Lipedema Thessaloniki | Treatment & Therapy

At a glance

Cost for Lipedema Treatment

The treatment of lipedema aims to improve both the aesthetic appearance and the functional problems it causes, ensuring a better quality of life for the patient. In advanced cases of lipedema—when conservative treatment is no longer sufficient—the only effective approach is therapeutic liposuction, with the most effective techniques being MicroAire PAL liposuction and water-assisted liposuction (WAL) using devices such as BodyJet. Lipedema is defined as the uneven distribution of fatty tissue, occurring almost exclusively in women and of unknown origin. Given its clear hereditary predisposition and its frequent occurrence among members of the same family, it is often attributed to genetic factors.

At a glance

Lipedema Treatments Cost

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The surgery to treat lipedema is primarily intended for women, who represent the vast majority of patients. This condition typically appears in the hips, legs, and arms, and these areas usually seem disproportionate compared to the rest of the body. Despite patients’ efforts to lose weight through diet and exercise, the fat in these anatomical regions persists. In most cases, the clinical presentation of patients includes a disproportionate body shape, characterized by a slim upper body and a noticeably wider lower body. To help you gain a clearer understanding, below we will take a closer look at what exactly this condition is and how a specialized treatment can help you improve your daily life and get rid of lipedema!

What is lipedema?

In short, lipedema is a metabolic fat disorder (uneven distribution of fatty tissue) of unknown origin that occurs in adult women and affects the upper and lower limbs, with a very characteristic distribution around the knees, calves, and arms.

The main symptoms include disproportionate limbs compared to the rest of the body, a cellulite-like appearance, abnormal fat accumulations in specific areas of the limbs, as well as pain and swelling in those areas. It is often accompanied by venous disorders, and patients with lipedema tend to bruise more easily on their extremities.

Given that it has a clear hereditary predisposition and is found among members of the same family, it is often attributed to genetic factors.

The “unknown” to many is Lipedema

For many years, the concept of “Lipedema” was unknown, leading many patients to struggle in vain to find answers to their questions:

Why can’t I lose weight despite dieting?
Why are my legs so disproportionate compared to the rest of my body?
Why do my legs hurt when I stand for a long time?

These and many other questions are answered with the introduction of the concept of lipedema. Historically, lipedema was first described in a publication by physicians Edgar Van Nuys Allen and Edgar Alphonso Hines Jr. in 1940, which is why the condition is also known as the Allen-Hines Syndrome. Even though nearly a century has passed since its first description, there remains a significant lack of awareness—both among patients and medical professionals—resulting in many lipedema cases remaining undiagnosed and untreated.

Although it is an independent condition, lipedema is often confused with obesity or other disorders, which leads to delayed diagnosis and treatment.

Show off your silhouette the way it deserves.

Lipoedema treatment focuses on body harmony, without pain, swelling and undue exhaustion.

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The Disease through Statistics

So how many cases are there? First of all, it should be noted that this condition primarily affects women of all ages, and statistics show that the percentage of women suffering from lipedema ranges between 7–15%, with an average of 11%. In practical terms, this means that one in nine women currently has lipedema. However, the likelihood of developing lipedema at some point during one’s lifetime is significantly higher. It is therefore estimated that in Greece alone, more than 500,000 women are currently living with lipedema, while the Hellenic Obesity Society suggests that the number may in fact exceed 1,500,000 patients. (There are statistical correlations linking lipedema to both heredity and hormonal changes.)

Where are all these cases located and what percentage receive some form of treatment?

From our experience in Greece since 2013, it appears that there is a gap between lipedema patients and their access to information and treatment. This is a misunderstood diagnosis that is often confused with obesity, lymphedema, or lipodystrophy, and many times the response from doctors who see the condition in these women is rather stereotypical: “There’s nothing we can do, that’s just how your body is.” The main issue, therefore, is the lack of awareness—both among patients and physicians. Since lipedema is a syndrome, meaning a combination of symptoms observed in patients, diagnosis is primarily clinical and does not necessarily require laboratory or imaging tests. The diagnosis relies on the physician’s experience in recognizing the characteristic appearance of the limbs and the symptoms reported by the patients.

From our experience, however, we see that a large percentage of lipedema patients who come to our center for treatment have been informed through other sources and have often already performed a self-diagnosis of lipedema. Unfortunately, in many cases, the diagnosis is made quite late, resulting in a more advanced stage of lipedema and making treatment more challenging.

When does Lipedema occur?

Lipedema usually appears during puberty, but it can also be triggered or worsened during pregnancy or perimenopause. It may also occur after gynecological surgeries, such as procedures on the uterus, ovaries, or fallopian tubes, or following any surgery performed under general anesthesia.

