Before any treatment of en/lipedemaa, the question of what the aim of the treatment is must be answered. Although many people have en/lipedemaa, only a fraction of all en/lipedemaa needs to be treated or can be treated.

Anyone who recognizes mild en/lipedemaa but neither has any symptoms nor feels aesthetically disturbed by it does not need to do anything. In most cases, en/lipedemaa will remain more or less as it is with the same body weight and will only change over time due to events such as pregnancy, menopause, etc. If the en/lipedemaa is only visually disturbing, weight control and eating discipline are the most important measures to ensure that the condition of the en/lipedemaa does not worsen. If desired, the appearance can be optimized by liposuction, but this is not necessary.

If en/lipedemaa - no matter how pronounced - causes discomfort, treatment should be initiated. Although en/lipedemaa is always benign and never requires emergency treatment, it can drastically reduce a person's quality of life. Effective treatment can often alleviate the symptoms and greatly improve quality of life.

Weight and en/lipedemaa

In principle, body weight should be normalized before any treatment. This is particularly beneficial for those patients who complain of worsening en/lipedemaa due to weight gain, regardless of whether they suffer from en/lipedemaa for aesthetic reasons or because of discomfort.

The target weight is difficult to maintain as a norm by using the scales or determining the BMI. I recommend assessing the trunk of the body, i.e. the area from the head to the stomach, in front of the mirror. If this area looks slim, the optimum weight reduction has been achieved. You can read again and again what should and should not be eaten to promote or alleviate en/lipedemaa. Unfortunately, there is not a single scientific study that has established a correlation between food choices and the severity of en/lipedemaa. With en/lipedemaa (as always in life), the body should not consume more calories than it needs. How much this is in each individual case is very individual: age, sex hormones, pregnancies, metabolic factors and much more determine and influence a person's weight.

Stage I en/lipedemaa improves both visually and clinically. Complaints diminish massively, the fat mantle "thins out".

Lymphatic drainage

Lymphatic drainage (possibly in combination with compression) is recommended as a first step. Lymphatic drainage is a method of reducing lymphatic fluid leakage. The massage activates the active lymph vessels in the best possible way, allowing the lymph to drain away more quickly. This reduces the swelling.

Manual lymphatic drainage is generally the best, but its quality is extremely dependent on the individual therapist. Unfortunately, diplomas alone do not guarantee good quality. Good manual lymphatic drainage is a "patting massage" that starts in the upper neck area on the left, then moves downwards from the front of the upper body to the groin with gentle pressing movements and then works upwards from the foot to the groin. This procedure corresponds to the anatomy of the lymphatic system and is based on the examinations and guidelines of Mr. Földi and Mr. Vodder. This massage is offered by many physiotherapists, but masseurs also perform this massage. Depending on whether it is recognized by the health insurance company, massage by physiotherapists is covered by basic insurance (on medical prescription), while treatment by masseurs is often only covered by supplementary insurance.

Mechanical lymphatic drainage can also help. Here, the legs are placed in inflatable air stockings that inflate repeatedly and then release the air, resulting in rhythmic pressure on the legs. This movement decongests the legs, but in contrast to manual massage, this method does not "open" the upper lymph nodes (which would be necessary in the case of lymphoedema). This treatment is also offered by physiotherapists, masseurs and beauticians. Depending on the provider, the health insurance company may pay for part or all of the treatment.

A special form of these massages is endermology, a suction roller massage. Here, the skin is sucked in by a vacuum and then worked on with massage rollers. Endermology helps to strengthen the connective tissue by stimulating local microcirculation, thus improving the elasticity and appearance of the skin. The result: congestion improves and the volume of the dynamic en/lipedemaa component decreases. Sensitivity to touch and pressure improves markedly, relaxation and well-being are triggered. This form of treatment is offered by various doctors, physiotherapists, masseurs and beauticians.

Compression therapy

Compression therapy certainly plays a decisive role among all therapy methods. By increasing the pressure on the legs (or, less frequently, arms), the return flow from the veins and lymph vessels is significantly increased. If you wear compression materials or a bandage, 50% more fluid flows back out of the legs even at rest. This effect is particularly enhanced by simultaneous movement, as the leg muscles then press the tissue against the compression material, which leads to additional decongestion.

