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 receive no clear answer for years.

Lipoedema is often mistaken for overweight or dismissed as a 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, in the case of a real lipedema, 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 of suffering from a real (and treatable) disease can be psychologically relieving and the starting point for effective therapy.

What you will learn in this article – incl. Delineations & 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. Among other things, you will learn:

• 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. This is 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 do you recognize lipedema? There are several typical signs, which occur together. Each patient is individual, but the following symptoms occur particularly frequently (and often in combination) with lipedema. Important: Not every symptom alone immediately means lipedema – 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 occur, which often worsen in the evening or after prolonged 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 wrists at the top and at the ankles at the bottom – a difference from lymphedema, in which 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 lipedema. Then symmetrical fat deposits also appear on the upper and lower arms, while the hands and fingers remain slim.

The symmetry is crucial: Both legs (and possibly both arms) are evenly thickened. This bilateral distribution and the sparing of hands and feet clearly distinguishes lipedema from other diseases. So if you 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 legs or arms. Lipedema patients tend to 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 consciously notice – can cause a visible bruise. So if you find that you 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 lipedema. As a rule, these signs are not found in simple obesity. So, should you notice unexplained hematomas and your legs are sensitive to touch and painfully tense, this is a clear indication that a doctor should clarify.

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 lipedema is primarily clinical – a special laboratory test or individual marker does not exist. Therefore, a detailed discussion with the patient and a careful physical examination are 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 anamnesis, in which the doctor asks about the medical history and current complaints. The discussion will include topics such as 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. Also a noticeable 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)? Stay Feet and hands free? Lipedema almost always affects both legs (and often both arms) evenly, while the feet/toes remain slim.

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

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 were 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 lipedema areas. As a result, a disproportion between a slim upper body and strong legs often remains.

This information helps to distinguish lipedema from pure obesity. In addition, the doctor inquires 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 anxieties that go hand in hand with the body image. All of this information together – family predisposition, hormonal triggers, typical pain, tendency to hematomas, diet resistance and psychological effects – already provide important clues to lipedema in the conversation.

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 examined closely. Often shows a finely knotted structure of the skin – colloquially Orange peel skin (cellulite) – especially in 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 arise, e.g. on the insides of the thighs or knees. The skin over the lipedema area is often rather cool and pale (no overheating) and shows fine bluish veins veins (spider veins/telangiectasia).

A very important sign is the Tendency to hematomas: Even minor bumps lead to bruises in lipedema patients. This is due to the increased fragility of the capillaries in the diseased fatty tissue.

The presence of numerous hematoma spots on the legs or arms thus supports the suspected diagnosis of lipedema. In contrast, skin inflammations, hardening or open areas typically do not occur in pure lipedema not If it does, secondary lymphoedema may already be involved.

The next step is palpation, i.e. palpating the affected areas. In lipedema, 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 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 underpins the diagnosis of lipedema. In addition, the Circumferences of the extremities are measured at defined points (e.g. on the ankle, calf, knee, thigh). Such measurements serve, on the one hand, 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 distinguish lipedema from lymphedema or other edematous 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 lift. Is this 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 an incipient lymphedema – in early stages, the skin may still be liftable. Therefore, the overall picture of the findings is always considered.

The daumen test checks whether in the tissue water edema available. In this case, the thumb is used to press on the swollen area for about 10 seconds and it is observed 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. The lipedema tissue contains hardly any free fluid in the early stages, so no water is displaced from the pressure area. In contrast, the thumb test 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 that moves to the side due to the pressure and only gradually flows back. A positive Godet sign would therefore against pure lipedema and rather indicate lymphedema or venous edema.

To summarize: Stemmer and thumb tests are negative in lipedema, positive in lymphedema. These simple clinical tests are among the most important differential diagnoses in lipedema 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 lipedema, but in certain situations, devices can be consulted to rule out other causes or to detect concomitant diseases.

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 diseases and lipedema are not uncommon together, so the venous condition should be checked by duplex sonography.

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

Furthermore, a high-resolution soft tissue ultrasound represent the subcutaneous fatty tissue. Typically, lipedema shows a 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 examination can be helpful if there is an atypical course or if there is a suspicion of other tissue changes (such as unusually hardened nodules that one wants to differentiate from tumors).

As a rule, CT/MRI are used for differential diagnosis, in order to rule out serious other diseases – such as liposarcomas (malignant fatty tissue tumors) or generalized edema as a result of 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.

Overall, however, the following applies: In most cases, lipedema can be recognized through anamnesis, clinical examination and the simple tests mentioned. Apparatus diagnostics are used in a targeted manner, if the clinical findings leave doubt or comorbidities are present.

Differential diagnosis – What is not lipedema?

Lipedema can easily be confused with other clinical pictures 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 available. The most important differentiations are described below.

