Lipedema (sometimes spelled “lipoedema”) is often confused with lymphedema. However, it is a separate and distinct disease.  Lipedema is also known as “painful fat syndrome.”

Development of lipedema

The word lipedema means “fluid in fat.” The edema in lipedema is produced by leakage of small amounts of fluid from the blood capillaries in the skin. Normally, fluid leaking from the blood capillaries is absorbed by adjacent lymph capillaries and returned through the body’s system of lymph vessels to the blood circulation. In lipedema, the growing, spongy layer of abnormal fat cells prevents absorption of the edema by the lymph vessels.  The stagnant edema sitting in between the fat cells causes inflammation, which in turn increases fat deposition and fibrosis.

Lipedema occurs almost exclusively in women and starts at puberty, pregnancy or menopause, so hormonal changes may influence its development. It is often seen in multiple female family members, indicating a primary genetic cause of the disease.

Differentiating lipedema from lymphedema or obesity

Lipedema affects the legs and occasionally, the arms. Unlike obesity, the fat of lipedema does not typically affect the trunk, and some patients can be very slender above the waist. Lipedema fat forms a layer that is different from normal body fat; it contains small nodules that may be felt with palpation. Lipedema fat has poor circulation, and does not break down to provide energy during typical dieting or exercise, so that while diets or bariatric surgery may reduce other stores of body fat significantly, the lipedema fat remains.

The legs, hips and buttocks are the body areas most often affected with lipedema. However, the feet are spared, with a defined “ridge” at the ankle where the fat swelling starts. This can give a “pantaloon” appearance to the legs. Unlike lymphedema, which tends to be asymmetrical, the swelling of lipedema is markedly symmetrical on both legs.

Lipedema tissue is painful to the touch. Easy bruising is another hallmark of lipedema, because the blood capillaries are very fragile. The symptoms of tactile pain and easy bruising/hematoma formation are not generally seen in lymphedema or obesity.

Lipedema Symptoms and Presentations

  • Occurs almost exclusively in women
  • Bilateral (affects both legs and symmetrical)
  • The feet usually are unaffected or minimally affected, often leading to a “pantaloon” appearance at the ankle, where the fat deposits end.
  • Minimal pitting edema; negative Stemmer sign
  • Pain and tenderness when pressed
  • Increased capillary fragility; easy bruising
  • Not improved by weight loss/dieting
Photo A: Presentation of lymphedema and lipedema. Note that the swelling of lipedema is very symmetrical, with larger swellings at the hips, and that the feet are not affected, giving a “pantaloon” appearance at the ankle where the fatty layer starts.
Photo B: Different stages of lipedema progression

Lipedema progression to secondary lymphedema/lipolymphedema

As the lipedema fatty layers grow and more fluid collects in the spaces between fat cells, the trapped edema provokes inflammation, which in turn causes buildup of fibrosis. The fibrosis and fat deposits, as well as an overload of edema (lymph fluid), destroy lymph vessels already hampered by the inflammatory environment. Eventually lipedema can progress to lipolymphedema, which is a form of secondary lymphedema. Photo B shows three women with lipedema, each at different stages of progression: stage one (early) to the left and stage 3, with lipolymphedema and significant fibrosis, to the right.

Treatment for lipedema and lipolymphedema

Various manual therapy techniques, compression garments and daily use of Lympha Press® can ease the pain of lipedema, reduce swelling and help prevent progression to lipolymphedema. It is important to remember that in early stages, swelling is typically less severe, and reductions in circumference may not be as great as in later stages, when the quantity of fluid edema is greater.

Because lipedema is often underdiagnosed, presenting your healthcare professional with good information can be a key to getting the help you need.  Leaders in the field of lipedema research recommend downloading the Standard of Care document, which is a consensus guideline on lipedema written by a US committee following the Delphi Method.  Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations, including pneumatic compression. These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.

Clinical trials have demonstrated that treatment with Lympha Press® reduces swelling, pain and capillary fragility in patients with lipedema.

Clinical Studies with Lympha Press® systems

  • Lymphedema treatment decreases pain intensity in lipedema

  • Lymphedema treatment decreases capillary fragility and easy bruising in lipedema

Webinars and videos

New Insights on Pathophysiology and Treatment of Lipedema

Dr. Karen Herbst, Board Certified Endocrinologist and lipedema specialist physician, discusses the pathophysiology and treatment of lipedema, and answers listener questions.



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The Psychosocial, Clinical and Dietary Impacts of Lipoedema

Dr. Catherine Seo is a world leader in psychosocial counseling in the field of lipoedema, and discusses psychosocial aspects of living with lipoedema.

Dr. Matthew Carmody discusses differential diagnosis of lipoedema and obesity.

Leslyn Keith, a lymphedema and lipoedema specialist and researcher, presents the Ketogenic Diet for Lipoedema.

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Lympha Press® Unique Features for Lipedema Treatment

  • Wave or peristaltic cycle – gentle drainage, for comfortable therapy over painful areas.
  • Adjustable pressure offers options for both sensitive legs and fibrotic tissue.
  • Complete deflation between compressions increases comfort.
  • Lympha Pants® treats the entire lower body, including abdomen, hips, thighs and buttocks.
  • Lympha Jacket™ treats arms and torso bilaterally
  • Pretherapy™ enhances lymph drainage and provides more therapy time to proximal areas.
  • LymphaPod® is available for larger patients.

Learn More

Read Karen Ashforth, , OT MS CLT-LANA’s article on lipedema and fibrosis on the Lymphatic Education and Research Network web site. She explains that if conservative treatment of elevation, compression, and exercise do not yield significant changes in swelling, pneumatic compression can be helpful, and that the ability to adjust the pressure and programming for comfort and effective treatment is important. You can access her article by clicking here.

Read Karen Herbst, MD, PhD on Tools for Lipedema during the COVID-19 pandemic and beyond. You can access Dr. Herbst’s article  by clicking here.