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// Workers AI · dad joke modeWhat did lipedema say to the lip? You're fat behind me.

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Lipedema
Other namesLipoedema, lipödem, lipalgia, adiposalgia, adipoalgesia, adiposis dolorosa, lipomatosis dolorosa of the legs, lipohypertrophy dolorosa, painful column leg, painful lipedema syndrome
Lipedema, type III, stage 1.
SpecialtyVascular medicine
SymptomsIncreased fat deposits under the skin in the legs, increased extracellular fluid, inflammation,[1] easy bruising, pain[2]
CausesUnknown[2]
Risk factorsFamily member with the condition[3]
Differential diagnosisLipohypertrophy, chronic venous insufficiency, lymphedema[2]
TreatmentPhysiotherapy, exercise[2] compression stockings, emollients, liposuction[3]
FrequencyUp to 11% of women[2]

Lipedema is a chronic medical condition that is almost exclusively found in women[3] and results in enlargement of both legs due to deposits of fat under the skin[2]. It is characterized by bilateral, symmetrical buildup of fat in the legs, and sometimes arms and lower trunk (includes hips, buttocks, and abdomen)[4]. Women of any weight may be affected[2][3] and the fat is resistant to traditional weight-loss methods like like nutritional intervention, exercise, elevation, diuretics or bariatric surgery[5].

The feet/hands are typically spared, presenting with a raised ridge or fold of fat, possibly a “cuff” at the wrists and ankles[4]. In earlier stages, there may be a subtle, raised ridge or fold of fat instead of distinct cuffing and sometimes in the later stages, this increased adipose above the ankle/wrist can cause the appearance of a “cuff”[4].

Approximately 50% of people with Lipedema report pain in their fat[6][7][4]. Other common symptoms include swelling, feelings of heaviness, and easy bruising in the affected areas[2][4]. Over time mobility may be reduced, and due to reduced quality of life, people often experience depression[3].

The cause is unknown but is believed to involve genetic and hormonal factors, lipedema onset is typically associated with periods of hormonal flux like puberty, pregnancy, or menopause[4] and it often runs in families.[2][3]. Other conditions that may present similarly include lipohypertrophy, chronic venous insufficiency, and lymphedema[2]. It is commonly misdiagnosed[8].

The condition is resistant to weight loss methods; however, unlike other fat it is not associated with an increased risk of diabetes or cardiovascular disease[5]. Physiotherapy may help to preserve mobility. Exercise may help with overall fitness but will not prevent the progression of the disease [2]. Compression stockings can help with pain and make walking easier[3]. Regularly moisturizing with emollients protects the skin and prevents it from drying out[3]. Liposuction can help if the symptoms are particularly severe.[3] While surgery can remove fat tissue it can also damage lymphatic vessels.[2] Treatment does not typically result in complete resolution.[9] It is estimated to affect up to 11% of women[2].

Signs and symptoms

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Common presentation[4][6][10]

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  • Almost exclusively affects women.
  • Starts or worsens at times of hormonal changes: puberty, pregnancy, or menopause.
  • Bilateral, symmetrical buildup of fat in the legs, and sometimes arms and lower trunk, that is resistant to nutritional intervention, exercise, elevation, diuretics, and bariatric surgery.
  • Feet/hands are typically spared, presenting with a raised ridge or fold of fat. In earlier stages, there may be a subtle, raised ridge or fold of fat instead of distinct cuffing to the ankle or wrist. Sometimes, especially in later stages, this increased adipose tissue above the ankle/wrist can cause the appearance of a “cuff” (“pantaloons” is an evocative term sometimes to describe this morphology in later stages).
  • Presence of nodular and/or fibrotic texture beneath the skin, which can create an uneven, dimpled appearance.
  • Complaints of pain, tenderness, and/or heaviness in affected areas.
  • Fatigue, brain fog, easy bruising.
  • Edema and joint hypermobility may also be present.
  • Texture and visual presentation may change with swelling and inflammation.

