Do I have lipedema or lymphedema? What is this mysterious swelling, will lipo help? (photos)

Question

Hi doctors! I am 5”5, 24 years old. 1 year ago I noticed my ankles getting swollen. I didn’t think anything of it so I didn’t research or see a doctor. Now it’s progressively worse and I don’t understand what it is. I saw 2 vascular surgeons at MGH and they couldn’t tell me what’s wrong. Can you help? I have IBS-C and used to take laxatives (which cause fluid retention) but unsure if related. Do I need lipo? Or what is going on here? Thank you.

Jaime S. Schwartz, MD, FACS · Answer

Lipedema is a very underdiagnosed condition in the US and the world. This is mainly from a lack of understanding. There are a lot of symptoms and differences from just weight gain. However, I would need to understand a lot more about your particular case. As an FYI, there is a small group of us that is working very closely with the lipedema community to educate as well as develop Standard of Care Guidelines for the US. 
For more information please visit our lipedema educational website.
Hope this helps!
Jaime S. Schwartz, MD, FACS

Diplomate, American Board of Plastic Surgery 
Fellow, American College of Surgeons
Associate Clinical Professor of Surgery
USC Keck School of Medicine
Division of Plastic and Reconstructive Surgery
#RealSelf100Surgeon

#RealSelfCORESurgeon

Thomas Wright, MD · Answer

Honestly, it is very hard to know from photographs what is your exact diagnosis.  Proper diagnosis requires a detailed history and a specialized exam combined with confirmatory testing. Because of the dents I see in the pics, you may have lymphedema.   Based on the shape of your legs, you may also have lipedema.  But these are only educated guesses. I recommend you consult in person with a physician specialist in lymphatic diseases who has a good deal of experience diagnosing these diseases to proper diagnosis.

Kenneth Hughes, MD · Answer

If you are diagnosed with lipedemia, lipo can remove the extra fat which would decrease limb volume and alleviate the discomfort that accompanies this condition.

Jason Emer, MD · Answer

You need a formal evaluation for not only vascular issues but also Lipedema. Please see an expert for treats this often.  Best, Dr. Emer.

Boris Volshteyn, MD, MS · Answer

It isn't easy to diagnose lipedema based on a few pictures. You may have a high salt diet, venus insufficiency, kidney issue, or other problems that may result in fluid retention in your legs. The first step is to wear a compression garment on your legs. If your symptoms get worse, easy bruising, hypersensitivity of the legs in the other areas, especially if it's more difficult for you to walk stairs, chances are you may have lipedema. Because you were so young, your symptoms may appear after your pregnancy or later in life.

Mats Hagstrom, MD (license on probation) · Answer

it's hard to give you a definitive diagnosis with limited information.  It is unlikely you have lymphedema of your ankles unless you've had the same type of injury or procedure that damaged your lymph vessels.  This may be lipedema which is poorly understood and not understood at all by some physicians. Lipedema usually affects only women in middle age and gradually worsens with time. It usually affects both the legs and thighs causing gradually increase in size of the lower extremities. There is no definitive test other than ruling out other conditions.  Some conditions can cause general Edema or swelling of the ankles but no change in the rest of the legs and thighs.  Some primary care phycisians know about lipedema and most plastic surgery ends do. There is no other treatment then liposuction for lipedema. Liposuction of the calves and ankles tends to be technically difficult and it's a high probability of developing  contour irregularities and imperfections. It is a technically difficult area to treat. My practice is devoted exclusively to liposuction and fat transfer I perform approximately 400 liposuction cases per year of these about one per year is liposuction of the calves and ankles. While swelling for most liposuction eight cases is substantially reduced or gone by about six weeks calves and ankles can take it to her three times longer.  That said, when the procedure is done correctly in someone who is a good candidate once the swelling has settled down patient satisfaction is usually very high.  Please consult with several board-certified plastic surgeons who have particular expertise and a proven track record of liposuction of the calves and ankles. The majority of plastic surgeons do not perform  liposuction on that part of the body. It may take some work to find someone who does and has a proven track record of delivering consistent good results in the calves and ankles . Best, Mats Hagstrom M.D.

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