidenz für diese Sichtweise gibt. Tatsächlich gibt es keinerlei Hinweis darauf, dass beim Lipödem ein relevantes Ödem – Ödem im Sinne von Flüssigkeit – vorliegt. Ebenso fehlt jegliche wissenschaftliche Evidenz dafür, dass dieses kaum (bzw. meist nicht) vorhandene Ödem für die Beschwerden der Lipödempatientinnen verantwortlich ist. Der regelmäßigen und dauerhaften Verordnung von Manuellen Lymphdrainagen mit dem Ziel der „Ödembeseitigung” fehlt daher jede Grundlage. Das Lipödem ist weit mehr als nur dickere, schmerzhafte Beine! Darum müssen wir manche der alten therapeutischen Pfade verlassen, Pfade, für die es keine wissenschaftliche Evidenz gibt, Pfade, die darüber hinaus auch unserer klinischen Erfahrung widersprechen. Eine umfassende Therapie des Lipödems sollte daher auch all jene Aspekte berücksichtigen, die nicht so offensichtlich sind wie das Augenscheinliche und das vordergründig Geäußerte. Lipödem-Therapie muss neben der Behandlung der somatischen Beschwerden auch auf die bereits in unserem ersten Beitrag beschriebenen psychosozialen und gesellschaftlichen Aspekte dieses komplexen Krankheitsbildes fokussieren. Die Vorstellung eines umfassenden Therapiekonzeptes für Lipödempatientinnen wird Inhalt im letzten Teil unserer kleinen Lipödemreihe sein. Neue Wege entstehen, in dem wir sie gehen – dies gilt auch für die Therapie des Lipödems!</p>

Lipedema is a little-known alteration or disorder in the distribution of body fat, which affects almost exclusively women and primarily involves the lower extremities.   Epidemiological data are currently scarce and not helpful to determine the exact incidence of lipedema in the general population; its etiology and physiopathology are not clear enough; its diagnosis is basically clinical, since there are no specific diagnostic tests or enough scientific evidence to support it. However, its clinical manifestations imply deterioration in patients’ quality of life due to the physical, psychological and social impact it entails.   Since about 70% of cases are associated with pain in extremities, these are usually referred to phlebology and lymphology specialists. Treatments to control the edema are not usually successful in reducing the volume of the extremities.   This is in addition to determinants of fashion from the 21st century that demand most women to have slender bodies, while the reality is that overweight and obesity are alarmingly increasing. About 80% of obese patients do not admit to have excess weight, complicating its early diagnosis and prevention of its evolution and, consequently, delaying treatment in patients with this disease.   Due to the clinical presentation and symptoms associated with lipedema, patients are often misdiagnosed with lymphedema, obesity, lipodystrophies or chronic venous insufficiency, and therefore they are not correctly and effectively treated; in the best case scenario, they are administered symptomatic treatments.   In the absence of unified criteria for lipedema, and given the national and international controversy surrounding the term, the Spanish Association of Lymphedema and Lipedema (AEL) has put together a multidisciplinary working group of health professionals from different fields involved in the diagnosis and treatment of this disorder to draft this Consensus Document.   The aim was to answer multiple questions using the documentary evidence and clinical experience available to date.   Is the currently described physiopathology enough to explain lipedema?   Is it a progressive alteration? Does it always get worse?   When you have lipedema, is the progressive increase in body fat percentage normal?   If the main symptom is not the edema: Is manual lymphatic drainage an essential tool for the treatment?   Is it correct to prescribe compression garments in all cases?   What are the most effective treatments?   This working group included the participation of: The Spanish Association of Lymphedema and Lipedema (AEL), the Spanish Chapter of Phlebology and Lymphology (CEFyL) from the Spanish Society of Angiology and Vascular Surgery (SEACV), the Spanish Society of Aesthetic Medicine (SEME), the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery (SECPRE), the Spanish Society of Dietetics and Food Science (SEDCA), the Complutense University of Madrid, and doctors specialized in Physical Medicine and Rehabilitation from the Spanish Society of Rehabilitation and Physical Medicine (SERMEF).   This document includes several chapters on the definition and physiopathology of lipedema, its diagnostic methods, differential diagnosis, classification and treatment using physical, pharmacological and surgical means. It is hoped that it can help people with lipedema and health professionals caring for them.   However, there is still a lot to learn about the etiopathogenesis, diagnosis and treatment of lipedema, so research must continue and be completed with epidemiological studies of its incidence and prevalence, always using an interdisciplinary approach.

Lipoedema is a disorder of adipose tissue that is characterized by abnormal subcutaneous fat deposition, leading to swelling and enlargement of the lower limbs as well as the trunk. This entity is often misdiagnosed as lymphoedema or obesity and, therefore, may be overlooked and missed in patients scheduled for bariatric surgery. Patients with lipoedema who undergo bariatric surgery may have to continue to have extensive lower extremity and trunk adiposity despite adequate weight loss. In this report, we present two patients who had extensive trunk and lower extremity adiposity, one of them before and the other after the bariatric surgery.

Background Lipedema is a chronic disorder presenting in women during puberty or other times of hormonal change such as childbirth or menopause, characterized by symmetric enlargement of nodular, painful subcutaneous adipose tissue (fat) in the limbs, sparing the hands, feet and trunk. Healthcare providers underdiagnose or misdiagnose lipedema as obesity or lymphedema. Materials and methods The benefits (friend) and negative aspects (foe) of lipedema were collected from published literature, discussions with women with lipedema, and institutional review board approved evaluation of medical charts of 46 women with lipedema. Results Lipedema is a foe because lifestyle change does not reduce lipedema fat, the fat is painful, can become obese, causes gait and joint abnormalities, fatigue, lymphedema and psychosocial distress. Hypermobility associated with lipedema can exacerbate joint disease and aortic disease. In contrast, lipedema fat can be a friend as it is associated with relative reductions in obesity-related metabolic dysfunction. In new data collected, lipedema was associated with a low risk of diabetes (2%), dyslipidemia (11.7%) and hypertension (13%) despite an obese average body mass index (BMI) of 35.3 ± 1.7 kg/m2. Conclusion Lipedema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema. More controlled studies are needed to study the mechanisms and treatments for lipedema.

Background Lipedema is a chronic disorder presenting in women during puberty or other times of hormonal change such as childbirth or menopause, characterized by symmetric enlargement of nodular, painful subcutaneous adipose tissue (fat) in the limbs, sparing the hands, feet and trunk. Healthcare providers underdiagnose or misdiagnose lipedema as obesity or lymphedema. Materials and methods The benefits (friend) and negative aspects (foe) of lipedema were collected from published literature, discussions with women with lipedema, and institutional review board approved evaluation of medical charts of 46 women with lipedema. Results Lipedema is a foe because lifestyle change does not reduce lipedema fat, the fat is painful, can become obese, causes gait and joint abnormalities, fatigue, lymphedema and psychosocial distress. Hypermobility associated with lipedema can exacerbate joint disease and aortic disease. In contrast, lipedema fat can be a friend as it is associated with relative reductions in obesity-related metabolic dysfunction. In new data collected, lipedema was associated with a low risk of diabetes (2%), dyslipidemia (11.7%) and hypertension (13%) despite an obese average body mass index (BMI) of 35.3 ± 1.7 kg/m2. Conclusion Lipedema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema. More controlled studies are needed to study the mechanisms and treatments for lipedema.