Lipedema is a long-term disease that causes a buildup of fat beneath the skin in the legs and sometimes the arms. There are four stages of lipedema. As the disease develops, a person’s pain, swelling, and fat accumulation may increase.

Lipedema is a chronic, long-term condition where fat tissue builds up most commonly in the legs and sometimes the arms. It almost always affects females. However, there are some rare reports of it developing in males.

Lipedema causes physical discomfort, and because public awareness of the condition is limited, it can also cause emotional distress.

This article outlines the different types of lipedema, how doctors diagnose the condition and its stage, and treatment options.

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The main symptom of lipedema is a buildup of fat in the arms and legs. Other symptoms include pain, swelling, loose skin, and easy bruising. The texture of fat beneath the skin can feel like peas, rice, or walnuts. Symptoms often begin at times of hormonal change, such as puberty, pregnancy, and menopause.

As the condition worsens, fat deposits can grow bigger, and a person’s lower half can become heavier.

Over time, these fat cells can block vessels in the lymphatic system. This can prevent the lymphatic system from draining lymph fluid, which can cause a buildup of fluid. This is called lymphedema.

Doctors do not know what causes lipedema. Around 60% of people with lipedema have a family member who also has the disease, so there may be a genetic link.

Learn more about lymphedema here.

Medical professionals categorize lipedema into five different types based on where it is in the body.

The types of lipedema are:

  • Type I: The fat is between the navel and the hips. It often covers the pelvis and buttocks.
  • Type II: The fat is around the pelvis and down to the knees.
  • Type III: The fat begins at the pelvis and continues down to the ankles. A person with this stage may have a prominent cuff of fat at the ankle.
  • Type IV: The fat spreads from the shoulders down to the wrists.
  • Type V: The fat is predominantly on the calves.

Some people have a combination of types, commonly Type II and IV or Type III and IV. Type V is very rare.

Doctors diagnose lipedema based on a clinical examination and a person’s specific symptoms. They may ask a person about their symptoms and medical history. They may also ask about an individual’s family medical history.

A medical professional may use imaging techniques, such as an ultrasound or an MRI scan, to help rule out other conditions with similar symptoms.

Medical professionals use the following criteria to diagnose lipedema:

  • a person’s sex — lipedema occurs almost exclusively in females
  • symmetrical fat deposits on both legs
  • minimal fat deposits on the hands and feet, which creates a cuff-like appearance
  • pain and tenderness on touch
  • a feeling of heaviness and tension in the affected limbs
  • symptoms that worsen over the day
  • cool skin
  • easy bruising
  • disproportionate swelling of the affected limbs even when a person loses weight
  • minimal pitting edema
  • telangiectasias — small, broken blood vessels on the surface of the skin around the fat deposits

Another indicator of lipedema is a negative Stemmer’s sign, where the skin fold between the second and third toe can be pinched and lifted. A positive Stemmer’s sign means the skin fold cannot be pinched and lifted and would indicate lymphedema or advanced lipedema — usually stage 4 or possibly stage 3.

Lipedema is a condition that develops over time. Medical professionals classify the disease in different stages, depending on its development. There are four stages of lipedema:

Stage 1

A person’s skin appears normal and is smooth to touch. The person will have nodules of enlarged fat present underneath the skin.

A medical professional can feel these nodules during an examination. A person with stage 1 lipedema may experience some pain and easy bruising.

Stage 2

The surface of a person’s skin becomes uneven. The skin may become dimpled, have indentations, and develop mattress-like patterns.

The amount of fat will also increase in stage 2 compared with stage 1.

Stage 3

A person may develop large extensions of skin and fat. These visible, large folds of skin and fat can protrude from the limbs. This can cause the legs to appear columnar.

These protrusions of fat can put pressure on a person’s joints and may affect their mobility and balance.

These protrusions develop due to inflammation and the thickening of tissues in the limbs. This causes a loss of elasticity, leading to reduced blood flow and lymph flow out of the fatty tissue, causing it to grow.

Stage 4

This stage is when lipedema and lymphedema are present in the body.

Lymphedema is the buildup of fluid in the body’s tissues due to a damaged lymphatic system.

Lymphedema develops when lipedema causes the buildup of fat cells to interfere with a person’s lymphatic system.

There is no cure for lipedema. However, there are several ways a person can manage their symptoms. These include:

Manual lymphatic drainage massage

Manual lymphatic drainage massage is a form of gentle massage that aims to stimulate the movement of lymph fluid around the body.

Massage can help drain lymph fluid from blocked areas into healthy vessels in the body. This can help reduce the risk of scarring and increase blood flow to the area, which may help with pain reduction.

A 2017 study found that manual lymphatic drainage massage combined with vibration therapy can effectively treat lipedema.

Learn how to perform a lymphatic drainage massage here.

Compression therapy

Compression therapy can also help manage lipedema. This treatment involves using stretchy bandages or clothing items that increase pressure on the tissues inside the swollen limbs.

This is often a cosmetic treatment. However, it may reduce a person’s chances of more fluid building up in their limbs.

Liposuction

Liposuction is a very effective treatment for lipedema when other treatment options fail.

Liposuction involves removing the lipedema fat while sparing the lymphatic vessels.

A surgeon inserts a hollow instrument called a cannula under the skin during liposuction. They then break up the fatty tissue and remove it from the body using a powerful, high-pressure vacuum.

The most effective types of liposuction for treating lipedema are:

  • Tumescent technique: This procedure involves injecting a saline solution into the fatty area before removing the lipedema fat. ​
  • Water-jet assisted liposuction (WAL): During this procedure, a surgeon uses Klein solution or saline as a jet that releases the fat for liposuction.

There is no known cure for lipedema. However, if a person receives the right treatment, they can manage their condition well.

One consequence of living with lipedema is experiencing poor quality of life. Lipedema is often misdiagnosed, mistreated, and misunderstood, which can negatively impact a person’s mental health.

In a 2021 study in Poland, many people with lipedema self-reported low quality of life and severe depression. The more severe their symptoms of lipedema, the lower their quality of life.

If a person believes they have lipedema, they should contact their doctor and discuss the condition. This may help prevent the condition from developing further.

Finding support from other people living with lipedema may help a person cope emotionally. For example, the Lipedema Foundation recommends searching for lipedema support groups on social media platforms.

Lipedema is a chronic disease that causes a disproportionate fat buildup beneath the skin. The condition is most common in the legs but can also affect the arms.

Lipedema almost exclusively affects females, with some rare cases in males.

Common symptoms of lipedema include the buildup of fatty tissue in the upper legs, pain, and easy bruising.

Doctors use staging to describe how extensive a person’s lipedema is. As the disease develops, a person’s pain, swelling, and fat accumulation increase.

The final stage of lipedema includes the development of lymphedema. This is the buildup of lymph fluid in the body’s tissues due to damage to the lymphatic system.

There is no cure for lipedema, but there are ways that a person can manage their symptoms. Finding a lipedema support group may help a person cope with the emotional effects of their condition.