What Is Lipedema?

Medically Reviewed by Jabeen Begum, MD on December 26, 2023
Written by Mary Anne Dunkin, Kristin Mitchell
7 min read

Lipedema is an abnormal buildup of fat in your lower body. It's a long-term condition that can affect up to 11% of women. Almost all the people who have lipedema are women. Lipedema happens when fat is distributed in an abnormal way beneath your skin, usually in your buttocks and legs. Although it begins as a cosmetic concern, it can eventually cause pain and other problems. 

Lipedema vs. cellulite

Cellulite is fat that collects beneath the skin and makes it look lumpy or dimpled. Unlike lipedema, cellulite is only a cosmetic condition, and it doesn’t cause pain. 

Lipedema vs. lymphedema

Lipedema can be mistaken for obesity or lymphedema. Your body's lymphatic system, which helps protect you against infection, moves a fluid called lymph through your body. When lymph builds up because lymph vessels or nodes that the fluid travels through are missing, damaged, or removed, that buildup is called lymphedema. Both lipedema and lymphedema can cause swelling, but lipedema is not caused by lymph buildup. 

Lipedema can lead to lymphedema. With lipedema, over time, fat cells can block the vessels of your lymphatic system. This blockage prevents the proper drainage of lymph fluid, leading to lymphedema.

If not treated, lymphedema can lead to problems such as infections, delayed wound healing, development of scar-like tissue called fibrosis, and hardened skin in the legs.

Unlike lymphedema, lipedema doesn't start in the lower legs (feet and ankles) but the upper legs, and it isn't related to prior surgery. It usually affects both legs.

Lipedema is labeled with different types based on where in your body the fat tissue builds up. 

Type I: The fat tissue collects around your hips and buttocks.

Type II: The fat builds up between your hips and your knees.

Type III: The fat is between your hips and your ankles. 

Type IV: The fat is in your arms.

Type V: The fat builds up in your calves. 

Sometimes, you may have different types of lipedema together. For example, type IV, with lipedema fat in your arms, is rare, and it usually happens in combination with type II or III, fat buildup in the lower body.  

Typical symptoms of lipedema include:

  •  Difference in size of feet and legs. If you have lipedema, there's typically a noticeable difference in size between your feet, which are not affected by the condition, and your lower half and column-like legs. For example, the top half of your body may be a size 8, but the bottom half may be a size 16. 

  • Pain. Lipedema can be painful, either constantly or only when pressure is applied. , Your skin may also bruise easily.

  • Heavy feeling and swelling. You may experience swelling and a heavy feeling in your legs.

  • Buildup of fat. As the condition progresses, fat continues to build up, and your lower body grows heavier. Fat can later collect in the arms. 

  • Loose skin. Lipedema can cause large folds of skin to form. 

  • Bumps. Bumps inside the fat may make it feel like something is under your skin.

  • Fatigue. If you have lipedema, you may feel more tired more often than usual.

Why does lipedema fat hurt?

How exactly lipedema causes pain is still uncertain. But some research suggests that hormones, inflammation, and excess substance in the body between cells may trigger the nervous system, causing pain.

 

 

The cause of lipedema is not known, however, some causes may include:

Hormones. but doctors suspect female hormones play a role. That's because the condition affects mostly women, and it often begins or worsens at puberty, during pregnancy, following gynecologic surgery, around the time of menopause, or when you're taking birth control pills.

Genes. Scientists also believe genes are involved, because many women with the condition (20% to 60%) have family members with the condition.

While obesity is not a cause of lipedema, most people with the condition have a BMI higher than 35. 

Lipedema sometimes gets misdiagnosed as something else with similar symptoms. No single test can diagnose lipedema, so a health care provider can diagnose it by taking your medical history and doing a physical exam, which may include feeling the texture of the affected areas.

Your health care provider may ask you about or check for several things that are common in people with lipedema, including: enlargement in both legs symmetrically, pain or tenderness when pressure is applied, easy bruising, and legs that are affected but feet that are not. They also may use the “Stemmer sign,” which is pinching the skin over the second toe. If the skin is thick and difficult to lift, that may mean you have lymphedema rather than lipedema.