Associated conditions and common co-morbidities

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Obesity: Lipedema is often confused with obesity because of increased adipose tissue deposition[4][6]. If obesity is present as a comorbidity, it can complicate Lipedema diagnosis because there may be no presentation of disproportion between the upper and lower body[4].

Lymphedema: Lipedema is often confused with lymphedema because of enlargement of the limbs and patient complaints of heaviness, swelling, and difficulty with mobility[11][4].

Chronic Venous Insufficiency (CVI): People with Lipedema may present with increased varicosities and CVI[12][11]. Assessment for vascular health is important to determine if a patient requires interventions like venous ablations, or resolution of a DVT (especially if the patient is considering liposuction or ‘lifts’)[13].

Hypermobile Ehlers-Danlos syndrome (hEDS): hEDS is an inherited connective tissue disorder that is caused by defects in a protein called collagen[14].  It is important for clinicians to assess patients with Lipedema for hEDS because it can have an impact on treatments offered, taking into account exercise programs, diet recommendations, skin sensitivities, pelvic floor considerations, surgery precautions and pain management approaches.

Depression and anxiety are very common for a variety of reasons, particularly the fact that diagnosis usually takes a long time and patients have received much advice on diet and exercise in the meantime, neither of which are effective treatments for lipedema although they may help associated conditions[15]. Joint pain, arthritis, dry skin, fungal infections, cellulitis, and slow wound healing are also associated with lipedema[15].

Cause

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The cause of lipedema is still unknown. There are various hypotheses about its pathophysiology, including altered adipogenesis, microangiopathy, and damage to the lymphatic system disturbing its microcirculation[16]. Lipedema has been described in familial clusters, suggesting a genetic component [17]. It often appears around times of hormonal change such as puberty, pregnancy, and menopause, suggesting a potential hormonal component.[18] Having obesity doesn't cause lipedema, but more than half of people with this condition have a BMI higher than 35 [19].

Diagnosis

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Lipedema requires diagnosis in a medical office by a clinician (a “clinical diagnosis”)[10]. A trained clinician reaches the diagnosis by considering patient history, including family history, and a physical exam[10]. Clinicians should avoid reliance purely on differential diagnosis as this will lead to a failure to diagnose people with Lipedema when they present with other co-morbidities like lymphedema, chronic venous insufficiency[10].

There is not yet a standardized test, such as bloodwork or imaging, that can confirm the presence of Lipedema, however, there are common clinical presentations that are specific to Lipedema.

[edit]

[20][21][22][23][24][8]

LipedemaLipo-lymphedemaLymphedemaObesityVenous insufficiency/venous stasis
Symptoms:Fat deposits/swelling in legs and arms not in hands or feet; hands and feet may be affected as the disease progresses.Fat deposits / swelling widespread in legs/arms/torsoSwelling in one or more limb, including hands and feetFat deposits

widespread

Swelling near ankles; brownish discoloration of lower legs (hemosiderin deposits). Minimal swelling is possible.
Male/female:FFF/MF/MF/M
Onset:Around hormonal shifts (puberty, pregnancy, menopause)Around hormonal shiftsAfter surgery that affects lymphatic system, or at birthAny ageAround onset of obesity, diabetes, pregnancy, hypertension
Effects of diet:Restricting calories ineffectiveRestricting calories ineffectiveRestricting calories ineffectiveDiets and weight loss strategies often effectiveNo relation to caloric intake
Presence of edema:Non-pitting edemaMuch edema; some pitting; some fibrosisPitting edema at first, later non-pitting edema with fibrosisNo edemaOften edema, but can also occur without edema in earlier stages
Presence of Stemmer Sign:Stemmer's Sign negativeStemmer's Sign positiveStemmer's Sign positiveStemmer's Sign negativeStemmer's sign may or may not be present in lymphedema/lipolymphedema
Presence of pain:Pain in affected areas likelyPain in affected areasNo pain initiallyNo painPain is likely
Affected population:Best estimate is 11% adult women (study done in Germany)Unknown; best estimate is a few percent of adult womenLow≥30% of US adults>30% of US adults
Presence of cellulitis:No history of cellulitisLikely history of cellulitisPossible history of cellulitisOften itching +/- discoloration mistaken for cellulitis
Family history:Likely(Of Lipedema) LikelyNot likely (unless primary lymphedema)LikelyVery likely

