Lipoedema diagnosis: How to recognize the disease early – and avoid misdiagnosis

True stories: Patients live with uncertainty for a long time

Many lipoedema patients have a long long odyssey behind them. They sense that something is wrong with their body – their legs are painful and disproportionately strong – but they often don’t get a clear answer for years.

Lipoedema is often mistaken for overweight or lymphatic problem. Such Misdiagnoses lead to those affected living with uncertainty and self-doubt for a long time. During this time, many try in vain to lose weight or follow other advice that would not be effective in the case of genuine lipoedema. bring no relief bring.

They only learn about the actual clinical picture years later lipedema – and are often relieved to finally have an explanation for their agonizing symptoms. The realization that they are suffering from a real (and treatable) illness can be psychologically relieving and the starting point for effective therapy.

What you will learn in this article – including differentiations & clinical procedures

In this guide, our specialist explains how you can recognize lipedema at an early stage and why a quick diagnosis is so important. You will learn, among other things:

• Typical symptoms and signs: Which symptoms and changes indicate lipoedema.
• Differentiation from other diseases: How lipedema differs from normal obesity or lymphedema – and how you can avoid misdiagnosis avoid misdiagnosis.
• Medical diagnostic procedures: What steps the doctor takes to diagnose lipoedema diagnosis (medical history, physical examination and further tests if necessary).
• No snap judgment: Why the BMI or the scales alone are not enough to diagnose lipoedema and why specialist doctors (phlebologists/lymphologists) are often the best address.

With this knowledge, you are well prepared to recognize the early warning signs and to ask the right questions to the doctor if necessary. Because: Lipoedema is an independent disease with clear characteristics – the sooner it is recognized, the better the symptoms can be alleviated.

Recognizing lipoedema – What are the typical signs?

How can you recognize lipoedema? There are several typical signsthat occur together. Although each patient is individual, the following symptoms occur particularly frequently (and often in combination) with lipoedema. Important: Not every symptom alone means lipoedema – but the A combination of the following features is a clear indication.

Pain, tenderness and a feeling of tension

An important alarm sign of lipedema are Pain in the legs – something that does not occur with pure obesity. Typical is a High sensitivity to pressureEven light touches or gentle pressure can hurt.

Many sufferers also describe a constant feeling of tension in the legs, as if the tissue is under pressure. This feeling of heavy, tense legs often persists even after resting.

Without external influence, spontaneous dull pain which often worsen in the evening or after long periods of standing and sitting. So if you notice that your legs hurt disproportionately when touched and feel constantly tense, you should pay attention.

Symmetrical fat distribution – legs, hips, arms if necessary

Lipoedema can be recognized by the characteristic distribution of fat on the body. Both halves of the body are equally affected: excessive fat is usually deposited on legs, hips and buttocks and indeed symmetrically on both sides.

The upper half of the body (waist, upper body) often remains slimmer in comparison. It is noticeable that Hands and feet not affected by lipedema are. The fat pads end at the top of the wrists or at the bottom of the ankles – a difference to lymphoedema, where the feet often swell as well.

This often creates a disproportion in lipoedema patients. disproportion: slim upper body, but strong legs (one also speaks of the “saddlebags phenomenon” in the hip-thigh area).

In some cases (about 30 % of those affected) the arms affected by lipoedema. In this case, symmetrical fat deposits also appear on the upper and lower arms, while the hands and fingers remain slim.

Symmetry is crucial: both legs (and possibly both arms) are evenly thickened. This bilateral distribution and the omission of hands and feet clearly distinguishes lipoedema from other diseases. So if you have uniform fat pads on the legs or arms that do not match the rest of the body could be an indication of lipoedema.

Hematomas and sensitivity – warning signs of the disease

Another warning signal are conspicuously frequent bruising on the legs or arms. Lipoedema patients tend to feel a slight discomfort at the slightest bump. hematomas (bruising) can develop.

The small blood capillaries in the diseased fatty tissue are more fragile; even a slight bump – which you may not even be aware of – can cause a visible bruise. So if you notice that you have get bruises disproportionately often on your legs without remembering an injury, you should be alert.

At the same time, the skin in the affected areas is often hypersensitive. Many sufferers report that even gentle touches or light pressure unpleasant or painful are.

This combination of rapid bruising and high sensitivity to touch is typical of lipoedema. As a rule, these signs are not found in people who are simply overweight. So if you notice unexplained hematomas and your legs are sensitive to touch and painfully tense, this is a clear indication that a doctor should investigate.

An early lipoedema diagnosis can confirm whether these warning signs are actually due to lipoedema – and helps to avoid misdiagnosis.

Medical diagnostic procedures for lipedema

The diagnosis of lipoedema is primarily made clinically – there is no specific laboratory test or individual marker. A detailed discussion with the patient and a thorough physical examination are therefore crucial.

Typical findings and simple clinical tests help to differentiate lipoedema from other diseases. Imaging procedures such as ultrasound, CT or MRI are only useful in certain cases, usually to rule out concomitant diseases.

Medical history & consultation – focus on your complaints

At the beginning there is a detailed anamnesisduring which the doctor asks about the patient’s medical history and current complaints. Among other things, the discussion will focus on since when the changes have existed and whether there were any triggering factors – lipoedema often occurs for the first time during hormonal upheaval phases such as puberty, pregnancy or the menopause occurs.

It is also important to know whether other family members (mother, grandmother) had similar fat distribution problems. A central topic is the SymptomsLipedema patients often report pain, a feeling of pressure or heaviness in the legs, sometimes spontaneous, sometimes when touched.

The pain is categorized more precisely (e.g. dull aching or stabbing, pain scale) and the patient is asked whether sensitivity to pressure exists and how pronounced it is. A conspicuous Tendency to bruising (hematomas) without adequate trauma is a typical sign that is asked about.

Another criterion in the conversation is the distribution of the swellingsIf the fat pads occur symmetrical on both legs (and possibly arms)? Remain Feet and hands free? Lipedema almost always affects both legs (and often both arms) equally, while feet/toes remain slim.

In contrast to lymphoedema, for example, lipoedema symptoms do not do not depend on the time of day or elevation This means that the leg circumferences are not significantly different in the morning than in the evening. These details are asked in order to differentiate lipoedema from venous or lymphatic oedema.

It is also asked whether the legs feel noticeably thinner in the morning and swell during the course of the day – an indication that would speak against lipedema and rather point to other types of edema.

The medical history also includes Weight and nutritional history. The patient is asked whether overweight is or has been in the past Diets have been tried and with what success. Typically, lipoedema sufferers report that they retain their disproportionately thick legs/arms despite losing weight – Losing weight is extremely difficult in the areas of lipoedema. This often results in a disproportion between a slim upper body and strong legs.

This information helps to distinguish lipoedema from pure obesity. The doctor will also ask about the Psychosocial stress levelThe unusual body shape and chronic pain often lead to psychological stress, self-esteem problems or social withdrawal.

Therefore, questions are asked about mood, possible depression or anxiety associated with the body image. All of this information together – familial predisposition, hormonal triggers, typical pain, tendency to hematoma, diet resistance and psychological effects – provide important indications of lipoedema during the consultation.

Physical examination – inspection & palpation

The medical history is followed by a thorough physical examination. First, general values are recorded: Blood pressure, pulse and body measurements (weight, height) to calculate the BMI and measurement of the waist-to-hip or waist-to-height ratioto assess possible overweight and fat distribution.

Lipoedema patients usually show a clear difference between a slim upper body and voluminous legs/hips – the proportions appear dysproportional. The doctor pays attention to the Examination (observation) in particular on this disproportionate fat accumulation in the extremities.

An abrupt transition at the ankles and wrists is often noticeable. Feet and hands are slenderwhile the tissue directly above is more extensive (so-called collar phenomenon). This sharp end of the fat increase at the ankles is characteristic of lipedema.

