Lipedema Los Angeles
Lipedema is a connective tissue disease that is caused by disproportionate growth of painful fat cells in the hips, legs, and thighs. Current research in lipedema is adding insight into this often-overlooked problem that causes chronic pain, discomfort, and uncontrolled fatty deposits in the lower body that cannot be controlled with traditional diet and exercise. If you have lipedema, its important to seek treatment by an experienced plastic surgeon and lymphatic surgeon who understands lipedema and its consequences.
Criteria for Lipedema Diagnosis (non-inclusive of all criteria)
- Bilateral, symmetric, and disproportionate fatty deposits in the lower limbs
- sparing of the hands and feet which is known as the cuff phenomenon.
- negative Stemmer sign* which relates to the skin fold between the second and third toe that is lost in lymphedema
- a feeling of heaviness and tension in the affected limbs
- pain on pressure and touch
- stable limb circumference with weight reduction or caloric restriction, diet, and exercise
- worsening of symptoms over the course of the day with a waxing and waning effect
- telangiectases and visible vascular markings around fat deposits
- hypothermia of the skin
- Source: Philipp Kruppa et al.
Patients with Lipedema are at an increased risk of being obese or having weight-related problems. The question remains whether lipedema and obesity are parallel diagnosis or whether they are part of a similar spectrum of diseases. Because lipedema fat is very unresponsive to diet and exercise, we generally think they are dramatically different disease processes related to excess fat. It is important, despite this assertion, that you maintain your weight as much as possible so that you do not get mired into being overweight once the lipedema fat is treated. We encourage you to explore a good exercise regimen even with lipedema treatment.
Hashtags for Lipedema patients: #lipedemawarrior #lipedemasurvivor #lipedema
A conservative study estimates that lipedema is an underrecognized fatty deposition disorder that affects approximately 25 million women in the United States alone. Unlike obesity, lipedema is a genetically-preprogramed deposit of fat cells that are less responsive to diet and exercise. The next time a physician recommends that you go on a diet to reduce your weight, you may consider a consult with board-certified plastic surgeon and board-certified lymphedema expert Dr. Raffy Karamanoukian and Dr. Hratch Karamanoukian.
Chronic Pain and Lipedema:
There are many different studies that have tried to shed light on why lipedema patients have pain and discomfort in their legs. This is a symptom that is unfortunately ignored by many physicians but it is real and can be a significant symptom after lipedema treatment. The perception of pain may be linked to several different problems including the dysregulation of local and regional sensory nerves, inflammation of nerves in the areas of lipedema, and increased pro-inflammatory mediators that hyperstimulate nerves. Some research that Dr. Karamanoukian has reviewed have linked the chronic pain to nerve pressure exerted by the fat cells.
- Local and regional dysregulation of nerves
- Inflammation of nerves
- Increased levels of pro-inflammatory mediators
- Nerve hyperstimulation
- Nerve pressure exerted by lipedematous fat
Could nerve pain be a stimulus for you to seek treatment for lipedema? We think it is a solid reason for insurance companies to medically approve lipedema treatments to help patients regain their lives. Lipedema treatments by Dr. Karamanoukian are safe and can improve your condition through staged lipedema liposuction using our SLIM Protocol.
Consultations and Diagnosis:
Scheduling a consultation for lipedema diagnosis in our Los Angeles lipedema center is facilitated by our patient care coordinators. We understand how frustrating lipedema treatment is for patients and that is why we offer both virtual and in-person consultations. Of course, we prefer to see you in person to discuss your specific needs and would encourage you to schedule a face-to-face consultation with our surgeons; if this is not feasible for you, then we can discuss options for a virtual consultation.
Dr. Karamanoukian will also review your medical history to see if any of the following problems are exacerbating your lipedema. A basic review of systems may include any of the following issues:
- Renal function
- Liver function
- Electrolyte regulation
- Thyroid issues
- Insulin resistance and diabetes
- Lipid profiles
- Fibromyalgia and chronic pain issues
Understanding the diagnosis is key so that we can discuss options for our renowned SLIM Protocol which addresses the fundamental aspects of lipedema as a connective tissue problem.
Many of the national academies of surgery are studying the effects of lipedema on quality of life. There are currently four stages of the lipedema which can help doctors characterize and classify the severity of lipedema and patients who are affected by this connective tissue disorder. Stage 1 lipedema has excessive subcutaneous fatty tissue with smooth skin. stage 2 has excess fatty tissue and larger mounds of nodular fat with uneven skin contour and indentations. Stage 3 lipedema exhibits large outpouches of fatty tissue that causes uneven contour on the thighs, buttocks, and around the knees. The skin is roughly contoured and uneven. In stage 4 lipedema, there is a combination of swelling lymphedema and lipedema that occur simultaneously with large outbound chains of skin and soft tissue the distort normal contour.
