Moving towards a better understanding of lipedema

Lipedema is a form of edema that is often confused with lymphedema. But instead of high protein water edema, the edema in lipedema is caused by inflammation produced by abnormal fat cells. The abnormal fat cells form a layer that is different from normal body fat; it has very poor circulation and does not break down to provide energy during typical dieting or exercise.
Lipedema occurs almost exclusively in women and starts at puberty, pregnancy or menopause, so a hormonal cause is suspected in its development.
Lipedema may be a genetic disorder and it is often seen in multiple female family members.

Lipedema affects the legs and occasionally, the arms. It does not typically affect the trunk. When the legs are affected, the feet usually are normal, so that there is a “ridge” at the ankle where the fat swelling starts. Unlike in lymphedema, which tends to be asymmetrical, the swelling of lipedema is markedly symmetrical on both legs.
The lipedema affected area is also very painful to the touch, and patients with lipedema bruise very easily because their blood capillaries are very fragile. Photo A shows the differences in clinical 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. We do not yet have a definite answer on the cause of lipedema, but there appears to be a hormonal influence that affects the venous and lymphatic circulation in fat tissues beneath the skin.

Small amounts of edema leaking from the fragile capillaries get embedded in the growing, spongy layer of abnormal fat cells and are not able to get absorbed by the lymph vessels.

As the lipedema fatty layers grow and more fluid leaks out, the inflammation causes scar tissue and fibrosis, which destroys larger lymph vessels. 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

Manual lymph drainage, compression garments and daily use of Lympha Press® can ease the pain of lipedema and prevent progression to lipolymphedema. It is important to remember that in early stages, the swelling is typically less severe, and reductions in circumference may not be as great as in later stages, as there is less fluid edema.

Clinical trials showed that treatment with Lympha Press® reduces capillary fragility and pain in patients with lipedema.

Photo A: Presentation of lymphedema and lipedema
Photo B: Different stages of lipedema progression

Lipedema Symptoms and Presentations

  • Occurs almost exclusively in women
  • Bilateral (affects both legs and symmetrical)
  • The feet usually are unaffected or minimally affected, sometimes 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

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® treat all the affected areas, including hips, thighs and buttocks.
  • Pretherapy™ enhances lymph drainage and provides more therapy time to proximal areas.
  • LymphaPod® is available for larger patients.

Learn More

Karen Ashforth has published an excellent article on lipedema 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.