Also the skin surface is closely examined. Often a finely knotted structure of the skin – colloquially Orange peel skin (cellulite) – especially in the early stages. In advanced stages, the dents can become coarser and resemble a mattress pattern reminiscent of a mattress pattern.

With increasing fat accumulation bulges or lobes develop, e.g. on the inside of the thighs or knees. The skin over the lipoedema area is often more cool and pale (no overheating) and shows fine bluish veins veins (spider veins/telangiectasia).

A very important sign is the Tendency to hematomasEven minor bumps lead to bruising in lipoedema patients. This is due to the increased fragility of the capillaries in the diseased fatty tissue.

The presence of numerous haematoma patches on the legs or arms therefore supports the suspected diagnosis of lipoedema. In contrast, skin inflammation, hardening or open areas typically occur in pure lipoedema. not If it does, secondary lymphoedema may already be involved.

The next step is palpationi.e. palpation of the affected areas. In lipoedema, the subcutaneous fatty tissue usually feels soft to doughy often with fine nodular structures under the skin. Patients sometimes describe the palpable feeling as if “little polystyrene balls” can be felt under the surface of the skin.

By pressing gently, the examiner can determine whether and where pressure pain can be triggered. A simple Pinch test (take the skin between two fingers and pinch lightly) tests the sensitivity to touch: in the lipoedema area, even light pinching is extremely uncomfortable or even painful for the patient. unpleasant to painfulwhile it causes no pain in unaffected areas of the body.

This reaction to the pinch test confirms the diagnosis of lipoedema. In addition, the Circumferences of the extremities measured at defined points (e.g. ankle, calf, knee, thigh). On the one hand, such measurements serve to extent of adipose tissue proliferation objectively, and on the other hand as a comparative value for the assessment of progress (e.g. whether therapies cause a reduction in circumference).

The Daumentest & Stemmer sign – the most important differential tests

Certain clinical tests help to differentiate lipedema from lymphedema or other edema conditions. The two most important are the Stemmer sign and the thumb test.

In the Stemmer test the examiner attempts to back of the toe (usually on the second toe) a small skin fold to be raised. If this is possiblethe Stemmer sign is considered negative. With lipoedema, the skin over the toes can typically still be lifted – the feet are not affected by lipoedema.

However, if the test is positiveno skin fold can be seen, this is a strong indication of lymphedema. lymphoedema. In lymphoedema, fluid accumulates in the tissue of the toes and the back of the foot, causing the skin there to thicken and tighten so that a fold cannot be felt.

A positive Stemmer’s sign is a classic feature of lymphoedema, whereas lipoedema no such a skin sign on the toes (Stemmer negative).

However, a negative Stemmer test does not always completely rule out the onset of lymphoedema – in early stages, the skin may still be able to be lifted. Therefore, the overall picture of the findings is always considered.

The daumen test checks whether in the tissue water edema are present. This involves pressing on the swollen area with the thumb for about 10 seconds and observing whether a dent remains (so-called Godet sign or pitting edema).

In the case of lipoedema, this test is negative – which means that the depressed area bounces back immediately, leaving no permanent no permanent indentation remains. In the early stages, the lipoedema tissue contains hardly any free fluid, so that no water is displaced from the pressure area. In contrast, the thumb test for lymphoedema (especially low-protein oedema) is often positive: The pressure leaves a visible dent dent that remains for a few seconds.

This is a sign that there is fluid in the tissue, which moves to the side due to the pressure and only gradually flows out. A positive Godet’s sign would therefore be against pure lipedema and rather indicate lymphedema or venous edema.

To summarize: Stemmer and thumb tests are negative in lipedemabut positive in lymphoedema. These simple clinical tests are among the most important differential diagnoses in lipoedema diagnostics.

Imaging procedures – when ultrasound, CT or MRI are useful

As lipoedema is primarily a clinical diagnosis Imaging examinations not routinely required. There is no specific imaging “proof” of lipoedema, but in certain situations, equipment can be consulted to rule out other causes or detect comorbidities.

Most commonly used is sonography (ultrasound) used. A simple ultrasound can be used to check whether venous problems are present – e.g. varicose veins or deep vein thrombosiswhich can cause venous leg edema could cause. In fact, chronic venous disorders and lipoedema often occur together, which is why the condition of the veins should be checked using duplex sonography.

A duplex ultrasound examination can show whether the venous valves are intact or whether venous congestion (chronic venous insufficiency) is contributing to the swelling. Under certain circumstances under the guise of lipoedema even a post-thrombotic syndrome – the ultrasound would reveal this.

Furthermore, a high-resolution soft tissue ultrasound the subcutaneous fatty tissue. Typically, lipoedema is characterized by uniform thickening of the subcutis with a finely striped echo structure – often as “snow flurry”-pattern – as well as echo-rich septa (connective tissue strands) and no large fluid clefts.

However, this ultrasound image is not clear in every patient and overlaps with findings in obesity, so that ultrasound alone cannot confirm the diagnosis.

However, an important area of application is the differentiation from lymphoedemaIf there are pockets of fluid in the tissue or thickened layers of skin, this could indicate lymphoedema.

In the case of pure lipedema no larger free fluid accumulations in the sonography – which again confirms that it is primarily a fat distribution disorder and not a classic edema. not classic oedema is involved.

Advanced imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) are only necessary in special cases. For example, an MRI scan can be helpful if there is an atypical course or other tissue changes are suspected (such as unusually hardened lumps that need to be differentiated from tumors).

As a rule, CT/MRI are used for differential diagnosisto rule out serious other diseases – such as liposarcomas (malignant fatty tissue tumors) or generalized edema due to organ diseases. For the Confirmation of the lipoedema diagnosis these more complex procedures are usually not necessary.

If the findings are unclear, a lymphoscintigraphy can also be considered to assess the function of the lymphatic drainage – this is particularly relevant if a combined lipo-lymphedema finding is assumed.

In most cases, however, lipoedema can be diagnosed through medical history, clinical examination and the simple tests mentioned above. Diagnostic equipment is used in a targeted manner, if the clinical findings leave doubt or comorbidities are present.

Differential diagnosis – What is not lipedema?

Lipoedema can easily be confused with other conditions or occur together with them. Therefore the Differential diagnosis crucial: The doctor must check whether the symptoms observed are actually due to lipoedema – or whether they are not due to overweight (obesity)a lymphoedema or even just cosmetic cellulite are present. The most important distinctions are described below.

Lipedema vs. lymphedema – foot involvement & Stemmer’s sign

Lymphoedema is swelling due to impaired lymphatic drainage. lymphatic drainagewhich can occur, for example, after lymph node removal or due to congenital malformations. It shows some clear differences compared to lipoedema.

Clinically important are above all the Affected feet/toes and the already mentioned Stemmer’s sign. With lipoedema the swellings are limited to the legs (and possibly arms), Feet and toes are left out.

Typically, lipedema ends abruptly above the ankles, so that the feet and back of the foot are free of edema and relatively slim (kink at the ankle). With lymphoedema on the other hand, the accumulation of fluid often extends to the foot: swelling of the back of the foot and toes occurs. the back of the foot and the toesrecognizable, for example, by a bacon folds above the toes.

Therefore, in lymphoedema the Stemmer’s sign is usually positive – the thickened toe skin cannot be lifted. In lipoedema, the Stemmer’s sign is negativeas the skin of the toes can be gripped normally.

Another difference is the Body side and symmetryLipedema always occurs always occurs symmetrically on both legs (or arms); lymphedema, on the other hand, often affects only one side or is at least asymmetrical.

For example, primary leg lymphoedema would typically show one leg significantly more swollen than the other, whereas in lipoedema both legs are relatively evenly enlarged.