Diagnosing Lipedema
To an untrained clinician, lipedema may be very similar to obesity and fat cells, but there are fundamental differences that are poorly understood by most physicians. Lipedema characteristics go far beyond the traditional fatty deposits seen with non-inflammatory disorders and this is why new research guidelines in lipedema have classified this problem as more of a connective tissue disease rather than purely a disease of fatty metabolism.
Dr. Raffy Karamanoukian and Dr. Hratch Karamanoukian are two double board-certified surgeons who specialize in the management of patients with lipedema. We find that the diagnosis can be made by a well-trained eye, a thorough medical history, and a solid clinical examination. Many patients with lipedema have concurrent problems with obesity, metabolic problems, inflammation, and chronic fatigue and chronic pain. In fact, many of these same patients have connective tissue problems that make losing weight very difficult.
Some of the telltale signs of lipedema are found in the clinical examination, and others during your medical history. There are no specific blood tests for lipedema, but we may routinely order specific tests that can identify chronic inflammation in the body. A diagnostic ultrasound may also be important to evaluate your legs for concurrent vein problems that can worsen lipedema.
Consultations In-Office
Consultations begin with an examination and assessment of your specific problems. A physical examination may be followed by a duplex ultrasound of the legs and assessment of lymphatic circulation. These visits are generally informative for the surgeons and for patients, as there are clear differences in choosing the right procedure for your specific needs. Our surgeons will examine the severity of the lipedema and also determine whether your condition warrants a surgical procedure. We will work very closely with a team of experts to manage your vein problems, circulatory problems, and even the chronic fatigue.
Common areas to undergo our surgeon-specific SLIM protocol include the following:
- Arms
- Buttocks
- Thighs
- Hips
- Legs
- Knees
A duplex ultrasound is especially important for patients who exhibit vein disease or problems with their lower leg circulation. It is important to understand how these two diseases interplay in order to more effectively treat each one.
Virtual Consultations:
These consultations are informative and allow a patient to pre-select the right procedure for their needs. Our center is multi-disciplinary and we see patients from all over the nation. If you are concerned about specific areas of lipedema, a virtual consultation with Dr. Karamanoukian can help you determine the right intervals of treatment. Our specialization allows us to follow the SLIM Protocol, developed by Dr. Hratch and Dr. Raffy Karamanoukian. This allows for the treatment of lipedema and the inflammation caused by chronic venous insufficiency and concomitant inflammatory connective tissue problems.
Our office will facilitate a virtual consultation with photos and video consultation to go over specific questions.
Diagnosing lipedema involves much more than a simple examination. The experts at Kare Plastic Surgery understand the subtleties and complexities of a lipedema diagnosis because it involves much more than simple accumulation of fat in the lower body. Lipedema is a connective tissue disorder according to experts in the field of lipedema and lymphatic medicine. A connective tissue disease usually has a genetic origin, but we now believe that the female hormones estrogen and progesterone play an important component in combination with inflammation of the soft tissue.
- Genetics
- Predisposition to soft tissue inflammation
- Stress
- Hormones Estrogen and Progesterone
- Cortisol levels (active research)
It is true that lipedema is usually, almost exclusively, found an adult females and this association has led many to believe that there are a host of factors the predispose to lipedema formation. Most importantly, lipedema is not regulated solely by diet and exercise and attempts to use weight loss surgery or weight loss protocols only as a means to tackle lipedema is fruitless.
Our Los Angeles-based surgeons have also found a high association between lipedema and circulatory problems involving the venous circulation. Vein problems such as Venus insufficiency, varicose veins, or venous hypertension have higher associations with lipedema and can become worse if left unattended. For this reason, we Recommend a vein screening to help identify problems with varicose veins underlying the inflamed lipedema tissue.
- Venous insufficiency
- Varicose Veins
- Venous reflux and Venous Hypertension
- Lipodermatosclerosis
- Obesity
The concept of using liposuction for lymphedema treatment is complex as the most favored options include lymphatic sparing liposuction techniques that use specialized cannulas directed parallel to lymphatic vectors In order to prevent undermining of the lymphatic channels.
Conservative Measures for lipedema
It is generally a good idea to consider conservative measures to improve your lipedema condition prior to surgery. Diet and exercise may improve your overall health but may do little to change the symptoms you are experiencing. Conservative measures will not necessarily reverse or maintain your lipedema, but are generally designed to improve your symptoms with lipedema. That is a difficult concept for patients to comprehend because they may be recommended regimens that have little impact on the progression of lipedema. The following is a basic list of conservative measures you may want to explore before or after talking to Los Angeles lipedema surgeon Dr. Raffy Karamanoukian.
- Manual lymph drainage by a lymphatic specialist
- Compression therapy
- Exercise therapy and following a supervised aerobic regimen
- Therapy to help you cope with symptoms of lipedema and the stress related to this disease
- Diet and weight management
What Type of Doctor Should You See for Lipedema? This is a rather complicated answer that deserves a bit more than a quick answer because lipedema is quite complicated as a disease process. Did you know that lipedema affects nearly 11% of the adult female population? LEARN MORE ABOUT LIPEDEMA DOCTORS