Treatment Of Lipedema Research Articles

Treatment Of Lipedema Using Cryolipolysis Associated With Microcurrents

Through a literature review, we present the technique of cryolipolysis with a mobile gauntlet as a treatment for lipedema. Since lipedema is a chronic disease with a high incidence that affects body aesthetics and self-esteem, it needs treatment in order to avoid emotional illnesses. Lipedema is a disease that occurs in adipose tissues through primary lipotrophy characterized by abnormal fat deposition, mainly in the buttocks and legs bilaterally. The mobile gauntlet technique associated with beta adrenergic stimuli promotes the biogenesis of mitochondrial crests, acting on beige adipose tissue as a treatment for obesity and comorbidities due to its thermogenic and neurogenic effect. The described technique is applied using the plates on a movable gauntlet in 4 cycles of 5 minutes in each 30 x 30 cm area associated with the use of microcurrents. Objective:The objective of this study was to review the literature on the cryolipolysis technique using a mobile handle and its association with microcurrents in lipedema in order to reduce adipose tissue and tone the dermis, reducing pain and the volume of lipedema, with the presentation of clinical cases. Materials and Methods: In this study, we performed a comprehensive review of all scientific articles available and indexed in PubMed and Web of Science over the last 20 years on this technology and its effects on lipedema. We discussed the scientific evidence available from clinical studies and analyzed the effects and possible mechanisms of action on lipedema by associating microcurrents. The treatments were performed using the mobile plate cryolipolysis handle technique, with intervals for reperfusion. We used 4 series of 5 minutes of freezing and in the intervals 3 minutes for return of circulation, that is, reperfusion without injury. We demonstrated the result after 3 sessions. Results: The association of cold with stimulation of the sympathetic nervous system through electrotherapy promotes activation of the PERK and MICUS systems. The action of freezing and simulating physical activity through microcurrent (release of hormones similar to physical activity) after lipolytic stimuli (electrolipolysis) encounters an environment with many lipid droplets that influence the organization of the ridges; Mitochondria perform β-oxidation of fatty acids, but when stimulated by cold, drastic changes in morphology occur due to activation of PERK; (Gallardo-Montejano, 2021). The mobile handle promotes the selective reduction of adipose cells and is effective in the treatment of cellulite and lipedema through the remodeling of dermal collagen (cryodermatringe). Histological analysis confirmed a selective and gradual reduction of adipose tissue by programmed death (apoptosis) triggered by reperfusion. The safety of the method is highlighted by the absence of significant increases in liver enzymes or serum lipids. Molecular studies did not demonstrate changes in peroxisome proliferator-activated receptor (PPAR) transcripts. No changes were evident in the transcripts, which highlights the safety of the technology used (Ferraro, 2012). In our case study, the patients were satisfied with the results, as shown in the photos. Conclusion: The literature review presented histological and biochemical aspects of lipedema. Although it is a disease considered primary lipodystrophy, with a high incidence, more studies on treatments are still needed to improve the quality of life and self-esteem of those with the disease. Among the treatments presented in the literature, the cryolipolysis technique with a mobile handle is presented as a treatment that reduces adipose tissue, as well as reduces the process of edema and inflammation with the association of microcurrent. The plates promote reperfusion in adipocytes, generate reactive oxygen species (oxidation) and activate apoptosis. Adipocytes are reactive to thermal shocks. The mobile handle promotes the selective reduction of adipose cells and is effective in the treatment of dermal collagen remodeling. Concomitant with this effect, there is the activation of PERK, which phosphorylates N-acetylglucosamine transferase (OGT), phosphorylating TOM70 at Ser94, increasing the import of the MIC19 protein into the mitochondria and promoting the formation of ridges and the formation of beige adipose tissue, rich in UCP1, which reinforces our hypothesis that in lipedema we need to inhibit transcription factors, PPRA gamma, and adipocyte typology starting with the mitochondria and their organelles responsible for inhibiting apoptosis (NAIPS).

S2k guideline lipedema.

This S2k guideline was developed on the initiative and under the German Society of Phlebology and Lymphology (DGPL) leadership. The guideline aims to optimize the diagnosis and treatment of lipedema. It is intended to bring together the different approaches of the respective professional groups in a consensus-based manner and thus offer a basic concept for the best possible treatment of patients with lipedema. Sixty recommendations were formulated and agreed on in diagnostics, conservative and surgical treatment options, psychosocial factors and self-management. The guideline is intended to reflect the current scientific knowledge and be widely used for diagnosis and treatment recommendations for patients with lipedema. In particular, the guideline comments on diagnostic criteria, differential diagnoses, and coinciding clinical pictures, their influence on diagnosis and treatment, sensible treatment measures, and self-management options. The lipedema guideline summarizes the current national and international evidence and the German expert consensus and derives recommendations for the best treatment for patients with lipedema. The recommendations in the guideline are intended as an orientation aid in the sense of action and decision-making corridors from which deviations are possible in justified cases.

