Publications

Table of Contents

1. Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report
2. Real time visualization of enhanced lymphatic flow when using a non-pneumatic active compression device (NPCD)
3. Effect of pneumatic compression device and stocking use on symptoms and quality of life in women with lipedema: A proof-in-principle randomized trial
4. A Case Series of Lymphatic Injuries After Suction Lipectomy in Women with Lipedema
5. A Young Woman with Excessive Fat in Lower Extremities Develops Disordered Eating and Is Subsequently Diagnosed with Anorexia Nervosa, Lipedema, and Hypermobile Ehlers-Danlos Syndrome
6. Standard of care for lipedema in the United States
7. Survey Outcomes of Lipedema Reduction Surgery in the United States, Plastic and Reconstructive Surgery
8. A 41-Year-Old Woman with Excessive Fat of theLower Body Since Puberty with Progression to Swollen Ankles and Feet Despite Caloric Restriction, Due to Lipedema and Protein-Calorie Malnutrition: A Case of Stage 3 Lipedema
9. Lipedema Fat and BMI
10. Lipedema – A Devastating Disease too Often Overlooked

Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report

Abstract

Background:

Lipedema is a chronic inflammatory subcutaneous adipose-rich connective tissue disease affecting millions of women worldwide. Disproportionate fat accumulation on the extremities characterized by heaviness, tenderness, and swelling can affect function, mobility, and quality of life. Treatments include conservative measures and lipedema reduction surgery (LRS). Here, we report lipedema comorbidities and surgical techniques, outcomes measures, and complications after LRS.

Methods:

This is a single outpatient clinic retrospective chart review case series of comorbidities and complications in 189 women with lipedema. Bioelectrical impedance analyses, knee kinematics, gait, physical examinations, Patient-Reported Outcomes Measurement Information System, and RAND Short Form-36 questionnaires collected before and after LRS were analyzed for 66 of the 189 women. Hemoglobin levels were measured by transdermal hemoglobin monitor (Masimo noninvasive hemoglobin monitoring; Irvine, Calif.).

Results:

Common comorbidities in 189 women were hypermobile joints (50.5%), spider/varicose veins (48.6/24.5%), arthritis (29.1%), and hypothyroidism (25.9%). The most common complication in 5.5% of these women after LRS was lightheadedness with a 2-g reduction or more in hemoglobin. After conservative measures and LRS in 66 women, significant improvements (P ≤ 0.0009) were found for: (1) knee flexion (10 degrees); (2) gait; (3) Patient-Reported Outcomes Measurement Information System T-score (16%); (4) mobility questions: gait velocity, rising from a chair, stair ascent; (5) RAND Short Form-36 scores: physical functioning, energy/fatigue, emotional well-being, social function, general health; (6) and Bioelectrical impedance analyses total and segmental body fat mass.

Conclusion:

LRS provided significant improvements to women with lipedema using direct physical measurements and validated outcome measures, comparable to those seen after total knee replacement.

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1.Wright T, Babula M, Schwartz J, Wright C, Danesh N, Herbst K. Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report. Plast Reconstr Surg Glob Open. 2023 Nov 30;11(11):e5436. doi: 10.1097/GOX.0000000000005436. PMID: 38046224; PMCID: PMC10688775. Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report

Real time visualization of enhanced lymphatic flow when using a non-pneumatic active compression device (NPCD)

Abstract

Lipedema and lymphedema remain misunderstood and underappreciated diseases. While the conditions appear similar, each presents with unique pathophysiology. Clinically, these diseases both present with edema, adipose tissue enlargement and extracellular tissue matrix remodeling or fibrosis yet they vary with respect to disease progression and molecular regulators of pathophysiology and genetics. Given the inherent challenges in managing these chronic diseases, it is important to understand if standard interventions are efficacious. In consideration of this, a novel ambulatory Non-Pneumatic Compression Device (NPCD) was utilized in this study to support lymphatic flow and improve tissue health while permitting and enabling movement. The study was designed as a controlled prospective open-label study. Lymphatic pathways and transport of lymph was recorded using Indocyanine Green and a Near-Infrared (NIR) camera. Bioimpedance, Tissue Dielectric Constant (TDC), and skin hardness were measured for all subjects before and after use of device, at baseline (day 0) and at day 90. Subjects were instructed to use the non-pneumatic compression device– Dayspring® in an ambulatory setting at home for approximately 1 hour a day. Results from this pilot study in evaluating a NPCD demonstrated improved lymphatic flow and uptake through ICG NIRFI. All three subjects presented with less intracellular water in the limbs and less fibrosis post 3 months of NPCD use.