In addition, the pain different: Pressure pain is a leading symptom of lipoedema – even slight pressure hurts – whereas pure lymphoedema is usually not painful reacts to pressure. Patients with lymphoedema tend to complain about a feeling of tightness or heaviness, but not about the sensitivity to pressure as with lipoedema.

The thumb test also behaves differently: In lipedema, no permanent dent can be pressed with the thumb (negative Godet), in lymphedema – at least in the early stages, as long as the tissue is still soft – a dent persists longer. dent remains longer (positive Godet).

In advanced stages, lymphoedema becomes hard and fibrotic, and it is no longer possible to press a dent; however, in the beginning, pitting oedema is characteristic.

With regard to the skin changes the following applies: lipoedema patients tend to suffer from haematomas, but inflammations or infections in the swollen areas are rare.

Lymphoedema, on the other hand, damages the skin barrier in the long term and often leads to hardening of the skin and an increased risk of infections such as erysipelas (erysipelas).

Visible changes such as papillomatosis, hyperkeratosis or barky skin are found in lymphoedema that has been present for a long time, but not in lipoedema.

Taken together, all these features usually allow a clear distinction to be made: Lipoedema shows symmetrical, pressure-painful fat pads with recessed feet (Stemmer negative)while lymphoedema is asymmetrical, rather painless, with coarse swellings down to the toes (Stemmer positive) is associated.

Lipedema vs. obesity – fat distribution & effect of diets

At first glance lipedema and general overweight (obesity) Both are associated with increased fatty tissue and often a larger body circumference. In fact, the clinical pictures can also occur in combination.

Nevertheless, there are important differences: In the case of pure obesity the fat is usually proportional to the whole body including the torso, abdomen and extremities. At the lipedema on the other hand, the proportions are inharmoniousEspecially legs, hips and possibly arms store excessive fat, while the upper body upper body remains comparatively slim. remains comparatively slim.

The patient’s upper body often appears two dress sizes smaller than the lower body region – a significant disproportion that does not occur with obesity alone.

Another distinguishing criterion is the symptoms and tissue characteristics. Lipoedema patients suffer from painful legs and very easily get bruiseseven with small bumps.

Overweight people without lipedema on the other hand, usually have no pain in their fat pads and no unusual tendency to hematoma. Fatty tissue caused purely by obesity is soft and not susceptible to pressure; it primarily causes mechanical problems (stress on joints etc.), but no spontaneous pain in the tissue.

This difference – painfulness vs. freedom from discomfort – is essential for differentiation. Experts also emphasize that lipoedema is not is not the result of a poor diet or obesity and will not disappear simply by losing weight.

Diet and exercise therefore play a role in the differential diagnosis: in the case of obesity, a reduction in calories can lead to significant fat loss all over the body, whereas in the case of lipoedema, even the strictest diets hardly reduce the pathological increase in fat on the legs/arms.

Many sufferers are frustrated to find that although they lose weight overall, the disproportionately thick legs or hips remain. This lack of success in the affected areas is typical of lipoedema. Therefore, a Therapy trial with weight loss may be an indication: If the extremities remain unusually full despite a normalized BMI, this indicates lipoedema.

Obesity fat on the other hand, melts away relatively evenly across the body under diet and exercise – in particular a reduction in the abdominal circumference is to be expected here, whereas with lipedema the leg circumferences remain disproportionately high.

However, it is important to note that lipoedema and obesity are often combined often occur in combination: A large proportion of lipoedema patients also develop obesity over the years.

In such cases, both aspects must be treated – the obesity (e.g. through dietary changes, exercise, possibly bariatric surgery) and lipoedema (conservative therapies, liposuction if necessary).

To summarize: Lipedema is characterized by a regional, painful increase in fat with diet resistancewhile obesity leads to global obesity without localized pressure pain leads to localized pressure pain.

Lipedema vs. cellulite – cosmetic effect vs. disease value

Cellulite (orange peel skin) and lipedema are sometimes colloquially confused, as both are associated with Dents in the skin go hand in hand. However, cellulite refers to not a clinical picturebut a purely cosmetic phenomenon due to structural connective tissue weakness. The Skin surface – especially on the thighs and buttocks – shows the typical wavy dimpling, especially when pinching or tightening, but cellulite does not cause any medical complaints. no medical complaints as a result.

It can affect both slim and overweight women and causes no pain. no pain. In contrast to this, lipedema is a chronic diseasewhich is also often accompanied by cellulite-like skin dimples, but also causes serious symptoms.

The main distinguishing feature is again the painLipoedema typically hurts (pain on pressure and touch, feeling of heaviness), cellulite on the other hand not painful. In addition to the skin changes, lipoedema patients also exhibit Swelling of the extremities, a feeling of tension and increased sensitivity – all of which are absent with pure cellulite.

While in the case of cellulite the skin unevenness but remains soft and normally supplied with blood, the tissue in lipedema often feels hardened and there are real fat nodules which can be felt. Cellulite dimples are caused by the protrusion of existing fat cells in weak connective tissue, whereas lipoedema dimples are caused by new increased fat cells and edema – the skin is thickened and firmer as a result.

After all, cellulite has no progression or complications: It remains an aesthetic skin appearance and at most requires cosmetic treatments. Lipoedema, on the other hand, is progressive (usually worsens over years without treatment) and can lead to considerable limitations.

To summarize: Cellulite is usually only an optical problem without disease value, whereas lipoedema represents a serious fat distribution disorder with pain symptoms. In case of doubt, the differentiation can easily be clarified by a specialist examination, as the Accompanying symptoms (or their absence) clearly show what you are dealing with.

Lipedema vs. lipohypertrophy – lack of pain, aesthetic phenomenon

The term lipohypertrophy refers to a congenital disproportionate fat distribution anomaly on the legs and/or arms, which mainly occurs in women. Externally, it can be very similar to lipoedema, as there is also an increased accumulation of fat on the lower and upper thighs (and possibly arms) – often also symmetrical and genetically familial.

The decisive difference lies in the symptoms: in lipohypertrophy, the pain and discomfort typical of lipoedema are absent. Although the fat deposits are present and may be cosmetically disturbing, they are not painful under pressurethere is no tendency to hematomas and no feeling of illness. Lipohypertrophy therefore has no disease value in the narrower sense, but is considered a normal variant of fat distribution.

In the medical literature it is described as a benign phenomenon without pathological changes. Basically, it is ” Strong legs without pain“.

Differentiation is important for the doctor: If all clinical symptoms are absent, but the legs are disproportionately thickis referred to as lipohypertrophy rather than lipedema. Sometimes this is also referred to as Lipedema stage 0 is called – it is, so to speak, a preliminary stagein which a fat distribution disorder is present but does not (yet) cause any pain.

In some cases, lipohypertrophy can “transition” into lipedema in the course of life, e.g. if hormonal changes occur or edema and pain are added.

However, as long as no pain, no edema formation and no functional impairment the diagnosis of lipohypertrophy remains. The Therapy is primarily cosmetic/conservative (weight optimization, compression garments if required) – more invasive measures such as liposuction are generally only considered in cases of painful lipoedema, not in cases of mere lipohypertrophy.

In summary: Lipohypertrophy looks like lipoedema, but does not hurt. It is an aesthetic increase in fat without any accompanying pathological symptoms and therefore by definition not lipoedema by definition.

Precise demarcation in everyday life – how patients recognize this

Many sufferers wonder whether their symptoms are due to lipoedema or “only” to obesity or other causes. As lipoedema is often associated with obesity (overweight) or also a lymphoedema it is important to know the typical signs of the disease.

