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Learn more about Lipedema

Porto Canal Lipedema Dr. Joana de Carvalho
Porto Canal Lipedema, Dr. Joana de Carvalho, Part 2
What is lipedema? Dr. Joana de Carvalho Allure Clinic
Lipedema treatment by Dr. Joana de Carvalho, Allure Clinic
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Lipedema: what is it?

Lipedema is a condition which is characterized by a disproportionate accumulation of fat in the extremities, most commonly in the lower limbs; in 30% cases, it can involve the upper limbs. It occurs symmetrically (both legs, both thighs, or both arms) and always spares the feet and hands, which do not experience the increase in volume.

Sometimes confused with obesity, this disease is little-known, underdiagnosed and very neglected by healthcare professionals. Patients report that they are unable to lose volume in their legs, despite their commitment to strict diets and the weight loss they achieve, thanks to volume loss in other areas of the body. They often appear discouraged and frustrated because their condition is seen as obesity (or even fluid retention), and its lack of resolution is attributed to "lack of effort." 

Many patients suffer from Lipedema for years without knowing it. Beyond the importance of early diagnosis and treatment, it is crucial to understand that this is a genetic, chronic condition that fluctuates according to various factors (hormones, stress, anxiety, nutrition, among other triggers identified in each individual case).

 Although it may seem like a new, recently discovered disease, Lipedema was first described at the Mayo Clinic by Allen and Hines in 1940. 

Dr. Joana de Carvalho and Professor Sérgio Sampaio are leading doctors in the diagnosis and treatment of lipedema. They follow all developments in the international scientific community's understanding of the disease, the most recent example being World Lipedema Congress, held in Potsdam (Berlin | October 5-7, 2023), in which they were present. 

 

The four stages of Lipedema 

If the disease is left untreated, symptoms can worsen over the years. This is a disease that can progress through 4 different stages:

  •  Stage I: the skin is smooth/soft, with mild pain and less frequent bruising; swelling increases during the day and may decrease with rest and elevation of the limbs; lymphatic drainage produces great results; responds well to treatment.
  •  Stage II: the skin's surface becomes uneven, resembling the texture of cellulite; pain and bruising are more frequent; edema increases during the day, with partial improvement after rest and limb elevation; may respond well to treatment.
  •  Stage III: connective tissue is hardened; presence of pain, postural changes and edema present and persistent; large areas of overlapping fat; less responsive to some treatment modalities.
  •  Stage IV: fibrosclerosis, possibly associated with lymphedema; consistent edema present; all symptoms increased in addition to disabling changes in quality of life; large areas of overlapping fat; also known as lipolymphedema; less responsive to some treatment modalities.

The five types of Lipedema

Types of Lipedema - Allure Clinic - Porto

The disproportionate distribution of fat typical of Lipedema is divided into five types, according to the affected area. Some patients may be classified as having more than one type:

  • Type I: Pelvis, buttocks and hips;
  • Type II: from the buttocks to the knees, with the presence of adipose tissue on the sides and lower part of the knees;
  • Type III: Glutes to ankles;
  • Type IV: Arms;
  • Type V: Lower leg.

Causes

This disease affects women exclusively. Although a cause has not been definitively established, it suggests a significant hereditary component, linked to the female sex. 

In fact, in most cases, there is someone in the family with the same problem; therefore, patients often report in consultations: "this leg shape runs in the family."

Also the onset of the disease and/or its worsening is noted at times in women's lives characterized by sudden and significant hormonal changes such as: puberty, the start of oral contraceptives, pregnancy and, in more advanced stages of life, menopause.

Lipedema also appears to be related to a chronic low-grade inflammatory response to potential food toxins. The truth is that food processing has evolved tremendously in recent decades, and our bodies haven't been able to keep up. Thus, along with other conditions such as irritable bowel syndrome or chronic pain syndromes, it can be a form of defense and alert for our body.

Far from being a merely aesthetic condition, the progression of this “fat legs” disease can lead to significant decline in quality of life and difficulties in walking due to changes in the joints.

