KEY TAKEAWAYS
- Lipoedema is a complex and poorly understood condition affecting fat accumulation in the legs and arms, almost exclusively in women. It is commonly misdiagnosed.
- Lipoedema is frequently mistaken for other conditions such as obesity, lymphoedema, other fat disorders, vascular conditions, and endocrine diseases. Accurate diagnosis and appropriate management are essential for the ongoing quality of life.
- Be Sculptured is exclusively a liposuction clinic in Sydney and Gold Coast that offers tumescent liposculpture procedures. This is considered the one of the most lymph-sparing standards of care to anaesthetise the fatty tissue prior to liposuction. Liposuction helps manage the signs and symptoms of lipoedema in the legs and in the arms.
What Lipoedema Is and Why It’s Often Misdiagnosed
Lipoedema is a chronic disorder of abnormal fat accumulation; it primarily affects the legs and sometimes the arms. It’s seen almost exclusively in women, and is believed to be driven by genetics and female hormonal changes associated with different stages of life.
The condition causes symmetrical fat buildup (i.e. even distribution on both sides of the body) that does not respond to diet, exercise, or even medical weight loss strategies. (While weight can be reduced, lipoedema fat is not lost evenly alongside the rest of the body; the legs – and potentially the arms – continue to look disproportionate and the fat itself appears abnormal.)
This condition can cause significant physical discomfort, pain, mobility issues, bruising, and emotional distress. It can make buying clothing difficult and, for a lot of women, has a very detrimental impact on self-esteem.
Lipoedema is also very poorly understood, and even doctors don’t always get the diagnosis correct. This can result in delayed or misdiagnosis and lead to inappropriate, inadequate, and ineffective advice and treatments and poor patient outcomes.
Common Conditions Confused With Lipoedema
There are several common medical and health conditions often mistaken for or confused with lipoedema. Some women with lipoedema are misdiagnosed with these. Note too that lipoedema can also co-exist with these conditions, complicating timely, accurate diagnosis further.
- Lymphoedema
- Obesity
- Cellulite
- Chronic venous insufficiency
- Iliac vein compression
- Cardiac (heart) or renal (kidney) conditions
- Rarer fat disorders, including Madelung’s disease, Dercum’s disease, and Acquired Lipodystrophy
- Fibromyalgia
Lipo-lymphoedema is a more advanced, severe form of dysfunction that occurs when lipoedema, obesity, and lymphoedema coexist.
Why is Lipoedema so Misunderstood?
Lipoedema was first described in 1940 at the Mayo Clinic in the USA. It was not, however, included in medical school curricula. Furthermore, and even to this day, research into it is relatively scarce; a majority of primary healthcare providers are not trained or properly informed on the condition to recognise and identify its unique signs or differentiate them from other, similarly-presenting health concerns such as lymphoedema and obesity.
Lipoedema has no conclusive diagnostic blood or imaging test. Many lipoedema symptoms and signs overlap with other conditions, and diagnosis is based on clinical observation. This can be very subjective, especially when the signs and severity of this condition are so variable between patients.
Add to this the issue of medical gaslighting, which is sadly too common, especially for women (and lipoedema only very rarely affects men). Many patients with lipoedema, especially in its moderate to severe forms, face societal (and medical) stigma and shame due to the belief that it is an issue of vanity and simply being overweight, as opposed to a legitimate medical condition.
Lipoedema vs. Other Conditions: Key Differences
Several key signs and symptoms of lipoedema differentiate it from other conditions.
Lipoedema vs Obesity – lipoedema generally only affects the legs (and sometimes the arms). The torso is usually a normal size, and the difference in body size between the top of the body and the bottom of the body can be significant. This makes buying clothing that fits properly and flatters challenging. Obesity, on the other hand, affects the entire body, is unlikely to cause soft tissue tenderness or pain, and usually responds to diet, exercise, and medical weight loss strategies.
Lipoedema vs Lymphoedema – lymphoedema is usually caused by venous disease, obesity, trauma, or in response to cancer or cancer treatment (e.g. radiation therapy). It often only affects one limb, is not symmetrical in its presentation, and usually also impacts the affected limb’s hand or foot.
Symmetry of Fat Distribution
Fat distribution (and hence the appearance of swelling) is bilateral and symmetrical; it affects both sides of the body equally. The soft tissue has palpable nodules that may feel like tiny grains of rice or be as big as hard peas or pearls. The skin does not “pit” when pressed. The hands or feet are almost always unaffected.
