diagnosis of lipedema
1. Self-diagnosis of lipedema
Are you wondering if you have lipedema?
It is important to diagnose yourself early. This disease affects people regardless of their BMI (Body Mass Index). It is therefore difficult, in the case of obesity, to diagnose lipedema just by the appearance of the lower and/or upper limbs alone.
Below you will find the signs of lipedema that can be seen in your body :
- An unharmonious body.
Do your lower and/or upper limbs look and feel different from the rest of your body ?
- You cannot lose weight.
- You have tried to lose weight, through diet and exercise, and only certain parts of your body have “responded”.
- Your waistline has become thin and you have not noticed any positive changes in your lower/upper limbs despite diet and exercise.
- Sensitivity to touch and pressure.
- This sensitivity may vary from person to person.
- Vascular fragility.
- Resulting in the spontaneous appearance of bruising on the affected areas.
- These bruises do not disappear easily and can leave marks.
- Enlargement of the lower limbs.
- This stops at the ankles, your feet are not affected; similarly for the upper limbs the tissue enlargement stops at the wrists.
- Your hands keep a normal appearance.
- You feel: swelling, heaviness of the affected areas.
- In some advanced cases of lipedema:
- You notice a loss of mobility. Muscle weakness that can lead to difficulty in moving, resulting in an abnormal gait. Self-diagnosis of lipedema is a first step towards recovery.
2. Clinical signs of lipedema
A. Clinical signs of lipedema: diagnosing them
The diagnosis of lipedema can be made by different health professionals (angiologists, general practitioners, plastic surgeons, etc.). This professional will rely on a set of clinical signs specific to lipedema, by questioning and physical examination.
First, the doctor will ask you a series of questions to learn more about the appearance of your lipedema.
He will ask you about your history and how you feel. He will ask you what symptoms of lipedema you are experiencing.
B. Clinical signs of lipedema: clinical examination.
During the physical examination, the first thing that will be looked at is the visual appearance of your body. In people with lipedema, there is a disproportionality between the upper and lower limbs and the rest of the body: in particular, the waist will remain thin compared to the limbs.
In the lower limbs, joints such as the knees and ankles disappear. In the upper limbs, the elbows and wrists are not very marked and are filled with fat.
However, the feet and hands are unaffected and have a normal appearance.
C. Clinical signs of lipedema: the “pole leg” appearance
On a global view of the body, the lower limbs have the appearance of “poles”.
A key sign of lipedema is the symmetrical and bilateral damage observed on the patient’s body.
The professional will then study the vascular system, he/she will be able to note with the naked eye the appearance of varicosities, a sign of vascular fragility, ideally assisted by an echo-doppler of the affected areas in order to have a complete visual of the possible vascular damage.
3. Classification of lipedema
Lipedema does not manifest itself in the same way in all sufferers, we can classify it into different stages (evolution) and different types (zones).
A. The 4 main stages of lipedema
The different evolutions of lipedema can be defined in four phases.
If the condition is not managed, lipedema will progressively worsen:
The 4 main stages of severity of lipedema :
The 4 main stages of lipedema in detail:
- Stage I: Smooth skin surface, soft to the touch, uniform thickening of the hypodermis.
- Stage II: Irregular skin surface, orange peel appearance, sensation of nodules on palpation.
- Stage III: Hard skin surface, increased volume, appearance of deformed limbs, functional discomfort.
- Stage IV: lipo-lymphedema. It is important not to confuse lipo-lymphedema and lymphedema: lymphedema is a mass of lymph and not of fat.
There are several signs that help to differentiate between these two conditions :
| Lipedema | Lymphedema | Obesity | Venous insufficiency | |
| Gender | Women | Women + men | Women + men | Women + men |
| Large legs | Bilateral + symmetrical due to adipocyte hypertrophy | Unilateral due to excess fibrolymphatic tissue | Symetrical (adipocyte hypertrophy) | Unilateral or bilateral (related to venous edema and not to adipocyte hypertrophy) |
| Hypersensitivity | Significant sensitivity to palpation | No | No | Cramping + tingling |
| Pain | Pain absent, moderate or intense pain | Continuous pain or burning sensations in the limb | Osteoarticular pain | Pain at the end of the day + standing pain |
| Edema | Yes (soft texture without pitting edema) | Yes (pitting edema) | Possible | Yes in later stages (pitting) |
| BMI | Normal or close to 25 | Normal | > 32 | Normal |
| Spontaneous bruising | Yes | No | No | No but varicos veins/varicosities/teleangiectasias at various stages |
| Affects the feet and hands | No | Yes | Yes | No |
| Stemmer’s sign (inability to pinch the skin between the 2nd and 3rd metatarsals) | No | Impossibility | No | No |
| Lymphatic Flow | Normal, defective, or impaired | Obstructed | Normal | Normal |
| Skin | Normal, cellulite ou nodules | Rough texture, dry and sclerotic skin | Skin folds, stretch marks, cellulite | Ulcer, pigmentation, eczema |
After passing stage III, lipedema can evolve into lipo-lymphedema (stage IV) :
A disorder of lymphatic flow is added to the lipedema, leading to an accumulation of lymph in the tissues.
B- The 5 types of lipedema
These types will be determined according to the location of the fatty deposits and the oedema.
We can define five main categories of lipedema types :
- Lipedema type I: Hips/buttocks.
- Type of lipedema II: From buttocks to knees (included).
- Lipedema type III: Buttocks to ankles (included).
- Lipedema type IV: Arms.
- Lipedema type V: Calves only.
4. Complementary assessment of lipedema : a must before surgery
During an initial consultation, the plastic surgeon specialising in lipoedema will ask for various examinations to be carried out before a possible operation.
A- Complementary assessment of lipedema: a venous Doppler ultrasound
A study of the deep and superficial venous network, or Doppler ultrasound, will allow the radiological signs of the patient to be established.
This study of the radiological signs of lipoedema will make it possible to report on the good venous circulation of the limbs. It is an essential prerequisite for cosmetic surgery by liposuction W.A.L. It will also allow us to decide whether vascular surgery for varicose veins should be proposed before liposuction W.A.L.
B- Complementary assessment of lipedema: lymphoscintigraphy for advanced stages
In addition, in advanced cases, often stages 2, 3 and 4 of the medical classification of lipedema, Dr. Nicolas Zwillinger will ask for a lymphoscintigraphy performed in nuclear medicine centres.
This examination precisely analyses the patient’s lymphatic state. This allows us to determine the lymphatic part sometimes associated in the disease explaining the large limbs.
C-Additional assessment of lipedema: a blood test is also necessary
In order to perform a liposuction W.A.L. operation , the plastic surgeon needs a pre-operative blood analysis to prevent possible anaemia or iron deficiency.
All of these additional results will allow Dr. Nicolas Zwillinger and his team to plan a precise surgical treatment strategy. This will allow the patient to be treated as a whole and in complete safety.
See also the : Treatment of lipedema.