Overview

Do you have a high buildup of fat in your thighs, and no matter what diet you try, it persists? Well, you are not alone. Generally, women tend to accumulate more fat in the thighs and hips compared to men. When fat accumulation in the thighs is accompanied by chronic pain, it could be a symptom of a condition called lipedema.¹ 

Lipedema is a condition that is often misunderstood and underdiagnosed, especially in people who are overweight. This condition can harm an individual's physical and emotional well-being. Hence, inculcating effective treatment strategies is paramount. In this article, you will learn about the role of liposuction in advanced lipedema. 

Understanding advanced lipedema 

Lipedema is a chronic and progressive condition characterised by the accumulation of fat cells in specific parts of the body. This includes the thighs, hips, and buttocks, excluding the hands and feet.¹ Symptoms of this condition include pain, a tendency to bruise easily, oedema, formation of subcutaneous lumps of adipose tissue, and difficulty burning fat despite a change in diet and regular exercise routine.¹ Lipedema was first described in 1940 by a cardiovascular surgeon, Edgar Van Nuys Allen, and a doctor from the Mayo Clinic, Edgar Alphonso Hines Jr. Hence, this condition is also known as Allen-Hines Syndrome.²

Lipedema occurs more in people assigned female at birth (AFAB) compared to people assigned male at birth (AMAB). Generally, studies have shown an approximately 11% occurrence in the general population, with about 6.5% in the USA, and15% to 18% in European countries.³ However, in some countries like Germany and Brazil, it can affect up to 39% of which 12.3% are women.⁴ Advanced cases of lipedema can contribute to the onset of various complications. These include: hypothyroidism, imbalance of electrolytes due to sodium deposition in the skin, cardiovascular issues, and decreased levels of vitamin D.⁵

What causes lipedema?

Although there is no specific cause of lipedema, a complex interplay of various factors is involved. These include hormonal imbalance, genetic predisposition, and structural irregularities in the vascular and lymphatic system.⁶ The female hormone, estrogen, also plays a significant role in the pathophysiology of lipedema. This is because the symptoms associated with lipedema often manifest during periods of hormonal fluctuations such as puberty, pregnancy, and menopause.⁷

Some patients suffering from lipedema have a female relative who was previously affected by the condition.⁷ When inherited via an autosomal dominant pattern, it can be divided into two main types: syndromic and non-syndromic. ⁵ In syndromic lipedema, there is a mutation that affects hormone secretion in the anterior pituitary gland. This mutation affects prolactin and thyroid-stimulating hormone, which causes hormonal shifts and, quite often, lipedema.⁸ In non-syndromic lipedema, a mutation occurs in the gene that plays an active role in the conversion of active progesterone into an inactive form. Consequently, a mutation in this gene disrupts the conversion process, leading to the accumulation of progesterone. This can contribute to abnormal deposition of fat tissues, which is the hallmark feature of lipedema.^{8, 9}

According to disease progression, lipedema can be classified into 3 stages. This is elucidated below: 

Types of lipedema 

In people without Lipedema, the excess fat tissue is stored within the abdominal cavity. In lipedema, fat accumulates predominantly in the upper thighs, inner part of the knees, hips, and calves. ¹¹ Apart from classification based on the stages of the condition, lipedema is also classified into 5 types depending on the site of fat deposition:

Treatment options for lipedema

The treatment options for lipedema aim to alleviate the symptoms, avoid disease progression, prevent complications, and enhance the physical and psychological quality of life for the patient. 

There are two major approaches for treating lipedema: conservative treatment and surgical approaches.¹² 

Conservative treatment includes the following:

• Patient education on strategies to balance hormones¹³
• Dietary changes and adoption of a regular exercise activity of choice
• Complex decongestive therapy, which includes manual lymphatic drainage (MLD), compression therapy, use of compression garments, and ultimate skin care¹³  
• Physical therapy, which includes therapeutic and focused ultrasound, and cryolipolysis¹³

The surgical option for this condition primarily consists of liposuction and lipectomy; however, the most common is liposuction. ¹³ Great precision and expertise are needed to spare lymphatic structures when performing liposuction. This is because a lack of special care can cause damage to the lymphatic system and worsen the symptoms associated with lipedema, leading to lymphedema.¹⁴