When it comes to compression, whatever helps is generally permitted. In some cases, light compression (a so-called "support stocking") is already a great relief; in other cases, higher medical classes are required and, very rarely, so-called "complex physical decongestive therapy (CDT)", a combination of manual lymphatic drainage and firm permanent compression. Depending on the severity of the en/lipedemaa, it may be difficult to find a suitable stocking that is still wearable and does not constrict in stage 3, for example. In this case, it may be necessary to first carry out complex physical decongestive therapy, which consists of a combination of lymphatic drainage and bandages. This improves the deformation of the soft tissue and then enables stockings to be applied.

Due to the sometimes grotesque accumulation of fat in the leg - and also due to the frequent sensitivity of the leg to pressure and touch - stocking is often poorly tolerated and frequently not tolerated. It should be noted that in almost all cases of en/lipedemaa, the compression stocking only makes sense to relieve the symptoms and swelling, and it is up to the patient to decide whether or not to wear the stocking. The stocking cannot influence the static component of en/lipedemaa (the accumulation of fat) and cannot prevent deterioration. Therefore, anyone who does not tolerate the stocking or bandages, i.e. feels worse with them, does not have to wear them!

Compression can alleviate symptoms and reduce swelling in individual cases, but it cannot cure en/lipedemaa.

Medication

The use of medication is advisable if the tendency to swell during the course of the day is very severe and bothersome. Diuretics can help in individual cases. They lead to a measurable weight loss by flushing out the excess water that has been stored in the body tissue. It is important that diuretics are not taken long-term.

Vein therapeutics , almost all of which are plant-based (phytotherapeutics), can provide good relief for complaints such as sensitivity to pressure and touch in the tissues. Their basic substances are obtained from horse chestnut, red vine leaves, sweet clover and butcher's broom.

Medication can help to alleviate the symptoms of en/lipedemaa and improve the swelling. Unfortunately, a lasting improvement in en/lipedemaa cannot be achieved with medication; you need to be aware of the limited effectiveness of the substances. No medication can reduce or even cure the general swelling tendency of en/lipedemaa, the so-called static component.

Sport and exercise

Lipoedema generally resists all efforts in the gym. Although physical performance increases and muscles grow, en/lipedemaa - i.e. the fat distribution disorder - is basically unimpressed by this. Quite the opposite: muscle building actually increases the volume of the legs or arms and the mass increases. This frustrates and unsettles many patients, as they have not been properly informed about the clinical picture and embark on the exercise adventure with false hope.

The fact is that exercise can massively reduce the symptoms and discomfort of the disease. For this reason, regular exercise is recommended, even if it will not lead to thin legs per se.

Exercise stimulates the calf muscle pump, which optimizes the removal of venous blood/lymph from the leg tissue and at the same time improves the fluid permeability of the capillaries. Anything that has to do with moving the legs improves the swelling tendency and symptoms in the legs.

Basically, the sport performed does not play a major role, the main thing is movement! Ideally, the ankle should be moved and the foot should be rolled well; this movement pattern almost always leads to relief of the symptoms and a reduction in the tendency to swelling in the legs. Hiking, walking, Nordic walking, jogging, aquafit, but also dancing and other sports that move the legs are therefore particularly recommended.

Affected people and physiotherapists have recently jointly developed a concept called lipoletic, which directly targets the musculoskeletal system: This exercise program strengthens muscles with slow, simple movements, stretches ligaments and relieves overstressed joints.

If you don't have time for sport, you can activate the muscle calf pump by wearing a special shoe. The MBT (Massai Barefoot Technology) shoe brings massive relief to many patients, because with every normal step the ankle joint is optimally rolled and the calf muscle pump is thus optimally activated. There are now several imitation models that can also be very effective. It is best to try out several shoes to find the model in which you feel most comfortable.

Carboxytherapy

Relatively new, carboxytherapy is gaining acceptance worldwide. Carboxytherapy is mainly used aesthetically to treat cellulite, to reduce diet-resistant fat deposits, to remove stretch marks and for skin rejuvenation. Other possible applications include the neck, aging hands, dark circles and bags under the eyes as well as the décolleté. Carboxytherapy can also lead to good results with scars, open legs (ulcers) and en/lipedemaa.

Carboxytherapy is a non-surgical method in which carbon dioxide is injected into the tissue under the skin via a small needle (0.3 mm diameter). From the injection site, the carbon dioxide spreads quickly into the surrounding tissue and works in two ways: first, the gas produces a vasodilating effect with a strong increase in blood flow, and immediately after the treatment the skin becomes warmer and slightly reddened. The blood circulation leads to increased oxygen in the tissue, which is more easily released from the blood into the tissue. Waste products are broken down and congestion disappears.

