Lipoedema

Lipoedema is a pathological change in adipose tissue that can lead to a significant reduction in quality of life as it progresses. As a rule, only women with lipedema are affected.

The starting point of the disease is usually a first hormonal changes, such as onset of puberty, pregnancy or menopausal – the menopause: during these hormonal upheavals of the woman there are shingling fatty tissue proliferation typical for the disease: thighs, lower legs, inside of the knee, Hips, buttocks and also arms.

The affected fat cells are inflated by the associated with the disease Lymphflüssigkeitsstau. Thus, in advanced lipoedema, e.g. In stage 3 grotesque body forms with overhanging skin-fat-lobes develop, which are then also in addition to the restriction of movement associated with considerable pain.

Do I have lipoedema?

“For some time now I have had a large increase in the size of the legs and would like to know if I have lipoedema”. The diagnosis of the clinical picture lipoedema is based purely on imaging techniques and clinical findings. It is not unambiguously simple by e.g. determine a specific blood value, but need the experience of specialists who deal with this disease.

According to recent studies (Földi, Marshall and Schwahn-Schreiber) in Germany about 10% of all women are affected by lipedema. In this case one can already speak of a “widespread disease”. There are only a few very experienced lipoedema-surgeons in Germany, in Berlin / Brandenburg Park-Klinik Birkenwerder is one of the few providers looking back on more than 20 years of experience with this disease.

All patients who come to our specialist clinic for the best possible treatment must have received the specialist diagnosis “lipoedema” from the phlebologist, vascular surgeon or another specialist familiar with the disease before the first consultation. Likewise, the flat-knit compression wash must have been worn and manual lymphatic drainage therapy begun.

Diagnosis by a specialist excludes other causes of weight gain, such as venous insufficiency, using ultrasonography and other clinical examination methods. If you have concomitant varicose veins associated with your lipedema, they must be treated prior to lipoedema.

The following 9 points could be an indication of an existing lipedema:

1. Prehistory: Did the legs start to get fat during puberty?
2. Skin: Is the surface of the skin very irregular and resembles a trip up and down?
3. Distribution pattern: Is there a symmetrical fat distribution on the hip and thigh side?
4. Hands and feet: Are not they affected by the increase in size?
5. Pain: Are you extremely sensitive to touch?
6. Progression: Was there an increased volume boost during pregnancy?
7. Sport and diet: So far, all diet and exercise trials remained without any noticeable effect?
8. Bruises: Do you often have bruises and do not know where from?
9. Inheritance: Are other family members affected by extremity swelling?

If you have answered at least 5 questions with “yes”, you may be suffering from lipoedema and should seek the appropriate trained specialist. An operation could then mean for you the solution of the problems.

How are lipedema divided?

From the experienced surgeon in the Park-Klinik Birkenwerder b. Berlin, liposuction is a very low-risk procedure, however, it is not possible to exclude developing skin retractions or contour irregularities (dents).

3 stages are divided:

1. Stage: Formation of orange peel (minor dents)
2. Stage: Development of larger dents (mattress skin)
3. Stage: large, harder flaps of skin and ridges, which even cover the hands and back of the feet

In addition, depending on the severity, there are 5 types:

1. Type: limited to the buttock-hip region
2. Type: up to the knees and fat rag on the knee inside
3. Type: to the ankles
4. Type: only hands and feet are not affected
5. Type: Water retention (edema) even in the hands and back of the feet, fingers and toes (lipolymph edema), damage to the larger lymphatics

The partial bruising that occurs during liposuction disappears after a few weeks.

What can be done to prevent lipedema?

The best therapy for lipoedema is the elimination or reduction of the cause of the discomfort, and these are the diseased fat cells. Water-jet-associated liposuction gently removes a great many pathologically altered fat cells from the tissue and thus significantly improves the lymphatic drainage and thus the drainage of the tissue.

