Treatment for Lipedema
At present, there are two courses of treatment for lipedema. The first is non-surgical conservative treatment which includes Comprehensive Decongestive Therapy (CDT), diet, exercise, emotional/psychological/social support. Second is surgical and consists of specialized lymph-sparing liposuction performed by a surgeon trained in lipedema treatment.
The goals for treatment include:
- reduction and in many cases the elimination of inflammation, swelling and pain
- increase in lymphatic flow which reduces/eliminates excessive fluid and the swelling that comes along with it
- overall management of the physical impact of lipedema
- quality of life which can include emotional, psychological/mental, spiritual and social enhancement in addition to physical management
Conservative treatment includes a complete array of non-surgical approaches to treating lipedema and lymphedema, and is often referred to as Comprehensive Decongestive Therapy (CDT). CDT is effective in treating lymphedema, lipolymphedema and edema (swelling) from lymphatic compromise and from venous insufficiency. It is a combination of manual lymph drainage (MLD), bandaging exercises and skin care.
CDT may also involve breathing exercises, compression garments and dietary measures. Cancer patients who have had radiation or surgery to treat cancer often develop secondary lymphedema that requires CDT. This treatment can relieve edema, fibrosis, and their accompanying pain and discomfort. For patients who have lipedema but do not have lymphedema, CDT along with diet and exercise can help curtail the progression of the disease.
Manual Lymphatic Drainage (MLD)
Manual Lymphatic Drainage is a unique therapeutic method of stimulating lymphatic fluid movement in the tissues. MLD is a gentle, rhythmic massage that follows the direction of lymph flow and can reduce swelling almost immediately. It assists the lymphatic system in removing fluids, waste products, protein particles and debris. MLD can also be used to break up fibrosis in a limb with lymphedema. The technique was created by Danish therapists Dr. Emil Vodder and Estrid Vodder in the 1930s.
While MLD is a specialized form of massage designed to support the lymphatic system, regular massage can be helpful in breaking up fibrotic areas where connective tissue begins to harden. Massage can support reduced pain and increased mobility for patients with lipedema and lymphedema.
Compression garments are considered the gold standard for conservative lymphedema treatment. Most lymphedema patients need to wear compression garments 24 hours a day in order to keep swelling down and retain the benefits of techniques such as MLD. Typical compression garments for lipolymphedema are tight elastic stockings that encourage movement of the lymph fluid through the lymphatic system. Compression garments are also recommended for lipedema management. While these garments won’t reduce the adipose accumulation, they can help in maintaining and managing the condition.
Pneumatic Compression Device
Pneumatic compression devices consist of an inflatable garment for various parts of the body and can include each arm, each leg, the trunk, or the chest and an electrical pneumatic pump that fills the garment with compressed air. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices. This moves the lymphatic fluid and supports its elimination. Often used as home-therapy in addition to Complete Decongestive Therapies to treat lymphedema or lipolymphedema. It can be helpful in preventing the progression of lipedema.
Even though lipedema fat is resistant to weight loss through dieting, diet is still an important part of treatment for lipedema and lymphedema. Patients who have obesity on top of lipedema find that they have significantly more problems with pain and mobility. Maintaining a healthy weight can help keep these symptoms under control. A healthy diet can also reduce the risk for other problems such as cancer, diabetes, and cardiovascular disease.
Ketogenic Way of Eating Proving Successful for Lipedema Treatment
Since August 2016 we have been trying out Ketogenic Way of Eating as a treatment for lipedema. Based on research by Leslyn Keith, OTD, CLT-LANA that reported significant results for those with lymphedema and obesity, we have facilitated groups using a Keto WOE with successful outcomes. Women report reduction/elimination of swelling, inflammation, pain, and weight loss. For more information KETO AND LIPEDEMA.
Some practitioners recommend supplements that help decrease swelling or improve immune system function. The following recommendations come from Linda-Anne Kahn, President, Lymphatic Therapy Services of San Diego in CA, USA and a holistic health care practitioner who specializes in lymphedema and lipedema treatment.
Selenium: Selenium is a helpful supplement for lipolymphedema patients because of its ability to reduce swelling. Taking selenium can increase the effectiveness of physical therapy, reduce the risk of certain kinds of bacterial skin infections (erisypelasis), and lower the production of free radicals.
Bioflavonoids: Bioflavonoids are a subset of fragrant plant compounds known as coumarins. Lipedema patients take bioflavonoids to improve their cardiovascular and immune systems as well as their connective tissue function. Bioflavonoids help maintain healthy blood vessel walls and fend off free radicals, and may assist in connective tissue maintenance.
Vitamin P – Bioflavonoids: These water-soluble super-antioxidants (hesperidin, rutin, citrin, flavones, and flavonols) are found in citrus, broccoli, brussels sprouts, mangoes, and papayas.
Horse Chestnut Seed Extract: Horse Chestnut Seed Extract strengthens the lymphatic system, reduces swelling, and helps treat chronic venous insufficiency.
Quercetin: Quercetin is a flavonoid that supports cardiovascular health, helps regulate blood pressure, and protects against stress by suppressing the release of cortisol in the body.