In everyday life, patients can pay particular attention to the following characteristics in order to distinguish lipoedema from other problems:

• Symmetrical fat deposits on the legs and/or arms: In lipedema, fat is deposited disproportionately on both legs (and possibly arms), while feet and hands are typically not are affected. This leads to conspicuous proportions – a narrow waist but strong legs (“saddlebags”). With general obesity, on the other hand, the fatty tissue is usually distributed more evenly over the whole body.
• Heavy, painful legs throughout the day: Lipoedema patients often report that their legs and arms swell during the day and become increasingly heavy. Pain, feelings of tension and heaviness increase towards the evening. Elevating the legs often brings little relief. Normal excess weight does not usually cause such pronounced pain or swelling.
• Pressure pain and a tendency to bruise: A key distinguishing feature is that in lipoedema, even slight pressure on the skin hurts and hematomas (bruises) can occur very quickly. In obese people without lipoedema, there is no such pressure pain and bruising does not occur more frequently.
• Diet and exercise have little effect: What is unusual for lipoedema is that the increased fat deposits can hardly be reduced by calorie reduction or exercise. People who are only overweight usually become thinner all over their body by losing weight – in lipoedema, however, the affected areas remain disproportionately fat. This fact frustrates many sufferers and often leads to the misconception that losing weight is “hopeless anyway”.

A simple self-test is the so-called pinch testThis involves gently pinching the skin at various points on the leg with your thumb and forefinger.

Typically, healthy or only overweight people feel slightly more pain on the inside of the thighs than on the outside. With lipoedema it is vice versa – in this case, the outer side usually hurts much more, as there is more abnormal fatty tissue there.

If even a slight pinch on the outer side of the thigh hurts a lot, there is a high high probability of lipoedema. Small, nodular indurations under the skin may also be palpable.

Important: If the pinch test is inconspicuous, this does not rule out early lipoedema with certainty – the sensation of pain is individual and can be influenced by regular complaints.

Overall, however persistent pressure pain in the legs/arms, which gets worse when touched, is a warning signalthat speaks for lipoedema in this form.

Conclusion: Those affected can pay particular attention to the symptoms mentioned in everyday life. If symmetrical fat pads (with slim feet), increasing swelling and pain throughout the day, an unusual amount of bruising and resistance to diet/exercise occur together, lipoedema is suspected.

In such cases, it is important to seek medical advice at an early stage – ideally from a specialist who is familiar with the clinical picture. An early Diagnosis is crucial, as untreated lipoedema progresses and can severely impair quality of life.

Questions you should ask your doctor

Being well prepared for the consultation helps to clarify all the important points. Here are some Questionsthat you should ask your doctor if you suspect or have been diagnosed with lipoedema:

• Are my symptoms definitely lipoedema, or are there possibly other or additional conditions (e.g. lymphoedema or venous insufficiency)? – Important to mixed disease (such as lipo-lymphoedema) and to plan the correct treatment.
• At what stage is my lipoedema at? – Ask for the doctor’s assessment of the progression of the disease (stage I-IV) and which areas of the body are affected. This is important as treatment recommendations often depend on the stage.
• Which therapy options are possible for me? – Let us explain to you which conservative measures (such as manual lymphatic drainage, compression therapy, exercise therapy) are useful and whether a surgical therapy (liposuction) is recommended. Ask about the advantages and disadvantages of the methods in your particular case.
• If the planned therapy is covered by health insurance covered? – Ask about the costs at an early stage. In Germany, conservative therapies (compression stockings, lymphatic drainage) are generally covered by health insurance.
  Liposuctions are generally not covered by health insurance, except for stage 3.
  
• What can I do myself in everyday life to positively influence the course of the disease? – Your doctor can give you tips on exercise (such as gentle sports like swimming or cycling), about diet (anti-inflammatory diet, weight management) and skin care. Use the consultation to clarify any uncertainties regarding exercise or diet for lipoedema.
• What will happen in the long term and what are the check-up appointments look like? – Ask at what intervals you should come for a check-up and how you can recognize a progression of the disease. Also clarify whether the doctor can refer you to a specialist or whether further treatment at a specialist center is necessary. Lipedema Center would be useful.

These questions help to get a comprehensive picture and to make an informed decision about the next steps together with the doctor.

Don’t hesitate to have the answers written down if necessary or to take someone with you to the interview – this can be very helpful, especially if you have a lot of information.

How to prepare for your appointment – tips from the VenaZiel Lipedema Center

Our experience at the VenaZiel Lipedema Center shows that patients who are are well prepared go into the appointment, benefit more from the conversation. Here are some practical tips that we recommend to help you prepare for your lipoedema appointment:

• Document symptoms: Make a note of your symptoms in advance. How long have you had pain or swelling? In which situations (e.g. after standing for a long time, in the evening) do they occur in particular? This information will help the doctor to get a clear picture of your medical history.
• Create a list of questions: Write down all the questions that concern you – e.g. about treatment options, prognosis, everyday life (see list above). This way, you won’t forget anything during the appointment and will receive answers to all important points.
• Bring documents with you: If available, take relevant medical documents with you. This includes, for example, previous findings or doctor’s lettersespecially if you have already had a vein examination (Doppler/duplex ultrasound) has already been carried out or a lipoedema diagnosis has already been made by a doctor.
  These documents (as well as any allergy passports) can provide the doctor treating you with valuable information. Although this is not absolutely necessary for an initial examination, it is very helpful.
• Suitable clothing: Choose comfortable, easily removable clothing for the appointment. Shorts or a skirt, for example, are recommended so that your legs can be examined without any problems. You should wear compression stockings before compression stockings before the examination – so plan to arrive a little earlier if you need time to change beforehand.
• Be honest and open: Tell the doctor openly about your symptoms and previous measures. For example, mention if you have not seen any improvement despite diet and exercise – this underlines the suspicion of lipoedema. Do not be afraid to talk about pain, psychological stress or restrictions in everyday life. The more complete the picture, the better we can help you.
• Consider accompaniment: If necessary, it can be useful to take a trusted person with you to the appointment. Especially if you are nervous or have a lot of questions, a companion can support you and recapitulate the information discussed with you later.

These tips from our center should help you to use the doctor’s consultation effectively. Our aim is that Your concerns are heard and you receive all the information you need. After all, a well-prepared consultation is the first step towards successful treatment.

Who makes the diagnosis – and who is the specialist?

The diagnosis lipedema is ideally made by am **Specialistdoctor** who has a lot of experience with this clinical picture. Unfortunately, not all doctors are familiar with fat distribution disorder – which is why many patients only receive a correct diagnosis after a veritable medical odyssey.

Lipoedema is often initially dismissed as pure obesity and patients are sent home with the advice that they should exercise more or lose weight. Such misdiagnoses cost valuable time and lead to frustration for those affected. This makes it all the more important to find the “right” doctor or the right point of contact at an early stage.

Specialists for lipoedema usually recognize the disease at first glance and can reliably distinguish it from obesity or lymphoedema. These specialists include in particular lymphologists, phlebologistsvascular specialists and plastic surgeons. In the following, we explain what role these and other specialties play in diagnosis and treatment.

Phlebologists, vascular & lymph specialists

If lipoedema is suspected, a practice for lymphology or phlebology is often the best address. Lymphologists are doctorswho specialize in diseases of the lymphatic system – and this includes lipoedema.

These are usually specialists in the field of dermatology (dermatologists), angiology (vascular internists) or internal medicinewho have completed additional training in lymphology.

Thanks to this expertise, they can often recognize lipoedema based on the typical body shape and symptoms and differentiate it from other diseases. A thorough clinical examination (medical history, inspection, palpation of the subcutaneous fatty tissue) then confirms the diagnosis.

Modern lymphologistsuse a gentle palpation test instead of the pinch test used in the past. palpation test in which the skin is checked for painful indurations.

Phlebologists are specialists in vein medicine who deal with venous diseases (e.g. varicose veins, CVI). Many phlebologists are also familiar with lymphoedema and lipoedema or work with lymphologists.inside together. As lipoedema and venous diseases can cause similar symptoms (swelling, heavy legs), a phlebological examination is often useful.

