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Equipe Lipoedeme du Dr Nicolas Zwillinger

Lipedema : Symptoms, Treatments and Prevention


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Lipoedema is a chronic disease characterized by abnormal accumulation of fat (adipose tissue) in the legs (ankles, calves, knees, thighs, hips), as well as in the arms and forearms in some cases. This leads to an increase in volume and circumference of the affected limbs, causing swelling and uneven skin texture in the affected areas.

Symptoms of lipedema may include feelings of heaviness or pain in the legs and arms, difficulty fitting into clothes or shoes due to the size of the limbs, and swollen or “marbled” appearance of the skin.

While lipoedema is believed to affect up to 11% of women, it is still relatively unknown in the medical world compared to its prevalence. It was first described by vascular physicians Drs. Allen and Hines at the Mayo Clinic in 1940.

It’s important to note that lipoedema is not related to excess weight, and weight loss will not have any impact on this condition. Regardless of the affected area, the accumulated fat deposits are resistant to both diet and exercise.

Causes of lipedema

The suspected causes of lipedema are related to hormonal and genetic factors. Lipoedema is exclusively diagnosed in women and often appears during hormonal changes such as puberty, pregnancy, and menopause. Genetic factors may also play a role in the development of the disease, as it is often observed in entire families.

Lipoedema can also be associated with other medical diseases, such as venous insufficiency, obesity, and restless leg syndrome. However, it’s important to note that lipedema is a distinct condition from these other disorders and cannot be treated in the same way.

Types and stages of lipedema

Classification of the 4 stages of lipoedema

Types and stages of lipedema
  • Stage 1 : Homogeneous skin surface
  • Stage 2 : Irregular skin surface with nodules and subcutaneous lipomas
  • Stage 3 : Deformities and hardening of limbs due to massive fat growth
  • Stage 4 : Presence of trophic disorders, the ultimate stage of lipo-lymphedema

5 types of lipedema based on the affected area 

Types and stages of lipedema
  • Type 1 : Involvement of hips and buttocks
  • Type 2 : Involvement of thighs
  • Type 3 : Involvement of entire lower limbs (excluding feet)
  • Type 4 : Involvement of arms
  • Type 5 : Involvement of legs only

It’s important to note that patients can present a combination of stages. The level of pain and symptoms may not necessarily correlate with the stage. 

Differences between lipedema and lymphedema

Lipedema is an abnormal accumulation of excess fat in the lower or upper limbs that spares the extremities: feet and hands. This condition is often associated with pain and venous insufficiency, and is sometimes referred to as limb lipalgia. Symptoms are usually symmetrical in most cases.

On the other hand, lymphedema is characterized by swelling in the legs or arms caused by an accumulation of lymphatic fluid in the subcutaneous connective tissues. This condition is typically unilateral and is linked to dysfunction of the lymphatic vessels. A study conducted in Germany in 2006 revealed that 15 to 17% of women treated for lymphedema also concurrently present advanced-stage lipoedema.

Although both conditions can lead to swelling in the lower and upper limbs, they have different causes and treatments.

Le lipoedème se différencie du lymphœdème
On the left, a patient with unilateral lymphedema, and on the right, lipedema.

How to know if you have lipedema ?

There are several ways to detect lipedema, by observing physical symptoms and undergoing medical tests. There are typical signs and symptoms, in addition to the characteristic disproportionate distribution of fat.

Symptoms of lipedema (non-exhaustive list)

  • Disproportionate distribution of fat deposits in the legs, thighs, hips, and/or arms
  • Exclusive occurrence in women
  • No response to weight loss in the affected areas
  • Spontaneous bruising (ecchymosis)
  • Pain (hypersensitivity to touch, no improvement when elevating limbs)
  • Feelings of heaviness (fatigue in the extremities)
  • Significant circular thickening of subcutaneous fat
  • Accumulation of adipose tissue at the knee popliteal fold

To confirm the diagnosis of lipedema, your doctor will perform a physical examination and ask about your medical history and lifestyle. They may also prescribe tests such as Doppler ultrasound or lymphoscintigraphy to rule out other possible diagnoses that could explain your symptoms.

It’s important to note that lipedema is not a condition that can be completely cured by conservative protocols. However, surgical treatments can significantly alleviate symptoms and improve quality of life in the long term.

If you suspect you have lipedema, it is recommended to consult a specialist for a confirmed diagnosis and appropriate treatment. Your specialist will ask about your medical history and conduct a comprehensive clinical examination to assess the presence of lipedema and exclude other possible causes of limb swelling.

Living with lipedema 

After a successful lipedema surgery, patients are eager to start a new and improved life. It is advisable to maintain a lifestyle based on two key elements : a healthy diet and regular exercise.

