Lipedema is a condition in which the fat in your body is not behaving as it should. This diseased fat grows in an abnormal structure and excessive amount, causing pain and discomfort.
The adipofascia – the connective tissue below the skin does not respond normally to diet and exercise making it difficult to loose weight despite your genuine efforts (Herbst, 2019). This blog will discuss the treatments for lipedema.
This blog is not meant to diagnose or treat any condition. You can read the post from top to bottom or navigate to the section that interests you by using this Table of Contents
Goals of Lipedema Treatment
While at present there is no cure for lipedema, there are three main treatment goals (Reich-Schupke, 2012):
- Improve the symptoms
- Prevent lipedema from progressing
- Prevent (or treat) Lipo-lymphedema
Treatment for Lipedema
There are several treatments for lipedema and it’s important to get the proper lipedema diagnosis so that you can begin treatment right away. This will help to manage the pain and slow the progression.
An appropriate diet is also important, but I will cover that topic in a separate blog on lipedema treatment diet.
Lipedema treatment can be classified as conservative treatment and surgery.
Conservative Lipedema Treatment
Conservative treatment for lipedema has several components, including;
- Skin care
- Exercise
- Decongestive therapy
- Manual lymphatic drainage
- Compression
- Pneumatic compression pump
- Weight management
- Deep breathing
These are the same treatments used to treat lymphedema so the best professional to work with would be a certified lymphedema therapist.
Skin Care for Lipedema
Taking care of the skin is always important, but when lipedema advances to lipo-lymphedema, then it becomes even more important. First of all, most people don’t know that the normal pH of the skin is slightly acidic at 4-6. You should use skin care products that match your natural pH to prevent the skin from drying out.
Dry skin can crack and cracked skin can get infected. This is all the more likely when lymphatic fluid is pooling just below the skin surface – that protein rich lymph is like a yummy buffet for bad bacteria.
If you suspect an infection get that looked at right away as skin infections can enter the blood and that is not something you want to mess around with. As a simple trick – draw a line around the red area so you can track if it is getting larger or smaller.
Exercises for Lipedema
As it is for all of us, exercise is definitely beneficial for lipedema. Some exercises that warrant special mention include (Herbst, 2021):
- Swimming or aquatics (water provides pressure of Lipo-lymphedema)
- Elliptical (easy on the joints and recruits the upper body)
- Yoga (deep breathing helps to move lymph fluid)
- Stationary bike (easier on the joints and a great leg workout)
- Whole body vibration plate (can help with balance and is great for beginners)
- Walking (a great all-round exercise, that costs very little and is accessible)
For the reasons mentioned above and more, exercise should be part of a lipedema treatment plan. Often mentioned by people with lipedema, but not included in the Standard of Care document is rebounding.
Two of the main benefits of exercise for lipedema are that it can help reduce non-lipedema body fat and it can help to reduce the fluid retention associated with lipo-lymphyedema (Reich-Schupke, 2012).
Compression for Lipedema
Compression for lipedema has two stages. First, the multilayer compression bandaging and then the compression garments. The bandaging should come first before the garments.
Multiplayer compression bandaging, is a form of decongestive therapy for lipedema. This is applied by a certified lymphedema therapist and using special short stretch bandages. This technique is also called “wrapping” and it the best way to help reduce the fluid that has built up.
The compression wrapping is usually left on for 23 hours a day and ideally is re-wrapped every day until the limb is no longer reducing. At this stage, you can be measured for compression garments, which can help to keep the swelling contained at this level. Your certified lymphedema therapist will give you instructions for your specific situation as to how long you should wear your wraps and how often they should be reapplied.
Lipedema Compression Garment
Once you have completed multilayer compression bandaging, then your certified lymphedema therapist will likely recommend custom compression garments. This can be either flat knit or circular knit and will include prescription grade compression measured in mmHg (millimetres mercury).
While it may take you some time to get used to wearing compression and it may feel uncomfortable at first, you will find that the compression will help to control your lipedema pain. The garments will also help to keep the lymphedema swelling under control. You should work with your lymphedema therapist to find the best options that you can put on and take off (don and doff) yourself.
As well as compression stockings/socks, thigh highs and full leg and panty compression garments there are also inelastic velcro options. Your therapist and fitter can help you find the right options. To read more about the various options and donning and doffing devices check out my blog on Lymphedema Products.
Your efforts will pay off, as women who consistently wear their compression, exercise and maintain a normal weight, usually have a distinctly better prognosis and milder course of lipedema (Reich-Schupke, 2012).
Lipedema Manual Lymphatic Drainage
Lipedema itself is not actually an “edema”, and so manual lymphatic drainage is only helpful if lipo-lymphedema is present (Reich-Schupke, 2012). If lymphedema is present, then manual lymphatic drainage or MLD can be very helpful for reducing pain and bruising tendency (Reich-Schupke, 2012).
For best results, MLD should be done in combination with compression therapy. That way, the reduction in swelling that is achieved by the MLD can be maintained with the compression.
Myofascial Therapy for Lipedema
According to the 2021 standard of care for lipedema, myofascial release and other manual techniques to reduce fibrotic restrictions and improve interstitial space should be done (Herbst, 2021). Of course, the intensity of the therapy needs to consider your individual tolerance to the treatment.
Myofascial release is used to reduce or eliminate scar tissue and adhesions. The technique uses slow gentle stretching of the connective tissue (fascia) to eliminate restrictions that cause pain and restrict range of motion.
The fascia is the thin layer of tissue that covers our muscles. Sometimes the fascia can be too restrictive, and despite the fact that is it thin, it is very strong and it can restrict healthy movement.