In specialized vein centers – such as our VenaZiel Center – lipedema diagnostics are part of the range of services. They often also use ultrasound checks whether there are additional venous circulatory disorders or whether the condition is purely lipoedema. For example, accompanying leg edema due to venous insufficiency can be ruled out before treatment begins.

Among vascular specialists we understand here above all angiologists (internal medicine vascular specialists) and vascular surgeons. These specialists can also recognize lipoedema, especially if they have training in lymphology. However, lipoedema is not treated purely by vascular surgery, as it is not a primary “blood vessel disease” – nevertheless, vascular specialists are important in order to other causes of leg swelling (e.g. deep vein thrombosis, arterial circulatory disorders, etc.).

In short: An interdisciplinary team from phlebology, angiology and lymphology offers the best conditions for a reliable diagnosis and individual treatment planning for lipoedema.

Also worth mentioning are Specialists for plastic and aesthetic surgerywho specialize in lipoedema. They come into play in particular when a Liposuction (liposuction) is being considered as a therapy. Many plastic surgeons perform lipoedema surgery; some work in their own lipoedema clinics or cooperate with lymphologists for holistic care.

It is important to choose a surgeon who has experience with lipoedema patients – this is not purely cosmetic liposuction, but a medical procedure that must be performed carefully and completely. Indications of good expertise can be, for example, certificates, further training in the field of lymphology or positive patient reports.

GPs & dermatosurgery: what are their roles?

Yourse **Doctorin** is often the first port of call, especially when it is still unclear what is behind the symptoms. General practitioner We know your medical history and can clarify other causes of weight gain or swelling – such as hormonal problems (thyroid), side effects of medication or general lifestyle factors.

However, many general practitioners are not familiar with the specific picture of lipoedema. As a result, lipoedema is easily overlooked by GPs or confused with obesity. Their role is to issue a referral to a specialist in the event of suspicion.

Do not hesitate to contact youre family doctordirectly about your suspected lipoedema and ask for a specialist consultation (with a phlebologist/lymphologist) if your family doctor is unsure.

However, some GPs are also involved in this area themselves – especially doctorswith the additional qualification phlebology could already make the correct diagnosis in the GP practice.

Under dermatosurgery refers to the surgical activity of dermatologistsfor example in the areas of liposuction and skin tightening. Dermatosurgery plays an important role in lipedema, as the technique of liposuction was originally developed in dermatology (by Dr. Jeffrey Klein). Dermatologist This means that surgeons with additional surgical training can perform liposuctions and treat many lipoedema patients, often in specialized practices or clinics.

This is sometimes also referred to as cooperative centersin which dermatologists (for diagnosis and conservative therapy) and dermatosurgeons or plastic surgeons (for surgical therapy) work hand in hand.

The role of dermatosurgery therefore lies primarily in the surgical treatmentFor example, if liposuction is indicated after a diagnosis has been made, a doctor who is experienced in dermatosurgery can perform the procedure.

Dermatologists are also involved in aftercare important – for example in wound healing, scar treatment or skin care after an operation.

To summarize: The family doctor takes over the basic care and the recognition of suspicious symptoms, while dermatosurgery specialists or plastic surgeons perform the specialized procedures. interventions to carry out. If possible, both should be networked with the lymphology/phlebology experts so that the patient receives comprehensive care.

When is it worth taking a second look at the Lipedema Center?

Precisely because not all doctors are familiar with lipoedema, it can be very useful to get a second opinion at a specialized lipoedema center. But when is such a “second look” recommended?

• Uncertainty in the diagnosis: If you have the feeling that your symptoms have not been correctly classified or the doctor is unsure, you should seek another opinion. An experienced lipoedema specialist often recognizes the clinical picture immediately and can clarify any doubts.
  Especially if you have been told “you just need to lose weight”, but you still suspect lipoedema, a visit to a specialist center is advisable.
• No improvement under therapy: Even if you have already been diagnosed and are wearing compression stockings or receiving lymphatic drainage, for example, but do not feel any improvement, a lipedema center can help. The treatment plan will be reviewed and optimized – there may be new approaches or the indication for liposuction should be reassessed.
• Planning an operation: If lipoedema liposuction is on the cards, it is worth going to a specialized center or clinic that frequently performs such procedures.
  Specialized surgeons can explain the procedure, have experience with gentle techniques (e.g. water-jet assisted or vibrating liposuction) and know what to look out for in lipoedema patients. A second opinion before a major operation gives you security and confidence in your decision.
• Dissatisfaction with the previous doctor: If you do not feel sufficiently informed or taken seriously, it is absolutely legitimate to change doctors. Different statements from different doctors can be unsettling – in this case you may well consult a third specialist. It is important that you feel you are in good hands and that the new doctor takes time for you.

In a Lipedema Center VenaZiel brings together various areas of expertise: Lymphology, phlebology, nutritional advice, physiotherapy and surgery work hand in hand. This means that patients can be assessed holistically.

A “second look” often brings new insights – be it a more precise diagnosis (e.g. recognition of mixed forms such as lipo-lymphedema) or an extended range of treatment options that the first practitioner may not have been able to identify.

In summary, a second opinion is always worthwhile if you are not fully satisfied with the first diagnosis/therapy. not fully satisfied or simply want certainty. Do not hesitate to exercise this right.

The guidelines and experts expressly recommend seeking detailed advice and, if necessary, a second opinion to catch up. After all, it’s about your health and quality of life – and these are at the heart of all good medical care.

The typical diagnostic procedure in your clinic

Many patients with lipoedema have already suffered for a long time. It is not uncommon for the fat distribution disorder to be misdiagnosed as overweight or other illness.

At your specialized clinic, we take care to avoid such misdiagnoses to avoid. So that you know exactly what to expect, we explain the typical procedure for the Lipedema diagnosis – from the first diagnostic interview to the documentation of the findings.

Initial consultation & anamnesis

It all starts with an empathetic initial consultation with a detailed anamnesis. Your doctor will take plenty of time for you: you can talk about your symptoms in peace and ask all your questions.

The important thing is when and how the symptoms began – for example during puberty or after pregnancy, as this is typical for lipoedema.

You will also be asked about your family history: does your mother or grandmother have similar problems? As lipoedema often runs in families, this information is valuable.

Do not be afraid to talk about painyour everyday feelings and any emotional stress. Lipoedema can be very stressful and your treatment team knows this. That’s why part of the diagnostic consultation also includes life situation and possible psychological stress – this is the only way to get a complete picture.

All of this information is included in your medical history and helps us to plan the next steps in the diagnostic process. Our patients often fill out a questionnaire about their medical history in advance so that we can prepare ourselves optimally.

In the initial consultation itself, we will then go through your answers together, clarify any uncertainties and listen to you carefully.

In short: In this phase, the focus is on listening and understanding in the foreground. You are the expert on your own body – the more precisely you describe your symptoms, the better the doctor can get a picture.

Typical signs of lipoedema are, for example, pressure-sensitive, painful legs that swell during the course of the day and a A tendency to bruise without any recognizable reason. All of this is recorded during the consultation. At the end of the anamnesis, your doctor will already have an initial suspicion – and you will have the good feeling that you are being taken seriously.

Examinations & tests – what happens per session

The interview is followed by a physical examination. Your doctor will take a close look at your affected body areas (usually legs, sometimes also arms). He or she will look for the typical picture of lipoedema: a symmetrical increase in fat on both legs or arms, often with a slender trunk and slender feet or

hands. The Distribution pattern differs from normal obesity – in lipedema, the fat pads usually end abruptly at the ankles, so that the feet remain normally slim (this is referred to as “collar formation”). “collar formation”).

Legs of women with different figures – with lipoedema, the legs and hips are often affected, while the feet and upper body remain slimmer.

