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This section includes current research on lipedema and related areas. While most of it is technical, scholarly and scientific in nature, this research offers many of the questions and areas being explored. Though more technical for those who have lipedema, it can be especially helpful to health care providers.

Classic text in the field of Lymphology: Foldi's Textbook of Lymphology: For Physicians and Lymphedema Therapists

Foldi

Chapter 8 Inflammation
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Chapter 9 Lipedema
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Rare adipose disorders (RADs) masquerading as obesity.
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Karen Herbst, M.D., Ph.D.
Department of Medicine,
University of Arizona,
Tucson, AZ, USA.
karenherbst@deptofmed.arizona.edu

Abstract

Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone.

In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidence-based data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.

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Lipedema
click here for pdf download of Lipedema overview document
click here for pdf download of Liposuction document

W. Schmeller, I. Meier-Vollrath

Prof. Dr. Wilfried Schmeller and Dr. Ilka Meier-Vollrath are both dermatologists with surgical background. Beside clinical treatment of patients from several countries they do research in lipoedema, write articles, hold lectures and organize congresses regularly.

Prof. Dr. W. Schmeller
Dr. Ilka Meier-Vollrath
Hanse-Klinik
St.-Juergen-Ring 66
D – 23564 Lübeck
Tel. ++49 – 451 – 50 27 20
info@hanse-klinik.com
Dr. Schmeller: ws@hanseklinik.com

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The Link between Lymphatic Function and Adipose Biology.

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Natasha L. Harvey
Florey Research Fellow,
Division of Haematology, The Hanson Institute, IMVS, P.O. Box 14,
Rundle Mall, Adelaide, South Australia, 5000, Australia.
Voice: +61-8-8222-3569; fax: +61-8-8222-3139.
natasha.harvey@imvs.sa.gov.au

Abstract

Despite observations of a link between lymphatic vessels and lipids that date as far back as 300 BC, a link between lymphatic vessels and adipose tissue has only recently been recognized. This review will summarize documented evidence that supports a close relationship between lymphatic vessels and adipose tissue biology. Lymphatic vessels mediate lipid absorption and transport, share an intimate spatial association with adipose tissue, and regulate the traffic of immune cells that rely on specialized adipose tissue depots as a reservior of energy deployed to fight infection. Important links between inflammation and adipose tissue biology will also be discussed in this article, as will recent evidence connecting lymphatic vascular dysfunction with the onset of obesity. There seems little doubt that future research in this topical field will ensure that the link between lymphatic vascular function and adipose tissue is firmly established.

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Defective lymphatic vessels identified as a novel cause of adult-onset obesity
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St. Jude Children's Research Hospital

Leaky lymphatic vessels are the leading cause of the adult onset obesity observed in a laboratory model developed by investigators at St. Jude Children’s Research Hospital. The findings suggest that the abnormal leakage of lymph fluid from the ruptured lymphatic vessels stimulates the accumulation of fat, particularly in regions of the body rich in lymphatics, the researchers said.

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Lipedema: A Frequently Misdiagnosed and Misunderstood Fatty Deposition Syndrome

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Caroline E. Fife, MD & Associate Professor & Department of Medicine & Division of Cardiology & The University of Texas Health Science Center & Houston, TX
Erik A. Maus, MD & Assistant Professor & Department of Medicine & Division of Cardiology & The University of Texas Health Science Center & Houston, TX
Marissa J. Carter, PhD, MA & President & Strategic Solutions, Inc & Cody, WY
ADV SKIN WOUND CARE 2010;23:81-92.

Lipedema is a genetically mediated disorder of fat deposition. It results in a characteristic pattern of lower-extremity enlargement that is resistant to diet and thus very demoralizing. It can eventually lead to lymphedema but should not be mistaken for lymphedema in its early stages.

