How to Treat Lipoedema

By Dr Mark Hanikeri

In recent years, there has been a rising awareness of the condition called lipoedema, a common chronic condition occurring in one in 11 women where they have significant fat accumulation, particularly around the thighs and legs.

What is Lipoedema?

Although there is not currently a single cause for the condition, it has been found that lipoedema develops after a woman experiences a specific hormonal event. These events include puberty, pregnancy, menopause, or a combination of gynaecological surgeries.

It is a condition that is associated with the change in the lymphatic system, which over time causes deposition of fat and fluid in the thighs, lower legs, ankles, knees, and sometimes upper arms.

What are the Symptoms of Lipoedema?

Patients with lipoedema may be healthy body weight, though they are sometimes overweight, leading to a delay and confusion with the diagnosis. Patients are particularly troubled by excess fat in their lower limbs which is often reported to be very painful.  The fat has a lumpy quality to it, and there is usually a sharp demarcation where the tissues return to average below the ankles (the feet are spared). There may be varicose veins or dilated capillaries, and the skin becomes soft, fragile, and bruises easily.

Over time, with the progression of the condition, there may be obstruction or damage to further lymphatics giving rise to fluid accumulation and eventually lymphoedema (Lipo-lymphoedema or stage IV lipoedema).

Treatment for Lipoedema

Lipoedema is often misdiagnosed as lymphoedema or obesity or even other diseases. Patients who believe they might have lipoedema should seek medical advice immediately to establish treatment options.

For appropriate patients, even if overweight, liposuction is one of the most suitable treatments for these women. The liposuction technique for patients with lipoedema differs from typical liposuction as it aims to minimise trauma remaining lymphatic channels which may become damaged with traditional liposuction. Typically, water-assisted liposuction (WAL) is used to minimise fluid shifts and maximise liposuction volumes whilst preserving the valuable remaining lymphatics. 

Patients may need several sessions of WAL since the volume of fluid and fat requiring removal often exceeds that which can be safely taken in one session. Typically, treatment is staged to address the worst area first followed by other regions as required.  The condition is also characterised by recurrence over time, and repeated WAL may be required to previously treated areas if symptoms recur.

Dr Mark Hanikeri is a specialist plastic surgeon and an ASAPS Member with extensive training and experience in his field. To read about Dr Hanikeri’s credentials, hospital accreditations and training, click here.



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