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This book is written as a guide for patients suffering from lipedema. Known as a common, painful fat distribution disorder characterised by a disproportional fat accumulation, lipedema represents an unmet medical need where scientific evidence on both pathophysiology and its treatment is still lacking. As the number of affected patients is increasing, besides striving to map the conundrum of clinical signs and relate these to their underlying mechanisms, developing standardised approaches addressing both fat mass reduction and body contouring are key issues able to warrant therapeutic success. In this book, our intention was to look at this complex disease from all its actual perspectives and provide a concise summary of the actual state of knowledge for all those affected. After looking into the most actual data on the aetiology, pathophysiology and course of the disease, the book then focuses on our complex treatment protocols wherecurrent conservative and surgical treatment options are systematically analyzed, considering their long-term chances of success as well as associated risks and side effects. We propose a three step treatment approach. 1st step initiates with weight control and addresses obesity, if present. 2nd step is an individual liposuction therapy plan to treat all lipedema areas, and more. 3rd step includes body contouring surgery, only in patients with massive skin laxity after liposuction and / or massive weight loss. Table of Contents Front Matter Pages i-xviii The Lipedema Zaher Jandali, Benedikt Merwart, Lucian Jiga Pages 1-68 The Lymphedema Corrado Campisi, Lucian Jiga, Zaher Jandali Pages 69-94 Treatment of Lipedema Zaher Jandali, Benedikt Merwart, Ralf Weise, Angel Pecorelli Capozzi, Lucian Jiga Pages 95-176 Body Contouring Surgery After Extensive Liposuction and Weight Loss Zaher Jandali, Benedikt Merwart, Lucian Jiga Pages 177-198 Additional Information about Treatment Zaher Jandali, Benedikt Merwart, Lucian Jiga Pages 199-204 Back Matter Pages 205-207

This chapter sets out the most promising modern directions of research in the field of magnetic resonance imaging. These include multinuclear studies aimed at the exploration of magnetic resonance (MR) image contrast induced by exogeneous (fluorine-19, hyperpolarized noble gases) and “built-in” (phosphorus-31, sodium-23) contrast agents for potential clinical benefits. The chapter covers electrodynamic elements of MR scanners that increase signal-to-noise ratio in low-field magnetic resonance imaging (MRI), hyperpolarization techniques that allow several orders of magnitude improved sensitivity in low-field MRI, as well as MRI methods to study dynamics of pharmaceuticals introduced into the body. Special attention is given to MRI methods based upon magnetization transfer aimed at the detection of myelination defects of axons in the brain and functional MRI characterizing brain dynamic response to external stimuli.

Background: Lipedema is a chronic and progressive adipose tissue disorder that causes significant morbidity and negatively influences mental health and quality of life, and increases the risk of depression, anxiety, and eating disorders. One construct of relevance to better understanding psychological disorders is emotion regulation (ER). Therefore, the aim of this study is to investigate the difficulties in ER among lipedema patients compared to healthy people without lipedema. Methods: This cross-sectional study assessed differences in ER and anxiety between two groups: 26 female patients with lipedema and 26 sex- and age-matched healthy controls. The Difficulties in Emotion Regulation Scale (DERS) assessed emotional regulation across six dimensions: Impulse control, goal-directed behavior, awareness, clarity, non-acceptance, and strategies. Anxiety was assessed by the Hamilton Anxiety Scale (HAM-A). ANOVA assessed differences in measures between lipedema and healthy control groups. Results: Lipedema patients presented with significantly more difficulties in ER and a higher level of anxiety than those without lipedema. Specifically, the lipedema group showed higher and significant differences in total DERS and anxiety scores and all DERS subscales scores compared to those without lipedema. Conclusions: Lipedema patients showed significant difficulties with ER, and were associated with anxiety symptoms, indicating that ER difficulties may play a role in developing emotional disorders, such as anxiety, for patients with lipedema. The health care provider should pay more attention to ER difficulties and psychological status among lipedema patients.

