Hormone imbalances - is it possible to have lipedema in the trunk area? (Photos)

Question

I have hormonal imbalances (insulin resistent im prediabetic) and despite diet and exercise I just can't loose fat from my midsection. I have tried physical therapy (for the tenderness), nutritionists, personal trainers. I finally went to an ND who suggested finding a lipedema specialist. All the research I've done shows pics of legs and arms not abdomen. How do I find a doctor to take me seriously? I'm on the slimmer side but my fat feels lumpy and disproportionate.

Thomas Wright, MD · Answer

Erani, There are many different metabolic conditions that affect fat distribution.  The most common metabolic condition is insulin resistance which causes fat deposition in the internal abdominal cavity, also called visceral fat accumulation.  There is lipomatosis or subcutaneous fat deposition disorder called multiple symmetric lipomatosis that cause excess fat accumulation in the abdomen and arms of people but generally spares the legs.  Lipedema is another metabolic lipomatosis that usually affect the leg and sometimes the arm and abdomen but never just the abdomen. 
Looking at your photos it is most likely that you have an insulin resistant fat accumulation in the abdomen, but it's hard to be sure from just looking at the photos.  I recommend you get a proper evaluation from a doctor who has some expertise metabolic fat disorders and lipomatosis.  Wishing you the best of health,

Aria Vazirnia, MD · Answer

Although lipedema classically affects the thighs, calves/ankles, and upper arms, it can also affect the torso area. The fat in lipedema can be metabolically active and contribute to a metabolic/hormonal imbalance leading to the accumulation of fat in the torso area. I would seek an in-person or virtual consultation with a lipedema specialist to thoroughly review your history and photos (and if possible, to conduct a physical examination) to determine if you have lipedema.

Boris Volshteyn, MD, MS · Answer

Lipedema usually affects women. It usually starts above the belly button and goes down along the legs. Commonly it also involves the arms. Unfortunately, there is no easy way to diagnose lipedema. It’s a combination of easy bruising, pain, and hypersensitivity. The problem is that some patients do not have typical pain or bruising. Some patients have components of other rare fat disorders. And I also realize that sometimes it’s difficult to find somebody comfortable with the diagnosis of the disease because most doctors hear the name of lipedema and all the fat disorders in their medical school once or twice and have no additional knowledge about it. It is rare to have isolated abdominal issues. Just because you cannot lose fat in the abdomen does not mean you have Lipedema. I suggest seeing a qualified and experienced Doctor In Lipedema to know if you technically have Lipedema. The treatment for lipedema is liposuction. If you do not have lipedema, you can still have liposuction. In essence, the question is who will pay for it, you or the insurance company.

Mats Hagstrom, MD (license on probation) · Answer

You do not have Lipedema.

Lipedema is a diagnosis of exclusions and that it cannot be tested for or diagnosed. It is a name that’s used for describing individuals who have excessive worsening fat distribution on their extremities.

If it’s not on the extremities it is not lipedema by definition.

So since your problem isn’t on your extremities you do not have lipedema.

You are overweight and carry fat in the subcutaneous fat on your midsection.

It would be important for us to know if you wanted us to make a solid assessment if you’ve had previous pregnancies.

In regards to the front of the abdomen there are four variables that determine the shape and contour. If someone doesn’t like the way their belly looks it is generally always because of one or more of these four variables.

The four variables are abdominal skin laxity, abdominal excess subcutaneous fat, muscle while separation from previous pregnancies called diastasis recti and lastly access visceral or intra-abdominal fat.

My best guess is you have a slight amount of all four of these but excess subcutaneous fat is probably the number one cause. If you have had previous pregnancies than muscle separation is probably number two.

It requires an examination to make an accurate assessment.

Weight loss works for all excess fat but does not change fat distribution. If the problem is subcutaneous fat and Liposuction is the solution and this would certainly fix your problem if you would like. Patients who have issues with skin laxity and or muscle separation from previous pregnancies call diastasis recti should choose a full tummy tuck. Excess visceral fat can only be lost through weight loss.

You do not have lipedema and you don’t need to find an expert other than someone who is very talented at Liposuction. Liposuction results vary substantially among providers in this as a major impact and overall patient satisfaction after the procedure. Delivering consistent high-quality Liposuction results is more difficult than most people believe.

For this reason patients should spend a significant amount of time and effort finding the most experienced and talented provider in their community. I recommend doing this by scheduling multiple in person consultations with local board-certified plastic surgeons who have extensive experience with Liposuction. During consultations ask providers to show their entire collection of before and after pictures of a nominal Liposuction. An experienced provider should easily be able to show you 50 or more sets of before and after pictures. Highly experienced surgeons will have several hundreds or potentially thousands of before and after pictures of just this procedure on this area.   Ask providers to show results of patients who have similar body characteristics to your own as well as results that didn’t turn out as well as they had hoped for and have them discuss why the results look different.

Lastly read all the reviews on various physician review websites for each provider you are considering and avoid providers with any significant number of justified negative reviews. If you can find a provider who has a collection of impressive before and after pictures that reads like a telephone book and has no justified negative reviews on various physician review sides while being in practice for more than 10 years you’ve probably found the person you want to do your procedure.

You didn’t include your weight but getting on a scale and calculating your BMI and checking this in comparison to what should be a recommended BMI or weight based on your height is a good starting point. Weight loss is and should be part of the solution.

Best,

Mats Hagstrom MD

Hormone imbalances - is it possible to have lipedema in the trunk area? (Photos)

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