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2.Wright, T. et al. (2023) ‘Real time visualization of enhanced lymphatic flow when using a non-pneumatic active compression device (NPCD)’, Annals of Case Reports, 8(6). doi:10.29011/2574-7754.101564.  https://www.gavinpublishers.com/article/view/real-time-visualization-of-enhanced-lymphatic-flow-when-using-a-non-pneumatic-active-compression-device-npcd#

Effect of pneumatic compression device and stocking use on symptoms and quality of life in women with lipedema: A proof-in-principle randomized trial

Abstract

Objective: Does short-term use of pneumatic compression devices (PCD) and off-the-shelf compression alleviate symptoms and improve quality of life in women with lipedema and secondary lipolymphedema?

Methods: Prospective, randomized controlled, industry-sponsored, proof-in-principle study comparing PCD plus conservative care (PCD+CC) to CC alone (control). Adult females with bilateral lipedema and secondary lymphedema were randomized to PCD+CC or CC. Outcome measures were lower limb and truncal circumferential measurements, bioimpedance, and quality-of-life, symptom, and pain intensity questionnaires.

Results: Both groups experienced improvements in leg circumference and bioimpedance with more improvement in the PCD+CC group than the CC group. Pain scores of the SF-36 survey and numerical rating scales were improved in the PCD+CC group. Wong-Baker Faces scores showed trends toward improvement in both groups.

Conclusions: This proof-in-principle study supports conservative management with graduated compression and with or without PCD for improvement in leg circumference, bioimpedance measurements, and pain in patients with lipedema.

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3.Wright T, Scarfino CD, O’Malley EM. Effect of pneumatic compression device and stocking use on symptoms and quality of life in women with lipedema: A proof-in-principle randomized trial. Phlebology. 2022 Dec 15:2683555221145779. doi: 10.1177/02683555221145779. Epub ahead of print. PMID: 36519532. https://pubmed.ncbi.nlm.nih.gov/36519532/

A Case Series of Lymphatic Injuries After Suction Lipectomy in Women with Lipedema

Abstract

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4. Thomas F. Wright, Karen L. Herbst. A Case Series of Lymphatic Injuries After Suction Lipectomy in Women with Lipedema. Am J Case Rep Accepted June 4 , 2022 Wright TF, Herbst KL. A Case Series of Lymphatic Injuries After Suction Lipectomy in Women with Lipedema. Am J Case Rep. 2022 Jul 11;23:e935016. doi: 10.12659/AJCR.935016. PMID: 35811389; PMCID: PMC9284075. https://pubmed.ncbi.nlm.nih.gov/35811389/

A Young Woman with Excessive Fat in Lower Extremities Develops Disordered Eating and Is Subsequently Diagnosed with Anorexia Nervosa, Lipedema, and Hypermobile Ehlers-Danlos Syndrome

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5. Wright TF, Herbst KL. A Young Woman with Excessive Fat in Lower Extremities Develops Disordered Eating and Is Subsequently Diagnosed with Anorexia Nervosa, Lipedema, and Hypermobile Ehlers-Danlos Syndrome. Am J Case Rep. 2021 Jun 14;22:e930840. doi: 10.12659/AJCR.930840. PMID: 34121088. https://library.lipedema.org/bibliography/JUPHV8G3

Standard of Care for lipedema in the United States

Abstract

Background

Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery.

Methods

This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system.

Results

Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested.

Conclusion

These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.

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6.Herbst KL, Kahn LA, Iker E, Ehrlich C, Wright T, McHutchison L, Schwartz J, Sleigh M, Donahue PM, Lisson KH, Faris T, Miller J, Lontok E, Schwartz MS, Dean SM, Bartholomew JR, Armour P, Correa-Perez M, Pennings N, Wallace EL, Larson E. Standard of care for lipedema in the United States. Phlebology. 2021 May 28:2683555211015887. doi: 10.1177/02683555211015887. PMID: 34049453. https://journals.sagepub.com/doi/10.1177/02683555211015887

Survey Outcomes of Lipedema Reduction Surgery in the United States, Plastic and Reconstructive Surgery

Abstract

Background:

Lipedema is a loose connective tissue disease affecting the limbs of women that is difficult to lose by diet, exercise, or bariatric surgery. Publications from Europe demonstrate that lipedema reduction surgery improves the quality of life for women with lipedema. There are no comparable studies in the United States (USA). This study aimed to collect data from women with lipedema in the USA who have undergone lipedema reduction surgery in the USA to determine if the quality of life, pain, and other measures improved after lipedema reduction surgery. Methods:  Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing lipedema reduction surgery in the USA. The significance set at P < 0.05 was determined by ANOVA, Tukey’s multiple comparison tests, or paired t-test. Results: Quality of life improved in 84%, and pain improved in 86% of patients. Ambulation improved most in lipedema Stage 3 (96%). Weight loss occurred in all stages by three months after surgery. Complications included the growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema.  Conclusions: Women with lipedema noticed significant benefits after lipedema reduction surgery in the USA. Prospective studies are needed to assess the benefits and complications after lipedema reduction surgery in the USA.

Methods:

Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing lipedema reduction surgery in the USA. Significance set at P < 0.05 was determined by ANOVA, Tukey’s multiple comparison test, or paired t-test.

Results:

Quality of life improved in 84% and pain improved in 86% of patients. Ambulation improved most in lipedema Stage 3 (96%). Weight loss occurred in all stages by 3 months after surgery. Complications included growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema.

Conclusions:

Women with lipedema noticed significant benefits after lipedema reduction surgery in the USA. Prospective studies are needed to assess benefits and complications after lipedema reduction surgery in the USA.

PRS-lipedema-surgery-outcomes-USA

7.Herbst, Karen L. PhD, MD*, †, ∥; Wright, Thomas F. MD§; Larson, Ethan E. MD; Schwartz, Jaime S. MD, FACS∥,** Survey Outcomes of Lipedema Reduction Surgery in the United States, Plastic and Reconstructive Surgery – Global Open: April 2021 – Volume 9 – Issue 4 https://www.lipedema.net/survey-outcomes-of-lipedema-reduction-surgery.html https://www.lipedema.net/survey-outcomes-of-lipedema-reduction-surgery.html

A 41-Year-Old Woman with Excessive Fat of theLower Body Since Puberty with Progression to Swollen Ankles and Feet Despite Caloric Restriction, Due to Lipedema and Protein-Calorie Malnutrition: A Case of Stage 3 Lipedema

BACKGROUND: Lipedema is a common condition that presents as excessive fat deposition in the extremities, initially sparing the trunk, ankles, and feet, and is found mainly in women, usually occurring after puberty or pregnancy. Lipedema can progress to include lipo-lymphedema of the ankles and feet. This report is of a 41-year old woman with Stage 3 lipedema and lipo-lymphedema with excessive fat of the lower body since puberty, with progression to swollen ankles and feet despite dietary caloric restriction.

CASE REPORT: A 41-year-old woman noticed increased fat in her legs since age 12. Her weight and leg size increased until age 21, when she reached a maximum weight of 165 kg, and underwent a Roux-En-Y gastric bypass. Over 12 months, she lost 74.8 kg. Her trunk significantly reduced in weight, but her legs did not. Fifteen years later, during recovery from hysterectomy surgery, she became progressively weaker and swollen over her entire body. Laboratory test results showed hypoalbuminemia (2.0 g/dL), lymphopenia, and hypolipoproteinemia. She was diagnosed with protein and calorie malnutrition with marked gut edema requiring prolonged parenteral nutrition. After restoration of normal protein, her health returned and her pitting edema resolved, but her extremities remained enlarged. She was subsequently diagnosed with lipedema.

CONCLUSIONS: This report demonstrates that early and correct diagnosis of lipedema is important, as women who believe the condition is due to obesity may suffer the consequences of calorie or protein-calorie deficiency in an attempt to lose weight.

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8.Wright, Thomas, Herbst, Karen. A 41-Year-Old Woman with Excessive Fat of theLower Body Since Puberty with Progression to Swollen Ankles and Feet Despite Caloric Restriction, Due to Lipedema and Protein-Calorie Malnutrition: A Case of Stage 3 Lipedema Am J Case Rep, 2021; 22: e930306 \DOI: 10.12659/AJCR.930306 https://amjcaserep.com/abstract/table/idArt/930306/id/t1-amjcaserep-22-e930306

Lipedema Fat and BMI

9.Wright T, Herbst K., Lipedema Fat and BMI. Vein Magazine. Fall 2021. Online 5-13-21. https://www.veindirectory.org/magazine/article/techniques-technology/lipedema-fat-and-bmi

Lipedema – A Devastating Disease too Often Overlooked

by Dr. Thomas Wright for the Vein Magazine

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