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Background Lipedema is a chronic disorder presenting in women during puberty or other times of hormonal change such as childbirth or menopause, characterized by symmetric enlargement of nodular, painful subcutaneous adipose tissue (fat) in the limbs, sparing the hands, feet and trunk. Healthcare providers underdiagnose or misdiagnose lipedema as obesity or lymphedema. Materials and methods The benefits (friend) and negative aspects (foe) of lipedema were collected from published literature, discussions with women with lipedema, and institutional review board approved evaluation of medical charts of 46 women with lipedema. Results Lipedema is a foe because lifestyle change does not reduce lipedema fat, the fat is painful, can become obese, causes gait and joint abnormalities, fatigue, lymphedema and psychosocial distress. Hypermobility associated with lipedema can exacerbate joint disease and aortic disease. In contrast, lipedema fat can be a friend as it is associated with relative reductions in obesity-related metabolic dysfunction. In new data collected, lipedema was associated with a low risk of diabetes (2%), dyslipidemia (11.7%) and hypertension (13%) despite an obese average body mass index (BMI) of 35.3 ± 1.7 kg/m2. Conclusion Lipedema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema. More controlled studies are needed to study the mechanisms and treatments for lipedema.

Background Lipedema is a chronic disorder presenting in women during puberty or other times of hormonal change such as childbirth or menopause, characterized by symmetric enlargement of nodular, painful subcutaneous adipose tissue (fat) in the limbs, sparing the hands, feet and trunk. Healthcare providers underdiagnose or misdiagnose lipedema as obesity or lymphedema. Materials and methods The benefits (friend) and negative aspects (foe) of lipedema were collected from published literature, discussions with women with lipedema, and institutional review board approved evaluation of medical charts of 46 women with lipedema. Results Lipedema is a foe because lifestyle change does not reduce lipedema fat, the fat is painful, can become obese, causes gait and joint abnormalities, fatigue, lymphedema and psychosocial distress. Hypermobility associated with lipedema can exacerbate joint disease and aortic disease. In contrast, lipedema fat can be a friend as it is associated with relative reductions in obesity-related metabolic dysfunction. In new data collected, lipedema was associated with a low risk of diabetes (2%), dyslipidemia (11.7%) and hypertension (13%) despite an obese average body mass index (BMI) of 35.3 ± 1.7 kg/m2. Conclusion Lipedema is a painful psychologically distressing fat disorder, more foe than friend especially due to associated obesity and lymphedema. More controlled studies are needed to study the mechanisms and treatments for lipedema.

Das Lipödem ist weit mehr als einfach nur dickere und schmerzhafte Beine! Die Erkrankung Lipödem ist mit zahlreichen Mythen behaftet. Im ersten Teil dieser Übersicht werfen wir einen kritischen Blick auf zwei populäre Statements zum Lipödem; Statements, die vor Jahrzehnten schon Eingang in wissenschaftliche Publikationen gefunden haben und seither unkritisch und stetig wiederholt werden; Statements, die inzwischen zum selbstverständlichen Wissensallgemeingut von Lipödempatientinnen und vor allem auch von Lipödem-Selbsthilfegruppen geworden sind. In unserer Darstellung über die Mythen des Lipödems fokussieren wir uns in diesem Beitrag vor allem auf zwei Aspekte, die aufs Engste mit dem Lipödem verbunden sind: auf die Adipositas sowie auf die psychische Situation von Lipödempatientinnen – die wiederum eng mit der Adipositas in Zusammenhang steht. Dabei überprüfen wir zwei häufig publizierte Statements auf wissenschaftliche Evidenz: 1. „Das Lipödem ist eine progrediente Erkrankung”, 2. „Ein Lipödem macht psychisch krank”. Beide Statements widersprechen in hohem Maße unserer seit Jahren bestehenden täglichen klinischen Erfahrung mit diesem speziellen Patientengut. Gleichzeitig haben wir im Rahmen unserer umfangreichen Literaturrecherche festgestellt, dass es auch keine Evidenz für diese in den „Lipödemsprachgebrauch” eingegangenen Behauptungen gibt. Tatsachlich ist das Lipödem in der Regel keine progrediente Erkrankung! Vielmehr liegt bei Lipödempatientinnen häufig eine Gewichtsprogredienz (meist eine Adipositasprogredienz) vor, in deren Folge sich auch das Lipödem verschlechtern kann. Unsere Pilotstudie zum 2. Statement macht deutlich, dass in der Regel nicht das Lipödem Ursache von psychischen Erkrankungen ist. Hier weisen unsere Ergebnisse in die umgekehrte Richtung: Eine – vorbestehende – psychische Vulnerabilität kann ganz wesentlich zum Krankheitsbild Lipödem beitragen. Um das Lipödem in seiner ganzen Komplexität und Vielfalt zu erfassen, braucht es mehr als nur Medizin. Psychosoziale Therapieansätze sollten integraler Bestandteil eines wirksamen multimodalen Behandlungskonzepts sein. Neben den beiden dargestellten Mythen gibt es weitere, die sich um das Lipödem ranken. Diese werden in weiteren Ausgaben dieser Zeitschrift diskutiert werden.

