Lipoedema (also known as lipedema) is a chronic, progressive disorder that is characterized by the excessive accumulation of fatty tissue. Affecting almost exclusively women, this condition is due to the body’s loss of ability to metabolise fat in specific parts of the body. The legs and hips are most commonly affected, however it can also occur in the arms. The fat cells in the affected areas become abnormally enlarged, and, as the excess body mass presses against blood vessels and nerve endings, the uncontrolled build up of fat can be painful and debilitating. Dieting and exercise have little or no effect. The condition can lead to serious health concerns and loss of mobility; and the disfigurement can cause distress and depression. The image illustrates various phases of the lipoedema condition.


As there is no specific test to diagnose lipoedema. It is identified through a clinical evaluation, the patient’s history as well as observations of:

  • Disproportionate fatty accumulation in a symmetrical distribution on the legs, potentially the arms, but not on the hands and feet (these latter are separated by a sharp ring-like transition zone)
  • Resistance to all attempts at diet and exercise
  • Painful and hypersensitive to the touch
  • Easy bruising with rubbery, inelastic, cold skin
  • Hypermobility of the skin, an abnormal gait, and joint pain
  • Non-pitting swelling
  • Onset is seemingly linked to hormonal change milestones (puberty, pregnancy, menopause)

Causes of lipoedema

The condition is of unknown causation, but strong familial predisposition suggest genetic changes in the fat cells membrane making them unresponsive to metabolic signals. Hormonal theory stipulates occurrence of lipoedema at the time of significant hormonal changes.

Will the condition get worse?

Lipoedema is both a chronic and progressive condition.  It typically develops through four stages, with varying degrees of responsiveness to treatment.

Stage I: Responds well to treatment

  • Skin is smooth
  • Swelling increases during the day and may resolve with rest and elevation of affected limbs

Stage II: May respond well to treatment

  • Skin has indentations
  • Lipomas may have developed
  • Eczema and erysipelas (superficial skin infection) may be present
  • Swelling increases during the day, with less resolution after rest and elevation of affected limbs

Stage III: Less responsive to some treatment modalities

  • Hardened connective tissue (fibrosclerosis)
  • Swelling consistently present and does not decrease with rest
  • Large masses of overhanging skin and fat

Stage IV: Not responsive to treatment

  • Fibrosclerosis with elephantiasis (deformed, tree-trunk like limbs)
  • Swelling consistently present and does not improve with rest
  • Larger masses of overhanging skin and fat
  • Also known as Lipo-Lymphedema as secondary lymphatic compression leads to lymphatic congestion

Liposuction treatment for lipoedema

The only known effective treatment for lipoedema is circumferential liposuction.  This is the removal of the fatty layer all the way around the affected limbs.  Depending on its severity, several liposuction sessions might be required to remove enough fat cells to make a difference.  Physiotherapy, leg elevation and good skin care are also helpful.  In grossly deformed limbs (later stage cases) surgical excision of the overhanging fatty and skin tissue might be required.