Conservative Treatments vs. Surgery

Treatment

for Lipedema

Lipedema treatments fall into two general categories: conservative treatments, which are typically safe and easy to implement, and invasive treatment–liposuction surgery.

Conservative treatments cannot cure lipedema, nor can they eliminate your symptoms. Instead, conservative treatments can help you manage your symptoms and reduce the likelihood of further disease progression. Each of the treatment options listed below act to help decrease the size of the affected limb, either by reducing the volume of fat (adipose tissue) or fluid.

Lipedema is not just a disease of abnormal fat accumulation; it is also a disease of abnormal fluid accumulation. It is believed to advance in part through a vicious cycle whereby fat deposition and swelling increases the amount of new fat deposition and swelling. Managing limb volume by reducing fat and fluid accumulation can thereby help reduce symptoms AND prevent disease progression.

1. Exercise Therapy
Regular exercise is beneficial and is widely recommended.
Exercise can work two-fold: first it can increase fluid drainage from the limb by increasing the activity of the venous system, and second it can help reduce the risk of obesity. Exercise should (1) be enjoyable by the patient so that it can be performed regularly and become routine, and (2) not cause pain or risk of injury. Regular purposeful walking, swimming and cycling can be great options.

2. Weight Loss
Weight loss will NOT reduce abnormal fat deposits caused by lipedema. Patients with lipedema can lose weight until they have very little fat, but this has no impact on their abnormal fat deposits caused by lipedema. Lipedema is not the same as obesity and cannot be cured through weight loss. Weight loss can help PREVENT the worsening of lipedema. Patients should strive to maintain an appropriate body weight and lose weight if they are overweight or obese as obesity exacerbates the symptoms of lipedema and lymphedema.

3. Compression
Compression and/or bandaging can help reduce the accumulation of fluid that occurs with lipedema and prevent further accumulation. These garments are the same as those used for lymphedema management and differ from regular tensor bandages and athletic compression garments. Since compression is a central tool of lymphedema management, it is particularly effective in treating cases of lipo-lymphedema, where normal lymphatic function is impaired and/or insufficient to eliminate excess lymph fluid.

4. Manual Lymphatic Drainage (MLD)
MLD can help reduce swelling. Like compression garments and bandaging, MLD works most effectively on patients with greater levels of swelling. It therefore has little utility for reducing swelling in early cases of lipedema, where excess fluid accumulation is not yet observed and normal lymphatic function is still maintained. MLD is particularly effective in treating cases of lipo-lymphedema, as MLD is a central tool of lymphedema management.

5. Intermittent Pneumatic Compression (IPC)
IPC is a device that reduces limb swelling. It is primarily prescribed for the treatment of venous insufficiency and sometimes lymphedema. It is basically a sleeve with air chambers and a pump system that applies sequential air pressure to squeeze the limb and push fluid out of it. It may reduce help swelling for some lipedema patients where noticeable swelling is present. It can be used by some patients as a supplement to compression, MLD and exercise therapy, if these are deemed insufficient.

Diuretics and laxatives are entirely ineffective against lipedema, as is weight loss in patients with otherwise normal body fat composition.

Surgery may be a treatment option for some to reduce the abnormal fat deposits caused by lipedema and is usually performed in multiple sessions. Following liposuction, women will typically benefit from compression therapy and MLD and should strive to maintain an active lifestyle and manage their weight to help delay the return of the condition. Surgery appears to also reduce the tendency to bruise and the symptoms of pain with pressure in lipedema patients. Surgery can improve patient mobility by removing fat deposits that are physically impairing mobility.

Davey, R. (2018). Patient Guide: Treatment of Lipedema and Lipolymphedema. Toronto Physiotherapy. Retrieved from: https://torontophysiotherapy.ca/patient-guide-lipedema-lipolymphedema-treatment/

Have something to share with others in the lipedema community? Please use the contact form.