Treatments for lipoedema

Many women suffer from lipoedema, which represents an independent clinical picture, although it is only recognised by few doctors and acknowledged by the insurance companies as such.

Lipoedema primarily demonstrates the following symptoms (although not all of these must definitely be present):

• A disproportionate increase in the amount of subcutaneous fat in the lower extremities, often seen in combination with a slender upper body
• heavy, congested legs with swelling which develops particularly in the evening
• sensitivity to touch, in part together with a sensation of painful legs
• as a result of the fragile capillary system, very easy development of haematomas following truly trifling injuries or more intensive contact

This clinical picture is a burden to the woman (it is rarely observed in males) not only because of the misshapen appearance, but also because of the considerable complaints which frequently occur due to congestion. Occasionally varicose veins are also found as a further complication, although the lipoedema is frequently found alone. It tends to develop during the third decade of life and following pregnancies.

Untreated, lipoedema leads to ever increasing complaints and, through an increasing loss in function of the important lymphatic vessels, to chronically congested and painful legs, in part also accompanied by intensely limited mobility in the older patients.

Modern duplex sonography instrument in a laptop format, with which one can perform a precise diagnose of the veins without any burden to the patient through the administration of contrast media and x-rays (phlebography).

Diagnostics: Lipoedema

First of all, the subcutaneous connective and fatty tissues of the legs must be examined precisely with the aid of ultrasound, while at the same time investigating the functional capabilities of the internal and superficial veins of the lower extremities with Duplex sonography.

Radiological presentations of the lymphatic vessels (with lymphography or scintigraphy) provide no additional information which might be considered useful for the therapy and are therefore dispensable, as is also the case with computed tomography or magnetic resonance imaging of the subcutaneous tissues. The experienced vein doctor can establish a clear diagnosis based on the physical examination, the sonography and the case history.

Therapy

If damage to the superficial veins in the sense of a varicose vein is to be found, this should be eliminated. Since the existence of lipoedema demands a preservation of all lymphatic vessels, the modern, "minimally invasive" procedures (like the radiofrequency, e.g. VNUS Closure® or the steam vein sclerosis method (SVS)) have proven to be more advantageous than employing conventional methods such as "stripping ". If no such venous damage is seen to exist, it is naturally unnecessary to perform any reconstruction here.

To alleviate the symptoms - but unfortunately only for this purpose alone – lymphatic drainage procedures can be performed. Both manual lymphatic drainage and so-called "complex lymphatic drainage", as well as mechanical lymphatic drainage by means of automatically inflating leg cuffs, can bring relief.

Likewise, the painful consequences of the lipoedema can also be relieved by consistently wearing the proper compression stockings or tights.

However, none of these measures result in a long-lasting change to the circumference of the leg or to the unnatural amount of fat under the skin in which the lymph collects. Interestingly, sport and diet have practically no effect.

According to the guidelines of the German Society of Phlebology, a reduction of the subcutaneous fat through operative measures is a sensible therapy, and is often able to relieve the complaints long-term and to simultaneously also reduce the extent of the misshapen extremities.

In the event of a lipoedema, this can be performed through targeted liposuction using fine (perhaps, mechanically vibrating) cannulas in the "wet technique", since here (in comparison to the traditional dry technique) practically no lymphatic vessels are damaged.

This liposuction of the lymphoedema requires a great deal of experience by the vascular surgeon carrying out this technique and should only be performed by physicians who also have sufficient knowledge in the treatment of venous disease.

Our institute: expertise in liposuction since 1994

At our institute, liposuctions have been performed since 1994, so that the experience has been accumulated through thousands of operative interventions. We perform this procedure both on out and inpatients (should this be desired) using local anaesthesia and tumescent local anaesthesia or under deep anaesthesia, and thereby follow especially the regulations requiring the strict preservation of blood and lymphatic vessels. A reconstruction of possible venous damage is also possible using the radiofrequency technique.

After the treatment, the appropriate compression stockings must be worn for at least 6 weeks.

The costs of lipoedema treatment

Unfortunately, the cost of liposuction treatment in cases of lipoedema is, as a rule, not covered by insurance companies. If afflicted veins are treated at the same time, these costs are generally covered by private insurance.

Find out about the costs of liposuction more precisely in the section on "Costs of vein treatment" which you can reach from the Start page: An exact estimate of the costs, however, can only be made after a detailed examination is performed by one of our specialised physicians.