Lipoedema - puneet

PERTAINING TO LIPOEDEMA

Lipoedema is a chronic condition characterised by the abnormal accumulation of fat, primarily in the lower half of the body—commonly affecting the hips, thighs, buttocks, knees, and sometimes the arms. Notably, the hands and feet are typically spared, and the fat distribution generally appears symmetrical on both sides of the body, giving it a disproportionate appearance relative to the upper body.
Often mistaken for lymphoedema or general weight gain, lipoedema is a distinct medical condition. Unlike lymphoedema, which is caused by fluid retention and often affects only one limb—starting from the hand or foot—lipoedema results from fat tissue dysfunction and presents differently in texture and distribution. While lymphoedema is more related to impaired lymphatic drainage, lipoedema involves abnormal fat growth and vascular fragility.
Lipoedema predominantly affects women and is believed to impact up to one in nine, although it remains significantly underdiagnosed. This under recognition is largely due to a lack of awareness and limited training among healthcare providers, as well as symptom overlap with other conditions.

Causes and Progression

The exact cause of lipoedema remains unclear, but research suggests a strong genetic component, often running through multiple generations. Hormonal changes—particularly during puberty, pregnancy, or menopause—are known to trigger or exacerbate the condition.

Stage I – Early Signs

The skin appears smooth and normal on the surface. However, upon palpation, small, firm nodules or irregularities in the underlying fatty tissue can be detected.

Stage II – Noticeable Irregularities

The skin surface becomes uneven or dimpled. The fatty tissue structure is more pronounced, with a distinct nodular or grainy texture upon touch.

Stage III – Advanced Deformity

Severe enlargement and distortion of the limbs occur. The fatty tissue forms large lobes or hanging masses, particularly on the inner thighs and knees. The condition significantly affects mobility and quality of life.
Lipoedema is typically progressive, and the rate of progression varies between individuals. Common symptoms include:
• Disproportionate fat accumulation resistant to diet and exercise
• A heavy or aching sensation in the affected areas
• Easy bruising from minor trauma
• Skin sensitivity or tenderness
At the cellular level, lipoedema involves the enlargement of fat cells and increased permeability of capillaries, which contributes to swelling and discomfort. Fragile venules further lead to frequent bruising.

Treatment Approaches

There is currently no cure for lipoedema, but effective management strategies are available to alleviate symptoms and slow its progression. These fall into two main categories: conservative therapy and surgical intervention.
• Conservative therapy, such as Manual Lymphatic Drainage (MLD), can provide symptomatic relief by reducing swelling, though it does not reduce fat volume.
• Surgical treatment, primarily through liposuction, is the only known method to remove excess fat tissue. However, the choice of technique is critical in lipoedema cases to protect lymphatic structures and minimise tissue damage.
Given the potential risk of developing secondary lymphoedema in advanced lipoedema, it is essential to avoid energy-based liposuction methods (e.g., laser, ultrasound, or radiofrequency) and instead opt for gentler techniques that use fine instruments.

