Lipoedema: What helps in the long term? An expert explains

Are men also affected by lipedema?

In the ten years that I have dedicated exclusively to lipedema, I have had two or three male patients – and around 3,000 female. This is related to the estrogen receptor: lipedema almost exclusively affects women.

What are the causes of the disease?

This is quite controversial in the small community of specialists who deal exclusively with lipedema. Some believe the cause lies in the lymphatic vessels, others see the blood vessels as the starting point from which the fat cells are secondarily affected. My theory, which we can also derive from our research: lipedema is a type of benign fat cell tumor that develops in the deep subcutaneous fat layer – comparable to a lipoma.

The difference: in lipedema, large areas of fat cells in the depths are affected, which grow and are hardly influenced. They can only be removed surgically. An operation can provide immediate relief to patients and help in the long term.

You were affected yourself – what was your path to diagnosis?

My whole family was and is very athletic – my father is 77 and still runs marathons today. I also did a lot of sports, but my legs didn't look like it. It took a long time before I knew why. I had a lot of self-doubt until the pain finally added to it. I was already an assistant doctor in plastic surgery and could hardly stand at night.

I went to a phlebologist – the obvious choice, as lipedema often occurs together with venous diseases. The diagnosis was: lipedema. The advice: have surgery. That surprised me at first, but at the same time, everything suddenly made sense – the last ten years since puberty. In 2016, I had surgery. That was the trigger for me to delve deeply into this field: The research is sparse, the treatments need improvement. I wanted to change both.

Lipedema is considered chronic and progressive. Does this mean you are not really cured?

The word "cure" doesn't quite capture it – but the surgery brings you very close to a cure. It is possible that some fat cells remain in the body, which, in a way, carry the lipedema within them. However, with a healthy diet, exercise, and an adjusted lifestyle, these cells can be well controlled. I have been symptom-free since the operation – for ten years now, no recurrence, no pain, no changes in shape.

What does aftercare look like following the surgery?

Physiotherapy and lymphatic drainage are crucial. We also recommend targeted dietary supplements to replenish nutrients. This is more important than many think: Many patients have severely restricted themselves for years, sometimes being both overweight and malnourished at the same time. Blood tests often show vitamin deficiency and lack of trace elements. The goal is not just a changed body image – the body becomes healthier overall.

How does lipedema liposuction differ from aesthetic fat removal?

In specialist training, you learn how to remove small, bothersome fat deposits. With lipedema, these are large areas – with correspondingly large wound areas. It is a major procedure: Often about 10 percent of body weight, sometimes pure fat, is removed in one operation. This is also a strain on the circulatory system.

Patients must stay overnight. Lipedema surgery is transformative and requires precise body contouring. It’s not just about suction but also about contouring. Often, more than one procedure is necessary.

Does the so-called weight loss injection (e.g., Mounjaro, Trulicity) help against lipedema?

No—clearly not. We do prescribe GLP-1 receptor agonists like Mounjaro or Trulicity, but with a very specific goal: they melt normal adipose tissue. For ordinary fat cells, these agents work very well. However, lipedema fat cells cannot be influenced by these—they behave like a benign tumor and do not respond to the weight loss injection.

So if someone thinks these medications would make my work redundant, I have to smile. Unfortunately, this is not the case. For patients who are both overweight and affected by lipedema, we use the weight loss injection to reduce weight and enable surgery.

Facts about Lipedema

• Lipedema is a chronic fat distribution disorderwhere pathological fat cells accumulate symmetrically, mainly on the legs, hips, and often also on the arms.
• An estimated 10-15% of women in Germany are affected – that corresponds to several million patients.
• Typical signs include disproportionately strong legs or arms with a slim upper body, pain upon pressure and touch, a feeling of tension, and rapid leg fatigue (lipedema fatigue).
• In contrast to obesity in lipedema, fat distribution is typically pathologically altered, while the upper body often remains of normal weight.
• In contrast to lymphedema in lipedema, often both legs (and/or both arms) are symmetrically affected. In lymphedema, more often only one side is swollen and a disorder of the lymphatic system is predominant.
• The condition predominantly affects women, partly due to hormonal factors. Men are very rarely affected.
• The diagnosis is one of exclusion and is often only made after years because lipedema is confused with obesity or venous or lymphatic diseases.
• Conservative measures such as compression garments, lymphatic drainage, and nutritional counseling can alleviate the symptoms, while surgical liposuction of the diseased fatty tissue can provide many patients with long-lasting relief from symptoms.