Liposuction using super tumescent local anesthesia is an important advance for the safe and effective treatment of lipedema, but appropriate diagnosis is the first step to successful management of this disorder, which causes significant morbidity and is more common than generally recognized, says Louis Habbema, M.D., Ph.D.
Some patients develop lymphedema as well, probably due to compression of the lymph vessels. Lipedema patients also may show anatomically abnormal lymph vessels, Dr. Habbema says.Due to a low awareness of the condition among physicians, patients seeking help may simply be counseled to lose weight and/or offered liposuction using conventional techniques. Although women with lipedema may also suffer from obesity, the abnormal fat that accumulates in lipedema is very resistant to conventional weight-loss measures, and it is destined to accumulate again after removal with conventional liposuction, says Dr. Habbema, who has been at the forefront of developing treatment for lipedema and efforts to increase awareness about the condition.
"Fat accumulation in lipedema cannot be controlled or eliminated through diet, and the swelling and aching associated with the condition are worsened by exercise. Women attempting to lose weight by these methods will simply lose fat from areas of the body that are not affected by lipedema, including the face, the breasts and the trunk, while the lipedema gets progressively worse," says Dr. Habbema, a dermatologist specializing in cosmetic medicine and founder, Medical Centre 't Gooi, Amsterdam.
"Our experience with around 800 women shows that lipedema treatment with circumferential liposuction performed using a large volume of tumescent anesthesia safely and effectively removes the fat and improves patient symptoms," he says. "Early intervention is desired to hopefully prevent progression and improve quality of life. However, the doctor must first recognize the problem in order to offer the correct treatment."
ASSOCIATED MORBIDITY The morbidity associated with lipedema includes physical, psychosocial and functional consequences. In addition to having low self-esteem because of their appearance, affected women become frustrated and discouraged by the failure of their weight-loss efforts, and the psychological burden may be compounded for those who go from physician to physician seeking help, only to receive the same advice about diet and exercise that they have already tried and know doesn't work.
In severe cases, the enlarged extremities can cause mechanical sequelae, including mobility issues and friction-induced skin breakdown. Expansion of the subcutaneous compartment with fat also causes discomfort, tenderness or even severe pain, and the affected areas may be prone to easy bruising.
"Women who've enjoyed long walks may find they must stop after just 10 minutes because of their pain, and merely touching the surface of the skin can cause distress," Dr. Habbema says.
"In addition, the pain may be misdiagnosed as originating from some other musculoskeletal condition and lead women to undergo unnecessary diagnostic and surgical procedures that will have no benefit on their chief complaint."