Efficacy of Liposuction in the Treatment of Lipedema: A Meta-Analysis.

Lipedema, a chronic and painful disorder primarily affecting women without a definitive cure, has traditionally been managed with conservative therapy, notably complete decongestive therapy, across many countries. Recently, liposuction has been explored as a potential surgical treatment, prompting this study to evaluate its effectiveness as possibly the first-line therapy for lipedema. Through extensive literature searches in databases such as CrossRef, Web of Science, PubMed, and Google Scholar up to December 2023, and using the Newcastle-Ottawa Scale for quality assessment, the study selected seven studies for inclusion. Results showed significant post-operative improvements in spontaneous pain, edema, bruising, mobility, and quality of life among lipedema patients undergoing liposuction. However, over half of the patients still required conservative therapy after surgery. Despite these promising results, the study suggests caution due to lipedema's complexity, significant reliance on self-reported data, and limitations of the studies reviewed. Thus, while liposuction may offer symptomatic relief, it should be considered an adjunct, experimental therapy rather than a definitive cure, emphasizing the need for a comprehensive approach to care.

Patient-Reported Outcomes of Liposuction for Lipedema Treatment.

Lipedema, as a disabling and consequential disease, is gaining more awareness due to its potential omnipresence. Patients suffering from lipedema show a characteristic painful display of symmetric accumulations of adipose tissue. The combination of swelling, pain and decreased quality of life (QOL) is outstanding for the diagnosis. The aim of this study was to identify the effect of liposuction in terms of the QOL for patients and underline important factors of current and pending research regarding surgical therapy of lipoedema. Patients suffering from lipedema prior to and after receiving liposuction at our hospital were included in this study. Patients completed a lipedema-specific self-designed 50 item questionnaire: the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Patient Health Questionnaire 9 (PHQ-9). A linear mixed model was used for outcome analysis. In total, 511 patients completed a questionnaire prior to the surgery at primary presentation to the hospital and a total number of 56 patients completed a questionnaire after liposuction. A total of 34 of these patients filled in both questionnaires prior to and after surgery. The general characteristics of the disease, such as daily symptoms and psychological health, pertinently improved after surgery. Liposuction can have a general improving effect on the QOL of patients, both in private and professional life. Liposuction may currently be the most evident and promising method in the treatment of lipedema.

Dietary supplements for lipedema.

Lipedema is a chronic disease that mostly manifests in females as the abnormal distribution of subcutaneous adipose connective tissue, usually coupled with bruising, pain, and edema. Lipedema molecular pathophysiology is currently not clear, but several studies suggest that genetics and hormonal imbalance participate in lipedema pathogenesis. Women with lipedema present in some cases with elevated body mass index, and the appearance of obesity in addition to lipedema, where the obesity can cause serious health issues as in lipedema-free individuals with obesity, such as diabetes and cardiovascular disorders. Unlike obesity, lipedema tissue does not respond well to diet or physical exercise alone. Therefore, in this review we discuss the effect of various dietary supplements that, along with diet and physical exercise, cause fat burning and weight loss, and which could potentially be important in the treatment of lipedema. Indeed, an effective fat burner should convert stored fats into energy, mobilize and break down triglycerides in adipocytes, boost metabolism and inhibit lipogenesis. Common ingredients of fat burning supplements are green tea, caffeine, chromium, carnitine, and conjugated linoleic acid. The use of fat burners could act synergistically with a healthy diet and physical exercise for decreasing adipose tissue deposition in patients with lipedema and resolve related health issues. The effects of fat burners in human studies are sometimes contradictory, and further studies should test their effectiveness in treating lipedema.