 

Lipedema: Symptoms

Lipedema: Symptoms

In addition to the disproportionate accumulation of fat, this disease is accompanied by:

  • A sensation of weight and tiredness in the legs;
  • pain and an exaggerated sensitivity to touch, according to the state of inflammation believed to characterize the disease;
  • A sensation of coolness in the skin of the legs;
  • Easy and frequent bruising (ecchymoses).
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Lipedema Photos: Before and After

Lipedema surgery of the leg, WAL technique, 3 months after intervention

Lipedema before after Allure Clinic Porto
lipedema before after allure clinic porto
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Treatments for Lipedema

Once the condition is confirmed, an individual treatment plan is created, which may be a conservative treatment (including an anti-inflammatory diet plan, appropriate physical exercise, massage, drainage, and supplementation), or, as a last resort, resorting to Liposuction specific to Lipedema, once the condition is stable, to control symptoms, reduce volume, and improve quality of life and self-esteem.

There are several specialties that make up the multidisciplinary team Lipedema treatment:

  • Vascular Surgery – diagnosis;
  • Nutrition – anti-inflammatory diet;
  • Nutrigenetics – identification of foods and agents that may be behind the inflammatory process and suggestion of appropriate supplementation;
  • Dermatofunctional Physiotherapy – pre- and post-operative drainage, facilitating recovery and enhancing the quality of results;
  • Plastic surgery – Liposuction specific for Lipedema.

Conservative Treatment of Lipedema

There are several measures non-invasive that can be adopted to improve not only the aesthetic aspect, but also complaints of pain and discomfort.

Just like the physical exercise, Nutrition It is one of the pillars of conservative treatment for Lipedema and, although it does not have a direct influence on the disproportionate distribution of fat, changing eating habits can be an added value in reducing pain and inflammation, improving prognosis and quality of life.

Through the Nutrigenetics, your genetic profile can be assessed, allowing you to understand your unique biochemistry and physiology. This knowledge allows you to define the most appropriate strategy for each patient.

 THE Physiotherapy It plays a very important role in the conservative and post-operative treatment of this disease, to treat and alleviate the discomfort caused by Lipedema.

Surgical treatment of Lipedema

Surgical treatment of Lipedema is indicated when, despite conservative treatment, symptoms persist and significantly interfere with quality of life.

Surgical techniques for lipedema are specific and must be performed by surgeons with experience and knowledge of the disease. Existing techniques include liposuction and the reduction surgery.

DOWNLOAD THE EBOOK ABOUT LIPEDEMA

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Medical Specialist
in Lipedema

Dr. Joana de Carvalho

  • Graduated from the Faculty of Medicine of the University of Porto
  • Specialist in Angiology and Vascular Surgery
  • Fellow of the European Board of Vascular Surgery
  • Member of the College of Phlebology
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Dr. Joana de Carvalho Dr. Joana de Carvalho Dr. Joana de Carvalho Dr. Joana de Carvalho Dr. Joana de Carvalho Dr. Joana de Carvalho Dr. Joana de Carvalho
Dr. Joana de Carvalho

Specialist Doctor
in Lipedema

Prof. Doctor Sergio Sampaio

  • Graduated from the Faculty of Medicine of the University of Porto
  • PhD from the Faculty of Medicine of the University of Porto
  • Specialist in Angiology and Vascular Surgery
  • Fellow of the European Board of Vascular Surgery
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Prof. Doctor Sergio Sampaio Prof. Doctor Sergio Sampaio Prof. Doctor Sergio Sampaio Prof. Doctor Sergio Sampaio Prof. Doctor Sergio Sampaio Prof. Doctor Sergio Sampaio Prof. Doctor Sergio Sampaio Prof. Doctor Sergio Sampaio
Prof. Doctor Sergio Sampaio

Medical Specialist
in Lipedema

Dr. Filipa Jácome

  • Specialist in Angiology and Vascular Surgery
  • Master's Degree in Medicine, from the Abel Salazar Institute of Biomedical Sciences (ICBAS)
  • Guest Lecturer at the Faculty of Medicine of the University of Porto (FMUP)
  • She was awarded 5 scientific merit awards.
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Dr. Filipa Jácome Dr. Filipa Jácome Dr. Filipa Jácome Dr. Filipa Jácome
Dr. Filipa Jácome

Frequently Asked Questions about Lipedema

1

How is Lipedema diagnosed?

The diagnosis of this disease is essentially clinical, that is, it is made based on what the doctor observes and examines, and, above all, on what the patient reports. There is no single test that allows for a diagnosis.

2

Is it important to perform an ultrasound Doppler?

Yes, it is important to perform an ultrasound Doppler to rule out the presence of venous disease that may also be causing the same symptoms.

