• What is Lipoedema?

  What is Lipoedema?

  Lipoedema is often described as the painful fat disease, thought to be genetic, female dominant, due to being at it’s worst or progressive in the times of hormonal changes for women (puberty, pregnancy menopause & perimenopause) but it has, on rare occasions, been known to affect men as well affected by elevated estrogen.

  Lipoedema is defined as fat cells, surrounded by an over production of thick and hard collagen fibers (connective tissue), usually quite thin in normal adipose tissue. Causing fibrosis and a painful heaviness.

  This can also affect surrounding nerves, becoming entrapped in the hard connective tissue, blood flow and lymphatic flow. Causing oxidative stress markers (imbalance of oxygen in the tissues) increased inflammation compared to an otherwise unaffected body, equating to more pain, more metabolic changes, which over time interrupts the clean environment and smooth running of the lymphatic system.

  Here’s what I look for when assessing for Lipoedema

  ~ body composition, increase in adipose/fat tissue in the legs, abdomen, hips, arms or calves alone, compared to the rest of the body.

  ~ heaviness, pain or tender to touch, the fat deposits can also hurt for no reason at all (likely due to the enlarged deposits surrounded by inflammation)

  ~ easy bruised

  ~ skin may feel extra soft, cool to touch, doughy, dimply, lost elasticity, over stretched and with an orange peel appearance.

  ~ hard like nodules under the skin

  ~ onset of oedema / swelling appearance, excluding the feet (unless compromised by venous insufficiency or lymphoedema)

  ~ family history

  In addition to the above, those with lipoedema may also suffer from:

  ~ being overweight / obesity (which is independent to lipoedema)

  ~ decreased mobility & physical activity

  ~ mental health concerns e.g. chronic stress, depression, eating disorders from a lifetime of dieting

  ~ lack of self-acceptance due to appearance and beauty ideals

  Treatment of lipoedema should also take into account these aspects, which are not always as obvious as the physical changes and reported symptoms.

• Stages of Lipoedema

  Stages of Lipoedema

  There are 4 stages of Lipoedema

  Stage 1 – normal skin surface with enlarged areas of fat

  Stage 2 – Uneven skin with indentations in the fatty areas, lumpy appearance

  Stage 3 – large extrusions of tissue causing deformations (thighs & knees)

  Stage 4 – Lipoedema with Lymphoedema (lipo-lymphoedema)

• Types of Lipoedema

  Types of Lipoedema

  There are 5 types of Lipoedema

  Type I – waist to buttocks & hips (saddle bag phenomena)

  Type II – waist to knees

  Type III – waist to ankles

  Type IV – arms

  Type V – lower legs only

  One characteristic that is persistent is the enlargement of hips buttocks and legs. Fat in these areas remain unaffected by weight loss efforts involving diet, exercise, weight loss medications, weight loss surgery, even though weight is lost from unaffected areas.

• Treatment for Lipoedema

  Treatment for Lipoedema

  There is lots of differing opinions on whether Lipoedema should fall under the oedema umbrella. Some reference other conditions causing the oedema, and others argue that there is an effect on swelling in the tissues with only pure lipoedema.

  Rather than pick a side, let’s just run with the consensus that until more is known and researched about the condition, we should treat our clients according to their grievances and symptoms.

  I have Lipoedema Stage 1, Type 3, and I could argue that since wearing my compression my limb size, pain and swelling has gone down considerably. Whether or not, this is relatable to a dynamic oedema or from an obstruction of the lymphatics? But the most important thing is I feel better for it. We can only manage our symptoms with the help of a professional and learned skills/tools to use at home.

  Keep in mind that each individual is different, so it’s hard to recommend a quantifiable number of treatments to get you through. I would always suggest talking to a specialised lymphoedema therapist as your first point of call, get everything else checked out and go from there.

  Additional problems can be a likely accompaniment to Lipoedema, such as, chronic venous insufficiency, excess weight gain and associated problems, abdominal and menstrual cycle issues, PCOS, endometriosis, ademyosis, irritable bowel, and they are still discovering more….. all of which, MLD (hands on manual lymphatic drainage) can be very helpful.

  In the later stages of Lipoedema, and due to less mobility, it then, if it hasn’t already, starts to affect the lymphatic system. Your lymphatic system relies heavily on movement, muscle contraction, good strong active heartbeats, deep breathing etc…… so when you come for an appointment with me, it’s more about looking at the full picture, rather than just Lipoedema. And there are a lot variables to consider.

