By Kate Kneisel
Surgery may not always be the best option, case report finds.
A 34-year-old woman presented to a hospital with an excessive accumulation of fat in the subcutaneous tissue of her legs. She said she had a long history of dealing with a “stubborn constitution” and that she had first gained weight soon after she began menstruating.
She noted that her legs had thickened during her teens, despite having a very active lifestyle. Through diet and exercise, she managed to lose weight in the trunk of her body, but her lower limbs remained essentially unchanged. At her heaviest, she said, she had weighed 95 kg (about 209 lbs). After losing weight, she was about 65 kg (143 lbs), but the volume of her legs stayed the same.
Clinicians performed a physical examination, which found no evidence of Godet or Stemmer signs. However, deposition of fat in the patient’s lower limbs was tender to palpation, and her score on the Lipedema Symptom Assessment Questionnaire (QuASiL), which the case authors developed, was 115 points out of 150 (with 0 representing no symptoms and 150 indicating the presence of all symptoms, and the highest impact on quality of life).
Superficial and deep-color Doppler ultrasound of the lower limbs revealed small varicosities in the thighs and legs, without significant reflux. Dermal thickness was 22.4 mm in the right pre-tibial region and 21.2 mm in the left pre-tibial region.
Bioimpedance examination found a BMI of 34.2, body fat percentage of 41.6%, and lower-limb volume of 572.21 mL. Clinicians diagnosed the patient with grade III lipedema.
Though surgical treatment with tumescent liposuction appeared to be indicated, the patient requested clinical treatment, which included an anti-inflammatory diet followed by a ketogenic diet along with regular aquatic physical exercise, manual lymphatic drainage, and antioxidant herbal medicines.
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