Lipedema, the Unknown Abstract. Lipoedema patients suffer from the widespread ignorance of their pathology. Considering its chronic, progressive and invalidating character, the early diagnosis of the disease must constitute the challenge of their caregivers in order to limit medical wanderings and the occurrence of complex clinical pictures. Treatments allow the reduction of lipedema and its long-term control. Management must be individualized according to the stage of the disease. The adherence of the patient, the supervision and the support of the practitioner are essential for obtaining the best results.

Zusammenfassung Die Prävalenz der Adipositas ist in den letzten 15 Jahren weiter stark angestiegen. Dabei fällt besonders die deutliche Zunahme der morbiden Adipositas auf, die wiederum bei den Älteren besonders ausgeprägt ist. Da mit dem Alter auch venöse Thromboembolien, chronisch venöse Insuffizienz und sekundäre Lymphödeme zunehmen, steigt die Zahl der Patienten mit venösen oder lymphatischen Erkrankungen, die gleichzeitig schwer adipös und häufig multimorbide sind, überproportional an. Die Adipositas, vor allem die viszerale, verschlechtert alle Ödemerkrankungen, erhöht das Risiko für thromboembolische Erkrankungen und postthrombotisches Syndrom und kann alleinige Ursache sein für die Adipositas-assoziierte funktionelle Veneninsuffizienz ohne Nachweis von Obstruktion oder Reflux. Das Adipositasassoziierte Lymphödem stellt inzwischen den größten Anteil unter den sekundären Lymphödemen. Mehr als 50 Prozent der Lipödempatientinnen sind adipös, die bei ihnen im Verlauf zu beobachtenden sekundären Lymphödeme in der Regel Folge der Adipositas, nicht des Lipödems. Die Symptomatik wird bei allen Krankheitsbildern durch Gewichtsreduktion gebessert. Neben mechanischen Faktoren wie der Erhöhung des intraabdominalen und intertriginösen Drucks, der wiederum zu einer venösen Drucksteigerung in den Beingefäßen führt, sind es vor allem die durch die Zunahme des viszeralen Fettgewebes verursachten metabolischen, chronisch inflammatorischen und prothrombotischen Prozesse, die für diese Zusammenhänge verantwortlich sind, erkennbar an niedrigen Spiegeln von Adiponektin und hohen von Leptin, Insulin, intaktem Proinsulin, PAI-1 sowie proinflammatorischen Zytokinen (Il-6, Il-8, TNF-α). Therapeutische Maßnahmen müssen also in erster Linie auf die Reduktion der viszeralen Adipositas und damit der Hyperinsulinämie bzw. der Insulinresistenz sowie auf die Bekämpfung der chronischen Entzündung abzielen. , Summary The prevalence of obesity has continued to rise considerably during the last 15 years. There is a striking increase of cases with morbid obesity (BMI over 40 Kg/m2), especially among the elderly. Since venous thromboembolic events, chronic venous insufficiency and secondary lymphoedema also increase with age, the number of patients who suffer from these conditions and, at the same time, are obese and often multimorbid, rises disproportionately. Obesity, especially if it is visceral, causes all sorts of oedema to deteriorate, increases the risk of thromboembolic events and postthrombotic syndrome and can be the sole cause of the so called obesity-associated dependency- syndrome, or rather the obesity-associated functional venous insufficiency without obstruction or reflux, as it ought to be called, with its skin lesions characteristic of CEAP stages C4 to C6. Among the various causes of secondary lymphoedema obesity is by now the most common. Of patients suffering from lipoedema more than 50 percent are obese, with the secondary lymphoedema often to be seen in those cases being the direct consequence of obesity, not the lipoedema itself. In all the conditions mentioned above symptoms can be ameliorated by weight loss. Aside from mechanical factors like intraabdominal and intertriginous pressure which in turn raise the intravenous pressure in the legs, it is foremost the metabolic, proinflammatory and procoagulatory effects of the augmented visceral fat tissue which can explain the correlation between obesity and thrombosis, oedema and, probably, the skin changes, too. These effects can be identified by low levels of adiponectin, which has antiinflammatory and vasoprotective qualities, and high levels of leptin, characteristic of leptin resistance, inflammation and insulin resistance, insulin and intact proinsulin (precursor of insulin, indicating β-cell insufficiency). Plasminogen Activator Inhibitor-1 (PAI-1), preventing fibrinolysis, and proinflammatory cytokines like Interleukin-6 (Il-6), Interleukin-8 (Il-8) and Tumour Necrosis Factor-α (TNF-α) are also found to be raised. In addition to treating the acute or chronic symptoms by anticoagulation, compression, manual lymphdrainage and wound care, therapeutic measures must endeavour to sustainably reduce visceral fat tissue, and thus hyperinsulinaemia, insulin resistance and inflammation. English version available at: www.phlebologieonline.de