A randomised controlled multicentre investigator-blinded clinical trial comparing efficacy and safety of surgery versus complex physical decongestive therapy for lipedema (LIPLEG)

BackgroundLipedema is a chronic disorder of the adipose tissue that affects mainly women, characterised by symmetrical, excessive fatty tissue on the legs and pain. Standard conservative treatment is long-term comprehensive decongestive therapy (CDT) to alleviate lipedema-related pain and to improve psychosocial well-being, mobility and physical activity. Patients may benefit from surgical removal of abnormally propagated adipose tissue by liposuction. The LIPLEG trial evaluates the efficacy and safety of liposuction compared to standard CDT.Methods/designLIPLEG is a randomised controlled multicentre investigator-blinded trial. Women with lipedema (n=405) without previous liposuction will be allocated 2:1 to liposuction or CDT. The primary outcome of the trial is leg pain reduction by ≥2 points on a visual analogue scale ranging 0–10 at 12 months on CDT or post-completion of liposuction. Secondary outcomes include changes in leg pain severity, health-related quality of life, depression tendency, haematoma tendency, prevalence of oedema, modification physical therapy scope, body fat percentage, leg circumference and movement restriction.The primary analysis bases on intention-to-treat. Success proportions are compared using the Mantel-Haenszel test stratified by lipedema stage at a 5% two-sided significance level. If this test is statistically significant, the equality of the response proportions in the separate strata is evaluated by Fisher’s exact test in a hierarchical test strategy.DiscussionLIPLEG assesses whether surgical treatment of lipedema is safe and effective to reduce pain and other lipedema-related health issues. The findings of this trial have the potential to change the standard of care in lipedema.Trial registrationClinicalTrials.gov NCT04272827. Registered on February 14, 2020.Trial statusProtocol version is 02_0, December 17, 2019

Differential diagnoses and treatment of lipedema

Lipedema is a frequently unrecognized and misdiagnosed disorder of the fatty tissue of extremities and hips, which affects almost purely women. The beginning of the disease usually occurs with hormonal changes, such as puberty, pregnancy, or menopause. Women suffer from pain, easy bruising, and disfigurement, which may lead to early immobility and social stress. Accurate diagnosis and treatment are essential. The differentiation between obesity and lipedema is difficult, as these two different entities often occur together. Other differential diagnoses are lymphedema, benign lipohypertrophy, and Dercum’s disease. A therapy targeting the underlying cause of lipedema is not available because the exact etiology of the disorder is not clarified yet. Decongestive physical therapy is the basic conservative treatment, which is usually necessary lifelong. However, liposuction has led to a paradigm shift in the treatment of lipedema. The purposes of this article are to describe the symptoms and treatment options of the still fairly unknown disease Lipedema and to show the distinctions to its differential diagnoses.

Comparison of Complete Decongestive Therapy With Intermittent Pneumatic Compression for Treatment of Lipedema

Comparison of Complete Decongestive Therapy With Intermittent Pneumatic Compression for Treatment of Lipedema

Treatment of lipedema by low-volume micro-cannular liposuction in tumescent anesthesia: Results in 111 patients.

Lipedema is a painful disease of subcutaneous adipose tissue leading to bilateral increase of leg and/or arm volume, but sparing hands and feet. Although conservative treatment with complex decongestive therapy has been considered as the fundamental treatment, micro-cannular liposuction in tumescent anesthesia has become a surgical option. We report on 111 patients mostly with advanced lipedema treated by this technique in our center between 2007 and 2018. The median age of the patients was 44 years. Eighty percent of patients had at least one comorbidity. There was an association of longstanding and advanced disease to obesity and diseases of the metabolic syndrome-spectrum. The median total amount of lipoaspirate was 4,700 ml, with a range of 950-14,250 ml. The median reduction of limb circumference was 6 cm. The median pain level before treatment was 7.8 and 2.2 at the end of the treatment. An improvement of mobility could be achieved in all patients. Bruising was also reduced. Serious adverse events were observed in 1.2% of procedures, the infection rate was 0% and the bleeding rate was 0.3%. Liposuction is an effective treatment for painful lipedema. The procedure should be performed in specialized centers.

Liposuction in the Treatment of Lipedema: A Longitudinal Study.

BackgroundLipedema is a condition consisting of painful bilateral increases in subcutaneous fat and interstitial fluid in the limbs with secondary lymphedema and fibrosis during later stages. Combined decongestive therapy (CDT) is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical treatment option. The aim of this study was to determine the outcome of liposuction used as treatment for lipedema.MethodsTwenty-five patients who received 72 liposuction procedures for the treatment of lipedema completed a standardized questionnaire. Lipedema-associated complaints and the need for CDT were assessed for the preoperative period and during 2 separate postoperative follow-ups using a visual analog scale and a composite CDT score. The mean follow-up times for the first postoperative follow-up and the second postoperative follow-up were 16 months and 37 months, respectively.ResultsPatients showed significant reductions in spontaneous pain, sensitivity to pressure, feeling of tension, bruising, cosmetic impairment, and general impairment to quality of life from the preoperative period to the first postoperative follow-up, and these results remained consistent until the second postoperative follow-up. A comparison of the preoperative period to the last postoperative follow-up, after 4 patients without full preoperative CDT were excluded from the analysis, indicated that the need for CDT was reduced significantly. An analysis of the different stages of the disease also indicated that better and more sustainable results could be achieved if patients were treated in earlier stages.ConclusionsLiposuction is effective in the treatment of lipedema and leads to an improvement in quality of life and a decrease in the need for conservative therapy.