Your health care provider also may order tests to help find out whether you have lipedema. These tests may include:

  • MRI (magnetic resonance imaging), a scan that provides images of the inside of your body
  • CT scan, a scan that provides images of your bones and soft tissues
  • Ultrasound, an imaging test that uses sound waves 
  • DEXA scan, an imaging test that measures bone density 
  • Nuclear medicine imaging, a scan that makes images by finding radiation from parts of the body after a radioactive material is injected

Stage 0 lipedema happens when you may not notice swelling but have general aches and a feeling of heaviness.

Lipedema has four stages as it progresses. They are:

Stage 1: Your skin looks normal, but it feels like there is something underneath it. 

Stage 2: Your skin looks uneven or bumpy, and it may be dimpled.

Stage 3: You have large folds of skin and fat, and your legs may look like rectangular balloons. The fat may make it difficult for you to move around.

Stage 4: You have both lipedema and lymphedema. You may have swelling throughout the lower body, as well as lipedema in your arms. 

Lipedema doesn't have a cure, but treatment can help improve symptoms. 

  • Exercise and a healthy diet. Lifestyle changes, such as a heart-healthy or anti-inflammatory diet, may help. Certain types of exercise can help increase lymph flow. 

  • Compression. Pneumatic compression devices, which are inflatable garments that you put on your legs and that fill with compressed air, and compression stockings may help reduce pain and improve symptoms. 

  • Skin moisturizer. This can help prevent your skin from drying out.

  • Medications, supplements, and antioxidant herbal medicines may help manage symptoms. For example, selenium may improve inflammation, and fat-burning supplements may help reduce fat. Amphetamines, diosmin, metformin, phentermine, and resveratrol may help with inflammation, swelling, and other issues.

  • Liposuction can remove fat and reduce pain. Water-assisted liposuction and tumescent liposuction can remove the lipedema fat. The procedure uses a hollow tube that is placed under the skin to suction the fat tissue. Several sessions may be needed depending on the amount of abnormal fat.

  • Bariatric surgery. Some research suggests that bariatric surgery can help reduce leg volume in people with lipedema. 

Complete decongestive therapy can ease painful symptoms. Complete decongestive therapy involves:

  • Manual lymphatic drainage. A form of massage that uses gentle, rhythmic pumping movements to stimulate the flow of lymph around blocked areas to healthy vessels, where it can drain into the venous system. This helps relieve pain and prevent fibrosis.

  • Compression. The use of stretch bandages or custom-fitted panty hose, panties, or spandex shorts to increase tissue pressure in the swollen legs and lessen the odds of fluid building up again.

  • Exercise. Helps to reduce fluid buildup, boost mobility, and maintain or improve how well your legs work.

  • Thorough skin and nail care. Helps lower the risk of wounds and infection if you have lipedema associated with swelling.

Unlike fat from obesity, fat from lipedema often is resistant to weight loss from diet, exercise, or bariatric surgery, so typical efforts to lose weight might not work on lipedema fat.

 

 

The buildup of fat from lipedema can make it difficult for you to walk and move around. 

Because fat from lipedema can block the lymphatic system, it can lead to lipo-lymphedema, which means you have both lipedema and lymphedema in your body.

The fat buildup with lipedema can cause joint problems, including knock knees. Lipedema may also lead to flat feet and venous (vein) disease. 

Along with physical complications, lipedema can affect your quality of life, because it may contribute to depression, distress about your appearance, and feelings of embarrassment and anxiety.

Lipedema happens when fat is distributed unusually beneath your skin. It typically appears in your buttocks and legs and can eventually lead to pain and other problems. Although there is no cure, treatment, including lifestyle changes, compression devices, and medical procedures, may relieve some symptoms. To diagnose it, your doctor may take a look at your medical history and do a physical exam.

  • How do you know if you have lipedema? No single test can diagnose lipedema, so a doctor can diagnose it by taking your medical history and doing a physical exam, which may include feeling the texture of the affected areas.
  • How do I know if I have lipedema or just fat? Lipedema is different from normal body fat because it can be painful and is uneven under the skin. With lipedema, there's also an obvious difference between the size of areas that aren't affected and areas that are (for example, your upper body versus your lower body).
  • Can you lose lipedema fat? More invasive treatments, like liposuction and bariatric surgery, can remove fat. Other treatments, like an exercise program and compression stockings, can help with lipedema symptoms.
  • Can lipedema be corrected? There is no cure for lipedema. For some people, lipedema is mild and doesn't progress. Others have worsening symptoms over time. Getting a diagnosis early can help to prevent complications from the condition.