Lipedema Compression Pump
A pneumatic compression pump can be used to treat lipo-lipedema (Reich-Schupke, 2012) and lipedema pain and post-op recovery (Herbst, 2021). The pumps come with inflatable pants, that look something like a sleeping bag with two leg compartments. The garment may stop at the top of the legs or continue up to your chest – it will depend your individual needs.
After slipping your legs into the pouches and zipping (or velcro) closing the device, the air hose is connected to the pump which is turned on. The compression will begin in a graduated rhythmic cycle which you can program for your individual needs.
The main goal of the pneumatic compression pump is to move the lymphatic fluid. By moving that lymphatic fluid out of the lipedema space, it can reduce pain, increase your mobility, reduce your tendency to bruise. But, it can also reduce pain in lipedema and be used to reduce the risk of blood clots after lipedema liposuction (Herbst, 2021).
Lipedema Weight Management
People with lipedema are at increased risk of weight gain and developing obesity, and being overweight can worsen the condition (Kruppa, 2020). Unfortunately a well as gaining lipedema fat, an individual can can non-lipedema fat as well. That’s why getting the right diagnosis and referral to a registered dietitian that understands lipedema can be helpful.
The nutrition strategies would be to avoid weight gain, to lose non-lipedema fat if possible and to choose an anti-inflammatory diet. Read more about lipedema diet.
Deep Breathing for Lipedema
Deep breathing can be helpful for pain management and also for moving lymph fluid when lipo-lymphedema is present.
To read more about conservative treatment for lymphedema and lipo-lymphedema and see step-by-step instructions read The Complete Lymphedema Management and Nutrition Guide.
Lipedema Surgery
The surgical treatment for lipedema is liposuction which should be only done by a plastic surgeon that is experienced with lipedema as there are unique skills and tools that separate this from ordinary cosmetic liposuction.
Lipedema Liposuction
There are several forms of liposuction which can be used as a treatment for lipedema.
Tumescent Liposuction
In this form of liposuction a solution called Klein solution which is a mixture of normal saline, lidocaine, epinephrine and sodium bicarbonate is first used to saturate the lipedema fat. The microcannula is used by the surgeon to slide through the fat in tiny, rapid vibrations to break the fat, which is then suctioned out (Vyas, 2022).
Water-jet Assisted Liposuction (WAL)
Klein solution or saline is used as a jet that releases the fat, which is then sucked up the cannula. This method does not require the waiting period that tumescent requires.
Laser-Assisted Liposuction
This method is used in areas where there is fibrosis, like the back of the thighs.
Liposuction is generally done in stages and not by removing all the fat at once. You may need three or more sessions with waiting time in between.
Lipedema Liposuction Results
Reports of results of lipedema liposuction show improvements in (Vyas, 2022):
- Pain
- Muscle cramping
- Tightening
- Itching
- Edema
- Bruising
- Appearance
Unfortunately, liposuction can be very costly and with multiple surgeries usually required, you will want to get as much insurance coverage for the procedure as you can.
Mental Health for Lipedema
Working with a mental health professional such as a psychologist, psychotherapist or social worker can help with issues that often occur along with lipedema including depression, eating disorders or anxiety.
Lipedema Specialists
There are definitely some health professionals that can help you out. The first group would be Certified Lymphedema Therapists. These professionals can be physical therapists, occupational therapists, massage therapists or nurses who have done additional training. Their training in lymphedema, also teaches them how to manage Lipo-lymphedema and they can help you with your condition too.
Lipedema Surgeons are specialists in performing lipedema liposuction. The best way to find a lipedema surgeon is to ask others with lipedema who they worked with and what their experience was. Not everyone is a good candidate for surgery, so that will need to be determined in your work-up appointment.
Lipedema doctors are not quite so easy to find. I suggest you ask your certified lymphedema therapist for a recommendation for a doctor in your area. There is not a medical speciality for lipedema, but doctors that tend to know more about it would likely include vascular surgeons (since so many people with lipedema also have vein problems), or bariatric doctors (since so many people with lipedema also have obesity).
The most well known lipedema doctor who has published the most research on lipedema as well as the Practice Guidelines is Dr. Karen Herbst who has offices in Beverly Hills, California and Tucson, Arizona.
Lipedema Treatment Bottom Line
Lipedema is treatable, there are many avenues for you to explore. My clients have told me how much better they feel with the MLD, compression, pumps, exercise and lipedema diet. With lipedema liposuction, results are amplified even more from conservative treatment.
While there is a lot of self-care involved for lipedema, at least you finally know what you are dealing with and that there are some options to help you. I wish you the best with your lipedema treatment!
If you are ready to take your self care to the next level, then Lymphedema Nutrition School, would be a great place to learn about nutrition for your lipo-lymphedema! You will learn about the nutrition strategies, set goals for yourself and meet others with lymphedema and lipo-lymphedema.
References for Lipedema Treatment
Alcolea JM, Alonso AB, Arroyo BA et al. Documento de Consenso Lipedema 2018. Feb, 2018. Accessed Mar 30, 2022.
Herbst KL. Subcutaneous Adipose Tissue Diseases: Dercum Disease, Lipedema, Familial Multiple Lipomatosis, and Madelung Disease. [Updated 2019 Dec 14]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
Herbst KL, Kahn LA, Iker E, et al. Standard of care for lipedema in the United States. Phlebology. 2021;36(10):779-796. doi:10.1177/02683555211015887
Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. Dtsch Arztebl Int. 2020;117(22-23):396-403. doi:10.3238/arztebl.2020.0396
Reich-Schupke S, Altmeyer P, Stücker M. Thick legs – not always lipedema. J Dtsch Dermatol Ges. 2013 Mar;11(3):225-33. doi: 10.1111/ddg.12024. Epub 2012 Dec 11. PMID: 23231593.
Vyas A, Adnan G. Lipedema. [Updated 2022 Feb 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.