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Long-term Outcome After Surgical Treatment of Lipedema

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Warren Peled, Anne MD; Slavin, Sumner A. MD; Brorson, Håkan MD, PhD
Annals of Plastic Surgery: March 2012 - Volume 68 - Issue 3 - p 303–307
doi: 10.1097/SAP.0b013e318215791e
Reconstructive Surgery

Division of Plastic and Reconstructive Surgery
University of California-San Francisco
505 Parnassus Avenue, San Francisco, CA 94143-0932, USA
anne.peled@ucsfmedctr.org

Lipedema is a condition characterized by abnormal deposition of adipose tissue in the lower extremities leading to circumferential bilateral lower extremity enlargement typically seen extending from the hips to the ankles. Diagnosis of the condition is often challenging, and patients frequently undergo a variety of unsuccessful therapies before receiving the proper diagnosis and appropriate management. Patients may experience pain and aching in the lower extremity in addition to distress from the cosmetic appearance of their legs and the resistance of the fatty changes to diet and exercise. We report a case of a patient with lipedema who was treated with suction-assisted lipectomy and use of compression garments, with successful treatment of the lipodystrophy and maintenance of improved aesthetic results at 4-year postoperative follow-up.

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Water Jet-Assisted Liposuction for Patients with Lipoedema: Histologic and Immunohistologic Analysis of the Aspirates of 30 Lipoedema Patients
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J. J. Stutz Æ D. Krahl

Abstract
Lipoedema is a fat distribution disorder causing massive, bilaterally symmetrical enlargement of the lower and in some cases the upper extremities in women. The atraumatic, anatomically appropriate procedure of water jet-assisted liposuction available today represents a promising treatment for these patients who generally suffer from severe subjective and objective impairment. Liposuction treatment can bring long-term improvement if the operative technique focuses on lymph vessel preservation. Immunohistologic analyses show minimal evidence of lymph vessel structures in lipoaspirates. The histologic analysis of the aspirates documents a relatively specific removal (‘‘apheresis’’) of primarily intact lipocytes with low vascular amount.


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Evaluation and management of the fat leg syndrome
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Warren AG, Janz BA, Borud LJ, Slavin SA
Harvard Medical School, Boston, MA, USA.

Plastic & Reconstructive Surgery. 2007 Jan;119(1):9e-15e.

Abstract

LEARNING OBJECTIVES:

After studying this article, the participant should be able to: 1. Discuss the initial evaluation of a patient presenting with lower extremity enlargement. 2. Distinguish underlying medical conditions causing lower extremity enlargement, including lymphedema and lipedema. 3. Discuss appropriate management and treatment for patients presenting with these conditions.

BACKGROUND:

Given the epidemic of obesity in the United States, many patients will consult the plastic surgeon with complaints of lower extremity enlargement secondary to "fat legs." In addition to cosmetic disfigurement, some patients may suffer from underlying medical conditions that are responsible for their symptoms. Knowledge of these other causes, including lymphedema and a disorder of abnormal fat deposition known as lipedema, ensures appropriate management and/or surgical treatment for affected patients.

METHODS:

Initial evaluation for lower extremity enlargement should include a discussion of pertinent medical history and a focused physical examination for findings that might indicate a pathologic underlying cause. When indicated, patients should undergo additional testing, including radiologic studies, to confirm their diagnoses.

RESULTS:

For those patients found to have lymphatic dysfunction, conservative management, such as massage therapy, use of compression garments, and limb elevation, should be initially recommended. Excisional or suction-assisted lipectomy may be considered in patients who fail conservative therapy. More extensive consultation with the plastic surgeon is recommended for patients seeking aesthetic improvement in contour and shape of large legs without a specified underlying abnormality.

CONCLUSIONS:

Patients with lower extremity enlargement may present to the plastic surgeon unsure of the specific cause of their deformity. A broad differential diagnosis exists for their presentation, which can be narrowed by using the common features and unique manifestations of the conditions.


A Closer Look at Lipedema and the Effects on the Lymphatic System
By Joachim Zuther, on December 13th, 2012

Lymphedema BLOG - posting on the relationship of lymphedema and lipoedema.

 

 

 

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updated 12 March 2017 from Cambridge, MA, USA
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