Lipedema patients suffer not only from visual stigma but also reduction in their quality of life through pain and performance loss in daily life. In clinical practice, it is still difficult to reliably diagnose the disease. This study aims to provide further insights into the characteristics of lipedema patients of all stages and provide a baseline prior to surgery for a surgical treatment evaluation by means of patient-reported outcome measures. Methods: Patients completed a lipedema-specific questionnaire containing 50 items, the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Patient Health Questionnaire 9 (PHQ-9). The data were analyzed using SPSS statistics 27. Patients who had already received liposuction were excluded. Results: Five hundred and eleven patients were included, of whom 337 completed the PHQ9 and 333 completed the WHOQOL-BREF questionnaires. The general characteristics of lipedema patients, especially the daily symptoms, are described. Previous observations, such as the frequent occurrence of hypothyroidism and the low rate of type 2 diabetes, were confirmed. Over 49% suffer from severe impairments in their jobs, whereby the disease shows a familial accumulation. The results of the WHOQOL-BREF and the PHQ-9 suggest a high level of mental stress. Discussion: As surgical intervention in lipedema patients is gaining traction, its effects should be well-documented. Therefore, a comprehensive baseline needs to be established prior to surgical treatment. The psychological components are just as important as the inclusion of daily impairments.

Abstract Background Lipedema is characterized as an abnormal deposition of fat in the buttocks and legs bilaterally that may be accompanied by swelling, pain, and tenderness. It is still often confused with more frequent conditions such as obesity and lymphedema. The estimated prevalence in Europe varies between 0.06% and 39%. Objectives To evaluate the prevalence of lipedema and identify health factors related to it in the Brazilian population. Methods Administration of a previously validated online screening questionnaire to a representative sample of the general population. The questionnaire was distributed and administered to anonymous volunteers representing the general Brazilian population using software designed for population analyses. Results 253 women answered the questionnaire, 12.3 ± 4% (Confidence Interval [CI] 95%) of whom presented symptoms compatible with a high probability of being diagnosed with lipedema. Furthermore, anxiety, depression, hypertension, and anemia were also correlated with a high probability of the diagnosis. Conclusions The estimated prevalence of lipedema in the population of Brazilian women is 12.3%. , Resumo Contexto O lipedema é caracterizado por deposição anormal de gordura em glúteos e pernas bilateralmente, que pode ser acompanhada por edema, dor e sensibilidade ao toque. Ainda é frequentemente confundido com condições mais frequentes, como obesidade e linfedema. A prevalência estimada na Europa varia entre 0,06% e 39%. Objetivos Avaliar a prevalência do lipedema na população brasileira e identificar fatores de saúde relacionados a essa doença. Métodos Foi aplicado um questionário de rastreamento on-line, previamente validado em amostra representativa da população geral. O questionário de rastreamento foi distribuído e aplicado em voluntárias anônimas representativas da população geral brasileira por software dedicado a análises populacionais. Resultados Um total de 253 mulheres respondeu ao questionário, e 12,3 ± 4% (intervalo de confiança de 95%) apresentaram sintomatologia compatível com alta probabilidade de diagnóstico de lipedema. Ansiedade, depressão, hipertensão e anemia foram correlacionadas com a alta probabilidade diagnóstica da doença. Conclusões A prevalência estimada do lipedema na população de mulheres brasileiras é de 12,3%.

Lipohyperplasia dolorosa (LiDo) - commonly referred to as lipedema - is a painful disproportionate but symmetrical fat distribution disorder of the extremities. An accompanying proportional symmetrical adipose tissue proliferation in the sense of coincident obesity can complicate the diagnosis and therapy of LiDo. Surprisingly, no valid anthropometric parameters are used to determine this obesity percentage. The often used parameter body mass index (BMI) lacks construct validity. An alternative is the waist-toheight ratio (WHtR).

