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Selecting an appropriate compression garment is probably the most challenging task in Lipedema treatment. During the decongestive phase of Lipedema treatment, the therapist will have learned whether, for instance, a bandage to the knee has caused an increase in knee or thigh volume. Usually an arm sleeve will be accompanied by a separate glove or gauntlet to prevent trapping fluid in the hand. If therapists back off on bandaging the hand during treatment and the patient does not experience any additional edema, this guides the decision as to whether to order a gauntlet, which just covers the back of the hand, or a full glove with edema control for all of the fingers. Some patients find they can even do without any hand garment, but in our practice, we always order at least a gauntlet since it is very difficult to predict exactly how every patient will respond.Medical grade garments are available in various compression classes measured in millimeters of mercury (mmHg). Many ready-made stockings have a higher stretch fabric over the upper thigh called a mantissa. Even garments with the same fabric throughout will give lower compression over a larger diameter body part.

Exercise causes increased blood flow which caused an increase in lymph load in an already compromised limb.
The areas where a limb bends (knee, elbow) stretch out more than the rest of the garment and then those areas do not receive the correct amount of compression which can allow pooling of edema fluid that can cause constriction at those areas. Some individuals can wear compression garments day and night and do not need to bandage their involved limb at night. Others may need to apply compression bandages for nighttime wear or use an alternative device such as a Reid sleeve, Tribute, or Jovi. 90% of the blood volume in the tissues is picked up by the veins and brought back to the central circulation. 10% of the fluid volume in the tissues can only be brought back to the central circulation by the lymphatics. So, even when you are sleeping, even if your arm is elevated, blood is getting to your tissues (thank goodness!).

Remember that in an impaired lymphatic system, the muscles need something to contract against to assist the flow of lymph fluid. However, you should always discuss your individual case with your treatment team, as there are no absolutes and each person is different. Some manufacturers say that you can put them in the dryer, but that will wear them out faster and they are costly to replace.

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