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Page 6 of 10 Wiedner et al. Plast Aesthet Res 2020;7:10 I http://dx.doi.org/10.20517/2347-9264.2019.51

Figure 6. Madelungs disease Type II with fat accumulations in the neck, shoulders, and arms

Figure 7. Patient after bariatric surgery and massive weight loss. She did not lose the lipedema fat in the affected lower legs

[28]
from other diagnoses . The list of differential diagnoses criteria of lipedema modified from Schmeller in
[29]
2005 is shown in Table 1 .

THERAPY
A targeted therapy aimed at the cause of lipedema is not known because the exact etiology is still
unexplained. Therapy has essentially two objectives: (1) resolve or improve symptoms (edema, pain, and
disproportion); and (2) prevent disease progression and the development of complications (lymphatic,
dermatologic, and orthopedic problems). A distinction is made between conservative therapy to decongest
the subcutaneous tissue and surgical therapy such as liposuction to reduce adipose tissue. As discussed
above, weight management is a key component of both objectives.

Conservative approaches include compression garment therapy or wrapping to reduce edema and
manual lymphatic drainage (MLD) as part of an outpatient context or as part of a complex decongestive
physiotherapy (CDP). CDP is a very time-consuming therapy, being performed twice a day for 45-60 min
over a period of 3-4 weeks, mainly in lymphedema clinics in an inpatient context. A component of CDP
is manual lymphatic drainage. MLD is a type of gentle skin massage which stimulates contraction of the
lymph collectors and enhances protein resorption. In addition to improving lymphatic circulation, MLD