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

Lymphoedema is swelling due to impaired lymphatic drainage. lymphatic drainage, which can occur e.g. after lymph node removals or due to congenital malformations. Compared to lipedema, it shows some clear differences.

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. The Stemmer 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 lymphedema complain more of a feeling of tension or heaviness, but not of the pressure sensitivity as with lipedema.

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) appear similar – 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 trunk, 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 also no unusual tendency to hematomas. Fatty tissue caused purely by obesity is soft and insensitive to pressure; it primarily causes mechanical problems (stress on the joints, etc.), but no spontaneous pain in the tissue.

This difference – painfulness vs. freedom from discomfort – is essential for differentiation. Experts also emphasize that lipedema 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 affected people frustratingly 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 lipedema. 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 change, lipedema patients also have 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 before, which you can feel. Cellulite dents are caused by the protrusion of existing fat cells with weak connective tissue, whereas lipedema dents 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 requires cosmetic treatments at most. Lipedema, 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, since 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 legs and/or arms, which occurs mainly in women. Externally, it can look very similar to lipedema, 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: Lipohypertrophy lacks the pain and discomfort typical of lipedema. The fat pads are present and may be cosmetically disturbing, but they are not painful under pressurethere is no tendency to hematomas and no feeling of illness. Lipohypertrophy 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 thick, one speaks more of lipohypertrophy than of lipedema. Sometimes this is also called 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 affected people wonder whether their symptoms are due to lipedema or “only” to being overweight or other causes. Since lipedema often comes 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 noticeable proportions – narrow waist, but strong legs (“riding breeches”). With general overweight, on the other hand, the fatty tissue is usually distributed more evenly throughout the 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: An essential distinguishing feature is that with lipedema, even slight pressure on the skin hurts and hematomas (bruises) can occur very quickly. In obese people without lipedema, such pressure pain does not exist, and bruises do not occur more frequently.
• Diet and exercise have little effect: Unusually for lipedema, the increased fat pads can hardly be reduced by calorie reduction or sport. Anyone who is only overweight will usually become thinner everywhere on the body by losing weight – with lipedema, on the other hand, the affected areas remain disproportionately thick. This circumstance frustrates many affected people and often leads to the misconception that weight loss 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 a slightly stronger pain on the inside of the thighs than on the outside. With lipedema 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 in the course of the day, an unusually large number of bruises and therapy resistance to diet/sport occur together, there is a strong suspicion of lipedema.

In such cases, it is important to seek medical advice early – 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

Preparing well for the doctor’s appointment 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 specific 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 conversation to clarify uncertainties regarding sport or diet with lipedema.
• What will happen in the long term and what are the check-up appointments look like? – Ask how often you should come for check-ups and how you can recognize a progression of the disease. Also clarify whether the doctor can refer you to specialists or whether further treatment in a 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 to the appointment, benefit more from the conversation. Here are some practical tips that we recommend to optimally prepare for a doctor’s appointment on the topic of lipedema:

• 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 a possible allergy pass) can provide the treating doctor 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 complaints and previous measures. Mention, for example, if you have not seen any improvement despite diet and sport – this underlines the suspicion of lipedema. Do not hesitate 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 to the appointment. Especially if you are nervous or have many questions, a companion can support you and later recap the information discussed with you.

These tips from our center are intended to help you use the doctor’s appointment effectively. Our goal is that Your concerns are heard and you receive all the information you need. Because a well-prepared conversation is the first step to 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 the fat distribution disorder – which is why many patients only receive a correct diagnosis after a true doctor odyssey.

Often, lipedema is initially dismissed as pure overweight and patients are sent home with the advice that they should do more sport or lose weight. Such misdiagnoses cost valuable time and lead to frustration for those affected. It is all the more important to find the “right” doctor or the right point of contact early on.

Specialists for lipedema usually recognize the disease at first glance and can safely distinguish it from obesity or lymphedema. These specialists include in particular lymphologists, phlebologists, vascular physicians and specialists in plastic surgery. In the following, we will explain the role these and other specialist areas play in diagnosis and therapy.

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 lipedema based on the typical body shape and complaints and differentiate it from other diseases. A thorough clinical examination (anamnesis, 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 venereology who deal with venous diseases (e.g. varicose veins, CVI). Many phlebologistsare also familiar with lymphoedema and lipoedema or work with lymphologists.inside together. Since lipedema and venous diseases can cause similar symptoms (swelling, heavy legs), a phlebological clarification is often useful.

