Lipoedema, the “invisible” condition that causes limb enlargement and pain

Chronic pain, legs and arms disproportionate to the rest of the body, and difficulty reducing limb volume despite diet and physical activity. Lipoedema, often confused with obesity or lymphedema, is still a little-known condition that can significantly impair the quality of life of those affected. Recognising it correctly is the first step toward establishing an appropriate treatment pathway.

Providing clarity is Dr Andrea Murante, a specialist in plastic, reconstructive and aesthetic surgery. Trained in Naples, Rio de Janeiro and Cartagena (Colombia), he later worked in Paris at the Henri Mondor University Hospital, focusing on reconstructive and aesthetic plastic surgery and gaining specific experience in the treatment of Lipoedema.

What Lipoedema is and how to recognise it

Lipoedema does not exclusively involve adipose tissue. As Dr Murante explains, «Lipoedema is a disorder of the loose connective tissue, therefore not only of fat, but also of blood vessels and the extracellular matrix». 

The condition «is characterised by a massive accumulation of fat in the lower limbs and sometimes also in the upper limbs, with sparing of the hands and feet». This distribution is a key distinguishing feature compared to other conditions. «This is an important differential diagnosis with obesity and lymphedema».

Another useful clinical sign is the so-called Stemmer’s sign. In Lipoedema, in fact, «there is an inability to pinch and lift the skin in the affected area – In addition – the limbs appear highly disproportionate compared to the rest of the body». There is also a significant difference: «Lipoedema causes pain, whereas lymphedema is rarely characterised by pain».

Causes: genetics and hormones

Lipoedema is now considered a multifactorial condition «and is recognised as an autosomal dominant disease with incomplete penetrance». The familial component is therefore significant: «60% of women affected by Lipoedema have a family history».

From a biological perspective, «there are genes involved in angiogenesis, lipogenesis and the formation of the extracellular matrix». Hormones also play a central role. «A very important role is played by oestrogens – It is no coincidence that – this condition essentially affects women” and “usually begins to develop from puberty».

Treatments: conservative management and surgery

The treatment pathway includes two phases. The first is conservative. «A first step is medical therapy, characterised by physical exercise, an anti-inflammatory diet, lymphatic drainage massage and compression garments». This approach must be followed consistently: «It is always recommended for at least six months».

In many cases, however, the benefits are partial. «If after all these measures there is no improvement, and this often happens, surgery is required». The main surgical procedure is liposuction.

Ultrasound-assisted liposuction

During his experience in Paris, Dr Murante treated numerous patients using a specific technique. «I treat over 150 women per year affected by Lipoedema». The method used is ultrasound-assisted liposuction. «Ultrasound works to emulsify the fat».

This technique allows for more selective aspiration, significantly reducing the blood component. «The amount of blood aspirated is infinitesimal compared to the fat removed». On average, he explains, «we aspirate around seven litres of fat per procedure». The results achieved have also been recognised in the scientific field: «This publication was accepted and published in the PRS Journal».

Daily management and future perspectives

Diet and physical activity remain fundamental elements in managing the condition. «The first step in treatment is six months of conservative therapy». In some early cases, «significant improvements are seen», although «often fat decreases in other parts of the body, but not the pathological fat in the lower and upper limbs».

Research is opening new perspectives. «There are studies and research projects we are carrying out, especially on advanced pneumatic compression devices», which «reduce swelling in the legs and limbs and the associated symptoms». Pharmacological therapies are also under investigation: «There are GLP-1 agonist drugs, such as Ozempic, which can help reduce excess fat, although they are not curative». At the same time, «there are studies on targeted molecular pathways» aimed at developing increasingly specific treatments.