Lipedema is a chronic metabolic disorder of the fat tissue characterised by an excessive build-up of subcutaneous fat, mainly on the legs and occasionally on the arms. It most often affects the hips, thighs and lower legs. Fat accumulation in these regions is typically symmetrical and disproportionate to the rest of the body.

It is a complex condition with an as yet not fully understood cause. Research suggests a genetic predisposition that may be triggered or aggravated by hormonal changes, especially during the reproductive years. This leads to uneven and excessive distribution of fat in the lower body, particularly in the thighs, hips and ankles.

Lipedema is divided into 4 stages based on the severity of symptoms and clinical signs. If early stages are not recognised and treated, the disorder gradually progresses (Figure 1). Pain, swelling, a feeling of heaviness in the limbs, fatigue and reduced mobility are just some of the symptoms women experience. In more advanced stages, chronic tissue damage leads to superficial venous insufficiency (phleboedema) and impaired lymphatic drainage (lymphedema). Besides physical discomfort, lipedema often causes emotional distress, loss of self-confidence and has a strong impact on psychosocial wellbeing.

Figure 1: Stages of lipedema and their effect on the shape of the lower body.

Accurate diagnosis begins with a detailed medical history followed by a thorough clinical examination. Ultrasound is then used to assess the stage of lipedema and to identify associated vascular and lymphatic disorders. Early recognition is key to preventing further progression.

At present, there is no cure that can completely eliminate lipedema. However, it can be effectively managed with a combination of conservative and surgical methods aimed at symptom control and improving quality of life. Treatment is always individualised and tailored to the stage of lipedema and the patient’s specific needs. Comprehensive management also includes patient education on self-care and effective strategies to cope with physical and psychosocial consequences of the condition.

Conservative treatment is especially important in the early stages and includes lifestyle and dietary changes, appropriate regular exercise, compression garments and manual lymphatic drainage. These measures help reduce pain and swelling, improve mobility and general wellbeing, and slow down the progression of lipedema.

Tailored Exercise

Regular physical activity is crucial for managing lipedema. Classic high-impact aerobic exercise (such as running or cycling) is generally discouraged. The most beneficial form of exercise is water-based activity (e.g. swimming, aqua aerobics), ideally at least three times per week. Training in water effectively reduces the sensation of heaviness and pain in the legs or arms and prevents excessive friction of the skin during movement. The water environment puts minimal stress on the joints and allows safe muscle strengthening. Water exercises should be combined with tailored strength training.

Compression Therapy

Daily use of individually fitted compression garments (compression class II) plays a key role in reducing swelling, heaviness and pain, and in improving circulation.

When conservative measures do not provide sufficient relief, surgical treatment can be considered. The aim is to reduce or remove pathological subcutaneous fat in the affected areas using liposuction. Surgery will not cure lipedema, but it can significantly and quickly reduce symptoms and improve quality of life.

One of the most advanced methods available today, and used at Medved Estetika, is VASER liposuction. This technique allows precise and selective removal of fat cells. Ultrasound energy first breaks down and liquefies the fat, making it easier to remove. Compared with traditional liposuction, VASER causes less damage to surrounding tissues (blood vessels and lymphatics) and is therefore a safer and more effective option for patients with lipedema.

Surgical treatment of lipedema with VASER liposuction can:

• reduce the volume of subcutaneous fat and the size of the legs,

   

• relieve heaviness and pain in the legs,

   

• restore body shape and silhouette,

   

• improve overall quality of life.

   

Surgery is usually only one part of a comprehensive treatment plan. Optimal and long-lasting results are achieved when it is combined with appropriate pre- and postoperative care: compression garments, manual lymphatic drainage, regular adapted exercise and long-term lifestyle and dietary changes.

Before any surgical treatment, a consultation with a surgeon experienced in lipedema management is essential, as the approach must always be tailored to the patient’s condition and the extent of their symptoms.

Because VASER liposuction specifically targets fat cells, recovery is significantly faster with less swelling, pain and bruising. The thermal effect of ultrasound waves also promotes skin tightening, which is particularly important in areas such as the legs. The entire procedure is performed through only a few 5 mm incisions. The resulting scars become almost invisible over time, as they are hidden in natural skin folds or beneath underwear. Most patients can return to everyday activities within 1 to 2 weeks.

During recovery, proper self-care is crucial. After surgery, patients receive detailed instructions, which include:

• wearing compression stockings for 6 to 8 weeks,
  
• regular, gentle exercise such as walking and water-based activities,
  
• manual lymphatic drainage,
• an individually tailored nutrition plan.

It is important that you describe your current condition and any health problems in detail during the initial visit and bring all relevant medical reports and test results with you. Before planning surgical treatment, a duplex ultrasound of the superficial veins of the legs (venous Doppler) is required to rule out superficial and deep venous insufficiency. If you have not yet had this examination, it can be carried out during your visit at our clinic.