Microsurgery Programme
What is lipedema?
If your legs look out of proportion with the rest of your body, if they hurt when touched, and if your upper body slims down when you lose weight while your legs stay the same — this is not a matter of willpower. Lipedema is a disease that needs to be recognised, and it affects around 10% of women.
Written and medically reviewed by: Doç. Dr. Tahsin Oğuz Acartürk — Plastic, Reconstructive & Aesthetic Surgery; University of Pittsburgh. Last updated:
What is lipedema?
Lipedema is a chronic condition in which fat tissue increases abnormally and symmetrically, accompanied by pain and tenderness on touch. It is seen almost exclusively in women.
Accumulation concentrates in the hips, thighs and calves; the arms are involved in around a quarter of cases. The upper body is usually spared. The feet are not involved — producing a sharp transition at the ankle known as the cuff sign, the most typical finding in lipedema.
Three features that define lipedema
- Symmetry: both sides are affected similarly
- Pain: tenderness on touch and easy bruising — the most important feature distinguishing lipedema from simple fat accumulation
- Resistance to diet: when weight is lost the upper body slims down while the regional accumulation remains
Lipedema is not a weight problem. Calorie restriction and exercise reduce overall fat mass but do not affect the diseased fat tissue. Patients are therefore often accused of "not trying hard enough" — when the problem lies not in willpower but in the tissue itself.
Why does lipedema occur?
The cause of lipedema is not fully known, but two factors stand out: hormonal transitions and genetic predisposition.
- Hormonal periods: the condition most often begins during puberty, pregnancy or the menopause. This points to the role of oestrogen in fat tissue distribution.
- Family history: a similar body shape is found in the mother, aunt or sister of a significant proportion of patients
- Occurrence in women: it is extremely rare in men and usually accompanied by a hormonal disorder
- Microcirculation and inflammation: increased small-vessel permeability and low-grade inflammation have been shown in affected tissue — explaining the pain and easy bruising
Lipedema is not a consequence of obesity. However, the two can coexist and obesity aggravates lipedema. Weight control does not eliminate the disease but reduces symptoms and the lymphatic load.
How it differs from obesity, cellulite and lymphedema
Lipedema is most often confused with these three conditions. The distinction matters because it changes the treatment entirely.
| Feature | Lipedema | Obesity | Lymphedema |
|---|---|---|---|
| Distribution | Regional — hips, thighs, calves | Spread across the whole body | Usually a single limb |
| Symmetry | Symmetrical | Symmetrical | Frequently asymmetrical |
| Foot involvement | Absent — cuff sign | Variable | Present — top of foot and toes |
| Pain | Marked, on touch | Absent | Heaviness predominates |
| Bruising | Bruises easily | Normal | Normal |
| On losing weight | Regional accumulation remains | Reduces proportionally | Unchanged |
| Stemmer's sign | Negative | Negative | Positive |
How it differs from cellulite
Cellulite is a change in the appearance of subcutaneous fat and is painless. In lipedema, pain and tenderness dominate the picture. Cellulite is a cosmetic condition; lipedema is a progressive disease.
Lipedema and lymphedema may also coexist. In untreated lipedema the increasing tissue volume eventually exceeds the transport capacity of the lymphatic system and lymphedema is added to the picture; this is called lipo-lymphedema. For detail see our lymphedema page.
How is lipedema diagnosed?
There is no blood test or definitive imaging method for lipedema. The diagnosis is clinical — made from the history and examination.
What is assessed in making the diagnosis
- When and in which period the symptoms began
- A history of pain on touch and easy bruising
- Symmetry and sparing of the feet
- The response to attempts at weight loss
- Family history
- Skin and tissue consistency, nodularity
- Stemmer's sign — negative in lipedema
Imaging is used where lymphatic involvement is suspected or for differential diagnosis; it is not required to make the diagnosis of lipedema.
Years of diagnostic delay are very common in lipedema. Most patients are given a diagnosis of obesity at their first consultation and sent away with advice to diet. The correct diagnosis is valuable in itself in preventing the disease from progressing.
Treatment of lipedema
Conservative treatment
Compression garments, manual lymphatic drainage, regular movement and weight control form the foundation of treatment. These approaches relieve symptoms and slow progression, but they do not remove the diseased fat tissue. For detail see our non-surgical treatment page.
Surgical treatment — lymphatic-sparing liposuction
Lipedema surgery is a medical treatment, not a cosmetic procedure. The aim is not to reduce volume but to remove the diseased fat tissue while preserving lymphatic structures, reduce pain and restore movement.
- WAL (water-jet assisted): a fine water jet gently separates fat cells from the surrounding tissue; lymphatic vessels and nerves are largely preserved
- PAL (power assisted): a vibrating cannula breaks down fibrotic and dense tissue with less trauma; preferred in advanced stages
Surgery does not eliminate the disease; it reduces the diseased fat tissue. Removed tissue does not return, but the condition persists in the remaining tissue. Compression garments, movement and a stable weight therefore remain part of treatment after surgery.
Frequently asked questions
What is lipedema, in short?
A chronic condition in which fat tissue increases symmetrically and abnormally, accompanied by pain on touch. It is seen almost exclusively in women, concentrates in the hips and legs, and the feet are spared.
Is lipedema a weight problem?
No. The diseased fat tissue resists calorie restriction and exercise. When weight is lost the upper body slims down while the regional accumulation remains — and the disproportion may even become more obvious.
Does lipedema occur only in women?
Almost entirely. It is extremely rare in men and, when it occurs, there is usually an underlying hormonal disorder.
Is lipedema dangerous?
It is not directly life-threatening, but it is progressive. Over time movement becomes restricted, the knee and hip joints are strained, and lymphedema may be added because of the burden placed on the lymphatic system.
Does lipedema go away?
The disease does not disappear completely. However, conservative treatment can relieve symptoms, and surgery can reduce the diseased fat tissue and markedly improve pain and restricted movement.
Are lipedema and lymphedema the same?
No. Lipedema is a disease of fat tissue, is symmetrical and is painful. Lymphedema is an accumulation of lymphatic fluid, is usually one-sided and involves the feet. The two may also coexist (lipo-lymphedema).
Doç. Dr. Tahsin Oğuz Acartürk
Plastic, Reconstructive & Aesthetic Surgery · Oral & Maxillofacial Surgery · University of Pittsburgh
Experience in this field: Lipedema surgery requires command of liposuction techniques that spare the lymphatic system. Assoc. Prof. Dr. Acarturk is among the first Turkish plastic surgeons to have worked on adipose tissue and stem cell technologies at the University of Pittsburgh; as a surgeon who also performs lymphedema microsurgery, he works with lymphatic anatomy in daily practice.
- Adipose tissue and stem cell research at the University of Pittsburgh
- Participation in the European lymphatic microsurgery group
- Presentation at the World Congress of Lymphology
The first step in lipedema assessment
Tell us when your symptoms began, how severe the pain is and which treatments you have tried; if possible attach photographs of your legs from the front and side.