Carboxytherapy can alleviate the symptoms of en/lipedemaa, and in some cases the fat mantle is also reduced during the course of treatment.

Liposuction

Liposuction - also known as liposculpture - is the only way to treat en/lipedemaa permanently. Only this treatment option can visibly and sustainably improve both the appearance and the extent of en/lipedemaa.

By removing the "diseased" fat under the skin, the swelling subsides; the balance between lymph production and drainage is restored and the symptoms disappear.

Liposuction has undergone intensive scientific research and further development in recent years: Instead of using large cannulas and long hospital stays, it can nowadays be performed on an outpatient basis using microcannulas under local anesthesia. Usual surgical risks such as infection and thrombosis become a rarity and the patient can return to work the very next day.

The guidelines of the German Society of Phlebology, which were newly published in October 2015, recommend liposuction for en/lipedemaa in all its stages as the only method of choice with a lasting effect. A separate study showed that over 98% of patients hardly suffered any swelling after liposuction and were pain-free.

As a specialist in en/lipedemaa, Dr. Linde performs liposuction on an average of 4-5 patients with this condition per week.

Photos of possible "before/after" results can be found in our gallery.

How does this procedure work?

Based on the latest studies on the subject and discussions with leading doctors worldwide, the following points can be noted that are important when en/lipedemaa is suctioned:

The area to be liposuctioned is anesthetized with a tumescent solution; this contains a highly diluted 0.9% saline solution, which is naturally present in the body. This suspension of the tissue causes the fat cells to fill with this fluid so that they can then be removed more easily and gently during suction. Damage to lymph vessels or nerves is also virtually impossible with this technique.

Another positive effect of tumescent anesthesia is that the filled tissue is pain-free. General or partial anesthesia is not necessary with this technique, which eliminates surgical complications such as thrombosis or pulmonary embolism.

It is essential that lymphological principles are observed during suction, as they are on the leg. This means that the course of the lymphatic vessels must be strictly followed and the direction of suction must be observed. This is the only way to prevent injury to the lymphatic vessels.

The use of small cannulas with a diameter of 1-2 mm is ideal, with vibrating cannulas the caliber can also be 3-4 mm. It is important that the cannulas are as atraumatic as possible to prevent injury to the lymphatic system. This also preserves the connective tissue bridges, which are very important for tightening the tissue.

Taking the above points into account, the fat is removed from its storage depots on the leg while protecting the lymphatic vessels. The connective tissue bridges that bind the skin to the muscles contract during the healing phase after liposuction, which leads to a tightening of the tissue. Excess skin does not remain, but tightens permanently.

The healing period after liposuction takes weeks to months. There is usually swelling in the liposuctioned area for a certain period of time - the desired inflammatory reaction that leads to tightening. Depending on the severity of the en/lipedemaa, the quality of the skin, etc., this swelling lasts for different lengths of time. As a rule, six months are expected before the final result is visible. However, it is quite possible that a significantly better leg silhouette will appear after just a few weeks and/or the symptoms will improve.

Variations of "traditional" liposuction

Vibrating cannulas
These cannulas vibrate at a very high frequency during liposuction, which causes the fat cells to be "shaken" out of their connective tissue beds rather than "scraped" out. This technique is said to be gentler than other concepts, but precise studies are lacking. One disadvantage of this technique is that the cannulas used are relatively thick with diameters of 3-4mm.

The application of this suction technique is less strenuous for the attending physician, which may explain the popularity of this method.

Water jet aspiration (WAL)
In contrast to tumescent anesthesia, with water-jet liposuction the tissue is inflated almost simultaneously with the tumescent solution and the fat is suctioned out. This means that considerably less fluid is required and the operation time can be drastically reduced.

^BodyTiteTM
Sometimes it is necessary to simultaneously tighten and smooth the skin during liposuction.

A certain amount of tightening can be achieved by the suction itself, but this is not enough for sagging tissue. The ^BodyTiteTM method uses a special suction cannula that is heated at its tip by radio frequency and thus heats the fatty tissue to 60° C, which achieves maximum tightening. This technique can be controlled very well using a temperature probe on the skin.