What diet to follow ?
Comment vivre avec un lipoedème

What diet to follow ? 

In the case of lipoedema, following an anti-inflammatory diet complements the postoperative maintenance of surgical treatment and helps maintain results over time.

This dietary approach aims to reduce subtle inflammation in the body, helping to “reduce oxidative stress, maintain acid-base balance, reduce inflammation, and improve gut microbiota.” Additionally, it can :

  • Strengthen the immune system
  • Adapt the body to external changes
  • Reduce the risk of inflammation
  • Alleviate chronic inflammation pain
  • Increase healthy lifespan

What are the best anti-inflammatory foods ?

  • Start your day with the juice of half a lemon : this stimulates the liver and efficiently detoxifies fats.
  • Use natural spices when cooking : turmeric, ginger, garlic, sage.
  • Incorporate the following plants and fruits into your diet: chicory, papaya, pomegranate, orange, psyllium, okra.
  • Consume plenty of omega-3 fatty acids. They help reduce lipedema and prevent the growth of new adipose tissue.
  • Avoid milk and all forms of dairy products, meat, products made from white flour, and foods with preservatives. 

Note that an anti-inflammatory diet can be used as an adjunct treatment, but it cannot replace anti-inflammatory medications, although it offers many benefits and is recommended by researchers and healthcare professionals. Please consult your primary care physician or a dietitian for more information.

What exercices are good for lipedema ?

It’s important to engage in regular physical activity to strengthen muscles, improve blood circulation, and enhance joint flexibility. Health organizations like the World Health Organization recommend a minimum of 150 minutes of moderate physical activity per week, which is about 20-25 minutes per day.

Best sports practices for managing lipedema : 

  • Water sports : swimming, aquabiking, aqua toning, etc. These activities combine physical exercise with the draining action of water to alleviate the sensation of heaviness in the legs.
  • 30 minutes of brisk walking daily, at least 5 times per week. This significantly increases heart rate and blood circulation in the legs.
  • 25 minutes of stationary bike cycling, at least 3 times per week. This exercise helps strengthen leg muscles and works on accelerating heart rate.

In short, this lifestyle combining exercise and an anti-inflammatory diet can slow down the progression of lipedema ; however, it alone cannot cure this condition. You can read an interview with a dietician affected by lipoedema to supplement the information in this article.

What exercices are good for lipedema ?

Can lipedema be avoided ?

There is no known way to prevent the onset of lipedema, but we can prevent the worsening of this condition. By understanding that there are measures you can take to alleviate symptoms and reduce their impact on your life, here are some tips that may help you : 

  • Exercise regularly : Physical activity can help improve blood circulation and strengthen muscles, which can reduce the appearance and sensation of swelling in the legs.
  • Wear compression garments : They can help reduce swelling and improve blood circulation.
  • Avoid standing or sitting for long periods: This can lead to water retention and swelling in the legs.
  • Maintain a healthy and balanced diet : A healthy diet can help maintain a stable weight and reduce the risk of developing other medical problems that could worsen lipedema.
  • Consult a specialist if you notice changes in your body : It’s important to monitor your health and consult a doctor if you notice changes that concern you, in order to obtain an early diagnosis and treatment.

Why get a Doppler ultrasound to diagnose lipedema ?

Doppler ultrasound is a medical imaging test that uses sound waves to visualize blood flow in the vessels. It can be used to diagnose lipedema in the lower and upper limbs.

By assessing blood circulation in these suspected areas, a plastic surgeon can determine if abnormal fat accumulation is caused by this disease. Additionally, 15 days after leg liposuction surgery, a post-operative Doppler ultrasound is recommended to monitor the risk of phlebitis.

In summary, Doppler ultrasound can be particularly useful for evaluating the severity and tracking the progression of lipedema stages over time. It can also help rule out other possible causes of fat accumulation, such as venous disorders, water retention, or lymphedema. 

Learn more here about Doppler ultrasound, an essential examination before and after lipedema surgery.

Doppler ultrasound

Why get a lymphoscintigraphy for lipedema ?

Lymphoscintigraphy is a functional imaging test performed in nuclear medicine centers that allows visualization of the lymphatic system and the study of lymphatic vessels, as well as measuring lymphatic flow in the legs.

In the context of lipedema, lymphoscintigraphy helps determine if the presence of lipoedema is associated with a lymphatic disorder. This examination usually does not question the lipo 360° intervention, but it provides information about whether the patients’ lymphatic system is normal or slowed (unilateral or bilateral lymphatic slowdown) or highlights lymphedema in certain cases.

To learn more about the procedure, you can read the article by clicking here.


