Home » Rehab Science Blog » Lipedema » Treatment of Lipedema

Patient Guide: Treatment of Lipedema and Lipo-Lymphedema

We are still waiting for research to give us a more complete picture of what causes lipedema, and so not surprisingly, we are also still waiting for a cure. But in the meantime lipedema treatment options exist that can help you control your symptoms and prevent progression to lipo-lymphedema, an advanced stage of the disease that includes the symptoms of lymphedema.

The goal of lipedema and lipo-lymphedema treatment is two-fold:

  1. To improve patient quality of life by managing the symptoms of lipedema.
  2. To prevent worsening of the condition, and the development of an advanced stage known as lipo-lymphedema.

How to treat lipedema

Background

Your treatment plan depends on your stage of lipedema, how severely you experience your symptoms, your goals, and of course should incorporate current clinical treatment guidelines for lipedema.

Most importantly, you and your health care team need to be on the same page so that you can set realistic treatment goals and avoid discouragement.

In order to set appropriate goals and achieve them you’ll need a clear understanding of:

  1. What lipedema is, and your particular symptoms and stage of progression. Our previous post on self-diagnosing lipedema and lipo-lymphedema describes in detail the symptoms of lipedema and how cumulative physiological changes lead to a worsening of symptoms. Our aim in that post was to create a comprehensive and reliable source of information to help you understand what lipedema is, which symptoms you have (and don’t have) and what stage of progression you are at.
  2. Available treatment options. We’ll discuss these bellow.
  3. The intended goal of each treatment option. We’ll discuss these below.

Available Lipedema treatment options and how they help

Lipedema treatments fall into two general categories: ‘conservative’ treatments that are typically safe and easy to implement, and ‘invasive’ treatments (surgery). These treatment options and how they can help are described in detail below, but for a quick overview see Figure 1.

I) CONSERVATIVE TREATMENT OF LIPEDEMA

Conservative treatments can not cure lipedema, nor can they eliminate your symptoms. Instead, conservative treatments can help you manage your symptoms, and reduce the likelihood of further disease progression.

Each of the treatment options listed below act to help decrease the size of the affected limb, either by reducing the volume of fat (adipose tissue) or fluid. Lipedema is not just a disease of abnormal fat accumulation; it is also a disease of abnormal fluid accumulation.

Lipedema is believed to advance, and its symptoms worsen, in part through a vicious cycle whereby fat deposition and swelling increases the amount of new fat deposition and swelling.  Fluid accumulation can eventually overburden the lymphatic system and culminate in lipo-lymphedema, a condition that combines the symptoms of lipedema and lymphedema. For a more in-depth description, please see our post on self-diagnosing lipedema.

Managing limb volume by reducing fat and fluid accumulation can thereby help reduce symptoms AND prevent disease progression.

Conservative treatments for managing limb volume and how they help:

