Therapy of the lipedema
Concept of treatment
The treatment concept for lipoedema includes nutritional advice with a view to controlling body weight or weight reduction, a sports or exercise program, water-jet-assisted liposuction, consistent compression therapy supplemented with manual lymphatic drainage and, if necessary, psychological support.
Conservative therapy
It is not possible to improve the symptoms through diet and sport. Physical activity can reduce obesity, but not the disproportionate increase in fat on the legs, the same applies to slimming cures and special diets. Treatment with "water tablets" (diuretic therapy) is not indicated. In principle, weight gain should be avoided or a normal weight should be striven for, since being overweight is a risk factor. The conservative treatment of lipoedema consists of two components: on the one hand, permanent compression treatment with support stockings and, on the other hand, manual lymphatic drainage. In addition to manual lymphatic drainage, intermittent mechanical compression can also be used: these are cuffed pants with overlapping air chambers that fill and empty in waves. The aim of this therapy is to improve the flow of lymph towards the heart and to maintain the return flow through compression. A reduction in the circumference is not to be expected with these measures, because solid tissue is being drained. In addition, careful skin care is important, as the skin dries out under the compression stockings. In addition, exercises are recommended.
Conservative therapy: lifelong necessary
These measures are lifelong in the case of pronounced lipoedema, which represents an enormous burden for those affected, who are often young, and means a significant reduction in their quality of life. However, these conservative measures only alleviate the pain caused by the backed-up tissue fluid. Conservative therapy does not help in any way against the disease - namely lipoedema. The fat continues to grow and the frustration increases - lipoedema can only be treated by surgically reducing the diseased fatty tissue. After liposuction, the symptoms often disappear completely and, in contrast to lymphatic drainage and compression treatment, the operation usually only has to be carried out once. The international specialist societies have therefore included liposuction in their guidelines for the treatment of lipoedema.
The operative treatment of the lipedema
Because of the fear of destroying the lymphatic system with a subsequent worsening of the clinical picture, surgical interventions were previously discouraged. Based on the experience of the last 10 years, this attitude has to be revised. With a correct diagnosis and treatment by an experienced surgeon with gentle water-jet-assisted liposuction, surgical therapy of the clinical picture is possible - this operation represents the only possibility of successful therapy. When removing the diseased fat cells with the help of water-jet liposuction in one In the early stages, measures such as lymphatic drainage or wearing compression stockings can be completely dispensed with. In any case, an increase in the quality of life, a reduction in the compression class of the stockings and the avoidance of manual lymphatic drainage can be expected. Since a lifelong increase in fatty tissue is to be expected in lipoedema, an operation should be attempted at an early stage, as soon as the first typical symptoms appear.
Case example before and after waterjet assisted liposuction
32-year-old patient, 157cm/77kg, lipoedema with a tendency to swelling, pain, increased sensitivity to pressure and a feeling of tension in the legs, which has been known for years. Therapy with compression stockings and repeated lymphatic drainage. Already 2 months after outpatient water jet liposuction, significantly fewer complaints and clearly visible contour improvement.