Pycnogenol (Grapeseed Extract and French Maritime Pine): Pycnogenol is an antioxidant and a bioflavonoid. Its antioxidant properties protect against damage caused by free radicals, while its bioflavonoid properties reduce capillary leakage, perivascular inflammation, and subcutaneous swelling.
N-Acetyl Cysteine (NAC): NAC is an amino acid that acts as an antioxidant, preventing tissue damage by reducing free radicals.
Butchers Broom: Butchers Broom contains flavonoids that treat chronic venous insufficiency as well as reduce swelling in the legs.
Ubiquinone / Co-enzyme Q10: CoQ10 has antioxidant properties that prevent tissue damage.
Alpha-Lipoic Acid: Alpha-Lipoic acid is an antioxidant that fights free radicals. It is particularly useful to lipedema and lymphedema patients because it is both water-soluble and fat-soluble, so it can work effectively throughout the body.
Milk Thistle and Dandelion Root: Milk thistle and dandelion root both support healthy liver function.
Noni: Noni has anti-inflammatory and antioxidant properties. It may inhibit the formation of blood vessels that contribute to lipomatosis, a condition in which benign tumors of fat tissue appear throughout the body.
Turmeric: Turmeric is an antioxidant with a wide range of anti-inflammatory properties.
Eleuthro Root and Rhodiola: These two trace minerals support healthy functioning of the adrenal glands.
Wobenzyme and Vitalzyme: These two systemic enzymes reduce fibrotic tissue and swelling in the body.
Conjugated Lineoleic Acid (CLA): CLA has been shown to decrease the volume of adipocytes (fat cells) and thereby reduce body fat.
Exercise, like diet, is important for maintaining overall health even though it is not effective in reducing lipedema fat. Lipedema patients often find swimming to be a great low-impact activity, as more vigorous activities like running are often too painful. Exercise also helps the lymphatic fluid move through the lymph system more effectively, and is excellent for preventing other issues such as cardiovascular problems. Bouncing on a trampoline/rebounder, yoga, pilates, moderate stretching, and walking are all movement that supports lymphatic flow.
Breath work has many benefits, including reducing stress and easing general anxiety. Lipedema patients can utilize targeted breath exercises to improve the circulation of lymph fluid through the lymphatic system.
As lipedema advances, intensive measures beyond conservative treatment may be deemed necessary. Specialized lymph-sparing liposuction is the surgical intervention available to lipedema patients, helping to reduce volume and pain, retain mobility, and slow the progression of the disease.
If surgical intervention is deemed necessary, patients can undergo lymph sparing liposuction. The liposuction removes lipedema fat, and has been shown to be effective at slowing or stopping the progression of lipedema and at reducing lipedema pain. Patients may undergo multiple sessions of liposuction treatment, which is typically an outpatient procedure with local anesthesia.
Physicians should discuss aesthetic expectations with lipedema patients prior to surgery, as successful liposuction may not significantly change the shape of the legs from a cosmetic viewpoint. The need for conservative treatments such as MLD and compression garments after liposuction surgery will vary from patient to patient. Patients can expect swelling, bruising, and tenderness after surgery that can resolve within a year.
Water-Jet Assisted Liposuction (WAL)
Water-Jet Assisted Liposuction is the specific technique we recommend for patients who require lymph sparing liposuction for lipedema. The lipedema fat is removed using a fan-shaped jet of water, which is less invasive to the surrounding tissues and makes the healing and recovery process faster.
Tumescent Local Anesthesia (TLA)
Tumescent Local Anesthesia is the anesthesia technique we recommend for lymph sparing liposuction surgery. TLA is designed to only affect the skin and subcutaneous tissues in a particular region and is considered safer than general anesthesia. Using tumescence allows surgery to be an outpatient procedure.
Other Liposuction Techniques
There are a number of other liposuction techniques available which may be used, including Smart Lipo, which uses coagulation to tighten skin and boost collagen performance, and Laser techniques. If you are considering other techniques, please be sure your surgeon has worked with lipedema patients before and is able to address your specific risks and needs.
Venous Insufficiency: Venous insufficiency often appears in conjunction with lipedema, and can result in varicose veins, leg heaviness, leg pain, swelling, and redness. In some instances a patients’ venous insufficiency must be treated in order to make them viable candidates for liposuction.
Sclerotherapy: Sclerotherapy is a technique that causes veins to reroute blood through healthier vessels. A physician injects a solution into a vein that has been damaged, causing it to collapse. Eventually the vein fades away and blood is transported in the body through other veins. Patients who have lipedema and venous insufficiency may require sclerotherapy before they are eligible for liposuction.
About The Friedman Center
The Friedman Center for Breast and Lymphatic Surgery at Northwell Health in New York was founded in 2013. Its focus has been on offering solutions for patients with lymphedema, a debilitating condition that occurs in many patients after cancer treatment.
The Friedman Center’s scope of care now includes treatment for lipedema, a condition that can also result in lymphedema. To that end, the Friedman Center has created the Lipedema Project, a comprehensive program to increase awareness and provide education, research and treatment for lipedema. The Friedman Center is proud to sponsor the lipedema documentary, The Disease They Call FAT, the 1st International Symposium on Lipedema, the Lipedema Think Tank, the Lipedema Solutions Forum for women with lipedema in April 2015 and this online CME eduring materials course for physicians.