Lipedema is a chronic disorder and condition that causes fat cells to be abnormally enlarged. Michael Schwartz, M.D., is a board-certified facial plastic surgeon and diplomate of the American Board of Cosmetic Surgery offering treatment for Lipedema to women throughout the United States and internationally, as well as the Pasadena and Los Angeles areas.
Lipedema is a condition first described in 1940 by Allen and Hines which represents an abnormality of fat cells of the extremities (1). The fat cells in Lipedema undergo enlargement and develop edema or increased fluid collection. This condition affects primarily women in the third decade of life but can occur anytime after puberty, and affects 11% of the female population (2). Many women who suffer with Lipedema are not aware that it is a medical condition rather than obesity, and many medical professionals are unaware of this condition as well. The hallmark of Lipedema is fatty enlargement of the legs and often the arms, sparing the trunk, hands and feet. Women with Lipedema look disproportionate with normal-appearing torsos and enlarged lower body and arms. Many have worked hard with diet and exercise and even bariatric surgery, none of which will improve Lipedema.
The abnormal fat cells in Lipedema continue to enlarge as the disease progresses resulting in weight gain, generalized pain in the extremities and feet, and painful nodules. The extremities can develop a nodular appearance with easy bruising, tenderness to the touch, and swelling that is non-pitting. Although seen primarily in the buttocks and lower extremities, Lipedema can affect the arms in 30% of patients (3). Many patients develop pain either on the sole of the foot or the dorsum or top of the foot. It is not clear what causes this pain and various treatments have limited effect.
Patients with Lipedema are often confused as having lymphedema (swelling of the extremities with malfunctioning lymphatic system) or generalized lifestyle-induced obesity. The hallmark of Lipedema is enlargement of fat cells of the buttocks, hips and legs that abruptly stops just above the ankles. Whereas Lymphedema can involve the feet, Lipedema does not, and there is an absence of the “Stemmer Sign” which is the inability to pinch the skin of the foot due to swelling of the skin seen in Lymphedema. As Lipedema progresses, patients can develop pain and swelling in the legs and arms, rendering them immobile and greatly limiting daily activities.
Because of the confusion and lack of knowledge in the medical community, patients are often shuttled from doctor to doctor and subjected to unfair judgement relating to “obesity” and lifestyle choices that are truly unrelated to this condition. This is an autosomal dominant disease which means that it is carried on one of the first 22 non-sex autosomal chromosomes. Since Lipedema affects primarily women (only two cases have been reported in men), each female child of a mother who carries the gene has a 50% chance of developing Lipedema.
How is Lipedema Treated?
Although compression and elevation of the extremities have been used, they are not very effective in treating Lipedema. These are effective for the generalized swelling of Lymphedema but not Lipedema. We can offer the newest technology in liposuction however, since this disease creates large areas of unwanted fat that can be removed, thereby improving appearance and function of the extremities. We use tumescent liposuction which involves the infiltration of a solution of local anesthetic containing lidocaine (to numb the fat compartment) and epinephrine (to constrict blood vessels and prevent bleeding) into the fat compartment. Tumescent anesthesia infiltration gently hydro-dissects the fat compartments without disturbing the lymphatics.
We then treat the fat with a Vaser probe. Vaser is ultrasound energy that expands the air bubbles in the tumescent solution, thereby separating the fat cells while sparing the lymphatic channels. Thus the combination of tumescent infiltration and Vaser are the least traumatic to the lymphatic system while very efficient at breaking up the fat which can often be fibrous. Vaser also induces skin tightening which is helpful in Lipedema patients, and may help prevent the necessity for skin excision procedures in the future. The final step in the process is suctioning of the excess fat with a power cannula that allows us to precisely remove unwanted fat deposits and sculpt the various areas.
- Allen EV, Hines EA Jr. Lipedema of the legs: A syndrome characterized by fat legs and orthostatic edema. Proc Staff Meet Mayo Clin. 1940; 15:184–187.
- Foldi E, Foldi M. Lipedema. In: Foldi M., Fold, E., eds. Foldi’s Textbook of Lymphology. Munich, Germany: Elsevier GmbH; 2006:417–427.
- Herbst, Karen L, Ph.D, M.D., www.lipomadoc.org
- Herbst KL. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin. 2012; 33:155–172.
Do you suffer from Lipedema? Do you want to learn more about the chronic condition and how to treat it? Dr. Schwartz is offering treatment for Lipedema to women throughout the United States and internationally, as well as the Pasadena and Los Angeles areas. Please contact board-certified facial plastic surgeon Michael Schwartz, M.D., a diplomate of the American Board of Cosmetic Surgery to schedule a personal Lipedema consultation.