In specialized vein centers – such as our VenaZiel center – lipedema diagnostics are part of the range of services offered. Frequently, it is also diagnosed using 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 lipedema, especially if they have lymphological training. However, lipedema is not treated purely from a vascular surgery perspective, as it is not a primary “blood vessel disease” – nevertheless, vascular specialists are important 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 surgery, who specialize in lipedema. They come into play especially when considering Liposuction (liposuction) as a therapy. Many plastic surgeons perform lipedema surgeries; some work in their own lipedema 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 point of contact, especially when it is still unclear what is behind the complaints. General practitionersWe 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 lipedema. Therefore, lipedema is easily overlooked by the general practitioner or mistaken for 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. In relation to lipedema, dermatosurgery plays an important role, because the technique of liposuction was originally developed in dermatology (by Dr. Jeffrey Klein). DermatologistsThis 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 perform. Both should be networked with lymph/phlebology experts as much as possible 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 in a specialized lipedema center. But when is such a “second look” advisable?

• Uncertainty in the diagnosis: If you feel that your complaints have not been properly classified or the doctor is unsure, you should seek a second opinion. An experienced lipedema specialist often recognizes the clinical picture immediately and can clarify doubtful cases.
  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 for in lipedema patients. A second opinion before a major operation gives you security and confidence in the decision.
• Dissatisfaction with the previous doctor: If you do not feel sufficiently informed or taken seriously, changing doctors is absolutely legitimate. Different statements from different doctors can be unsettling – in this case, you can certainly consult a third specialist. It is important that you feel in good hands and that the new doctor takes time for you.

In a Lipedema Center like VenaZiel, various expertises are bundled: lymphology, phlebology, nutritional advice, physiotherapy and surgery work hand in hand. Thus, a patient can be assessed holistically there.

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 are, 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 obtain. After all, it is about your health and quality of life – and these are at the heart of every good medical care.

 

The typical diagnostic procedure in your clinic

Many patients with lipedema already have a long history of suffering behind them. Not infrequently, the fat distribution disorder was falsely identified 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 here step by step the typical course of 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.

Likewise, you will be asked about your family history: Perhaps your mother or grandmother has similar problems? Since lipedema often occurs in families, this information is valuable.

Do not be afraid to talk about pain, your everyday feelings and any emotional burdens. Lipedema can be very stressful, and your treatment team knows that. Therefore, part of the diagnostic interview is that we discuss your life situation and possible psychological stress – this is the only way to get a complete picture.

All this information flows into your medical history and helps us to plan the next steps of the diagnostics in a targeted manner. Often our patients fill out a questionnaire about their medical history in advance so that we can prepare 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 for your own body – the more accurately 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 recognizable cause. All this is recorded in the conversation. At the end of the anamnesis, your doctor already has an initial suspicion – and you yourself have the good feeling of 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 areas of the body (usually legs, sometimes arms). He pays attention to the image typical of lipedema: 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 uses his hands to check the texture of your subcutaneous fatty tissue. Early on, typical abnormalities appear: The skin may feel as if there are small nodules or polystyrene beads underneath.

An important part of the examination is the pinch test: Here, the skin on the outside of the thigh is carefully pinched. In lipedema patients, this test is usually significantly 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 measure your Body circumference – typically circumference measurements on legs, hips and waist. This allows, on the one hand, to record the extent of the fat distribution disorder, and on the other hand, 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 are used. 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 exactly. Such objective measurements help later to check the success of the therapy.

If necessary, we will arrange for additional laboratory tests. For example, a blood sample can Thyroid function, liver and kidney values etc. are checked. Why? Certain internal problems (e.g. an underactive thyroid) can promote edema or be associated with lipedema.

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 extra for every step. At the end of the examination, you usually know very well 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 Findings note: from your anamnesis data to the results of the pinch test to measurement results such as circumference measurements. In specialized centers, Photos or 3D scans are often made to record the initial findings. Such visual reference material can be valuable later to objectively assess changes.

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

In the final consultation, the doctor will diagnosis of lipedema discuss with you – if it has been confirmed – and explain all the findings to you. So you will know exactly what we have found out. Don’t worry: Of course you can ask further questions. Our concern is that you understand your disease. This also includes an outlook: The doctor will explain to you how the Further procedure may look like. In addition, Progress observations are planned: That is, we record which controls or measurements are useful in the future. For example, we note your current leg circumferences in order to be able to 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.

At the end of the diagnosis, you as a patient have a solid basis on which the treatment can build. All important points are now in black and white in your file. With this clear finding in mind, your doctor can develop 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?

In your specialized clinic, you will not simply be sent home after the diagnosis, but will be comprehensively informed about the next steps. In the following, we explain what happens immediately after confirmation of the diagnosis.

Step 1: Exclude differential diagnoses

Before the actual therapy begins, your doctor will make sure that only only the lipoedema behind your complaints – and no other or additional disease. The elimination of Differential diagnoses is crucial in order to avoid incorrect treatment.