Lipedema stages

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Lipedema is classified by stage: Stage 1: Normal skin surface with enlarged hypodermis (lipedema fat). Stage 2: Uneven skin with indentations in fat and larger hypodermal masses (lipomas). Stage 3: Bulky extrusions of skin and fat cause large deformations, especially on the thighs and around the knees. These large extrusions of tissue drastically inhibit mobility[25][26].

Similar conditions

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Lipedema is often underdiagnosed due to the difficulty in differentiating it from lymphedema, obesity, or other edemas[27].

Lipo-lymphedema

[edit]

Lipo-lymphedema, a secondary lymphedema, is associated with both lipedema and obesity (which occur together in the majority of cases), most often lipedema stages 2 and 3[25].

Dercum's disease

[edit]

Lipedema / Dercum's disease differentiation – these conditions may co-exist. Dercum's disease is a syndrome of painful growths in subcutaneous fat. Unlike lipedema, which occurs primarily in the trunk and legs, the fatty growths can occur anywhere on the body [28][29].

Treatment

[edit]

Each body is different, and no single formula works for all. People with Lipedema are encouraged to slowly incorporate different treatments into their routine to see what best works for them. The primary goals of treating Lipedema are to: manage inflammation, reduce fibrosis, decrease adipose tissue, improve lymphatic flow, increase mobility, minimize fatigue, manage pain, prioritize emotional and mental health, and promote overall health[30]. The research into effective treatments is still evolving.

Several treatments may be useful including physiotherapy and light exercise which does not put undue stress on the lymphatic system[31]. The two most common conservative treatments are manual lymphatic drainage (MLD) where a therapist gently opens lymphatic channels and moves the lymphatic fluid using hands-on techniques, and compression garments that keep the fluid at bay and assist the sluggish lymphatic flow[32].Pneumatic compression device or “pump” is useful if there is a lot of swelling or for pain control[4].

The use of surgical techniques is not universal but research has shown positive results in both short-term and long-term studies[33][34] regarding lymph-sparing liposuction and lipectomy[35].

The studies of the highest quality involve tumescent local anesthesia (TLA), often referred to as simply tumescent liposuction. This can be accomplished via both Suction-Assisted Liposuction (SAL) and Power-Assisted (vibrating) liposuction[22][36]. The treatment of lipedema with tumescent liposuction may require multiple procedures. While many health insurance carriers in the United States do not reimburse for liposuction for lipedema, in 2020 several carriers regarded the procedure as reconstructive and medically necessary and did reimburse[37]. Water Assisted Liposuction (WAL) is technically not considered to be tumescent but achieves the same goal as the anesthetic solution is injected as part of the procedure rather than before-hand. Developed by Doctor Ziah Taufig from Germany, it is usually performed under general anesthesia and is also considered to be lymph-sparing and protective of other tissues such as blood vessels[38].

Prognosis

[edit]

There is no cure. People living with Lipedema report reduced functionality (mobility and gait), poor quality of life, depression, anxiety, and pain[8].

Epidemiology

[edit]

According to an epidemiologic study by Földi E and Földi M, lipedema affects 11% of the female population, although rates from 6-39% have also been reported.[39][40]

History

[edit]

Lipedema was first identified in the United States, at the Mayo Clinic, in 1940[41][42]. Most attribute the original identification of lipedema to E. A. Hines and L. E. Wold (1951)[41]. Despite that, lipedema is barely known in the United States to physicians or to the patients who have the disease. Lipedema often is confused with obesity or lymphedema, and a significant number of patients currently diagnosed as obese are believed to have lipedema, either instead of or in addition to obesity[8].

