Lipedema

Lipedema is a chronic condition in which fat builds up disproportionately and symmetrically on the legs, and often the arms, while the trunk, hands and feet remain slim. It affects almost exclusively women and usually starts or worsens with hormonal changes: puberty, pregnancy or menopause. It is frequently underdiagnosed and confused with obesity or cellulite.

What lipedema is

In lipedema, fatty tissue in the limbs grows abnormally and becomes inflamed. Unlike fat from excess weight, lipedema fat hurts to the touch, bruises easily and barely decreases with diet and exercise. Its cause is not well understood, but there is a clear hormonal and family component.

How to recognise lipedema

Typical signs of lipedema are:

• Disproportion: the lower body is much larger than the upper body.
• Symmetry: both legs or both arms are equally affected.
• Feet and hands are spared: the fat stops at the ankle or wrist, forming a “cuff”.
• Pain, tenderness and heaviness, worse during the day and in the heat.
• Bruises that appear without obvious knocks.

Diagnosis is clinical and is made by a doctor experienced in lipedema; it distinguishes lipedema from lymphedema (which does affect the feet and is usually asymmetric) and from obesity.

Stages of lipedema

Lipedema is staged according to the skin and fatty tissue: in stage 1 the skin is smooth with small nodules underneath; in stage 2 the surface is uneven with larger nodules; and in stage 3 there are large masses of hanging tissue, especially on the inner thighs and knees. In advanced stages lymphedema may develop as well (lipolymphedema).

Treatment of lipedema

Lipedema cannot be cured, but its symptoms can be controlled:

• Conservative treatment: made-to-measure compression stockings or garments, manual lymphatic drainage, low-impact exercise (swimming, cycling, walking) and weight control. They relieve pain and swelling but do not remove lipedema fat.
• Lipedema-specific liposuction: using lymph-sparing techniques (tumescent, water-assisted or vibration-assisted), it removes the diseased tissue, reduces pain and improves mobility. Several procedures are often needed, with compression afterwards.

Because it is a medical condition and not just an aesthetic concern, lipedema should be assessed by a specialist before deciding on any treatment.