Fluid compartments in the human body are divided between the intracellular and extracellular spaces. The extracellular space constitutes about one-third of total body water, which is further divided into intravascular plasma volume (25%) and the extravascular interstitial space (75%). The fluid balance between these compartments is maintained by hydrostatic pressures and oncotic pressures described by Starling. The other two factors that play an important role in fluid balance are vessel wall permeability and the lymphatic system. The lymphatic system collects fluid and filtered proteins from the interstitial space and returns that back to the vasculature. Any disturbance in this delicate homeostasis that results in net filtration out of the vascular space or impaired return of fluid by lymphatics leads to the accumulation of fluid in the interstitial space that is called edema. Edema can affect any part of the body and ranges from local swelling to full-blown anasarca, depending on the underlying pathology. A classic example of local swelling is an insect bite. An example of anasarca can be seen in nephrotic syndrome.[1] Edema, other than localized edema, does not become clinically apparent until the interstitial volume has increased by 2.5 to 3 liters because the tissues constituting the interstitium can easily accommodate several liters of fluid. Therefore, a patient's weight may increase by nearly 10% before pitting edema is evident.

Lipedema is a condition where there is abnormal, increased deposition of adipose tissue in the subcutaneous tissues. This distinct clinical entity was initially described by Allen and Hines, affecting the lower limbs. The longstanding and progressive nature of this disease condition often results in discomfort, pain, and disfiguration, which can affect an individual’s quality of life.There is a preponderance of women compared to men and most frequently affecting the age groups from puberty to mid-30s. Lipedema can affect both lower and upper limbs (in 30% of cases) with symmetrical bilateral distribution. One particular distinguishing feature is sparing of the hands and feet which is seen in lipedema as compared to lymphedema. Due to the misdiagnosis of lipedema as obesity or lymphedema, the true prevalence is significantly under-reported. Although the precise prevalence is evasive, it is estimated that 1 in 10 women can develop lipedema.As such by the time the diagnosis has been obtained, chronic irreversible changes such as pain, tightness, bruising tendency are already present, which result in significant challenges to effective treatment.

Introduction Lipoedema is a chronic feminine disease with disproportional painful fat deposition of the lower body half and occassional arm affection. Aim: The objective of the present study was to assess LA volumetric and functional properties by three-dimensional speckle-tracking...

The thigh lift procedure is one of the 5 most requested procedures associated with skin excess from massive weight loss (MWL). The procedure also has the highest reported complication rate amongst MWL procedures. The complication rate is most commonly associated with regional blood flow, higher bacterial involvement associated with proximity to the perineal region and poor-quality dermal thickness to support closure. Technical aspects of ideal management of the region include proper use of lipoplasty, skin excision, multi-layer tissue approximation and suspension. The following chapter reviews the regional anatomy, analysis, and the range of surgical techniques associated with this challenging procedure.

Objective Lipedema is an inflammatory subcutaneous adipose tissue disease that develops in women and may progress to lipolymphedema, a condition similar to lymphedema, in which lymphatic dysfunction results in irresolvable edema. Because it has been shown that dilated lymphatic vessels, impaired pumping, and dermal backflow are associated with presymptomatic, cancer-acquired lymphedema, this study sought to understand whether these abnormal lymphatic characteristics also characterize early stages of lipedema prior to lipolymphedema development. Methods In a pilot study of 20 individuals with Stage I or II lipedema who had not progressed to lipolymphedema, lymphatic vessel anatomy and function in upper and lower extremities were assessed by near-infrared fluorescence lymphatic imaging and compared with that of a control population of similar age and BMI. Results These studies showed that, although lower extremity lymphatic vessels were dilated and showed intravascular pooling, the propulsion rates significantly exceeded those of control individuals. Upper extremity lymphatics of individuals with lipedema were unremarkable. In contrast to individuals with lymphedema, individuals with Stage I and II lipedema did not exhibit dermal backflow. Conclusions These results suggest that, despite the confusion in the diagnoses between lymphedema and lipedema, their etiologies differ, with lipedema associated with lymphatic vessel dilation but not lymphatic dysfunction.