More rarely, lipedema can be triggered after an extremely stressful situation, as increased cortisol levels can cause an inflammatory response.

In summary, lipedema typically develops during periods of hormonal changes, such as:

During puberty.
During pregnancy.
During perimenopause.
After gynecological surgeries.
In cases of intense stress, due to elevated cortisol levels.

Symptoms of Lipedema

The first symptoms that patients with lipedema typically notice include:

Pain in the soft tissues of the body — either at rest, while walking, or even upon touch.
Sudden fat deposits developing from the waist down to the knees or ankles, excluding the feet.
Fat accumulation forming into painful nodules or small skin folds that put pressure on the joints, sometimes making normal walking difficult.
Skin that gradually loses its elasticity.
Frequent bruising and swelling.

Within just a few months after the onset of early-stage lipedema symptoms, patients often begin to notice the following:

Persistent sensation of cold in the affected areas.
Fatigue.
Skin that becomes softer, uneven, and fatty in texture.
Chronic pain accompanied by a gradual reduction in mobility.

All these factors, combined with the aesthetic concerns caused by changes in body appearance, can lead to feelings of despair, anger, and sadness.

More detailed symptoms of lipedema:

Disproportion of limbs to the torso:

The first and most important symptom, which can even appear at a very young age, is the disproportion of the limbs in relation to the torso. This picture can also be seen in pre-pubescent girls, even under 10 years of age. We typically see a disproportionate hyperplasia of fat in the lower extremities and a one-piece appearance of the limbs, especially around the ankles and knees.

The knees:

The most characteristic image is around the knees, where the patella often “disappears”, a cushion is created on the inner side of the knee and on the upper part of the shin and there is intense retention and cellulite above the knee. The disproportion of the limbs can of course concern the entire lower limb or even the upper limbs. We often encounter women with a very thin abdomen and waist with a great disproportion in relation to the lower limbs and the circumference and they may be obese individuals or even individuals of normal weight. There is almost always an underlying lipedema that is responsible for this image.

Inability to lose weight:

A common manifestation among patients with lipedema is the **inability to lose weight**. This condition often creates a vicious cycle regarding body weight. On one hand, lipedema itself contributes significantly to excess weight; on the other, in its more advanced stages, it causes mobility issues that limit daily walking and physical activity — leading to a **slower metabolism**. At the same time, **excess body weight further aggravates lipedema**, which in turn makes losing weight even harder. Psychological strain plays a major role in this cycle, as patients often experience **eating disorders** (such as following an inappropriate diet for lipedema), depression, and a general sense of resignation or social withdrawal. For these reasons, many patients seeking medical care for lipedema are also overweight or obese — although it is important to emphasize that **lipedema does not originate from obesity**.

Cellulite:

Lipedema can often **resemble cellulite** in appearance. Since it is a **metabolic disorder of fat** that also affects the lymphatic vessels, fat accumulation leads to **significant fluid retention**. In overweight individuals, the skin’s surface may appear dramatically uneven, with **deep dimples and pronounced fatty protrusions**, while in those of normal weight, it often manifests as a **cellulite-like texture**. In our view, **cellulite itself can be considered a symptom of lipedema**, rather than a separate condition.

Limb pain:

In more severe cases, functional problems begin and the most common is pain in the extremities. The pain is more intense after standing and can be in the form of burning, pressure or stinging and can affect any area of the lower extremities or arms, most commonly the knee area. Many patients often mistakenly come to the orthopedic surgeon with acroalgia, without any obvious orthopedic problem and the pain comes from lipedema.

Easy bruising:

A symptom that occurs in some patients is that they bruise easily. It is not constant in all cases of lipedema but can occur regardless of stage, severity and weight. Patients typically report that they have bruises in the extremities, without any known injury. Lipedema is often found together with other diseases, such as venous insufficiency. Possibly, venous insufficiency is accompanied by some insufficiency of the lymphatic system, or is also responsible to some extent for the lipedema. Venous insufficiency appears in the form of varicose veins, skin spider veins and swelling in the legs. In more advanced stages, especially when lipedema is accompanied by obesity, we encounter a dramatic picture of the lower extremities, the architecture of the fat is completely lost and often lymphedema and skin lesions coexist.

Stages of Lipedema

Depending on the severity of the lipedema condition, we distinguish 4 stages. This staging is based on the clinical picture and symptoms and can vary in each part of the body. For example, there may be 2nd degree lipedema in the arms, 3rd degree in the thighs and 4th degree in the knees. However, the categorization of each patient is done taking into account the most severe stage. In summary, the stages of lipedema are as follows:

Stage 1: Mild forms, with slight cellulite and small nodules on palpation. The skin is smooth.
Stage 2: More intense cellulite, swelling and pain. Hyperlipidemia is more evident.
Stage 3: Severe fat malformation, mobility problems and hard nodules on the extremities.
Stage 4: Lipolymphedema, with severe dysfunction and skin lesions.

