Selecting an appropriate compression garment is probably the most challenging task in Lipedema treatment. It is important to begin the discussion of garments early in the course of treatment. It often takes time for patients to adjust to the fact that they will need a garment. In many instances, patients must pay all or part of the cost of the garment, and they will need to plan in advance for the expenditure.Important factors to consider when choosing a compression garment are: coverage, compression class, appearance, custom-made versus ready-made, material, construction, suspension, skin condition/sensitivity, donning/doffing, and cost and source of payment.
When considering coverage, preventing edema distally or proximally to the garment is important. During the decongestive phase of Lipedema treatment, the therapist will have learned whether, for instance, a bandage to the knee has caused an increase in knee or thigh volume. In that case, the patient will need a garment to the thigh or perhaps to the waist. Usually an arm sleeve will be accompanied by a separate glove or gauntlet to prevent trapping fluid in the hand. Some individuals never experience significant edema in the hand. If therapists back off on bandaging the hand during treatment and the patient does not experience any additional edema, this guides the decision as to whether to order a gauntlet, which just covers the back of the hand, or a full glove with edema control for all of the fingers. Some patients find they can even do without any hand garment, but in our practice, we always order at least a gauntlet since it is very difficult to predict exactly how every patient will respond.
Medical grade garments are available in various compression classes measured in millimeters of mercury (mmHg). These are standardized as:
Class I: 20-30 mmHg
Class II: 30-40 mmHg
Class III: 40-50 mmHg
Class IV: 50-60 mmHg
In a stocking, these numbers are the compression at the ankle with a gradually decreasing compression gradient to the top of the garment. Many ready-made stockings have a higher stretch fabric over the upper thigh called a mantissa. Even garments with the same fabric throughout will give lower compression over a larger diameter body part. Arm sleeves are generally Class I or II, and gloves and gauntlets are typically Class I. Lower extremity garments are generally Class II or III. Additional compression for the leg can be gained by using a higher compression class of garment or by layering a knee-high stocking under or over a longer stocking.
Manual Lymphatic Drainage (MLD)
MLD is a type of gentle massage which is intended to encourage the natural drainage of the lymph from the tissues space body. The lymph system depends on intrinsic contractions of the smooth muscle cells in the walls of lymph vessels (peristalsis) and the movement of skeletal muscles to propel lymph through the vessels to lymph nodes and then beyond the lymph nodes to the lymph ducts which return lymph to the cardiovascular system. Manual lymph drainage uses a specific amount of pressure (less than 9 ounces per square inch) and rhythmic circular movements to stimulate lymph flow.
There is no one diet to recommend and this area is often controversial. The RAD, Paleo, and the low inflammation diets are reported to help.
The Flexitouch system is an innovative, automated device designed for the at-home treatment of lymphedema and lipedema.
Based on the gentle work-and-release of manual lymphatic drainage (MLD) therapy, the Flexitouch system is the only device proven to be more effective than self-MLD in maintaining or reducing limb volume between clinic visits.
By removing the obstacles to consistent, effective self-care, the Flexitouch system helps patients improve their overall health and enjoy a higher quality of life.
Although there is currently no cure for Lipedema, patients have been finding removing fat through Liposuction can relieve pain associated with Lipedema. There are two forms of Liposuction that have been helping Lipedema patients:
The tumescent technique for local anesthesia involves the injection of large volumes of very dilute lidocaine (local anesthetic) and epinephrine (drug that shrinks capillaries) into subcutaneous fat. The word tumescent means swollen and firm. With the tumescent technique, the volume of dilute lidocaine that is injected into fat is so large that the targeted areas literally become tumescent (swollen and firm). The tumescent technique produces profound and long-lasting local anesthesia of the skin and subcutaneous fat. Tumescent liposuction designates a form of liposuction that uses tumescent local anesthesia.
Water Jet Assisted Liposuction (WAL)
Water jet assisted liposuction is another method of liposuction being used by cosmetic surgeons today. As in all types of liposuction, fatty deposits are removed from beneath the skin for a more contoured look. Liposuction is optimal for people who are in good physical shape and who aren’t interested in using liposuction as a weight loss measure.
Instead of injecting the body with tumescent fluid and removing the fat cells manually with a cannula, or using laser technology to melt and dislodge the fat, water jet assisted liposuction actually uses a slightly pressurized stream of saline to dislodge fat and simultaneously remove the cells. Instead of destroying fat cells, this type of liposuction loosens the fat cells to facilitate more gentle removal. Water Jet Assisted liposuction injects tumescent fluid (saline and medicines including a local anesthetic) into the body part being treated. Tumescent fluid is proven effective and several alternate liposuction technologies are now using the tumescent technique for its local anesthetic benefits. In the case of water jet assisted liposuction, it then uses different processes to actually remove the fat and manage fluid levels.
Once the local anesthesia has taken hold, a cannula is then introduced into the tissue to irrigate and then simultaneously suction the loosened fat cell from the body. Finally, any remaining fluid is removed. The procedure is considered gentle and minimally invasive and the force seen in traditional liposuction methods is not needed when using jet-assisted liposuction. There is usually very little bruising or swelling and water jet assisted liposuction often has a very short recovery time, partially because the use of water means that there is less tissue trauma to the body.
This is another liposuction technology that does not require general anesthetic, which reduces risks to the patient and reduces costs.