Although possible other causes were already considered during the diagnosis, but now you look at it again specifically. Typical diseases that can resemble a lipedema 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 lipedema, increased fat occurs on the legs and hips (often in puberty), butThere is no pain no pain, no bruises and no swelling.
  
  Lipohypertrophy is easily confused with lipedema, but is actually “only” a figure variant. However, it can develop into a lipedema 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 – that is, even with weight loss, the affected areas remain disproportionately thick. In 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 the ratio of waist to hip to distinguish between general obesity and lipedema.
  
  Often, lipedema patients also have mild obesity; then 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 cause in the legs. Therefore, a look at the Veins. Your phlebologist may have detected a Vein check made. This excludes that your complaints primarily originate from a venous disease.
  
  If varicose veins are found, they can be treated in parallel – because untreated varicose veins would reduce the therapeutic success in lipedema (they increase swelling and pain). Therefore, all findings – lipedema and any concomitant diseases – are taken into account in your treatment plan.

After all these differential diagnoses checked off are, you can be sure: The main cause of your complaints is actually the lipedema. This clear foundation is important to now initiate the appropriate therapy steps.

Step 2: Treatment planning – conservative or surgical?

Now the therapy planning. Your doctor will discuss with you in detail which treatment paths are available. Basically, two approaches are available: a 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 recommended to first exhaust all conservative options. These aim to alleviate symptoms and slow down the progression of the disease.

If the conservative treatment does not bring the desired success or your lipedema is already far advanced (e.g. stage III), an operative measure can also be considered. Together with you, we weigh 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 building blocks. Your doctor will in almost all cases prescribe medical compression garments for example, custom-made compression stockings or leggings.
  
  These exert pressure on the tissue and can thus reduce pain and reduce swelling. Important to know: Compression does not melt away the fat itself, but it shapes the extremities and prevents further fluid accumulation.
  
  Especially if a lymphedema is also involved, compression is indispensable. In addition, Manual lymphatic drainage (MLD) recommended. This is a gentle medical massage by specially trained physiotherapists who move congested lymph fluid towards the trunk.
  You usually feel a relief afterwards because the pressure in the legs decreases. 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 in all of this – you will learn how you can actively help to improve your complaints. The conservative therapy requires some patience and cooperation at the beginning, but in most cases it forms the 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.
  In this process, excess, pathologically altered fatty tissue is permanently removed in a surgical procedure. DLiposuction 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, sometimes also ultrasound methods (e.g. VASER). The goal of the surgery 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. Your doctor will advise you in detail (if necessary, you will receive a separate clarification interview 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 therapy plan can consist of a combination of these approaches. For example, many patients start with 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 makes sense – then, of course, conservative treatment is still carried out until the surgery date in order to prepare your legs in the best possible way. Your treatment team will advise you comprehensively on which strategy is best 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 the joint therapy planning, we will not leave you alone. In the VenaZiel Lipedema Center now the first steps of your treatment begin specifically. Everything will be individual tailored to you so that you are optimally cared for. 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: We determine which conservative measures you will receive and in which order. For example, the supply 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 equip. 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 therapy plan, we arrange check-up examinations – initially perhaps every few months, later individually as needed.
  
  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 regularly checked and renewed if necessary (because over time the material can decrease or your dimensions can change). If you have had surgery, close follow-up checks take place to assess wound healing and the result of liposuction. And of course we are also available between appointments for questions. You should feel in good hands at all times.

In summary: After your lipedema has been diagnosed, you will receive a clear roadmap from us. You know which therapy steps are pending, get personal recommendations for everyday life and have fixed contact persons who accompany 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 clues. An example is the Pinch testThis involves gently pinching the skin of the thighs (inside and outside).

If you feel a clear pain even with a slight pinch on the outside, this speaks with a high probability for a lipedema (because the increased fat cells press painfully on the nerve fibers). Digital questionnaires also ask about typical symptoms and give a rough orientation.

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 may initially be normal or increased. Therefore, lymphoscintigraphy for lipedema diagnosis is 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 only the beginning. Based on the findings, the actual therapy can now begin – with the goal of alleviating your symptoms and your 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 touch sensitivity, so that even slight touches can cause pain. The pain can increase during 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, feelings of tension and increased touch sensitivity in the affected areas. Those affected often notice an increase in fatty tissue, especially on the hips, thighs, lower legs or arms, while 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 lipedema pinch test can help by pinching the skin on the thighs and paying attention to pain sensitivity. A pinch that hurts more than on the inside could indicate a lipedema, as this is often the opposite in healthy people.

Other signs are rapid bruising, swelling that worsens in the evening, and an uneven skin texture with possibly nodular areas. A visit to the doctor is essential for a final diagnosis, as the symptoms can also occur in 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 a lipedema. A dermatologist or a specialist in plastic and aesthetic surgery with a specialization in lipedema 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.