More specifically, the stages of lipedema are as follows:

Stage 1

It concerns the mildest forms of lipedema, where the most characteristic feature is the disproportion between the trunk and the limbs. Many times, diagnosis at this stage is more difficult, however, it is easier if one knows which points to focus on. The point that is usually affected first is the knee and calves, where we find the so-called “one-piece” image in the knee and ankles. Also, the cellulite image predisposes to first-degree lipedema. Patients with first-degree lipedema do not have any particular symptoms, apart perhaps from a feeling of heaviness in the legs after standing and possibly bruise more easily. When palpating the skin on the lower extremities, some small nodules may be noticeable.

Stage 2

The picture is more severe than in the first stage, that is, the fat accumulations are more intense, the skin begins to have a pronounced form of cellulite with dimples and bumps, nodules are noticeable during palpation within the fat. The symptoms are also more intense, with more frequent pain in the lower extremities, unexplained bruises and swelling after standing. The body weight is usually higher, because the lipedema begins to accumulate and add significantly to the scale.

Stage 3

In the later stages, it is not easy to distinguish whether lipedema is what causes the weight gain or whether the increased weight worsens the lipedema, however, almost all patients with grade 3 lipedema and above are overweight and all have great difficulty losing weight. The symptoms are even more intense, the pain is more frequent and more intense and there are scattered hard nodules throughout the lower extremities. The fat has now almost completely lost its architecture and the skin has a completely uneven and irregular surface. Patients at this stage also experience mobility problems, due to the pain and discomfort caused by lipedema in the legs.

Stage 4

It is the most severe form of lipedema, where in addition to the above lesions that we encounter in patients of the 3rd degree, the so-called lipolymphedema also appears. This means that the lymphatic vessels have been greatly affected, resulting in a picture that resembles lymphedema, especially around the knees, thighs and calves. Patients at this stage are always overweight, have severe mobility problems and the quality of life is low due to the lipedema.

Lipedema Treatment:
Management and Therapeutic Approaches

Below is a summary list of the **main treatment options for lipedema**:

Conservative Treatment:
- Lymphatic drainage massage.
- Use of compression stockings or tights.
- Avoidance of prolonged standing.
- Improved and customized nutrition plan.
Liposuction Techniques:
- MicroAire-assisted Liposuction (Recommended):
  A vibrating technology that safely removes fat while preserving surrounding tissues.
- Water-Assisted Liposuction (WAL):
  A newer method using a pulsating water jet for a more atraumatic fat removal (BodyJet device).
- Traditional Liposuction:
  Removes fat effectively but may damage lymphatic vessels (less recommended).
Surgical Skin Tightening:
- Complementary procedure to restore the aesthetic appearance of loose skin after liposuction.

The field of cosmetic and plastic surgery has made **significant technological advancements**, allowing for **effective and lasting treatment of lipedema**.
Although lipedema management can be challenging, these modern techniques offer excellent aesthetic and functional results — ultimately leading to **a better quality of life for patients**.

See your body in a new balance

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Conservative treatment of lipedema

In mild cases — that is, in stage 1 or 2 lipedema — treatment is usually conservative, focusing on relieving the lower limbs from fluid retention. At this stage, regular physiotherapy with lymphatic drainage massage is recommended, along with avoiding prolonged standing, wearing special compression stockings or tights, and adopting a balanced, customized diet.

Conservative Treatment for Lipedema:

Lymphatic drainage massage.
Compression stockings or tights.
Improved nutrition plan.
Avoidance of prolonged standing.

MicroAire PAL Liposuction for Lipedema (Recommended)

In our practice, the technique primarily recommended and applied by the doctor is MicroAire PAL (power-assisted liposuction), as it offers significant advantages compared to other methods. The MicroAire PAL, thanks to its oscillating motion technology, reduces surgical time and tissue trauma, making the procedure safer and more tolerable for the patient. At the same time, it allows us to proceed with absolute precision and safety even in large-volume liposuctions, enhancing the overall result and recovery. We emphasize once again that the technique itself does not ultimately play the most important role in the outcome of the procedure, but rather serves as an aid for the surgeon.