Additional Resources

[edit]
  1. Lipedema patient self-advocacy guide
  2. Clinician's guide to Lipedema
  3. Diagnosing Lipedema
  4. Treating Lipedema
  5. Lipedema World Alliance Delphi Consensus- Based Position Paper on the Definition and Management of Lipedema

Notes

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See also

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References

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  1. ↑ Herbst KL, Kahn LA, Iker E, Ehrlich C, Wright T, McHutchison L, Schwartz J, Sleigh M, Donahue PM, Lisson KH, Faris T, Miller J, Lontok E, Schwartz MS, Dean SM, Bartholomew JR, Armour P, Correa-Perez M, Pennings N, Wallace EL, Larson E. Standard of care for lipedema in the United States. Phlebology. 2021 May 28:2683555211015887. doi: 10.1177/02683555211015887. Epub ahead of print. PMID 34049453.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 "Lipedema". rarediseases.info.nih.gov. Archived from the original on 18 March 2021. Retrieved 30 December 2016.
  3. 1 2 3 4 5 6 7 8 9 "Lipoedema". nhs.uk. 2 October 2020. Retrieved 1 April 2021.
  4. 1 2 3 4 5 6 7 8 9 10 11 Kruppa, Philipp; Crescenzi, Rachelle; Faerber, Gabriele; Forner-Cordero, Isabel; Cornely, Manuel; Shayan, Ramin; Karnezis, Tara; Simarro, Jose Luis; de Souza, Paula Frederichi; Herbst, Karen Louise; Ghods, Mojtaba; Michelini, Sandro (2026-01-10). "Lipedema World Alliance Delphi Consensus-Based Position Paper on the Definition and Management of Lipedema: Results from the 2023 Lipedema World Congress in Potsdam". Nature Communications. 17 (1) 427. Bibcode:2026NatCo..17..427K. doi:10.1038/s41467-025-68232-z. ISSN 2041-1723. PMC 12796449. PMID 41519859.
  5. 1 2 Torre YS, Wadeea R, Rosas V, Herbst KL (March 2018). "Lipedema: friend and foe". Hormone Molecular Biology and Clinical Investigation. 33 (1) 20170076. doi:10.1515/hmbci-2017-0076. PMC 5935449. PMID 29522416.
  6. 1 2 3 Faerber, Gabriele; Cornely, Manuel; Daubert, Constance; Erbacher, Gabriele; Fink, Jodok; Hirsch, Tobias; Mendoza, Erika; Miller, Anya; Rabe, Eberhard; Rapprich, Stefan; Reich-Schupke, Stefanie; Stücker, Markus; Brenner, Erich (2024). "S2k guideline lipedema". JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 22 (9): 1303–1315. doi:10.1111/ddg.15513. ISSN 1610-0387. PMID 39188170.
  7. ↑ Al-Ghadban, Sara; Evancio, Jane V.; Alfiscar, Paula E. F.; Herbst, Karen L. (2025-09-03). "New Characterization of Lipedema Stages: Focus on Pain, Water, Fat and Skeletal Muscle". Life. 15 (9): 1397. Bibcode:2025Life...15.1397A. doi:10.3390/life15091397. ISSN 2075-1729. PMC 12471503. PMID 41010339.
  8. 1 2 3 4 Herbst, Karen L (2012). "Rare adipose disorders (RADs) masquerading as obesity". Acta Pharmacologica Sinica. 33 (2): 155–72. doi:10.1038/aps.2011.153. PMC 4010336. PMID 22301856.
  9. ↑ Anne Warren Peled, Anne; Kappos, Elisabeth (August 2016). "Lipedema: diagnostic and management challenges". International Journal of Women's Health. 8: 389–395. doi:10.2147/IJWH.S106227. PMC 4986968. PMID 27570465.
  10. 1 2 3 4 "Diagnosing Lipedema: Symptoms, Criteria & Evaluation – Lipedema Foundation". Lipedema Foundation. Retrieved 2026-08-06.