Lipedema: A Relatively Common Disease with Extremely Common Misconceptions.

Lipedema, or adiposis dolorosa, is a common adipose tissue disorder that is believed to affect nearly 11% of adult women worldwide. It is characterized most commonly by disproportionate adipocyte hypertrophy of the lower extremities, significant tenderness to palpation, and a failure to respond to extreme weight loss modalities. Women with lipedema report a rapid growth of the lipedema subcutaneous adipose tissue in the setting of stress, surgery, and/or hormonal changes. Women with later stages of lipedema have a classic “column leg” appearance, with masses of nodular fat, easy bruising, and pain. Despite this relatively common disease, there are few physicians who are aware of it. As a result, patients are often misdiagnosed with lifestyle-induced obesity, and/or lymphedema, and subjected to unnecessary medical interventions and fat-shaming. Diagnosis is largely clinical and based on criteria initially established in 1951. Treatment of lipedema is effective and includes lymphatic support, such as complete decongestive therapy, and specialized suction lipectomy to spare injury to lymphatic channels and remove the diseased lipedema fat. With an incidence that may affect nearly 1 in 9 adult women, it is important to generate appropriate awareness, conduct additional research, and identify better diagnostic and treatment modalities for lipedema so these women can obtain the care that they need and deserve.

Diagnosis and treatment of lipoedema

SummaryThe following article is a summary of important benchmarks of the new guideline for diagnostics and treatment of the lipoedema, whish was updated October 2015.

Commentary on: isolation and differentiation potential of human mesenchymal stem cells from adipose tissue harvested by water jet-assisted liposuction.

In this article, Meyer et al examine the yield of mesenchymal stem cells (MCSs) with water jet-assisted liposuction (WAL).1 WAL uses simultaneous infiltration and suction to dissect and extract fat during liposuction. Using water to dissect tissues is an idea that evolved in the last century and was later geared towards the dissection of fat in 2001.2 Since that time, a number of studies have suggested advantages to the use of WAL, including decreased pain, decreased intraoperative swelling, better contouring, and decreased need for anesthesia.3-5 The gentle nature of WAL has been utilized in the treatment of lipoedema, where clinicians noted that this aspiration method may induce less trauma to lymphatics.6 With the evolution of fat grafting, the utility of WAL for fat harvest has been explored.5 Harvest method can certainly impact graft …

Liposuction: A Surgical Tool to Improve the Quality of Life after Morbid Medical Conditions: Review of Literature

Introduction: The purpose of this literature review is to conduct a systematic review of the clinical applicability and safety of the liposuction technique and to familiarize the reader with the scope of non-cosmetic indications. The procedure of liposuction used not only as a tool of rejuvenation but also used to improve the quality of life after many disabling medical conditions such as: Lipomatosis syndromes, Adipose tissue diseases, chronic lymphedema of the extremities, fasciocutaneous, and myocutaneous bulky Flaps, subcutaneous lipomas, axillary Hyperhydrosis, post ablative surgery and Radio dermatitis. Methods: An online search of the Cochrane Library, MEDLINE, Embase and SciELO was conducted. Studies included in the review were 47 original articles reported from 1982 to February 2014. The articles included the use of liposuction for treatment of non-cosmetic and disabling medical conditions, with description of clinical applications and complications. The criteria used for papers selection were: papers with large size of samples, papers with significant statistics, and original papers. The case reports were excluded. Results: There was a broad agreement in the reviewed literature about the applicability and the efficacy of the liposuction for treatment of these chronic medical conditions. Literatures review confirmed that this technique has provided significant and stable cure. Conclusion: Liposuction is the most frequent aesthetic procedure world-wide for adipose tissue reduction and treatment of lipedema. Apart from aesthetic indications, liposuction also is suitable for treatment of chronic medical diseases and non-cosmetic conditions. It alternates some of surgical procedures like debulking of flaps, undermining the subcutaneous tissues. It is an adjuvant tool for breast reconstruction. Liposuction is not a simple procedure but requires extensive knowledge and experience to prevent irreversible medical or aesthetic complications.