Water-Assisted Liposuction (WAL) for Lipedema

Water-Assisted Liposuction (WAL), also known as Bodyjet, is a modern fat removal technique based on the use of a water jet. The preparation of the tissues with a local anesthetic solution follows the same principles as power-assisted liposuction. The main feature that differentiates the WAL method is the way in which the fat is detached and removed. Specifically, through a special cannula, a pulsating jet of water is emitted, which breaks down fat cells and other unwanted tissues. The detached fat is immediately suctioned out through the same cannula, offering greater precision and control during the procedure. This method is known for its gentle and less traumatic nature, which can facilitate recovery. However, the duration of the procedure tends to be longer, and larger amounts of fluid are required, which may lead to more noticeable swelling and temporary discomfort during the first few hours after the procedure. Despite these particularities, Water-Assisted Liposuction (WAL) remains an ideal option in certain specialized cases, offering excellent results with enhanced safety for the patient.

Liposuction as a Therapeutic Solution for Lipedema

However, once lipedema has progressed, these measures are no longer sufficient, and patients no longer experience relief, no matter how frequently the treatments are performed. In such cases, the only effective treatment is therapeutic liposuction.

Liposuction for lipedema can be life-changing, but it also carries certain risks. This is why it must be performed under very specific conditions and with appropriate equipment. Traditional liposuction, which removes tissue using negative pressure suction, has the disadvantage of also removing or damaging lymphatic vessels.

It is crucial to preserve these vessels in lipedema. For this reason, any intervention should be performed using specialized assisted-liposuction equipment, which is much more gentle and protective of the lymphatic system.

Vaser Liposuction for Lipedema

Other techniques, such as Vaser liposuction, have also been tested with good results. However, they tend to increase the duration and cost of the procedure without offering any significant advantage compared to power-assisted liposuction, while some techniques are entirely unsuitable, as they do not allow for the removal of large fat volumes.

After Lipedema Treatment

The Microaire PAL oscillating liposuction and the water-assisted liposuction (WAL) using devices such as the Bodyjet are two revolutionary tools that allow for a more effective treatment of lipedema, while also enabling patients to return to their daily activities much sooner.

Given their minimally invasive nature, the procedure is painless, and postoperative pain after lipedema treatment is minimal.

This approach allows faster liposuction procedures and gives the plastic surgeon the ability to safely remove large volumes of fat. Since the surrounding tissues, nerves, and blood vessels are not affected, the risks typically associated with traditional liposuction are significantly reduced.

The procedure for lipedema is mild in intensity, requires no hospitalization, and the recovery period lasts approximately 3 to 4 weeks.

Patients who undergo this treatment report a significant improvement in their quality of life, reduced pain, and enhanced mobility.

In collaboration with the Interbalkan Medical Center, and due to the large number of cases we treat, we have now established a dedicated Lipedema Clinic. The clinic is staffed not only by Dr. Papaioannou but also by a specialized team of physiotherapists, nutritionists, and physicians from other specialties within the Interbalkan Medical Center. Our goal is to provide an even more comprehensive therapeutic approach to this complex condition and to make our innovative clinic a national and international reference point in the treatment and management of lipedema.

Lipedema Self-Diagnosis

Lipedema self-diagnosis is a process that can prove to be particularly useful.

Lipedema and diet

The role of nutrition in lipedema is very important, as the consumption of certain foods appears to significantly affect both the progression and the treatment of lipedema.

Lipedema and genetics

Lipedema and heredity appear to show a statistical correlation.

Lipedema and hormonal changes

The hormonal profile and hormonal changes of women throughout their lives seem to play a huge role in the occurrence of lipedema.

Lipedema and obesity

Body weight plays a very large role in the manifestation of lipedema, but in turn, lipedema as a condition often leads to the inability to maintain a low body weight.

Lipedema Treatment with Liposuction

To date, liposuction is the most appropriate and commonly accepted by the medical community treatment for lipedema of any degree and extent.

Conservative treatment of lipedema

Conservative treatment of lipedema usually focuses on lifestyle and dietary changes in order to improve lipid levels in the female body.

After liposuction for lipedema

Recovery after liposuction is a critical phase for the successful completion of the procedure.

Surgical correction of sagging skin

A major concern for many patients with lipedema is what will happen to the skin if they lose some weight or undergo extensive liposuction.

Dr. Prodromos Papaioannou

He completed his plastic surgery residency in Germany, at the Pirmasens Hospital, the Asklepios Wandsbek Hospital in Hamburg, the University Hospital in Magdeburg and the Braunschweig Clinic. He worked as a specialist-deputy director at the Braunschweig Clinic (specializing in breast reconstruction after cancer and cosmetic surgery). He also participated in scientific research and completed his doctoral thesis (Dr. Med.) at the Magdeburg Clinic.

Lipedema

What is lipedema?