top of page
MANAGEMENT OPTIONS
Since the condition was first described, the consensus medical recommendation is to advise the patient to accept the condition and try modifying their life. There is lack of sufficient information regarding the disease pathophysiology and only few therapeutic options are suggested and have been researched till date. Main goals of treatment include reduction in symptoms including pain, limitation of the functional and physical debility and prevention of disease progression. There should be lifestyle modification and conservative treatment options should be adopted to relieve patients from psychological and physiological distress they are suffering and limiting the disease progression by early diagnosis and management. The patient's education is very important and should be provided at all times along with the advice on dietary modification and weight management. Surgical approaches should be limited to only selected cases. Below is explanation of some conservative and surgical treatment options available for the patients:
CONSERVATIVE TREATMENT:
Although the conservative management brings only a small reduction in the tissue volume, it lessens pain and the tightness in the limbs. It also helps in prevention from skin lesions during advanced stages of the disease. Conservative management cannot be considered as the gold standard of treatment and there is not enough evidence that it prevents the progression of the disease. The following options can be used for conservative management and the initiation, extent, and duration of treatment should depend on the patient's condition and suffering caused by the disease.
-
patient education on self-management
-
dietary counselling and weight management
-
psychosocial therapy
-
physiotherapy and exercise therapy
-
appropriate compression therapy with custom-made, flat-knitted compressive clothing (compression classes II–III)
-
manual lymph drainage, on a regular basis if necessary
Patient education:
Patients should be informed that the disease is chronic and is progressive in nature if left untreated. They should be informed about all of the treatment options in a “non-ideological” way and how they can self manage and actively influence the disease progression. Professional help should also be offered for coping emotionally with the disease. The pros and cons should be discussed of the patient. An adequate informational material should soon be provided, along with contact data for the relevant self-help organisations after the diagnosis is confirmed
_edited.jpg)
Weight control:
There is an increased risk of developing morbid obesity in patients with lipedema and being overweight worsens the manifestations of lipedema. The pathological subcutaneous fat remains unaffected with diet control but the weight management and regular exercise can nevertheless improve symptoms
Dietary modification:
There is not enough research or randomised and controlled trials on this topic and no specific evidence diet has been advised for patients with lipedema. Current dietary guidelines suggest hypocaloric intake which helps in lowering the body weight and can cause inhibition of systemic inflammation with anti-oxidative and anti-inflammatory components and decrease in fluid retention . Many patients with lipedema also suffer from eating disorders and dietary modification should be carried out with proper psychologist consultation and follow up .
Complex Decongestive Therapy:
Manual lymph drainage (MLD), compression therapy, exercise therapy, and skin care are the pillars of complex decongestive therapy .
The use of intermittent pneumatic compression devices (IPC) when used in ambulatory care, may lessen the frequency of MLD and lessen both tissue tension and the patient’s symptoms. Mild pressure should be applied in the supplementary use of IPC to treat lipedema to prevent the collapse of the superficial lymphatic vessels. There should be tailored exercise plans according to the patient's individual needs and disease stage. The beneficial types of exercises could be controlled, cyclical walking or running movements that activate the calf-muscle pump but do not cause any excessive tissue trauma.
​​Pharmacological Options:
Beta-adrenergic agonists, corticosteroids, diuretics, flavonoids, and selenium, have also been suggested as pharmacological options, although their efficacy in this condition remains to be elucidated .
SURGICAL TREATMENT:​​
Surgical treatments are only advised if the patient's condition is continually progressive and not getting controlled by any conservative management. There is improvement in pain perception, feeling of tightness and improvement in quality of life and also improvement in leg circumference. The frequency and extent of conservative treatment is also effective and the complication rates were low. Although the therapeutic benefit has not yet been evaluated in any randomised controlled trials, but if the symptoms persist and impair the patient’s quality of life despite appropriate conservative management, the potential indication for liposuction should be evaluated. In different research studies of liposuction with follow-up for up to eight years, significant relief of symptoms were found after surgery. It can have a lasting reduction of fatty tissue and bring improvement in both subjectively and objectively measured variables.
LIPOSUCTION:
Some dry liposuction procedures which were used before, carry an unacceptable risk of lymphatics damage in patients suffering from lipoedema but following the introduction of Tumescent Local Anaesthesia (TLA), super-TLA, and vibrating cannulas, this risk with the surgery has considerably decreased. TLA is highly effective in terms of both cosmetic and functional outcomes and it has been proved by several investigations. Some studies have reported better outcomes and prevention from disease progression if done in the early stages of lipoedema compared with advanced ones. TLA requires specialised skills and should be performed only in specialised centres. In advanced lipoedema stages, multiple sessions are frequently necessary to remove larger amounts of adipose tissue and prevent recurrent fat deposition. In addition, despite several promising short-term results, only a few studies have evaluated the long-term efficacy of TLA for lipoedema treatment.
A more invasive surgical approach consisting of excision of large localised deposits of lipoedema fat tissue (“lumps”) as a debulking procedure (lumpectomy) may be considered in complicated and advanced cases of lipoedema with severe mechanical limitations. Future research with longer-term outcomes will help support the role of liposuction in the management of this chronic condition.
bottom of page