Dr Gupta’s Specialised Microlipo Technique

Dr. Puneet Gupta is one of Europe’s few surgeons trained directly by Dr. Jeffrey Klein, the pioneer of Microlipo—a minimally invasive technique specifically suited for treating lipoedema. This advanced procedure uses microcannulas to delicately remove fat, reducing symptoms while preserving lymphatic health.
Although lipoedema is a lifelong condition, Dr. Gupta’s expertise in Microlipo has helped many patients achieve significant improvement in both physical comfort and body contour.
Operative process
Liposuction for lipoedema is performed using fine cannulas (1–2mm), ensuring minimal trauma, smooth results, and a natural appearance. Dr. Gupta uses local anaesthesia, avoiding general anaesthesia for increased safety. This treatment is not purely cosmetic—it alleviates pain, reduces bruising, and improves mobility and quality of life. NICE is currently reviewing liposuction as a valid treatment for chronic lipoedema, although NHS access remains limited. The procedure is staged over multiple sessions, typically 4–6 weeks apart, and can be performed across various body areas. Microlipo, a day-case procedure, is lymph-sparing, causes minimal tissue damage, and allows for fast recovery with no hospital stay.
Recovery care
Following the procedure, all patients are required to wear compression garments to support recovery and reduce the risk of post-operative bruising. Areas such as the inner thighs and lower legs are particularly delicate during the healing process, so patients are advised to wear the garments for a minimum of two weeks and elevate their legs regularly to aid circulation and recovery.
Compression wear is fitted immediately after surgery, and patients receive detailed guidance on how to maintain proper compression throughout the healing period. Due to the advanced technique and effective post-operative drainage, bruising is typically minimal or absent.
A personalised treatment plan is developed during the initial consultation, with ongoing follow-up appointments scheduled to monitor progress. Our dedicated team remains available to support patients as they adapt to the positive changes brought about by the procedure.
Expense
While the fee for liposuction to treat lipoedema is understandably an important consideration, it should not be the sole determining factor when evaluating the procedure.
The overall cost is influenced by multiple variables, with the surgeon’s time, expertise, and the complexity of the treatment playing a central role. Dr. Gupta carefully assesses the number of areas to be treated, whether they can be addressed in a single session, and the anticipated level of difficulty based on the patient’s size and treatment zones.
Some regions of the body may require greater precision and time, which can impact the total cost. Importantly, Dr. Gupta only proceeds with liposuction for individuals he believes will truly benefit from the procedure.
As each patient presents unique needs, suitability and final pricing are determined following a detailed consultation.

ADDITIONAL INFORMATION

NOTEWORTHY INFORMATION ON LIPOEDEMA

1. Lipoedema Is a Long-Term Fat Storage Disorder

Lipoedema is a chronic medical condition characterized by the abnormal and symmetrical buildup of fat, predominantly affecting the legs and, in some cases, the arms—while typically sparing the hands and feet. This fat accumulation differs from normal body fat and is associated with metabolic and lymphatic dysfunctions.

2. It Disproportionately Affects Women

The condition overwhelmingly affects women and is believed to be hormonally driven. It often manifests during periods of hormonal fluctuation such as puberty, pregnancy, or menopause, suggesting a strong link to oestrogen and other female hormones.

3. Commonly Misdiagnosed as Obesity or Lymphoedema

Due to its visible fat accumulation, lipoedema is frequently misinterpreted as simple obesity or confused with lymphoedema, a condition involving fluid retention. Misdiagnosis can lead to inappropriate treatments and delay proper management, exacerbating the patient’s symptoms and frustration

4. Lifestyle Changes Alone Do Not Reverse It

Unlike ordinary fat, lipoedemic fat is resistant to traditional weight-loss interventions such as diet and exercise. Patients often find that while their upper body responds to weight management, their lower body remains disproportionately enlarged, leading to further physical and emotional distress.

5. Symptoms Include Pain and Easy Bruising

A hallmark of lipoedema is persistent discomfort. Affected areas are often painful, tender to the touch, and bruise easily—even with minor trauma. This pain can be deep, aching, and sometimes severe enough to affect daily functioning.

6. The Condition Progresses Without Intervention

Lipoedema tends to worsen over time if not properly managed. As the disease advances, fat deposits increase and may lead to impaired mobility, reduced physical activity, and secondary conditions such as joint problems or the onset of lymphoedema (lipo-lymphoedema).

7. Compression Therapy Provides Therapeutic Support

Wearing medical-grade compression garments can help manage the symptoms. These garments assist with improving lymphatic drainage, reducing swelling, alleviating discomfort, and slowing the disease’s progression when used consistently.

8. Liposuction Is Currently the Most Effective Treatment

While conservative measures can manage symptoms, tumescent liposuction—especially lymph-sparing techniques like micro lipo—is currently the only method proven to permanently remove lipoedemic fat. This surgical intervention significantly reduces the physical burden and improves mobility and quality of life.

9. There Are Serious Psychosocial Consequences

Lipoedema often leads to emotional and psychological strain. Patients may suffer from low self-esteem, anxiety, or depression due to persistent body disproportion, chronic pain, and social stigma. The lack of understanding from healthcare providers or peers can worsen these challenges.

10. Early Detection and Specialist Intervention Are Essential

Timely and accurate diagnosis by a knowledgeable clinician is vital. Early intervention helps mitigate disease progression and enhances treatment outcomes. A multidisciplinary approach—including vascular specialists, surgeons, physiotherapists, and mental health support—can provide comprehensive care and long-term relief.