  11. 1 2 Fiengo, Elettra; Sbarbati, Andrea (2026-04-28). "Comorbidities in lipedema: toward a systemic perspective - a narrative review". Clinical and Experimental Medicine. 26 (1): 236. doi:10.1007/s10238-026-02157-9. ISSN 1591-9528. PMC 13284013. PMID 42047836.
  12. ↑ Luta, Xhyljeta; Buso, Giacomo; Porceddu, Enrica; Psychogyiou, Roxani; Keller, Sanjiv; Mazzolai, Lucia (2025-03-20). Grubić Kezele, Tanja (ed.). "Clinical characteristics, comorbidities, and correlation with advanced lipedema stages: A retrospective study from a Swiss referral centre". PLOS ONE. 20 (3) e0319099. Bibcode:2025PLoSO..2019099L. doi:10.1371/journal.pone.0319099. ISSN 1932-6203. PMC 11925301. PMID 40111978.
  13. ↑ Khalid, Muhammad Umar; Prasada, Sameer; Jennings, Courtney; Bartholomew, John R.; McCarthy, Meghann; Hornacek, Deborah A.; Joseph, Douglas; Chen, Wei; Schwarz, Graham; Bhandari, Rohan; Elbadawi, Ayman; Cameron, Scott J. (February 2024). "Venous thromboembolic outcomes in patients with lymphedema and lipedema: An analysis from the National Inpatient Sample". Vascular Medicine. 29 (1): 42–47. doi:10.1177/1358863X231219006. ISSN 1477-0377. PMID 38334096.
  14. ↑ Fiengo, Elettra; Sbarbati, Andrea (2025-10-12). "Lipedema and Hypermobility Spectrum Disorders Sharing Pathophysiology: A Cross-Sectional Observational Study". Journal of Clinical Medicine. 14 (20): 7195. doi:10.3390/jcm14207195. ISSN 2077-0383. PMC 12565064. PMID 41156066.
  15. 1 2 Herbst, K. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol Sin 33, 155–172 (2012). https://doi.org/10.1038/aps.2011.153
  16. ↑ Kruppa, P.; Georgiou, I.; Biermann, N.; Prantl, L.; Klein-Weigel, P.; Ghods, M. (June 1, 2020), "Lipedema—Pathogenesis, Diagnosis, and Treatment Options", Deutsches Ärzteblatt International, 117 (22–23): 396–403, doi:10.3238/arztebl.2020.0396, PMC 7465366, PMID 32762835
  17. ↑ Lipedema: Diagnosis, causes, and types, March 15, 2022, retrieved April 13, 2024
  18. ↑ What Is Lipedema?, retrieved April 13, 2024
  19. ↑ Lipedema, June 1, 2023, retrieved April 13, 2024
  20. ↑ Fat Disorders Research Society Lipedema Description Archived 2015-07-31 at the Wayback Machine
  21. ↑ Todd, Marie (2010). "Lipoedema: Presentation and management". British Journal of Community Nursing. 15 (4): S10–6. doi:10.12968/bjcn.2010.15.Sup3.47363. PMID 20559170. S2CID 22897427.
  22. 1 2 Fife, Caroline E.; Maus, Erik A.; Carter, Marissa J. (2010). "Lipedema". Advances in Skin & Wound Care. 23 (2): 81–92. doi:10.1097/01.ASW.0000363503.92360.91. PMID 20087075. S2CID 14350132.
  23. ↑ Földi, Michael; Földi, Ethel, eds. (2006). "Lipedema". Földi's Textbook of Lymphology. Munich: Elsevier. pp. 417–27. ISBN 978-0-7234-3446-7.
  24. ↑ Trayes, K. P.; Studdiford, J. S.; Pickle, S; Tully, A. S. (2013). "Edema: Diagnosis and management". American Family Physician. 88 (2): 102–10. PMID 23939641.
  25. 1 2 Leopoldo Cobos, MD, Karen Herbst, PhD, MD, Christopher Ussery, MS, CSCS, MON-116 Liposuction for Lipedema (Persistent Fat) in the US Improves Quality of Life, Journal of the Endocrine Society, Volume 3, Issue Supplement_1, April–May 2019, MON–116
  26. ↑ Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012;166(1):161‐168. doi:10.1111/j.1365-2133.2011.10566.x
