What Is Lipedema?
Lipedema is a condition that occurs when fat is unevenly distributed in an irregular manner beneath the skin, most often in the legs and buttocks. Although for many patients it begins as a cosmetic concern, once it progresses, it can eventually cause pain and other symptoms. Lipedema is often mistaken for obesity or lymphedema, but it is a unique condition that requires treatment from a skilled, experienced surgeon. Lipedema can be very frustrating both physically and mentally, especially if it is undiagnosed. Beverly Hills, CA board-certified plastic surgeon Dr. Jaime S. Schwartz is a renowned plastic surgeon that treats lipedema, who regularly collaborates with Dr. Karen L. Herbst, a national expert on lipedema. He also regularly lectures on this topic.
At Total Lipedema Care (TLC) in Beverly Hills, Dr. Schwartz offers therapeutic nonsurgical and surgical treatments for lipedema. You may have heard it called the "painful fat disorder," or thought people who suffer from this were just extremely overweight or morbidly obese. There is much more to the story. The truth of the matter is that having lipedema is not the same as being fat. How can Dr. Schwartz tell the difference? The adipose cells that form have extra fluid, plus the fat, which causes the area to distort the skin, change its size, shape, color, texture, and sensitivity on one or multiple areas of the body. Fatty areas of the body with lipedema may show characteristics in the lower body (calves, knees, thighs), the mid-body (torso, hips, buttock, abdomen), and upper arms. As a progressive disorder in men and women, lipedema is not cured — only managed. The fluid buildup can cause chronic pressure and pain in the affected body part (especially if it is near a nerve).
What Causes Lipedema?
There is ongoing research on what causes lipedema. We do know that it can be triggered by a stressful event, the hormone variations or changes in puberty, pregnancy, or menopause. One in nine women has lipedema. It is also genetic, which means it can run in families. This is not a fat disorder for just men and women who are overweight or obese. Lipedema can present itself in a person who is underweight — it is not limited to the weight/size of the patient. Diet and exercise modification can help alleviate symptoms but will not eliminate the disorder.
What Are The Symptoms?
A person who is symptomatic of lipedema (most likely to present in women — in fact, one in nine) will look symmetrically swollen in the affected area. In the lower body, the thighs, knees, and calves may look extremely disproportionate to the rest of the body. The fat will stop at the ankle and not affect the feet. In the midsection, lipedema will cause the lower abdomen skin to hang (like an apron). The buttock will not have an even amount of fat either because lipedema causes it to collect on the upper region only – thus the need for an upper buttock shelf treatment. The upper arms are the most visible area that can exhibit lipedema. The arm skin gets so heavy that it atrophies rapidly and looks pendulous (even at an early age). Like the feet, the hands will not show the signs of lipedema as it will stop at the wrist. The fat may take on a cellulite-like appearance, which is also known as "mattress skin." Lipedema can be very frustrating and debilitating, especially if it is undiagnosed. If you have lipedema, you may also experience the following:
- You have pain in the affected area
- Your skin is super sensitive to touch when it is inflamed
- You feel chronically fatigue or malaise
- You bruise easily
- You have medial knee fat pads
- Your skin is cooler to the touch than someone who does not have lipedema
- Your legs and feet may be swollen after standing or moving around
Dr. Schwartz sees patients in all stages and types of lipedema who suspect something is wrong or "not right" with their health when diet and exercise are not helping – no matter the level of effort. If you have lipedema, you may feel like you can't do anything for your situation. Dr. Schwartz is one of the few plastic surgeons that treats lipedema, and he wants his patients to feel normal and healthy.
What are the Types of Lipedema
There are five types of lipedema, which can develop in any body type. The area with lipedema will be hypersensitive to touch, present spider or varicose veins, and fat distributed in abnormal ways under the skin.
Type I: Buttock
The fat collection will not be distributed evenly on the buttocks. Lipedema will cause the fat to accumulate on the upper part of the buttocks only (known as the upper buttock shelf). If you have lipedema in the buttock area, you may wear a very large size in your midsection but a small in the upper body. This type of fat can make sitting rather uncomfortable and painful at all times.
Type II: Buttock/Hips/Thighs
You may see Type II lipedema as just having a "pear-shaped" figure, which is a normal reaction. However, when the fat buildup and swelling become more advanced, the buttock, hips, and thighs become very disproportionate to the rest of the body.
Type III: Hips/Thighs/Calves
Encompassing the entire lower body to the feet, Type III lipedema can make legs feel very heavy. With the enlargement of the hips, thighs, and calves, a patient with this type of lipedema may find it difficult to walk without feeling pressure and pain. There will be thick fat pads surrounding the knees and folds of fat on the inner and outer thigh. Commonly, Type III patients walk with the thighs rubbing together, which can lead to the break down of the skin and infections.
Type IV: Arms
Lipedema within the arms may be the most visible out of the five types and is present in 30% of all lipedema cases. With a large amount of fat in the upper arm, lipedema may create a "bat wing" appearance as the skin will hang. If the lipedema extends to the lower part of the arm, it will stop at the wrist. The lower arm skin will not hang like the upper arm, but it will look very swollen. This can make wearing T-shirts and form-fitting clothing uncomfortable. Sleeves can often feel very tight or collect at the underarm if too short.
