Lipedema: what it is and how it is treated

What is lipedema

Lipedema is a chronic, progressive disorder of the fat tissue under the skin. It affects almost exclusively women and causes symmetrical, disproportionate fat accumulation on the legs, hips and buttocks, and in some women the arms. The feet and hands usually stay unaffected.

The key differences from ordinary weight gain are pain and tenderness of the tissue and its weak response to dieting. A woman may lose weight in her face, chest and waist while her thighs and lower legs barely change.

Causes and risk factors

The exact cause is unknown. Research links lipedema to hormonal changes and heredity: it often starts in puberty, during or after pregnancy, or around menopause, and many patients have relatives with similar changes. Lipedema is not caused by overeating or lack of exercise, although excess weight can make it worse.

Symptoms

• Symmetrical enlargement of the legs, less often the arms, with a relatively slim upper body.
• Pain, tenderness or a feeling of pressure when touched.
• Easy bruising.
• Heaviness and swelling that worsen in the evening, in the heat and after long standing.
• A “cuff” above the ankles or wrists: the tissue stops abruptly, the feet and hands are slim.
• Small nodules felt in the fat layer.
• Affected areas respond poorly to diet and exercise.

Stages

Stage	What happens
I	Smooth skin, thickened fat layer, small nodules
II	Uneven skin surface, larger nodules
III	Large lobes of tissue and overhanging folds, especially around the knees and inner thighs

The stage does not always match the level of pain, so the treatment plan takes all symptoms into account.

Types by location

Type I — buttocks and hips; type II — hips to knees; type III — hips to ankles; type IV — arms; type V — mainly the lower legs. Types can combine.

Lipedema, obesity and lymphedema

	Lipedema	Obesity	Lymphedema
Who	Almost only women	Women and men	Women and men
Symmetry	Yes	Yes	Often one limb
Feet	Unaffected	May enlarge	Often swollen
Pain to touch	Typical	Not typical	Rare
Bruising	Easy	Not typical	Not typical
Weight loss	Little effect on affected areas	Whole body slims	Independent of weight

Diagnosis

Lipedema is diagnosed clinically: the doctor takes your history, examines and palpates the tissue and assesses fat distribution, pain and bruising. There is no specific blood test. At our clinic the consultation usually includes a soft-tissue ultrasound, a vein ultrasound if indicated, and assessment of other causes of swelling.

Treatment

Conservative therapy — flat-knit compression garments, manual lymphatic drainage, regular exercise such as swimming, weight management and psychological support — eases pain and swelling but does not remove lipedema tissue. More on conservative therapy.

Lymph-sparing liposuction removes the diseased fat tissue with thin cannulas while protecting lymphatic vessels. It is considered when pain and limitations persist despite conservative treatment. Long-term studies show that most patients experience less pain, bruising and swelling and better mobility after surgery. Results vary with the stage, tissue volume, weight and aftercare. More on liposuction.