How to treat lipedema ?

It’s important to know that there is no one-size-fits-all natural treatment, but there are several ways to manage the condition and alleviate the pain and discomfort caused by lipoedema (although this doesn’t mean that the progression of your lipedema will stop).

Currently, there are four treatment options available to relieve symptoms and treat lipedema :

  • Lifestyle changes, such as adopting a healthy diet, an anti-inflammatory diet, and regular exercise, can help improve blood circulation.
  • Lymphatic decongestion therapies, such as manual lymphatic drainage and pneumatic compression, can help reduce edema and improve blood and lymphatic circulation.
  • Medical treatments, such as compression stockings and gradient compression garments, can help alleviate pain and support the legs.
  • Surgical interventions, such as 360-degree liposuction, can be used to remove the majority of accumulated fat. However, these interventions are often considered a last-resort treatment.

We recommend consulting a specialist or healthcare professional to determine the best approach for you if you haven’t already.

Which doctors diagnose the lipedema ?

The lack of awareness about this condition within the medical community often leads to misdiagnosis, delaying the provision of effective treatment for patients. Before receiving appropriate treatment for their condition, patients first need an accurate diagnosis of lipoedema.

While most patients consult their primary care physician, a formal diagnosis of lipedema can only be made by a specialist such as a lymphologist, angiologist, phlebologist, or specialized plastic surgeon.

To reduce medical misadventures, it’s important to seek out specialists with experience in diagnosing lipedema. Currently, there are only a handful of specialized teams worldwide dedicated to diagnosing and subsequently treating this condition.

For victims of lipedema who are seeking a specialist in France, the good news is the existence of a pioneering team of lipoedema specialists led by plastic and aesthetic surgeon Dr. Nicolas Zwillinger, who provides care for affected patients.

Where to undergo leg lipedema surgery ?

Your diagnosis confirms that everything you are suffering from indicates lipedema. After trying all traditional treatments and finding very few improvements that do not meet your expectations, you are determined to undergo surgery to put an end to the suffering caused by lipedema.

Lipoedeme France – The first clinic dedicated to treating lipedema was established by Dr. Nicolas Zwillinger in France with the goal of providing comprehensive treatment for leg lipoedema. As a pioneer in Europe, Dr. Nicolas Zwillinger is advancing both medical and surgical protocols in France and is increasing awareness of this condition in the medical community to better care for patients.

This dedicated clinic is one of the leading clinics worldwide and the only clinic in France specialized in the surgical treatment of lipoedema since 2018. From diagnosis to surgery and through the recovery process, the specialized team accompanies you at every step of your surgical lipedema treatment.

Equipe Lipoedeme du Dr Nicolas Zwillinger
Dr Nicolas Zwillinger’s Lipoedeme team

360° lipo : circular liposuction for lipedema treatment

“Lipoedema requires circumferential treatment because the spread of fat cells in lipoedema disease extends circularly around the legs subcutaneously,” says Dr. Nicolas Zwillinger. “Therefore, I focus on a method: 360° lipo, which is more effective compared to traditional liposuction.”

With his expertise, Dr. Nicolas Zwillinger stands out in the field of plastic and aesthetic surgery with his unique “360-degree” method and post-operative lipoedema protocol aimed at treating it once and for all.

360° lipo involves eliminating the fat altered by lipedema in a circular manner and sculpting the affected areas to recreate a well-proportioned and more pleasing silhouette. This unique procedure significantly relieves leg pain, heaviness sensation, and hypersensitivity. Additionally, the appearance of spontaneous bruises and edema is significantly reduced after surgery.

During the 6-month post-operative follow-up, 100% of patients who underwent the 360° lipo procedure reported a much better quality of life and self-confidence. We also observed that patients tripled the aesthetic score of the treated areas compared to the preoperative state.

360° liposuction is an umbrella term for clinical methods of fat removal through aspiration, consisting of three signature techniques practiced by plastic surgeon Dr. Nicolas Zwillinger :

  • WAL Liposuction : This method involves using high-pressure water jets to assist in fat removal. The water jets are sprayed by the cannula directly into the affected fat cells caused by lipedema, dislodging them. During the procedure, fluid injection and suction occur simultaneously. The WAL technique helps preserve nerves and lymphatic vessels in the limbs. It has been proven that intensity of edema, pain, and heaviness sensations are considerably reduced with the WAL liposuction technique.
  • TAL Liposuction : TAL involves injecting a infiltration solution before liposuction into the subcutaneous fatty tissues. This creates temporary swelling of the tissues by injecting water, allowing the cannula to subsequently suction the fat.
  • VASER Liposuction : VASER, short for “Vibration Amplification of Sound Energy at Resonance,” also known as high-definition liposuction, uses ultrasound waves to break down and liquefy fat, making it easier to extract through the cannula. This method is particularly effective for removing fat from areas where excess fat doesn’t easily disappear. It is especially effective for removing fat that is difficult to eliminate through conventional liposuction.