The inspection is followed by palpation (palpation) to. Your doctor will use their hands to check the condition of your subcutaneous fatty tissue. Typical abnormalities will become apparent early on: The skin may feel as if there are small nodules or polystyrene beads underneath.

An important part of the examination is the pinch testThis involves carefully pinching the skin on the outside of the thigh. In lipoedema patients, this test is usually clearly more painful than at a comparable point in unaffected areas. This means that if you pinch an area of lipoedema, it hurts excessively, whereas pinching the abdomen or the inside of the legs, for example, causes fewer problems.

This different sensation of pain is a strong indication of lipedema. The Sensitivity to pressure is checked overall, e.g. whether even slight pressure with the finger on the legs is uncomfortable.

Thorough diagnostics often include further tests within the same session. Your doctor will Body circumference typically measuring the circumference of the legs, hips and waist. This allows the extent of the fat distribution disorder to be determined on the one hand, and a Differentiation from obesity to make.

For example, a comparison of waist circumference and leg circumference shows whether there is a disproportionate fat distribution. In addition, your Weight and your height are recorded to calculate your BMI – this also helps to rule out other causes for your figure.

If necessary Devices and imaging procedures for use. Very often a Ultrasound examination (sonography) of the legs. This enables the doctor to determine, for example, whether varicose veins or venous insufficiency that could contribute to swelling.

Although lipoedema cannot be “seen” directly on ultrasound, this examination is important in order to other causes swollen legs (such as a venous disease) can be ruled out.

Ultrasound can also be used to roughly assess how thick the layer of fat under the skin is, which gives an indication of the lipoedema stage can give an indication of the stage of lipoedema.

In some cases, our clinic also uses more modern techniques – for example 3D body scanners or bioimpedance analysis – to measure your body composition precisely. Such objective measurements help to check the success of the therapy later on.

If necessary, we will arrange for additional laboratory tests. For example, a blood sample can Thyroid function, liver and kidney values etc. must be checked. Why? Certain internal problems (e.g. hypothyroidism) can promote oedema or be associated with lipoedema.

Your doctor wants to make sure that no such underlying disease is overlooked. All these tests – physical examination, ultrasound, laboratory – can usually be carried out in one appointment. So you don’t have to come in separately for each step. At the end of the examination, you will usually already know exactly where you stand.

Securing results – documentation, progress, findings

After all examinations have been completed, the next step is the careful documentation of the results. Your doctor will check all Findings from your medical history data to the results of the pinch test and measurement results such as circumference measurements. Specialized centers often also Photos or 3D scans are made to record the initial findings. Visual reference material such as this can be valuable for objectively assessing changes later on.

All the data together make up your medical reportwhich clearly states whether lipedema is present and if so, in which stage.

Lipoedema is usually divided into three stages (some experts even speak of four stages) – so your doctor will look at your skin condition and palpation findings and classify you accordingly.

Important: The staging primarily describes the changes in the tissue (e.g. smooth skin vs. lump formation), but does not automatically say anything about the severity of your symptoms. Even at an early stage, someone can have severe pain. Nevertheless, the stage documentation helps to Therapy planning.

In the final consultation, the doctor will diagnosis of lipedema with you – if it is confirmed – and explain all the findings to you. So you will find out exactly what we have found out. Don’t worry: you can of course ask further questions. Our aim is for you to understand your illness. This also includes an outlook: The doctor will explain to you how the Further procedure can look like. In addition Progress observations planned: This means that we record which checks or measurements are useful in the future. For example, we make a note of your current leg circumferences so that we can compare them at later appointments.

This allows us to see objectively whether, for example, a therapy is working or whether the lipoedema is progressing. If necessary, a next appointment for a follow-up if necessary – especially if conservative measures are to be tried first.

Once the diagnosis has been made, you as the patient have a sound basis on which to build your treatment. All the important points are now in black and white in your file. With these clear findings in mind, your doctor can make a individual treatment plan for you.

Thanks to the thorough diagnosis, you now know exactly where you stand – and together we can tackle the next steps. You can read more about the possible forms of treatment for lipoedema in our further guide on conservative and surgical treatment options.

Diagnosis confirmed – and now what?

The diagnosis lipoedema has been made – you may feel relieved to finally have some certainty and at the same time worried about what will happen next.

The important thing is: You are not alone with this finding. What happens now?

At your specialist clinic, you will not simply be sent home after the diagnosis, but will be given comprehensive information about the next steps. Below we explain what happens immediately after the diagnosis is confirmed.

Step 1: Exclude differential diagnoses

Before the actual therapy begins, your doctor will make sure that only only the lipoedema is behind your symptoms – and not another or additional illness. The elimination of Differential diagnoses is crucial in order to avoid incorrect treatment.

Although other possible causes were already taken into account during the diagnosis, they are now being looked at again specifically. Typical diseases that can be similar to lipoedema are

• Lymphoedema: Here, tissue fluid accumulates in the arms or legs, usually on one side or unevenly. In contrast to lipoedema, lymphoedema often also affects feet/toes – recognizable by the positive Stemmer’s sign (the skin above the toes cannot be lifted).
  Lipoedema, on the other hand, leaves the feet free; the Stemmer’s sign is negative (skin fold can be lifted). Lymphoedema also causes a feeling of tightness rather than pain. Your doctor will carefully check for signs such as these.
  
  If necessary, lymphatic scintigraphy can be used to test lymphatic function in order to rule out lymphoedema.
  Important to know: Both diseases can also occur occur simultaneously occur at the same time (so-called lipolymphedema). If lymphoedema is present alongside lipoedema, this will be included in the treatment plan.
• Lipohypertrophy: This refers to a purely aesthetic fat distribution disorder without disease value. Similar to lipoedema, there is increased fat on the legs and hips (often during puberty), butThere is no pain no pain, no bruises and no swelling.
  
  Lipohypertrophy is easily confused with lipoedema, but is actually “only” a figure variant. However, it can develop into lipoedema over the years.
  In your case, the doctor has recognized from the medical history and examination that pain and tenderness are present – this rules out pure lipohypertrophy.
• Obesity (overweight): Severe obesity can lead to similar fat gain, but usually all over the body (especially the abdomen) and not as disproportionately on the legs/hips.
  
  Crucial: Lipedema fat is resistant to diet – This means that even with weight loss, the affected areas remain disproportionately fat. With obesity, on the other hand, a change in diet would reduce the fat in all areas. Your doctor has probably determined your BMI and measured your waist-to-hip ratio to differentiate between generalized obesity and lipedema.
  
  Lipoedema patients often also have mild obesity, in which case both problems are addressed. It is important to Consequential risks of being overweight (e.g. high cholesterol or sugar levels) – therefore cholesterol, blood sugar etc. were tested in the laboratory if necessary.
• Venous diseases: Varicose veins or chronic venous insufficiency can also cause Swelling and feelings of heaviness in the legs. A reliable diagnosis of lipoedema therefore always includes a look at the Veins. Your phlebologist may have detected a Vein check made. This will rule out the possibility that your symptoms are primarily caused by a vein disease.
  
  If varicose veins have been detected, they can be treated at the same time – because untreated varicose veins would reduce the success of lipoedema treatment (they increase swelling and pain). Your treatment plan will therefore take into account all findings – lipoedema and any accompanying illnesses.

After all these differential diagnoses checked off you can be sure: The main cause of your symptoms is actually lipoedema. This clear foundation is important in order to initiate the appropriate treatment steps.

Step 2: Treatment planning – conservative or surgical?

Now the therapy planning. Your doctor will discuss the treatment options with you in detail. There are basically two approaches available: one conservative therapy (without surgery) and a surgical therapy. The plan will individually tailored to you – depending on the severity of your lipoedema, your personal wishes and circumstances.

It is often advisable to exhaust all conservative options first. These are aimed at alleviate symptoms and slow down the progression of the disease.