1. Exercise Therapy
  • Regular exercise is beneficial and is widely recommended.
  • Exercise can work two-fold: first it can increase fluid drainage from the limb by increasing the activity of the venous system, and second it can help reduce the risk of obesity. Swelling and obesity both act to exacerbate lipedema and promote disease progression.
  • Exercise activities should be chosen thoughtfully. Exercise should be (1) enjoyable by the patient so that it can be performed regularly and become routine, (2) do not cause pain or risk of injury. Regular purposeful walking, swimming and cycling can be great options.
2. Weight Loss
  • Weight loss will NOT reduce abnormal fat deposits caused by lipedema. Patients with lipedema can lose weight until they have very little upper body fat, even to the point of being “skinny”, but this has no impact on their abnormal fat deposits caused by lipedema. Lipedema is not the same as obesity, and cannot be cured through weight loss.
  • Weight loss can help PREVENT the worsening of lipedema, in overweight individuals. For a patient with otherwise normal body fat composition, weight loss will have no effect on their lipedema, as described above. However, patients should strive to maintain an appropriate body weight, and lose weight if they are overweight or obese as obesity will exacerbate the symptoms of lipedema and lymphedema. In fact, extreme obesity can even be a cause of lymphedema on it’s own. This is because excess fat accumulation promotes additional fluid build-up (and in some cases also physically deform lymphatic vessels) which contributes to overburdening the lymphatic system and resulting swelling and lipedema symptom progression.
3. Compression garments / compression bandaging
  • Specialized compression garments or bandaging can help reduce the accumulation of fluid that occurs with lipedema, and prevent further accumulation. These garments are the same as those used for lymphedema management, and differ from regular tensor bandages and athletic compression garments. The more swelling you have, the greater the benefit of compression. Since compression therapy is a central tool of lymphedema management, it is particularly effective in treating cases of lipo-lymphedema where normal lymphatic function is impaired and or insufficient to eliminate excess lymph fluid.
  • Compression CAN help reduce feelings of tightness and pain by reducing swelling.
  • Compression CAN help improve mobility. Garments can to some extent help reposition and redistribute the excess tissue in many cases, which can help improve mobility while it is worn (ref 1). Increasing mobility has obvious quality of life and health benefits. In advanced cases of lipo-lymphedema, where swelling can directly contribute to mobility impairment, compression can in turn directly improve mobility.
  • Compression CAN help prevent disease progression. Since compression can help maintain smaller limb volume, and increased limb volume exacerbates the condition, it can be helpful in preventing lipedema progression.
  • Compression CANNOT reduce the amount of adipose tissue (fat) that is already present.
  • Compression garments are widely recommended. Since compression garments are beneficial while also being relatively easy to implement, and safe, it is a widely recommended treatment tool for managing lipedema.
  • Compression therapy is most effective when delivered in combination with Manual Lymphatic Drainage, a specialized form of massage.
4. Manual Lymphatic Drainage (MLD)
  • MLD CAN help reduce swelling. Like compression garments and bandaging, MLD works most effectively on patients with greater levels of swelling. It therefore has little utility for reducing swelling in early cases of lipedema, where excess fluid accumulation is not yet observed and normal lymphatic function is still maintained. MLD is particularly effective in treating cases of lipo-lymphedema, as MLD is a central tool of lymphedema management. It is delivered through specialized hands-on massage by a certified practitioner that acts to draw the accumulated fluid out of the limbthrough lymphatic channels to return it back into circulation. MLD should be delivered in conjunction with compression therapy to help maximize its effect and minimize patient expense.
  • MLD CAN help reduce pain and bruising. MLD, especially when delivered with appropriate compression garments / bandaging has been observed to significantly reduce both the pain (ref 2) and susceptibility to bruising (ref 3) that is typical of lipedema. Even in early cases of lipedema where MLD is not needed to reduce swelling, MLD still appears to relieve pain and promote well being (ref 1 and 4). The authors of one study commented: “There is hardly a therapy prescribed by physicians that promotes well-being more and is therefore demanded vehemently by patients.” (ref 4).
  • MLD CAN help improve mobility in advanced cases of lipo-lymphedema, where swelling can directly contribute to mobility impairment.
  • MLD CAN help prevent disease progression. At more advanced stages of lipedema, where noticeable swelling is present, MLD can help maintain smaller limb volume. Since increased limb volume can lead to a worsening of the condition of lipedema, MLD can be helpful in preventing its progression.
  • MLD CANNOT reduce the amount of adipose tissue (fat) that is already present.
  • MLD works hand-in-hand with compression, by reducing limb volume before compression garment fitting, in order to maximize the benefits of the compression. Compression garments are particularly effective at preventing additional fluid accumulation, but are also effective at reducing existing swelling, depending on the level of compression used. Compression garments are composed of “short-stretch” materials that have a range over which they stretch before becoming inelastic, and they are sized for each person to suit their particular limb’s needs.  It can be detrimental to size them too tightly, and not effective if they are sized too loosely. Patients are therefore measured for their compression garment(s) ideally after a fluid reduction phase of treatment, involving Manual Lymphatic Drainage massage.
5. Intermittent Pneumatic Compression (IPC)
  • IPC is a device that reduces limb swelling. It is primarily prescribed for the treatment of venous insufficiency, and sometimes lymphedema. It is basically a sleeve with air chambers and a pump system that applies sequential air pressure to squeeze the limb and push fluid out of it.
  • It may reduce help swelling for some lipedema patients where noticeable swelling is present. It can be used by some patients as a supplement to compression, MLD and exercise therapy, if these are deemed insufficient.
  • Use of this device should be assessed on a case-by-case basis, as it will not be effective for some patients, or may be too painful for patients who are particularly pain sensitive.
  • There is a risk of complications for some patients. Incorrect use could in some cases lead to swelling in the genitals and fluid cysts (ref5).