Type V: Calves
Patients with lipedema in the calves only may benefit from wearing compression garments to help with the swelling. The enlargement of the calves will have a negative impact on the lower body in general as it will put pressure on the joints, disrupt the natural gait, and contribute more discomfort as it gets progressively worse.
What Are The Lipedema Stages?
Each stage can also be characterized as a beginning (early), middle, or severe degree of lipedema. The symptomatic features of lipedema can be categorized into four stages:
- Skin is still unaffected (no dimpling or cuffing)
- Body parts may start to look disproportionate but not severe
- Pain occurs but will feel better when the area is in a compression garment or elevated
- Will respond to treatment the best at this stage
- Skin will start to change in appearance (may see a cobblestone-like pattern in the skin)
- Swelling becomes more frequent and longer-lasting, even with elevation
- Lipomas (large, benign tumors) may be present
- Depending on the type of lipedema, Stage II should respond well to treatment
- Tissue affected by lipedema will naturally begin to feel hard and chronically appear swollen
- Connective tissue may feel fibrotic (knotty)
- Large amounts of fat will overhang and distort the shape of the body part
- Early onset arthritis on joints overburdened with the weight of excess fat
- Will not respond well to less invasive treatment methods
- The most aggressive form of lipedema (will not respond too well to most treatments)
- Extensive swelling and hardening of the legs and arms
- Multiple areas will have flaps of skin and folds of fat that overhang on the body
- Can develop lipo-lymphedema (non-pitting edema will present as pitting edema)
Is It Lipedema or Lymphedema?
While they share common characteristics, lipedema and lymphedema are not the same conditions.
- A patient with lymphedema has a blockage in the lymphatic system, which means fluid will not drain properly from the body. Lipedema is not initially as severe. It starts out as fat that is distributed in irregular ways under the skin that collects fluid within the fatty tissues. Not until lipedema is in the critical stages will it endanger and undermine the functionality of the lymphatic system.
- Lipedema symptoms present within both sides of the body. This is not true for lymphedema. You can have one healthy leg and one enlarged leg where the lymphatics are not working properly.
- Lymphedema does not discriminate at where it will show up, including the hands and feet. Lipedema will stop (or cuff) at the wrist or ankle, which is a hallmark characteristic of the condition.
- Diet and exercise may help keep either condition from getting worse, but it will not cure it. Losing weight is helpful but may not make a significant impact on the course of lipedema and/or lymphedema.
- A telling sign of lymphedema is a condition called pitting edema, which is only present in the late stages of lipedema or pre-lymphedema. By pushing on the skin with one finger, a lymphedema patient will retain the depression in the skin from the touch.
- Both conditions have a fluid buildup within the tissue. Lymphedema, however, has an accumulation of fluid that is protein based, not water based.
- A compromised lymphatic system from lymphedema can cause the skin to be prone to ulcers, infections, and blood clots.
There are many similarities and differences between these two conditions. Dr. Schwartz wants you to know that he will do what is necessary to provide you with a diagnosis that is appropriate for you.
How do You diagnose it?
Having an initial consultation at Total Lipedema Care with our knowledgeable plastic surgeon, Dr. Jaime S. Schwartz, is your first step into getting the medical help you need. The diagnosis will happen in stages (nonsurgical and surgical). Dr. Schwartz has well-trained eyes for spotting lipedema. He may perform a manual examination of your skin by massaging in the areas of question in search of nodules. He will also ask many questions regarding your health and look for the other telltale signs of this disorder. At this time, there are no blood tests to check for lipedema. If you decide to have the tissue suctioned out with liposuction, Dr. Schwartz can take a sample, study the fat tissue, and determine if the tissue is normal fat or lipedema.
Can Lipedema Be Treated?
You can manage lipedema, but the treatments (no matter how aggressive) will not cure it. Fortunately, you have Dr. Schwartz and his team if your symptoms seem to worsen after attempts to treat it. At Total Lipedema Care, we want you to feel your best and look healthy without the presence of the fluid-filled fat cells within your body from lipedema. We offer the medical management of lipedema cases in all stages or types. If left untreated, lipedema can progressively diminish the softness of your skin, your mobility, your self-esteem, and the quality of your life. Also, you increase your chances of developing blood clots and lipo-lymphedema, which can lead to skin ulcers, infections, and a severely blocked lymphatic system. Dr. Schwartz will recommend treatment based on your needs and stage of lipedema.
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Beyond Your Lipedema
It is easy for a doctor to misdiagnose you as just being overweight or obese because of the extra weight you carry. The fat on your body may tell a different story. This is why you need to consult with fat disorder experts and plastic surgeons well versed in lipedema. If you are looking for a doctor to find answers, treatment, and long-term management for lipedema, Dr. Schwartz and his team in Beverly Hills understand that lipedema treatment is not about fixing a cosmetic problem – it is about improving your quality of life with a medical intervention. Call and schedule your first appointment today.