Here are the highlights of the interview conducted at COPE with Dr. Alexo Carballeira, leader of the Specialized Lipedema Unit at the Hospital Clínica Fontana, Valencia.

What is Lipedema?

• Lipedema is a disorder of the loose connective tissue, that is mainly shown as an excessive accumulation of fat in women. It affects mostly women. And this accumulation of fat appears in the lower limbs and, to a lower extent, in the arms. This fat can often be painful, and does not appear below the ankle or in the wrists, but is unbalanced with the rest of the body. It is often mistaken for cellulitis, when this is really a disproportion between the amount of fat in the body, in the lower limbs,
  and the torso.

Which parts of the body are more affected?

• It can affect in different ways: involving buttocks, thighs, calves or arms, or any combination of these. The common element is the lack of proportion with the fat in the torso. This fat is refractory to diets; that is to say, these patients get very frustrated because they try to lose weight and achieve it in their torso and their face, but not in their legs or thighs.

What happens with this fat?

• This fat presents hypertrophy and hyperplasia, i.e. it grows and gets larger.

Faced with such a common problem, he sees the need to create a Unit specific for Lipedema.

• This is becoming to some extent a trendy condition, even though it has always existed. It was recognised as a disease by the World Health Organization in 2018. Now it has suddenly become extremely widespread, there are many women suffering from it to a higher or lower extent, and it limits the lives of some of them.

What is your objective in creating a Unit Specialized in Lipedema within the Hospital Fontana?

• Well, I have been treating Lipedema surgically for many years, conducting liposuction in the limbs in order to eliminate the local fat; but surgical treatment is not the only solution. There are other standard treatments such as adequate nutrition, psychological support, correct diagnosis by a vascular surgeon, and ruling out other potential causes for pain such as varicose veins. Therefore, I felt the need to surround myself with more disciplines in order to achieve comprehensive treatment. This is something that does not occur anywhere else in Europe, according to what I am told by international groups of Lipedema patients, and there is a limited number of centres with comprehensive treatment.

Is it usually mistaken for Cellulitis or Obesity? Which are the differences?

• Up to 50% of patients can present some obesity, which makes diagnosis more difficult; but both conditions could be present. There are many cases described of people who have lost 50-70 kilos, either on their own or through stomach reduction, and with persistent fat there. There are even cases of anorexia with Lipedema.

Regarding cellulitis, I think that many cases of cellulitis are in fact Lipedema. Basically, what they see are little fat nodules when they appear subcutaneously. To make it simple: if there is discomfort when pinching, that cellulitis case will probably be Lipedema; and besides, in many cases there is a family history, that is to say, their mother or grandmother also have the same.

Is pain the key to detect Lipedema?

• Not all of them have pain, but it was described initially as the Painful Fat Syndrome, or the Two Bodies Syndrome. Patients often tell me that they feel discomfort when their cat walks over their legs, or they have a feeling of heaviness in their legs, and for many of them this is normal; well, in fact, this is not normal, this type of discomfort is another thing that can be associated with this condition.

An incipient stage, i.e. Stage 1 which can barely be visually noticed, does not entail lack of pain. These patients are usually the ones who feel least understood.

When does the disease appear?

• This will usually appear at puberty, and gets worse with hormonal changes, i.e. with pregnancies or menopause.

“I felt the  need to surround myself with a multidisciplinary team in order to treat Lipedema in a comprehensive manner”

How can a woman identify whether she has Lipedema?

Generally, most patients arrive at us through online social networks. There is an important movement in social networks, there are lots of accounts by girls who associate their name with Lipedema. Once you see some images, someone who might have it will come to mind, and girls feel very identified.

How is Lipedema diagnosed and which specialist must be consulted?

Diagnosis is basically clinical; that is to say, based on patient history and those characteristics I have just mentioned; but many specialists can diagnose it, such as GPs, physical therapists, vascular surgeons or plastic surgeons.

Which is the process to contact the Specialized Lipedema Unit? What should these patients do when they believe they can suffer from this condition?

• You can contact directly with us through Hospital Fontana, where we are located, or contact us through social networks.

Is there a good prognosis? Which is the final solution?

There is currently no cure for this chronic condition. It can be controlled to a higher or lower extent with conservative treatment, using compression clothes that can alleviate discomfort, and with an adequate diet and sports with low impact on joints. And in those cases where this is not enough, surgical treatment can be considered in order to extract the higher volume of fat possible, to prevent it from appearing again. The solution is not surgery, but it supports the other measures.