Lipectomy (or lumpectomy) is a surgical technique that involves the removal of large localised deposits of lipedematous tissue, called lumps, that can form in lipedema.⁶ This procedure may be considered in complicated and advanced lipedema with severe physical constraints, such as impaired mobility.⁶ Lipectomy aims to remove the severe mechanical limitations caused by these deposits and to improve mobility and gait in affected individuals.⁶

Role of liposuction in advanced lipedema

Liposuction is one of the most effective surgical techniques employed to remove the abnormal adipose tissues in lipedema. Different liposuction techniques have been developed with distinct advantages over others. Liposuction is recommended by physicians in severe cases of lipedema where conservative approaches employed have had little or no improvement.⁶ It is effective in reducing abnormal adipose tissue and improving symptoms in some patients with lipedema. Additionally, procedures such as lipectomy can be used to remove large localised deposits of lipedematous tissue, especially if it is accompanied by physical hindrances or severe deformities.⁶ 

Liposuction techniques are generally divided into two; 

• Dry liposuction, performed under general anaesthesia, involves lymphatic drainage, with complications of edema and bleeding
• Wet liposuction:  preserves the lymphatic system, reduces complications, and combines the use of a vasoconstrictor and anaesthetic in saline⁵  

Wet liposuction techniques include the following: tumescent, super wet, and water-assisted liposuction. However, for younger patients, laser-assisted liposuction results in better surgery outcomes in the aspect of tightening of the skin and contouring of the limbs. Its effectiveness is limited in older people.⁵

 Among all these methods, tumescent liposuction is considered the gold standard as it efficiently removes adipose tissue with little impact on the lymphatic system.¹⁵ Tumescent liposuction is further grouped into water-jet assisted and vibration-assisted techniques.¹⁵ The difference between tumescent liposuction and water-assisted liposuction is described below:

Can lipedema be prevented?

Lipedema is a complex condition with a genetic basis; therefore, it is not particularly preventable in comparison to other health conditions. Hence, for people with a genetic predisposition, it is essential to maintain a healthy weight, early diagnosis, and address any underlying health conditions that will help prevent the progression of the condition. 

Most importantly, differentiating lipedema from a condition like lymphedema could help control the symptom progression. Swelling in lymphedema is usually unilateral, whereas

Lipedema is bilateral. Also, lymphedema that occurs secondary to advanced lipedema compromises the lymphatic system and leads to adipocyte hypertrophy.¹⁵

FAQs

Can you lose lipedema fat by fasting?

Although different types of fasting are recommended in people who are overweight and can lead to weight loss, it is generally not effective for specifically targeting and reducing lipedema fat. Lipedema is a condition where fat accumulates in the thighs and buttocks, and this fat is often resistant to a typical weight loss program.

How do you know you have lipedema?

If you have lipoedema, your legs appear swollen and sensitive to touch. The swelling can occur from the hips down to the ankles, including your calves. However, the feet are usually excluded. Skin is usually tender and spongy. 

Can children have lipedema?

While lipedema occurs more frequently in adult females, this condition can also affect children (girls). Early detection and support for lipedema in children are vital to effectively manage the condition and improve their quality of life. 

Are there complications associated with lipedema?

Advanced lipedema can lead to the development of lymphedema, which can induce a host of complications. These complications include mental health issues, chronic inflammation, progressive fibrosis, cellulitis, etc.

Summary

• Lipedema is a condition characterised by abnormal fat deposition in the thighs and buttocks
• This condition is more prevalent in women than in men and occurs due to a complex interplay of risk factors
• These factors include hormonal fluctuation (during pregnancy, puberty, and menopause), genetic factors, and vascular abnormalities
• The disease progresses in 3 stages and is divided into 5 types depending on the severity and areas of fat deposition
• Treatment strategies are grouped into conservative treatment and surgical intervention. This depends on the stage and severity of the condition
• Patient education, weight management, use of compression therapy, dietary changes, and physical therapy are some of the conservative treatments used
• Liposuction aims to effectively remove abnormal adipose tissue with minimal lymphatic involvement. It is recommended in advanced cases of lipedema, and the gold standard is tumescent liposuction