If conservative treatment does not produce the desired results or your lipoedema is already at an advanced stage (e.g. stage III), surgery may also be considered. Together with you, we will weigh up the benefits and risks of the options – You help decide which path is right for you.

An overview of the two therapeutic approaches:

• Conservative therapy: This includes all non-surgical measures. Central is the Complex physical decongestive therapy (CDT)which combines various components. In almost all cases, your doctor will prescribe medical compression garments for example, custom-made compression stockings or leggings.
  
  These exert pressure on the tissue and can thus reduce pain and swelling. Important to know: Compression does not melt away the fat itself, but it shapes the extremities and prevents further fluid accumulation.
  
  Compression is essential, especially if lymphoedema is also involved. In addition Manual lymphatic drainage (MLD) recommended. This is a gentle medical massage performed by specially trained physiotherapists that moves accumulated lymphatic fluid towards the trunk.
  You will usually feel relief afterwards because the pressure in your legs will ease. Other conservative measures include Exercise therapy (e.g. swimming, gymnastics in compression stockings) and skin care.
  
  Also an adapted diet is also part of this: Although lipoedema cannot be “dieted away”, healthy eating habits help to control accompanying factors such as obesity or inflammation.
  Your doctors will guide you through all of this – you will learn how you can actively help to improve your symptoms yourself. Conservative therapy requires a little patience and cooperation at the beginning, but in most cases it is the best solution. Basis of the treatment.
• Surgical therapy: If the lipedema is very pronounced or the non-surgical measures have not brought enough relief, a liposuction (liposuction) can be considered.
  Excess, abnormally altered fatty tissue is permanently removed in a surgical procedure. D Liposuction for lipedema is performed in specialized centers and usually in several sessions. several sessionsas only a certain amount of fat can be removed per operation.
  
  Modern techniques such as vibration-assisted or water-jet assisted liposuction are used, as well as ultrasound procedures (e.g. VASER). The aim of the operation is to reduce fat deposits and thus reduce pressure pain and movement problems.
  Many patients report a significant improvement in their quality of life after successful liposuction – their proportions finally fit together better and, above all, the daily pain subsides.
  
  Nevertheless, liposuction is not an easy step to take. Your doctor will advise you in detail (you may receive a separate consultation with the surgeon).
  
  It is also important that conservative measures are continued after liposuction. continued e.g. temporarily more intensive lymphatic drainage and permanent compression to maintain the result. An operation supplements conservative therapy, but does not replace it completely.

Your individual treatment plan may consist of a combination of these approaches. For example, many patients start with a few months of conservative therapyand if the symptoms do not improve sufficiently, the decision is made to undergo liposuction.

In other cases, it is clear from the outset that an operation is advisable – in this case, conservative treatment will of course still be carried out until the operation date in order to prepare your legs in the best possible way. Your treatment team will advise you comprehensively on the best strategy for you.

We are guided by current medical guidelines, but also by your personal goals and wishes.

Step 3: First steps at the VenaZiel Lipedema Center – individual recommendations

After the diagnosis and joint therapy planning, we will not leave you alone. In the VenaZiel Lipedema Center the first steps of your treatment will now begin. Everything will be individual tailored to you so that you receive the best possible support. What can you expect directly?

• Detailed final consultation: First of all, your doctor will sit down with you again and explain the next steps in detail. You will have the opportunity to ask any unanswered questions.
  During this consultation, the results of the diagnosis (your findings) will be explained to you in an understandable way and the planned treatment will be discussed point by point.
  
  The aim is for you to know exactly what happens next and why.
  This personal consultation is very important to us – you should go home with a clear plan and a good feeling.
• Tailor-made advice & planning: This is followed by the concrete therapy organization. Together with you we create a customized therapy plan.
  This means that we determine which conservative measures you receive and in what order. For example, the treatment with compression garments arranged.
  
  Our specialists take your measurements and help you choose the right compression class and materials so that your stockings/trousers fit perfectly.
  You will be given detailed advice on how to put them on, when to wear them and how to care for them – all step by step and without haste.
  If manual lymphatic drainage is part of the plan, you will receive a prescription for it.
  
  If other specialists need to be involved – such as a vascular surgeon for a large number of varicose veins or an endocrinologist for hormonal issues – we will also coordinate these referrals for you.
  
  Surgical steps (e.g. liposuction) are also planned together: You will learn how to prepare for the operation, what you need to consider post-operatively and what support is available during rehabilitation.
• Individual everyday tips: A major focus of our center is to prepare you for everyday life with lipedema. everyday life with lipoedema to be equipped. You will receive practical tips and recommendationshow you can help to alleviate the situation yourself – always adapted to your personal situation.
  
  This includes, for example, advice on exercise (“Exercise as often as possible, activities that are easy on the joints such as swimming or cycling are ideal – even with compression stockings on”), on diet (an anti-inflammatory diet can be helpful, but crash diets are not effective) and on skin care (regular application of suitable lotions to protect your skin under compression).
  
  We also provide you with strategies for dealing with any emotional stress: Don’t be afraid to accept support – be it through exchanges in self-help groups or, if necessary, through psychological counseling.
  All these tips should help you to cope better in everyday life and actively contribute to the success of your therapy.
  
  Of course, you will receive this advice in writing or in the form of leaflets so that you can read everything at home at your leisure.
• Aftercare and follow-up: At VenaZiel, we understand lipedema therapy as a continuous process. That’s why, right from the start, your Aftercare appointments planned. Depending on the treatment plan, we will arrange check-ups – perhaps every few months at the beginning, later on an individual basis as required.
  
  In these appointments we review the progressFor example, we measure your circumferences again, ask about your current complaints and adjust the therapy if necessary.
  
  Your compression supply is checked regularly and replaced if necessary (as the material may deteriorate over time or your measurements may change). If you have undergone surgery, you will have close follow-up checks to assess wound healing and the results of the liposuction. And of course we are also available to answer any questions you may have between appointments. We want you to feel that you are in good hands at all times.

To summarize: Once your lipoedema has been diagnosed, you will receive a clear roadmap from us. You will know which treatment steps are due, receive personal recommendations for everyday life and have a fixed contact person to support you.

The journey may be long, but you’re not going it alone – your VenaZiel team is by your side.

You can also find out how to cope better with lipoedema in everyday life in our guide with practical everyday tips and lifestyle strategies.

What to do if the findings are unclear?

Seek a second opinion or specialist at the lipedema center

Many lipoedema patients only receive a correct diagnosis after many years – on average it can take up to 10 years can pass before lipoedema is medically recognized.

This is also due to the fact that doctors without specialist knowledge often misinterpret lipedema symptoms as mere obesity.

It is therefore worth seeking a second opinion if the findings are unclear. second opinion and consult an experienced specialist or a lipedema center.

Such a specialist (such as a lymphologist, phlebologist or plastic surgeon with lipoedema expertise) knows the clinical picture and can assess the situation competently.

An additional opinion creates certainty about the findings and strengthens confidence in the treatment decision – precisely because lipedema is often misdiagnosed, the view of a second expert helps to carefully weigh up all the options.

Self-tests & screening tools – yes or no?

To date, there is no simple laboratory or imaging test that can clearly detect lipedema – even ultrasound examinations cannot provide direct evidence.

Ultimately, only a medical examination by an experienced specialist (e.g. phlebologist or lymphologist) can provide clarity. Self-tests or online screening tools can at best provide initial indications. One example is the Pinch testThis involves gently pinching the skin of the thighs (inside and outside).

If you feel a distinct pain even when lightly pinching the outside of your body, it is highly likely that you have lipoedema (because the increased fat cells press painfully on the nerve fibers). Digital questionnaires also ask about typical symptoms and provide a rough guide.

Please note, however, that such self-tests are only an initial orientation and cannot replace a medical diagnosis by a specialist not replace. In any case, the final diagnosis should be made by an experienced doctor by means of a clinical examination.