These three techniques play a significant role in the surgical treatment of lipoedema performed by Dr. Nicolas Zwillinger. During the preoperative consultation, the surgeon involves the patient in the decision-making process for choosing the preferred method based on the analysis results and the patient’s characteristics.

lipedema surgery
liposuccion VASER

Does lipedema return after 360° liposuction ?

The result of a 360° liposuction is permanent. Lipoedema treated by liposuction does not return. The surgical removal of fat cells is a permanent action.

Due to the nature of fat, once removed by liposuction, it does not regenerate. Fat cells do not reproduce or multiply. This means that once affected fat cells are removed, they cannot reappear. 

For patients who have undergone liposuction, it is advisable to maintain a healthy lifestyle to avoid weight gain after the surgery. Maintaining a stable weight prevents the remaining adipose tissues from hypertrophying. 

However, if a patient gains a significant amount of weight, an increase in other fat cells throughout the body, including previously treated areas, can be expected. If a patient does not gain excessive weight over time, the results will remain permanent. 

Nevertheless, body deformation or skin laxity associated with the aging process will occur gradually. This is inevitable, even after liposuction. Therefore, it is essential to develop the habit of exercising to slow down the influence of aging on your body.

Can the lipoedema be removed with simple liposuction ?

Liposuction is an invasive surgical procedure that involves removing excess fat caused by lipedema using a probe called a cannula. It is a serious aesthetic surgery, typically performed in areas such as the hips, thighs, arms, legs, calves, and knees. 

The number of interventions needed to treat your lipedema depends on several factors, such as the affected area, severity (type and stage), etc. It is generally advised to perform liposuction on the entire lower limbs in two sessions (below the knees and above the knees), as patients are at risk of losing too much blood when the practitioner operates on all lower limbs at once, especially the risk of anemia, and become weak and fatigued after the procedure. 

Giving your body enough time to heal is important, and yes, “Paris wasn’t built in a day !”.

How long does edema last after 360° liposuction ?

The result of a 360° liposuction cannot be immediately appreciated after surgery. The operated legs will exhibit edema after the procedure. Rest assured, post-operative knee and leg edema is a natural response of the body to surgery.

Normally, the peak of painful edema occurs between 3 to 10 days after the procedure. However, the disappearance of post-operative edema varies considerably among patients. It takes about 3 to 6 months for complete swelling reduction and for the temporarily traumatized tissues to fully recover before achieving a definitive result.

How to reduce post-operative edema as quickly as possible ?

  • Apply cold to the knees, legs, or arms with edema for 15 to 20 minutes every 2 hours in the first few days following the surgery
  • Elevate the legs to help drain the fluid
  • Use anti-inflammatory medications like ibuprofen as needed
  • Lymphatic drainage on the operated areas starting from postoperative day 10 or earlier if possible
  • Follow the post-operative protocols recommended by your surgeon
Lymphatic drainage

What type of pants or compression to use for lipedema ?

Compression pants, tights, or stockings are medical compression garments and an essential part of your post-operative lipedema care. 

It has been proven that wearing a post-operative compression garment helps to :

  • Minimize and expedite the disappearance of edema
  • Reduce post-operative pain
  • Improve blood circulation
  • Accelerate recovery

It’s important to ensure that compression garments are properly fitted, not too tight to hinder mobility and blood circulation. At Lipoedema France, post-operative garments are prescribed and custom-made before the surgery. A prescription from your attending surgeon often allows for reimbursement of the post-operative garment by social security and your supplementary health insurance.

During your 360° liposuction procedure, compression garments (compression stockings or sleeves) will be applied in the operating room immediately after the surgery, depending on the treated areas.

Here is the 3-month post-operative compression garment protocolopératoire : 

  • Day 0 to Day +10 : Double compression (Biflex compression or Lipoelastic panty + Class 3 stockings), day and night.
  • Day +11 to Day +30 : Single compression Class 3, day and night.
  • Day +31 to Day +60 : Single compression Class 3, day or night.
  • Day +61 to Day +90 : Single compression Class 2, day or night.
What type of pants or compression to use for lipedema ?
convalescence liposuccion WAL

Lipoedema before / after


We hope this article has revealed nearly all aspects of lipoedema and will guide you in treating this condition. Please don’t hesitate to contact us if you have any additional questions. Dr. Nicolas Zwillinger and his surgical team are at your service. You can schedule an appointment by clicking here.

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