  27. ↑ Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L (2019). "Lipedema: A Call to Action!". Obesity (Silver Spring). 27 (10): 1567–1576. doi:10.1002/oby.22597. PMC 6790573. PMID 31544340.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  28. ↑ Beltran K, Herbst KL. Differentiating lipedema and Dercum's disease. Int J Obes (Lond). 2017;41(2):240‐245. doi:10.1038/ijo.2016.205
  29. ↑ "FDRS Diagram". Archived from the original on 2017-10-11. Retrieved 2015-07-09.[full citation needed]
  30. ↑ "Lipedema Treatment, How to Treat Lipedema - Lipedema Foundation". Lipedema Foundation. Retrieved 2026-08-06.
  31. ↑ Fetzer A, Wise C. Living with lipoedema: reviewing different self-management techniques. Br J Community Nurs. 2015;Suppl Chronic:S14‐S19. doi:10.12968/bjcn.2015.20.Sup10.S14
  32. ↑ Hardy, Denise (October 2016). "Best practice guidelines for the management of lipoedema". British Journal of Community Nursing. 22 (Sup10): s44–s48. doi:10.12968/bjcn.2017.22.Sup10.S44. PMID 28961048 – via CINAHL.
  33. ↑ Dadras, Mehran; Mallinger, Peter Joachim; Corterier, Cord Christian; Theodosiadi, Sotiria; Ghods, Mojtaba (2017). "Liposuction in the Treatment of Lipedema: A Longitudinal Study". Archives of Plastic Surgery. 44 (4): 324–331. doi:10.5999/aps.2017.44.4.324. PMC 5533060. PMID 28728329.
  34. ↑ Baumgartner, A.; Hueppe, M.; Schmeller, W. (May 2016). "Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years". British Journal of Dermatology. 174 (5): 1061–1067. doi:10.1111/bjd.14289. PMID 26574236. S2CID 54522402.
  35. ↑ Sandhofer M, Hanke CW, Habbema L, et al. Prevention of Progression of Lipedema With Liposuction Using Tumescent Local Anesthesia: Results of an International Consensus Conference. Dermatol Surg. 2020;46(2):220‐228. doi:10.1097/DSS.0000000000002019
  36. ↑ Langendoen, S.I.; Habbema, L.; Nijsten, T.E.C.; Neumann, H.A.M. (2009). "Lipoedema: From clinical presentation to therapy. A review of the literature". British Journal of Dermatology. 161 (5): 980–6. doi:10.1111/j.1365-2133.2009.09413.x. PMID 19785610. S2CID 30001846.
  37. ↑ "Cosmetic and Reconstructive Services of the Trunk and Groin". November 12, 2019.
  38. ↑ Forner-Cordero, I.; Szolnoky, G.; Forner-Cordero, A.; Kemény, L. (2012). "Lipedema: An overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review". Clinical Obesity. 2 (3–4): 86–95. doi:10.1111/j.1758-8111.2012.00045.x. PMID 25586162. S2CID 45550292.
  39. ↑ Foldi, E. and Foldi, M. (2006) Lipedema. In Foldi's Textbook of Lymphology (Foldi, M., and Foldi, E., eds) pp. 417-427, Elsevier GmbH, Munich, Germany
  40. ↑ Reich-Schupke S, Schmeller W, Brauer WJ, et al. S1 guidelines: Lipedema. J Dtsch Dermatol Ges. 2017;15(7):758-767. doi: 710.1111/ddg.13036
  41. 1 2 Wold, LE; Hines, EA; Allen, EV (1 May 1951). "Lipedema of the legs: a syndrome characterized by fat legs and edema". Annals of Internal Medicine. 34 (5): 1243–50. doi:10.7326/0003-4819-34-5-1243. PMID 14830102. S2CID 12401140.
  42. ↑ HINES, EA (2 January 1952). "Lipedema and physiologic edema". Proceedings of the Staff Meetings of the Mayo Clinic. 27 (1): 7–9. doi:10.1016/S0025-6196(26)02414-6. PMID 14900206.
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