II) INVASIVE TREATMENT OF LIPEDEMA

For patients who show no improvement in symptoms with conservative treatment, or who continue to see disease progression, they may consider surgery as an option.

1. Liposuction and Lipectomy
  • Surgery, and in particular liposuction, may be a treatment option for some to reduce the abnormal fat deposits caused by lipedema. It is usually performed in multiple sessions. Following liposuction women will typically benefit from compression therapy and MLD, and should strive to maintain an active lifestyle and manage their weight to help delay the return of the condition. Reports suggest that for as many as 65% of patients, liposuction can decrease the need for ongoing conservative management (ref 6).
  • Surgery appears to also reduce the tendency to bruise, and the symptoms of pain with pressure in lipedema patients (ref 7).
  • Surgery can improve patient mobility by removing fat deposits that are physically impairing mobility.
  • Surgery is NOT a cure, and will not prevent further fat deposition. Many patients will revert to their original condition within a few years. Conservative measures described above should be followed to help delay its return.
  • Surgery cannot alleviate the lymphedema component, if present. Lymphedema resulting from lymphatic damage that was present before the operation, will remain afterwards.
  • Surgery can have complications, and you may not qualify to have it covered by health insurance. You should discuss this option with your family physician, including the potential complications, and your insurance eligibility. It is important to note that complications exist, and this may include the possibility of damaging the lymphatic system and developing secondary lymphedema (ref 8).

III) SUMMARY OF LIPEDEMA TREATMENT OPTIONS

Lipedema treatments options and how they work

Fig1: Overview of lipedema treatment options and how they act to reduce symptoms.

 

How NOT to treat lipedema

Diuretics and laxatives are entirely ineffective against lipedema, as is weight loss in patients with otherwise normal body fat composition.

Sharing is caring! If you have any questions or comments, please submit them below :)

References:

  1. Reich-Schupke S., Altmeyer P., Stucker M. Thick legs – not always lipedema. J Dtsch Dermatol Ges. 2013 Mar;11(3):225-33.
  2. Szolnoky G., Varga E., Varga M., et al. Lymphedema treatment decreases pain intensity in lipdema. Lymphology. 2011 Dec;44(4):178–182.
  3. Szolnoky G., Nagy N., Kovacs R.K., et al. Complex decongestive physiotherapy decreases capillary fragility in lipedema. Lymphology. 2008 Dec;41(4):161–66.
  4. Meier-Vollrath I., Schneider W., Schmeller W. Lipödem: Verbesserte Lebensqualität durch Therapiekombination. Dtsch Ärztebl. 2005;102: A1061–67.
  5. Wagner S. Lymphedema and lipedema – an overview of conservative treatment. Vasa. 2011 Jul;40(4):271–79.
  6. Warren Peled A., Kappos E.A. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016 Aug 11:8:389-95.
  7. Schmeller W., Hueppe M., Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012 Jan;166(1):166: 161–68.
  8. Suga H., Araki J., Aoi N., et al. Adipose tissue remodeling in lipedema: adipocyte death and concurrent regen­eration. J Cutan Pathol. 2009;36(12):1293–1298.

4 Comments

  1. Michele Whitworth Michele Whitworth says:

    Can u please tell me where i can get diagnosed in ont..(barrie area possible)??

  2. Lindsay Davey Lindsay Davey says:

    Hello Michele,
    I am happy to help. There are about 5 or 6 CDT therapists listed on the Toronto Lymphocare Website for the city of Barrie (under their Find A Therapist link). Also, you could search by city on the Vodder International website, which also lists certified CDT therapists. I hope that helps!
    Sincerely, Lindsay Davey

  3. Sharon Sharon says:

    Could I please have the links to the places you mention above. Im trying to find services around the Ottawa region and or physiotherapists that may specialize or have knowledge of this disease…doctors are no help.

  4. Lindsay Davey Lindsay Davey says:

    Hello Sharon,
    Here are the links to the websites I mentioned:
    http://www.torontolymphocare.com/html/contact.html
    https://www.vodderschool.com/find_a_therapist
    Best Wishes,
    Lindsay

Leave a Reply

Your email address will not be published.