21 Aug What is Lipedema?

Lipedema is a loose connective tissue disease characterized by the disproportionate accumulation of fibrotic subcutaneous adipose tissue and extracellular fluid in the limbs of women due to microvascular inflammation.

There is a bilateral symmetric enlargement of the subcutaneous adipose tissue in the limbs, sparing the hands, feet, and trunk. It is found almost exclusively in women and is most often isolated to the lower extremities. There is a disproportionate increase in leg circumference in relation to a slender torso that cannot be reversed by physical exercise or diet. Dr David Boudana offers treatment for lipoedema at his private Forest Hill plastic surgery clinic in Toronto.

How frequent is Lipedema?

The reported incidence from specialized edema clinics varies between 10% and 20%. The prevalence in the general population has been estimated to be as high as 39% in the German lipedema-3 trial.7 Despite this high prevalence, lipedema is often underdiagnosed and misdiagnosed with other similarly presenting diseases. Lipedema, lymphedema, lipolymphedema, veno-lipolytic- phedema/ phlebedema, lipohypertrophy, gynecoid obesity, and Dercum’s disease are all part of a spectrum of pathologies that are not well defined.

How is lipedema diagnosed?

Before lipoedema treatment, it is essential to receive a proper diagnosis. At his private Forest Hill plastic surgery clinic in Toronto, Dr David Boudana can assess the excess fat and determine if lipoedema is the cause.
The heterogeneous presentation and anatomy of the condition and the lack of a diagnostic imaging exam that is easy to perform and interpret complicate its diagnosis. Lipedema is a clinical diagnosis made based on clinical examination findings.

What is the treatment of lipedema?

An etiological treatment for lipedema is currently still lacking. Treatment is focused on symptom reduction, functional limitation amelioration, and prevention of disease progression.

Therapeutic approaches also aim at impacting factors negatively influencing lipedema progression, such as obesity, lymphedema, venous insufficiency, and decreased physical activity.

At Forest Hill Plastic Surgery in Toronto, we have developed a multimodal approach to lipedema that includes the following treatments:

• Personal training sessions with our experienced personal trainer to improve mobility, muscular mass and circulation before and after surgical treatment.
• Lymphatic massage therapy is performed at our office by our specialized massage therapist.
• Customized compression: compressive garments will be custom-made to your proportions to provide adequate contention and reduce oedema before and after surgery
• Staged liposuction surgeries: Tumescent Power Assisted Liposuction to the hips, thighs, calf or arms can be performed to improve functionality and aesthetics.

What is staged tumescent power-assisted liposuction?

At Forest Hill Plastic Surgery in Toronto, Dr David Boudana uses power-assisted liposuction. This is a type of liposuction where a machine creates the reciprocated movement required during liposuction to break the fat cells before they can be aspirated. Compared to classic liposuction, power-assisted liposuction is less aggressive for the patient and less tiring for the surgeon.

Tumescent liposuction is a technique where a large amount of fluid containing epinephrine is infiltrated in the area of treatment before the liposuction: it has been shown that it decreases blood loss, allows the surgeon to aspirate more significant amounts of fat deposits safely and improves the post-operative recovery. Also, some studies suggest that tumescent liposuction preserves the lymphatic vessels more than classic liposuction. This is important as lymphedema (accumulation of lymphatic fluid in the limbs) can be worsened or induced by liposuction as it damages the lymphatic vessels.

As large amounts of fat deposits often need to be extracted by liposuction, staging is an essential aspect of the treatment plan. A personalized staged approach is discussed during the first consultation, and the goals and objectives of the treatments are agreed upon.