This therapy must always take place in combination or / and following an essential conservative therapy using flat-knit compression and manual lymphatic drainage. In addition to surgical and other conservative measures, we strongly recommend that you respect healthy eating habits and support the outcome of the operation through sports such as, ideally, water sports, walking, cross-country skiing or walking.

What results can I expect after a lipoedema operation?

Numerous benefits are achieved by surgical removal of diseased adipose tissue:

1. Volume is significantly reduced, lymph can flow again
2. Pain is significantly alleviated or eliminated
3. The appearance becomes more beautiful and garments, such as Worn boots again
4. The mobility increases, sport, everyday life are possible again without problems
5. Consequential damage to the joints and X-legs can be avoided
6. The progression of the disease is stopped

What does this therapy look like?

The gentle Waterjet Assisted Liposuction (WAL) removes the diseased lipoedema fat cells without destroying the connective tissue structures, blood vessels, lymph channels and nerves. This can be aesthetically quite beautiful results on the affected body regions.

On the day of the operation, the surgeon first marks the operating area with a pen. About a few tiny small punctures then a saline solution is injected. It also contains adrenaline and a local anesthetic. The solution quenches the bleeding that occurs during aspiration, soothes the pain of the patient and causes the fat cells stored there to swell, making them easier to remove. Using a small cannula, you can then aspirate up to 9 liters of fat cells, lymph and blood from the subcutaneous fatty tissue.

The operations take about 120 minutes each. An anesthetist is always present accompanying the operation and can offer either a drowsy sleep or a general anesthetic if necessary. As a rule, one night is planned in the clinic. For further safety and avoidance of complications, maximum fat removal of up to 10% of body weight should not be exceeded. Also, the operated body surface must be kept as low as possible, which is why lipoedema must always be operated in several steps.

Can every surgeon operate on lipoedema?

Do not rely on “your” surgeon’s choice for “5 star” internet ratings. Make sure at first contact, whether your surgeon enough time and can answer all your questions. There should also be expertise in the field of liposuction by WAL, as this method is the drug of choice in the treatment of the disease. The experience in this area of expertise should be credible.

At best, the surgeon will also bring with you a passion and enthusiasm for the method of treatment, which should also be noticeable to you in contact. Liposuctions are not easy operations! It takes experience, passion and sensitivity to achieve the best possible result.

And then?
The supply of a previously measured compression corset takes place immediately after the operation nor in the operating room a, in addition, an elastic winding of the extracted region is still made. On the second day after the operation, patients recover their own flat knitwear and start manual lymphatic drainage therapy again. The typical lipoedema pain is usually gone immediately, hematoma and swelling are temporary. Immediately the relief is literally palpable, and the new life can begin.

How does water jet assisted liposuction (WAL) work?

In the WAL, the gentle power of the water is used by a pulsating jet of water to gently remove fat cells from their connective tissue network. The blunt tip of the fine aspiration cannula has a double lumen, which allows the simultaneous operation of dissolving and suction of the fat cells.

Advantages of WAL

• Through the pulsating jet of water, the cannula smoothly makes its way without injuring other structures (lymph channels, blood vessels, nerves and connective tissue), the tissue is spared.
• The surgeon only has to use a small amount of force, so you have less pain, swelling and hematoma as a patient. Overall, this leads to a faster convalescence.
• With the WAL, no uncomfortable infiltration of large quantities of liquid and long exposure times is necessary, as with the tumescence method (tumescere = swell up), this leads to a time savings and thus to shorter anesthetic times.
• Because of the unnecessary flooding, the surgeon can feel the tip of the needle at any time during the operation and control its movements. This allows precise fine modeling and results are predictable.
• Due to the simultaneous process of irrigation and suction, your body tissue only has contact with the rinsing solution and its medication additives (adrenaline) for a short time, which is a tighter stimulus for your body.
• The hoses used are disposable materials, the fat is obtained in a closed system (LipoCollector®). Absolute sterility is guaranteed

All these advantages lead to the fact that with lipoedema also large quantities of fat can be taken.