Fatter through Lipids or Water: Lipohyperplasia Dolorosa versus Lymphedema

Abstract

Lipohyperplasia dolorosa and lymphedema are completely different disease entities, although both are classified under lymphology. Whereas in lipohyperplasia dolorosa a congenital lipid distribution disorder leads to a high volume insufficiency and corresponding clinical symptoms, lymphedema is characterized by a congenital transport incompetence of the vessels or acquired disorders of transport capacity. According to current knowledge the solid increase in volume with lymphedema is due to a malfunctioning bio-mechanism by which the release of additional proteoglycans in the homeostasis system of the fluid in the interstitial space plays an important role. Therapeutic approaches aim to remove this tissue and the sponge-like proteoglycan substance. Manual lymph drainage and compression can evacuate the sponge but not remove it. Lymphological liposculpture has been successfully used to treat lipohyperplasia dolorosa by removing subcutaneous fatty tissue, present as hyperplasia and not hypertrophy. After lymphological liposculpture, tenderness is no longer present and complex decongestive therapy is no longer necessary because the congenital fatty masses do not recur after surgical removal. The improvement is thus permanent. Lipohyperplasia dolorosa is therefore curable by lymphological liposculpture. The procedure can even achieve a drastic improvement in quality of life for patients with secondary lymphedema by adjusting the symmetry of the extremities and reducing or even avoiding complex decongestive therapy.