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Lipoedema is a chronic and painful fat disorder that occurs almost exclusively in women. It mainly affects the legs and sometimes the arms. The condition not only causes physical complaints but also has a major impact on daily functioning and quality of life. Despite this, lipoedema is still poorly understood and appropriate care is often lacking. In this dissertation, we reviewed the existing literature on the functioning of people with lipoedema. In addition, we explored how they experience living with the condition, the challenges they face in managing it, and how healthcare professionals can provide better support. The studies show that lipoedema is more than meets the eye. Earlier research mainly focused on the physical aspects, while psychosocial issues such as shame, stigmatisation, and reduced social participation are equally important. Participants emphasised the need for personal guidance, access to specialised care, and reliable, evidence-based information. To address these needs, we developed a new self-management intervention: SELF-MANAGING your lipoedema. This programme helps people cope more effectively with their condition, take control of daily life, and set achievable goals together with their healthcare professionals. This dissertation highlights that good care for people with lipoedema must go beyond symptom management. A holistic approach is needed, alongside better knowledge and training for healthcare professionals, and policies that promote collaboration across disciplines. Such improvements can truly enhance the quality of life of those living with lipoedema.

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

"Cardiovascular risk is determined by many factors involving genetics, environmental factors and lifestyle. Thus, the determination of the global cardiovascular risk has to consider several factors. The most important ones are age, blood pressure, cholesterol and its subfractions - in particular, LDL cholesterol and non-HDL cholesterol - and diabetes. The ScoreCard of the European Society of Cardiology considers these factors to determine the 10-year cardiovascular risk to have a major cardiovascular event, such as myocardial infarction, stroke and death. Other important risk factors, such as noise, pollution, family history and nutrition are more complex to be included in the global cardiovascular risk but should be clinically considered"--

Lipedema is a disorder characterized by large amount of subcutaneous fat in the upper and lower legs due to both hyperplasia and hypertrophy. It occurs almost exclusively in females, although a few cases in men have been reported.(,) The condition is relatively rare and often seen in patients with a family history of the disease.(,) Lipedema does not yet have a registered diagnosis in the International Classification of Diseases (ICD-10) of the World Health Organization (WHO), making it difficult to establish its prevalence. However, lipedema is believed to affect nearly 11% of adult women, with noted significant differences in prevalence worldwide.(,)(,) The literature search for this report did not find epidemiological data for lipedema in Canada. The cause of lipedema is unknown, and it is likely that the condition is frequently misdiagnosed or wrongly diagnosed as lifestyle-induced obesity or lymphedema (i.e., localized fluid retention and tissue swelling).(,) However, although lipedema and obesity can co-occur, unlike obesity, lipedema usually targets the legs and thighs, without affecting the feet or hands, and the adipose tissue in lipedema is painful.(,)(,)(–) The lymphatic system remains unimpaired in the initial stages and can keep up with the increased amount of interstitial fluid.(,) However, patients with lipedema may develop secondary lymphedema (lipolymphoedema) if the fatty deposits compromise the lymphatic system. Lipedema targets both legs (and sometimes, also both hands) to the same extent and has a bilateral, nearly symmetrical presentation.(–) The excessive fat deposits are typically unresponsive to traditional weight loss interventions such as physical activity or dietary measures.(,)(,) Symptoms of the condition include pain in the lower extremities, particularly with pressure, loss of strength, easy bruising, and deterioration in daily activity levels that can greatly impact the health and quality of life of the individual with lipedema.(,)(,) Untreated lipedema may result in secondary problems including osteoarthritis, reduced mobility, psychological impairment, and lowered self-esteem. Over time, the weight of the excessive fat build-up can cause the knees to knock inward or droop to the side of the leg, and impair the inability to walk. As mentioned, in the later stages, secondary lymphedema can occur due to imbalance in the amount of fluid produced and drained by the lymphatic system.(–)(,)(,)(,) Lipedema poses a significant psychosocial burden for most patients, and associated effects often limit capacity for exercise. In severe cases, lipedema may lead to absence from work or occupational disability. There is no known curative therapy for lipedema. The primarily focus of treatment is to reduce its related lower extremity symptoms, disability, and functional limitations to improve patients’ quality of life, as well as preventing disease progression.(–)(,)(,) Treatment is divided into conservative therapy and surgical interventions. The conservative therapy includes promotion of individually adjusted healthy lifestyle, combined decongestive therapy (CDT), and other supportive measures, such as psychosocial therapy and orthopedic counseling. Conservative therapy can alleviate some lipedema symptoms such as heaviness, pain, and secondary swelling. However, these benefits are short-lived, usually requiring repeat treatment within days. Liposuction is the main surgical interventions for lipedema. Commonly used liposuction methods for lipedema are tumescent anesthesia (TA) liposuction, and water assisted liposuction (WAL). In TA liposuction, tumescent is infused in the subcutaneous tissues to cause the fat cells to swell and vessels to constrict; then blunt micro-cannulas are used to suction the fat.(,)(,) Water assisted liposuction uses a pressure spray of tumescent fluid to dislodge the fat from the connective tissue, rather than utilizing a cannula. Unlike traditional liposuction, both TA and WAL rely on the local anesthetics in the tumescent fluid and do not require general anesthesia. The objective of this report is to summarize the evidence regarding the clinical effectiveness of liposuction for the treatment of lipedema and the recommendations of evidence-based clinical guidelines regarding its use for this condition.

This condition, which has the full name of 'erythrocyanosis frigida crurum puella rum' (cold reddish blueness of the legs of girls), is extremely common. It is not always recognized, being misdiagnosed as lymphoedema, vasomotor disease, arterial insufficiency, and other things. The skin of the legs is cold to the touch and exhibits patches of bluish discoloration. There may be chilblains and small superficial ulcerated areas. There is often an abnormally large amount of fat particularly above the ankle and around the tendo Achillis. For this reason it is sometimes called ' lipoedema'. The affected patches are often hypersensitive to light touch and may irritate with changes of temperature. Deeper palpation may reveal tenderness and nodularity of the underlying fat. The condition is usually symmetrical or alsmost so. The feet often remain normal. At typical case is illustrated in Figs. 14.22 and 14.23