  Treatment options available in clinic with Sal

  • (MLD) Manual hands-on lymphatic Drainage
  • Combined (MLD) & Pneumatic Compression Pump
  • Decongestive Therapy – Bandaging
  • Wound Management
  • Scar & fibrosis management
  • Low Level Laser Therapy
  • Muscle & Myotherapy treatments (see muscle pages for details)

  In the meantime… 

  ‘See the Conservative Management @ Home page for tips on home care

  If all else fails and you’re still not getting enough relief, lipoedema specialised liposuction surgery may be a good option for you.

  If you were wanting to go down the surgery path, I would encourage you to do your homework, not all cosmetic or plastic surgeons are the same, and not all are well educated on lipoedema either.

  Also keep in mind, MLD treatment, compression garments / pneumatic pump and nutrition will be extremely important pre & post surgery. Get in touch to discuss treatment packages to ensure optimal results and a speedy recovery.

• Are you considering liposuction surgery?

  Are you considering liposuction surgery?

  I haven’t had surgery myself but I treat and talk to many that have.

  Surgery can provide you with relief from pain and symptoms, and may give you not only better looking legs, but better mobility and overall quality of life. It’s about personal choice, and what you need to make you feel better, for the body, mind and soul.

  Be sure to clean up your diet, get moving as soon as able to enjoy the best possible long lasting result.

  An absolute must, to be included in your budget, is your before and aftercare. There will be an element of damage done to your lymphatic system, which will need professional help to recover properly.

  If you choose to go down this path, it’s very important that you find a surgeon well educated and experienced in the treatment for Lipoedema, and better yet seek a Specialist Plastic Surgeon.

  You can find one near you via the ASAPS registrar https://aestheticplasticsurgeons.org.au/

  Each surgeon has a different surgery protocol. So it’s important you do your homework. Some will just perform liposuction, another liposuction plus incision and skin removal. Some can do either but will evaluate and determine case by case what will best suit your condition etc….

  I know there can be quite a waiting period to get a consult and then a surgery date. But the delayed wait time is a good opportunity to do your due diligence. 

  Pre Surgery Checklist 

  • Goals
  • Expectations
  • Realistic timelines
  • Costs – budget and know what you are paying for 
  • Hospital costs
  • Surgery costs
  • Anaesthetist
  • Time off work – 2-4 weeks minimum
    • Trouble bending knees
  • Compression Garments before & after surgery (with front zips)
  • Pneumatic Compression Pump 
  • MLD Treatments Pre- Surgery (x 2-3) in the days leading up to
  • Home carer – will be hard work, they also need to be prepared
    • If travelling overseas need a support person with you (faint risk)
  • Mental Health check – See psychologist 
  • Find some chat / support groups, chat with others that have been to same surgeon etc… Facebook or Whats App (some surgeons will direct you to some)
  • Diet changes now
    • Prepared meals (freezer)
  • Iron levels need to be normal going in
  • Best health practices for best outcomes
  • Sleep
    • Extra Pillows for comfort in bed
  • Exercise / movement now
  • Wear your garments now
  • Health Funds – Check cover
  • Request forms for travel & accomodation claims
  • Research
  • Surgeons (Plastics over cosmetic) Lipoedema specialist is best for Lipoedema
  • Types of surgery
  • Surgery Outcomes
  • Reviews
  • Patient experiences
  • Supplies
    • puppy pads for your bed – leaking lymph
    • walking stick is very handy for first 2 weeks as you may be feeling dizzy
    • Over the counter pain killers
    • unsweetened cranberry juice
    • Bathroom wipes
    • Probiotics after antibiotics
    • Heparin / bruise cream
    • Post surgery clothes, dark colours, long dresses or loose linen pants, to hide the leaking for 1-2 weeks
    • Cooling fan – air conditioning
  • Be prepared

   

  Post Surgery Checklist

   

  Hospital 

  • Get up and walk as soon as possible
    • it’s the muscle pump that helps get the fluid moving
  • Speak up to health professionals
  • It’s major surgery, everything you feel counts
  • Compression on 24/7 for up to 6 weeks, depending how progressing.

   

  Team of Therapists

  • Surgeon – follow-ups and ensure you let them know if there are any problems, phone consults if you need assistance before scheduled appointment
  • GP – make sure they are on board and  aware of your plans
  • Psychologist – this is a big deal and the no.1 key recovery component mentioned by others is your mental health
  • MLD Therapist – you can’t do this alone, pre-book your post recovery appointments before your surgery for 10 days post op, (minimum 2 x per week for 4-6 weeks).
  •  

  Home Care

  • Pneumatic Compression Pump (practiced and used prior to surgery)
  • Garment Assistance
  • Home carer available for….
  • Bathing / Dressing / Grooming / Toileting
  • Meal prep / Housekeeping / Shopping / Communication / Community Access / Recreation / Vocation
  • Consider what you will need for your mental health as well and that your at home support person is on board for helping do them.

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