Lipedema: Which Etiological Pathways? Abstract. The pathogenesis and epidemiology of lipedema are uncertain, and its diagnosis often delayed. Lipedema almost exclusively affects women, and a link to sex hormones is likely. The metabolic risk of this accumulation of fat in the lower limbs is not known, and weight loss has no impact on the morphology of the lower limbs. Due to the aesthetic discomfort and frequent initial misdiagnosis which results in inappropriate treatment, this condition can lead to significant psychological suffering for the patient. A better understanding of this disease is essential to the proper diagnosis and support for these patients, as well as guiding them in the effective care.

In this mini-review pathology, diagnosis, signs and symptoms, as well as treatment of lipedema are discussed. As the cause of lipedema is unknown for nearly 80 years, therapy is supportive and aimed at prevention of progression of the disease. Symptoms, signs and phenotypes of these patients are well defined. Guidelines for treatment are clear. When supportive therapy is inadequate surgical tumescent liposuction is the treatment of first choice. Surprisingly, the unproven compression and manual lymphatic drainage therapies of lipedma patients are covered by insurance, while the rational tumescent liposuction is not covered. Quality of life, mobility, lipedema pain, altered gait all improved by tumescent liposuction and disease progression is slowed. Insurance coverage of this procedure will help lipedema patients greatly. Cost-benefit analyses should be made. Research in pharmacotherapy of lipedema that makes sense should be stimulated

Surgical Treatment for Lipedema Abstract. Lipedema is a progressive disease that occurs in adolescence and affects one in nine women. The signs are limited to the lower limbs. Early signs are nonspecific, which is why the diagnosis is often ignored. Later, pain and heaviness of lower limbs become predominant. Finally, at an advanced stage, tissue fibrosis is associated with significant edema. At this stage, patients become severely disabled and bedridden. At the early stage, the treatment is conservative. Liposuction is indicated at the onset of pain. Its effectiveness pain and long-term control has been demonstrated on. Finally, late stages require heavy and complex surgeries combining dermolipectomy and liposuction.

Lipedema is a chronic disorder of subcutaneous adipose tissue of unknown etiology not uncommon among post-puberty women. The disease has a negative impact on selfesteem, mobility, and quality of life. Lipedema is characterized by symmetrical, disfiguring hyperplastic adipose tissue combined with bruising and pain. Untreated lipedema fosters osteoarthritis, secondary lymphedema, limitedmobility, and psychosocial stigmatization. Treatment consists of conservative complex decongestive therapy and surgery by microcannular tumescent liposuction. Liposuction is the only available treatment capable to reduce the pathological adipose tissue durable and to prevent complications.