When it makes sense to supplement imaging procedures (ultrasound, lymphoscintigraphy)

A clinical examination forms the basis of the diagnosis, but if necessary imaging procedures can be used to confirm the findings or rule out differential diagnoses.

In particular the ultrasound helps to rule out other causes for the pain – for example, venous insufficiency or varicose veins can be detected in the sonogram and ruled out as the cause of the pain.

In contrast, the fatty tissue itself does not look any different in lipoedema does not look any different than with normal obesity, so this method cannot make lipoedema directly visible.

A lymphoscintigraphy (visualization of lymphatic drainage using radioactive marker substances) is only carried out in special cases, for example if it is unclear whether there is also lymphoedema is also present.

This procedure visualizes lymphatic drainage disorders in the extremities and is primarily used in cases of suspected chronic lymphoedema or a mixed form (lipoedema plus lymphoedema, so-called lipolymphedema) is used.

In the case of pure lipedema, there is usually no Lymph congestion; studies even show that lymph transport can be normal or increased initially. Therefore, lymphatic scintigraphy for lipoedema diagnosis not routinely but can provide helpful information in unclear borderline cases.

Conclusion & next steps

• Overview: After a clear diagnosis has been made, many sufferers feel great relief. This certainty about the cause of the symptoms is already the first successbecause targeted treatment can now be planned.
• Recommendation: Make an appointment for an official diagnosis as soon as possible – ideally at a specialized lipedema center such as VenaZiel. Modern procedures (e.g. high-resolution ultrasound or lymphoscintigraphy) are available there to make a precise diagnosis and rule out other diseases.
  Thanks to this expertise, you not only receive certainty, but also a customized treatment plan for the next steps.
• Note: Remember that the diagnosis is just the beginning. Based on the findings, the actual therapy can now begin – with the aim of alleviating your symptoms and improving your health. quality of life of life.
  
  With the support of experienced specialists (such as the VenaZiel team), you can continue on your path: from treatment to aftercare – for a more active and pain-free life again in the future.

FAQ on lipoedema diagnosis

• How is lipedema diagnosed?

The diagnosis of lipoedema is made by a combination of medical history, physical examination and, if necessary, imaging procedures, in particular ultrasound.

Doctors such as phlebologists, vascular specialists, dermatologists or plastic surgeons are responsible for making the diagnosis, as they have the necessary specialist knowledge and experience with the disease.

• How can I tell if I have lipedema?

Lipoedema can be recognized by several signs, which typically include symmetrical fat distribution on the legs and hips, pain and tenderness in the affected areas, and a tendency to bruise without an identifiable cause.

Other indications may be heavy, aching legs that swell during the day and may also hurt at night, as well as a disproportionate figure with a slimmer upper body and increased fat deposits on the legs and/or arms.

• What are the first signs of lipoedema?

The first signs of lipoedema include a symmetrical increase in fat on the legs and/or arms, often extending to the ankles or wrists, while the hands and feet remain slim.

Other early symptoms include tenderness and pain in the affected areas, as well as an increased tendency to bruise. A feeling of tension and heaviness in the limbs can also indicate lipoedema.

• What does the pain of lipoedema feel like?

The pain associated with lipoedema is often described as a described as a pressing feeling of tension that is comparable to sore muscles.

Those affected report sensitivity to touch, so that even light touch can cause pain. The pain can increase during the course of the day and be exacerbated by prolonged standing or sitting.

• Where exactly do the legs hurt with lipoedema?

Lipoedema causes pain mainly in the legs, although the intensity of pain can vary from person to person. Typically, the legs are affected, especially the thighs and lower legs, although the hips and buttocks are also often involved.

The pain is often described as pressing, pulling or stabbing and can also occur with a light touch or without any external influence.

• How does lipoedema begin – where do the symptoms first appear?

Lipoedema begins typically begins with a symmetrical fat distribution disorder, which is usually seen on the legs and/or arms. is usually seen on the legs and/or arms.

The first symptoms are often pain, a feeling of tightness and increased sensitivity to touch in the affected areas. Those affected often notice an increase in fatty tissue, particularly on the hips, thighs, lower legs or arms, while the hands and feet are usually not affected.

• What does stage 1 lipedema look like?

Stage 1 lipoedema is characterized by a uniform thickening of the subcutaneous tissue on the arms and legs, usually with a smooth skin surface, but which can show the first signs of “orange peel skin” or dents when pressure is applied or the skin is pushed together. The fat structure is fine-knotted and those affected often report pain or tenderness in the affected areas. Further details on stage 1 lipoedema:

• • Symmetrical fat distribution disorder
  • Smooth skin
  • Fine nodular fat structure
  • Pain and sensitivity to pressure
  • Tendency to bruising
  • No or little swelling
  • Different body proportions

• No change despite exercise and dieting

• What is the difference between normal fat legs and lipoedema?

Lipoedema is a fat distribution disorder that differs from normal thick legs as it is associated with pain, tenderness and a tendency to bruise.

In addition, the distribution of fat in lipoedema is symmetrical and often disproportionate to the rest of the body, whereas fat legs are often caused by other factors such as obesity, lymphatic drainage disorders or vein problems.

• Can lipedema also occur at a normal body weight?

Yes, lipoedema can also occur at a normal body weight or even if you are underweight. It is a chronic fat distribution disorder that is not exclusively associated with being overweight.

• How can I test myself to see if I have lipedema?

A self-administered test can give an indication of possible lipedema, but is not definitive. The lipoedema pinch test can help by pinching the skin on the thighs and looking for tenderness. Pinching that hurts more than on the inside could indicate lipoedema, as this is often the opposite in healthy people.

Other signs include rapid bruising, swelling that increases in the evening and an uneven skin texture with possibly nodular areas. However, a visit to the doctor is essential for a definitive diagnosis, as the symptoms can also occur with other diseases.

Explanation of the pinch test:

• The pinch test is carried out by pinching the skin on the thighs between the thumb and index finger.
• Pay attention to whether you feel pain or an unpleasant feeling of pressure.
• With lipoedema, sensitivity to pain is often greater on the outside of the thighs than on the inside, in contrast to healthy people.

• How reliable is the Stemmer’s sign in distinguishing lymphoedema?

The stemmer mark is a useful, but not completely not completely reliable characteristic for distinguishing lymphoedema from other swellings, especially lipoedema.
A positive Stemmer’s sign, i.e. the inability to lift a fold of skin in the affected area, indicates lymphoedema, but does not rule it out with certainty.

A negative Stemmer’s sign, in which the skin fold is slightly raised, does not definitively rule out lymphoedema either, as it can also occur with lymphoedema.

• How long does the diagnostic process take if lipedema is suspected?

The diagnostic process for suspected lipedema can vary, but on average it takes about 10 yearsuntil a diagnosis is made.

This is often because the symptoms can vary from woman to woman and lipoedema is not recognized by many doctors as a disease in its own right.

• Which doctor diagnoses lipedema?

A phlebologist (specialist in vein medicine), a lymphologist or a vascular specialist can diagnose lipoedema. A dermatologist or a specialist in plastic and aesthetic surgery who specializes in lipoedema can also make the diagnosis.

• Can a gynecologist diagnose lipedema?

A gynecologist can recognize signs of lipedema, but a definitive diagnosis should be made by a specialist, such as a phlebologist, lymphologist or vascular specialist.

It is important to see a doctor who specializes in lipedema to ensure a correct diagnosis and treatment.

• When does the health insurance company officially recognize lipoedema?

A health insurance company officially recognizes lipoedema if certain criteria are met, in particular stage III lipoedema and at least 6 months of unsuccessful conservative treatment.

The body mass index (BMI) can also play a role, whereby a BMI over 35 often requires concomitant obesity treatment and a BMI over 40 can rule out surgery.