Lipoedema (Lipedema)

Lipoedema is a long-term condition in which fat builds up symmetrically in the legs, hips and sometimes the arms, while the feet and hands stay slim. It affects women almost exclusively and usually starts or worsens around puberty, pregnancy or the menopause.

It is not ordinary weight gain. The affected fat is tender, bruises easily and responds poorly to dieting, so the upper body can slim down while the legs hardly change. It is often confused with obesity or lymphoedema, and many women wait years for the right name.

Symptome

• Disproportionately large legs or arms with a clear step at the ankle or wrist
• Heavy, aching legs that are painful to pressure
• Easy bruising without a clear knock
• Soft, nodular fat that feels like small beads under the skin
• Feet and hands that are not swollen, unlike lymphoedema
• Swelling that worsens through the day and in hot weather
• Difficulty finding clothes that fit both halves of the body

Ursachen und Risikofaktoren

The cause is not fully understood. It runs in families, and the timing around hormonal change points to an oestrogen-related effect on fat tissue and small blood and lymph vessels. It is not caused by overeating, although weight gain makes it worse and the two often exist together. In later stages the enlarged fat can overload the lymphatic system and produce a combined picture called lipo-lymphoedema.

Wie es diagnostiziert wird

• Clinical examination: The diagnosis is made from your history and the look and feel of the tissue. There is no blood test or scan that proves lipoedema.
• Stemmer sign and foot check: A skin fold at the base of the second toe that can be pinched, with slim feet, points away from primary lymphoedema.
• Ultrasound or venous duplex: Used to rule out vein disease and to measure tissue thickness, not to confirm the diagnosis.
• Lymphoscintigraphy: Reserved for cases where lymphatic damage is suspected as well.

Behandlungsmöglichkeiten

• Compression garments: Flat-knit compression reduces aching and heaviness. It does not remove the fat.
• Movement and weight management: Swimming, walking and cycling help symptoms and stop ordinary weight gain adding to the load on the legs.
• Manual lymphatic drainage: Can ease pain and swelling for a time, mainly where fluid is part of the picture.
• Lymph-sparing liposuction: Tumescent, water-assisted or power-assisted liposuction along the limb axis is the only treatment that removes the diseased fat. It usually takes 2 to 4 staged operations, because the volume removed in one session is limited for safety.
• Skin tightening surgery: Occasionally needed later if large volumes were removed and loose skin remains.

Wenn es dringend ist

Lipoedema itself is never an emergency. A leg that suddenly becomes red, hot and painful with fever may be cellulitis, and one-sided calf swelling with pain may be a deep vein thrombosis. Both need same-day care where you are, as does any breathlessness or chest pain after surgery.

Reisen nach Türkiye zur Behandlung

Staged liposuction for lipoedema is a common reason to travel, and it can be planned well. Be realistic about the calendar: each stage needs about a week in the city, compression for weeks afterwards, and a gap of 6 to 12 weeks before the next area. Long flights soon after large-volume liposuction raise clot risk, so ask about blood thinners and timing. Compression fitting, physiotherapy and weight support have to continue at home, so arrange them before you leave.

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