Lipedema management



Lipidema is a chronically progressive, symmetrical accumulation of fat in the subcutaneous tissue with orthostatic edema. It occurs almost exclusively in women with the onset of hormonal changes (puberty, pregnancy, perimenopause, menopause).Diagnosis is challenging at early stages of disease; often assumed to be simple weight gain.

It presents with disproportion between the upper and lower body, due to pathological fat deposits and primarily affects lower extremities. Unlike normal fat, lipedematous fat can’t be lost through diet and exercise​. It is characterized by tenderness and vascular fragility leading to excessive bruising​ in the affected area.

In addition to an increase in fat cells (some of which are hypertrophic), a high volume of capillary blood vessels is found in the interstitial tissue. Decompensation occurs when the increased lymphatic load has exceeded the available transport capacity (over years or even decades).

MLD treatment protocol

  • ​Edema reduction phase is typically 2 weeks
  • Daily MLD therapy with multi-layer compression bandaging (CDT)
  • Compression bandaging worn 24-7 during intensive treatment phase
  • High density foam worn under bandaging to create micro-massage effect; breaking up fibrosis and induration
  • Daily skin care, performed by patient and therapist, to prevent skin breakdown (typically Eucerin or similar products, zinc oxide, anti-fungal creams)
  • Immediate fitting for custom-fitted compression garments following edema reduction phase
  • Custom-fitted compression garments are a necessity for lipedema, as off-the-shelf garments lead to a re-escalation of the disease
  • Compression garments, worn daily during the maintenance phase of therapy
  • Some exceptional cases will be treated with only MLD therapy and compression garments
  • Maintenance phase requires MLD therapy once every 4 to 6 weeks
  • Maintenance phase is for life to maintain tissue health and prevent regression of disease
  • For lipedema presenting with a lymphedema overlay, the default treatment is that for lymphedema​​​