Lipedema: which therapy helps?

Legs and arms very voluminous, body, hands and feet slim: this is what distinguishes lipedema. Almost only women are affected. Which alleviates the discomfort

Short skirts or trousers are taboo for Susanne M., a visit to the swimming pool is unthinkable. The 36-year-old is ashamed of her voluminous legs. "I have been on countless diets and exercised in a disciplined manner, but the problem got bigger instead of smaller," she says. The tissue on her legs was tight and painful, the slightest pressure formed bruises. Doctors had little to do with M.'s story of suffering until a phlebologist - a doctor specializing in vascular diseases - finally diagnosed lipedema.

How do you recognize lipedema?

"In the early stages it can actually be difficult to differentiate lipedema from simple obesity," explains Professor Stefanie Reich-Schupke from the German Society for Phlebology. If it progresses, it can be easily recognized by the symmetrically developed fat distribution disorder. "Legs and arms are very voluminous, the middle of the body as well as hands and feet stay slim," says the dermatologist and phlebologist from Recklinghausen.

Lipedema almost exclusively affects women. There is probably a genetic predisposition. "Hormonal causes are likely because the symptoms usually begin in phases of hormonal change such as puberty or after pregnancy," says Reich-Schupke. The adipose tissue cells enlarge and multiply. The smallest blood vessels, the capillaries, become more permeable and vulnerable, and changes occur in the connective tissue. Water retention - edema - exacerbates the problem. They increase with warmth, long periods of sitting and standing.

Often lipedema is confused with obesity. But in the case of pathological obesity, the proportions remain normal and the fatty tissue does not cause pain. "The increased fat tissue in lipedema has nothing to do with the calorie intake and does not decrease with a diet. Measures that help against the edema do not change anything in the fat tissue. That is the problem with this disease," says Professor Wilfried Schmeller from the Hanse- Lübeck Clinic. However, every second patient with lipedema is also obese.

What helps against lipedema?

Doctors first recommend conservative treatment. This includes regular manual lymph drainage and custom-made compression stockings. With lymph drainage, the physiotherapist uses gentle hand movements to unblock the legs or arms, and the swelling under the skin is reduced. This measure is mainly used in lymphedema, where mainly fluid accumulates in the tissue. But it is also effective in lipedema. Those affected should also lose excess weight and exercise regularly. "Water sports are best. They have an effect similar to lymphatic drainage and are gentle on the joints," says Reich-Schupke. This treatment accompanies the patient for a lifetime. If it is stopped, the symptoms worsen again.

Sucking off fat: helpful, but often not paid for

Longer lasting improvement can only be achieved with liposuction, or liposuction as a specialist. The operation is now considered a standard measure, but is only paid for by the statutory health insurance in certain cases. Many aesthetic surgeons now offer liposuction, but Wilfried Schmeller strongly advises a doctor who has experience with the entire course of the disease: "Anyone who specializes only in cosmetic liposuction is not familiar with the clinical picture." The operation is more complex and often several interventions are necessary. In addition, the surgeon must ensure that nerves and vessels are not damaged.

This measure also costs time and, above all, money - up to 5000 euros per procedure, depending on the findings. But the long-term results are impressive. "Investigations over a period of up to eleven years after the liposuction showed that the legs were still slim and the body proportions were still normal," says Schmeller. A quarter of the patients no longer need any therapy after the procedure, some still wear compression stockings and go for lymphatic drainage - but this less often and with far fewer complaints.

"Liposuction would be an option for me, then maybe I would dare to go to the swimming pool again," says Susanne M. But first she wants to try lymph drainage and aqua jogging. Reich-Schupke agrees: "In any case, you should try consistent conservative therapy for three to six months." If there is still no improvement, one can think about liposuction.