Pain and Sensitivity in Affected Areas
Lipoedema can be extremely physically uncomfortable. The affected legs or arms can feel heavy, fatigued, and painful. The tissues can be tender to the touch and may bruise very easily.
How is Lipoedema Diagnosed?
There is currently no specific diagnostic test for lipoedema. An experienced doctor who understands the condition will make their diagnosis based on a comprehensive clinical assessment that includes:
Assessment of Patient History
- Consideration offamily history of similar body type (parent, grandparent, sibling)
- Onset/worsening during puberty/hormonal contraceptive use/pregnancy/menopause
- Difficulty losing fat from affected areas, regardless of diet and exercise
- Tendency to bruise easily
- Tenderness, heaviness, fatigue, or pain in affected areas
- Loss of function/mobility and quality of life
Physical Examination
- Disproportionate fat accumulation of the limbs that is symmetrical
- Palpable nodules in the soft tissue
- Cuffing at the ankles/wrists (hands and feet are not swollen or “fat”)
- Negative “Stemmer’s Sign” = pinch test for lymphoedema
- Up to 70% of women with lipoedema exhibit signs of joint hypermobility
- Tissues usually feel soft (as opposed to lymphoedema, whereby tissues feel hard and tight)
- Pain is common
The Role of Medical Professionals in Diagnosis
The diagnosis of lipoedema requires a complete clinical examination by a supportive, qualified doctor who has the training and experience to understand and recognise the condition, knowing what to look for and appreciating the differences between lipoedema and other conditions that may present similarly. Visiting a really good GP (who ideally has experience diagnosing this condition) or a venous or lymphatic specialist is a great place for patients to initially seek help.
Diagnostic Tests for Lipoedema
There is no diagnostic test for lipoedema; diagnosis is based on a comprehensive clinical assessment and ruling out other medical issues. Imaging and other diagnostic tests may, however, be carried out to rule out other conditions. This is why it’s so important to visit an experienced doctor who understands lipoedema.
What to Do If You Suspect You Have Lipoedema
You may have lipoedema if you:
- Are biologically female
- Have a disproportionately overweight lower body compared with your upper body (torso).
- Fat accumulation is symmetrical (equal on the right and the left)
- Your ankles/feet are not affected; there is a “collar” of fat at the ankles
- Legs look lumpy or like “tree trunks”
- Fat itself feels tender, painful, and nodular
- Your legs bruise easily
Steps to Take for Accurate Diagnosis
Any unexplained swelling that has recently appeared requires that you see your GP as soon as possible.
If you are having ongoing symptoms and suspect you may have lipoedema, see your GP. Addressing this issue sooner rather than later will make managing it simpler and lead to better outcomes. It’s also important that you get an accurate diagnosis, as some similarly presenting conditions require very prompt attention.
Many GPs have only limited experience and expertise regarding this condition. Self-diagnosing does not replace a formal diagnosis, but “knowledge is power”, and you can (and should) play an active role in your medical care, advocating for yourself to get the diagnosis and treatment you deserve.
If your GP can’t help to your satisfaction, seek a second opinion.
Finding the Right Doctor
You need to see the right doctor. Seek a referral to a vascular surgeon, lymphatic disease doctor, dermatologist, obesity doctor, or a cosmetic proceduralist or plastic surgeon who has experience in liposuction/liposculpture for lipoedema.
Management options will depend on the stage and severity of the lipoedema and any concurrent or complicating medical issues.
If you suspect you may have lipoedema, book a consultation with Dr Meaghan Heckenberg at Be Sculptured.
Dr Heckenberg is an experienced medical doctor and a highly trained liposuction/liposculpture proceduralist. She has specific training to accurately diagnose and offer effective management for lipoedema. She has also had liposculpture herself, giving her a unique insight into understanding the patient experience.
Tumescent liposculpture is currently considered the standard of care for liposuction for lipoedema and helps to reduce or alleviate the symptoms of Stage 1 or Stage 2 lipoedema.
This is what we offer at Be Sculptured.
Contact Be Sculptured for a Consultation
Take the first step to managing lipoedema for a more comfortable life.
Book a consultation at Be Sculptured (at our Sydney or Gold Coast Clinic) now: visit our website or call 0484 898 977 during business hours.
You may also elect to complete our consultation form or email us at [email protected].