3

Can I schedule an online appointment for a Lipedema evaluation?

Yes, it's possible to schedule a teleconsultation. To do so, simply contact Allure Clinic. 

4

Is this disease genetic? Hereditary?

The etiology of lipedema is being studied and is not yet fully understood. However, genetics are believed to be a very important factor. Naturally, our diet and lifestyle are also related to both the development and worsening of the disease.

5

Is it harmful to train with machines in the gym?

Any exercise is better than none, as long as each person feels good. When it comes to machine training, it's known that heavy weight training can cause inflammation. Therefore, while machines can be used, it's advisable not to exceed certain load limits. Each person will have their own perception of how they feel after training.

6

Is there a cure for Lipedema?

There is no true cure, as it is a chronic disease. There is, however, treatment for Lipedema. Conservative treatment involves an anti-inflammatory diet, exercise, drainage measures, and, possibly, medication. Surgical treatment (WAL liposuction) is also possible. It is believed that surgery may be the closest thing to a cure. Studies show benefits from the intervention for at least eight years after surgery.

7

How many times will I need surgery to solve the problem?

The answer to this question depends largely on the severity, location, and total volume of the lipedema. In certain situations, it's possible to treat the entire condition at once; in others, three surgeries are necessary, and in extreme cases, four. We would say that when the entire limb is affected—that is, when there is lipedema above and below the knee—two surgeries should almost always be considered, separated by a few weeks. Most often, we begin by aspirating the area below the knee and then move on to the thighs (above the knee).

8

Does nutrition influence lipedema?

A balanced diet that promotes glycemic control, rich in foods with antioxidant and anti-inflammatory properties and avoiding processed and sugary products, appears to contribute to reducing inflammation and associated symptoms. Maintaining a normal body weight also plays a key role, as excess weight and obesity contribute to the worsening of this condition. Therefore, changing eating habits can be beneficial in reducing pain and inflammation, improving prognosis and quality of life.

9

What foods aggravate the disease?

Indeed, nutrition has an impact. Therefore, what we eat is important, and, in fact, an inadequate diet can worsen the symptoms and appearance of this condition. Thus, processed foods such as cookies, chips, some toasts, ham, sausages, cold cuts, soft drinks, some cheeses, fast food and pre-prepared meals, sauces, hydrogenated oils and those rich in trans fats, alcoholic beverages, sweeteners, and sugary products should be avoided. Other foods or food groups can aggravate lipedema, but these recommendations require supervision and advice from your nutritionist.

10

What foods are beneficial?

Eating fruit and vegetables is always beneficial. We also highlight dark green leafy vegetables, cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.), the allium group (onions and garlic), beets, and rhubarb. Among the fruits, red fruits (strawberries, blueberries, blackberries, raspberries, cranberries), grapefruit, kiwi, and pineapple are the most recommended. We also encourage the consumption of water and tea, cocoa with over 75% of cocoa (natural, without sugar or sweeteners). Additionally, the use of spices such as turmeric and ginger is important.

11

Is the ketogenic diet the most suitable?

The most appropriate therapy depends on each case, so an individualized approach is essential. Although more scientific studies are needed to confirm and explore the mechanisms involved in the ketogenic diet, current research suggests that this approach contributes to:

– weight loss;

– glycemic control;

– reduction of inflammation;

– reduction of pain;

– improvement in quality of life.

12

Is fasting beneficial?

Available scientific evidence suggests that fasting:

  • promotes weight loss and healthy weight maintenance;
  • contributes to metabolic improvements (reduction in insulin, glucose and LDL levels);
  • decreases the degree of inflammation.

Thus, considering the biological process of Lipedema, this nutritional strategy seems to be indicated. However, we recommend seeking advice and monitoring from a healthcare professional, as there are several related and possible strategies; not everyone responds in the same way, nor can everyone maintain such a regimen long-term; in some, it can lead to episodes of binge eating or "food reward." 

13

How much does Lipedema treatment cost in Portugal?

The price of lipedema treatment depends on the case assessment and the individual treatment plan that can be outlined for each patient. Therefore, to receive a reference price, please request this information through our contact form.

14

Where to treat Lipedema in Portugal?

At Leg Clinic® by Allure, you'll find a team specialized in treating lipedema, as well as the most advanced tools for diagnosing and treating this chronic condition. If you're looking for specialists to treat lipedema, contact us and regain your health.