INTRODUCTION: Nowadays, liposuction is the most frequently performed aesthetic surgery procedure in Western Countries. This technique has had rapid development since the 1970s, when it was experimented for the first time by A. and G. Fischer. It is currently widely used in clinical practice for many different situations in aesthetic, reconstructive and functional fields. MATERIALS AND METHODS: This review aims to describe the historical evolution of liposuction by analyzing the transformation of the method in function of the introduction of innovative ideas or instruments. We have also focused on reporting the major clinical applications of this surgical technique, applicable to almost the entire body surface. We finally analyzed the complications, both major and minor, associated with this surgical technique. RESULTS: Liposuction is mainly used to correct deep and superficial fat accumulations and remodel the body contour. It has become an essential complementary technique to enhance the aesthetic result of many other aesthetic procedures such as reduction mammoplasty, abdominoplasty, brachioplasty, thigh lift and post bariatric body contouring. However, it can be largely used for the treatment of innumerable pathologies in reconstructive surgery such as lipomas, lipedema, lipodystrophies, pneudogynecomastia and gynecomastia, macromastia e gigantomastia, lymphedema and many others. The complication rate is very low, especially when compared with conventional excisional surgery and the major, complications are generally associated with improper performance of the technique and poor patient management before and after surgery. CONCLUSION: Liposuction is a safe, simple and effective method of body contouring. It has enormous potential for its application in ablative and reconstructive surgery, far from the most common aesthetic processes with a very low complication rate.

Lipedema an often overlooked but treatable disease Lipedema is a painful disease that affects some women between puberty and menopause through a subcutaneous fat accumulation especially in the lower extremities. Patients suffer from pain and pressure tenderness. The larger fat accumulation, especially on the inside of the thighs and knees, causes walking difficulties. This can successfully be treated by liposuction with good long-term results in terms of pain reduction and prevention of osteoarthritis development in the knee and ankle joints.

Lipedema is a chronic disorder of subcutaneous adipose tissue of unknown etiology not uncommon among post-puberty women. The disease has a negative impact on self-esteem, mobility, and quality of life. Lipedema is characterized by symmetrical, disfiguring hyperplastic adipose tissue combined with bruising and pain. Untreated lipedema fosters osteoarthritis, secondary lymphedema, limited mobility, and psychosocial stigmatization. Treatment consists of conservative complex decongestive therapy and surgery by microcannular tumescent liposuction. Liposuction is the only available treatment capable to reduce the pathological adipose tissue durable and to prevent complications.

The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). The recommendations are based on a systematic literature search and the consensus of eight medical societies and working groups. The guidelines contain recommendations with respect to diagnosis and management of lipedema. The diagnosis is established on the basis of medical history and clinical findings. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Other findings include edema, easy bruising, and increased tenderness. Further diagnostic tests are usually reserved for special cases that require additional workup. Lipedema is a chronic, progressive disorder marked by the individual variability and unpredictability of its clinical course. Treatment consists of four therapeutic mainstays that should be combined as necessary and address current clinical symptoms: complex physical therapy (manual lymphatic drainage, compression therapy, exercise therapy, and skin care), liposuction and plastic surgery, diet, and physical activity, as well as psychotherapy if necessary. Surgical procedures are indicated if - despite thorough conservative treatment - symptoms persist, or if there is progression of clinical findings and/or symptoms. If present, morbid obesity should be therapeutically addressed prior to liposuction.

Lymphedema is a chronic, progressive, and common but often unrecognized condition. The diagnosis of lymphatic disease on clinical grounds alone remains a challenge. Without proper diagnosis, therapy is often delayed, allowing disease progression. There is a need for a practical diagnostic algorithm and its imaging technique to guide clinical decision-making. The aim of this topical review is to provide a practical approach for assessing patients with suspected lymphedema and to give a critical appraisal of currently available imaging modalities that are applied in clinical practice to diagnose and map lymphatic disease.