Lipoedema assessment and treatment

Lipoedema is a disorder of subcutaneous fatty and connective tissue.

It occurs predominantly in women and usually affects both sides of the body symmetrically. The hips, thighs and lower legs are commonly involved; the arms may also be affected. The feet and hands are usually spared, which can create a distinct cuff at the ankles or wrists. Lipoedema is not simply obesity and can occur at any body weight, although obesity may coexist with it and can make symptoms and mobility more difficult.

Diagnosis is based mainly on the history and clinical examination. There is no single blood test or scan that confirms lipoedema, so assessment must also consider other causes of limb enlargement or swelling, including lymphoedema, venous disease and generalised weight gain.

The exact cause is not yet fully understood.

Lipoedema can run in families, suggesting a genetic contribution, and it often begins or changes during periods of hormonal change such as puberty, pregnancy or the menopause. It is not caused simply by eating too much or by a lack of exercise.

Healthy weight management remains important for general health and surgical safety, but dieting alone does not reliably remove lipoedema tissue.

The correct garments are essential before, around the time of and after any operation.

They help control swelling and discomfort, support the tissues during recovery and protect the surgical result. Garments must be selected and fitted for the individual; this planning starts before surgery and is reviewed as limb shape changes.

For suitable patients, we offer Body-Jet water-assisted liposuction.

A controlled fan-shaped stream of fluid helps separate the fatty tissue as it is gently removed. We favour this approach because it permits precise, even treatment with less reliance on forceful mechanical cannula movement than conventional mechanical liposuction. In our view, this provides a controlled and tissue-respectful way to treat a limb in which the connective tissues, small vessels and lymphatic system require particular care.

Both water-assisted and power-assisted techniques are recognised approaches to lipoedema surgery. Current evidence does not establish that one method is universally superior. Safe treatment depends on the surgeon’s experience, careful patient selection, a lymphatic-sparing technique, appropriate limits on the amount treated at each operation and a well-planned postoperative garment programme.