Lipoedema / Lipedema Treatment

Lipedema / Lipoedema (swollen fat syndrome or painful fat syndrome) is a condition that afflicts most people and is yet not commonly known. It is a chronic and progressive ailment and occurs mostly in females affecting approximately 11% of the female population who suffer from some degree of Lipoedema.

It causes an abnormal accumulation of fat in specific areas of the body. The disease is characterized by bilateral, symmetrical fatty tissue accumulation, mainly in the hip region, upper and lower leg areas and combined with a tendency for leg swelling that worsens with standing for prolonged periods. Since it is a progressive condition, symptoms will also worsen and change with time. So it requires on-going symptom management to ease discomfort and prevent progression to more advanced stages that may include lipo-lymphoedema.

Patients with Lipoedema / Lipedema are mostly misdiagnosed as having lymphoedema. Lymphoedema results from malfunction of the lymphatic system, whereas lipoedema is thought to primarily be a disorder of adipose tissue. Confusingly, however, patients with lipoedema may develop lymphatic dysfunction. This combination of lipoedema and secondary lymphoedema is sometimes referred to as lipo-lymphoedema.

Cause of Lipedema –

This condition is usually not associated with overeating or lack of exercise. It is thought to be a genetic disorder with autosomal dominant inheritance with gender limitation usually to women, although it can occur in men very rarely.  Hormonal influences play a role in the development and progression of the disease and in the majority of patients, the disease usually starts after puberty, but may also develop at other periods of hormonal change, such as pregnancy or menopause.

Signs, Symptoms and Diagnosis of Lipedema –

A “typical” sufferer of lipedema have a marked discrepancy between their slim upper body and disproportionately over-sized lower body with subcutaneous fat deposition.  This is often called the two body condition where the upper half of your body is a size 10 and the lower half of the body is a size 16.  Individuals with lipedema are often misdiagnosed as simply being overweight, or their condition is mistaken to be a different swelling condition known as lymphedema.

In early stages patients with lipedema experience mild to no symptoms. Often in the early stage the fat accumulation may appear similar to the much more common cellulite fat or Lipohypertrophy which also causes a disproportionate fat accumulation in the legs, but does not cause pain or swelling.  Lipedema is also often confused with Lymphedema which is characterised by asymmetric swelling of the limbs (often only one arm or leg is affected) and is usually painless.But in later stages, the proper diagnosis can be made as lipedema progresses to fat hyperplasia [over accumulation of fat]. Females having lipedema report a spontaneously occurring feeling of pressure or swelling and a hypersensitivity to touch and heaviness in their lower portion of body especially the thighs and lower legs.

Progression of Lipedema –

The symptoms generally worsen as the day progresses, particularly after standing or sitting for prolonged periods. Over time, the hyperplasia of fat in the subcutaneous tissue can begin to affect the lymphatic channels. The fat accumulation can affect mobility and the disproportionate shape can become very distressing, especially if there is no recognition or understanding of its underlying cause. The secondary weight gain is often disfiguring and painful which causes distress to the patient. Lipedema patients may develop swelling with lipo-lymphedema only if they also become obese, which can interfere with lymphatic drainage.

Stages of Lipedema –

Stage I – In the first stage, the skin is smooth and the subcutaneous layer is thickened; soft to touch possibly with small nodules. The skin may be cool in certain areas as a result of functional vascular disbalance.

Stage II –  Subcutaneous nodules and the skin surface becomes uneven.

Stage III –  Patients have huge amounts of tender subcutaneous tissue and bulging protrusions of fat, often at the inner side of the thighs, knees, ankles or gluteal area (buttocks)

Lipedema Treatment Procedure –

A treatment called Comprehensive Decongestive Therapy (CDT) can ease painful symptoms due to lipedema. The therapy involves Manual Lymphatic Drainage (MLD), bandaging/compression garments, exercises and skin care.

Manual lymphatic drainage (MLD) – It is a unique, light massage therapy which uses gentle, rhythmic pumping movements to stimulate the flow of lymphatic fluid around blocked areas towards healthy vessels, where it can drain into the venous system. It assists the cutaneous lymphatics in picking up and removing not just fluids, but other waste products, protein particles and debris from our system. This helps relieve pain and prevent fibrosis.

Compression Garments -The use of compression bandages or custom-fitted stockings to increase tissue pressure around the swollen legs prevents further build-up of fluids. These are  helpful in controlling the progression. However; the compression only works for the swelling component of the lipedema and does not address the lipohypertrophy or excess fat.

This conservative therapy can bring a reduction in circumference of approximately 10% and improves pain and symptoms of hypersensitivity to pressure.  If the CDT is discontinued, the swelling and symptoms gradually return.

Surgical treatment of lipedema – It is usually done by using tumescent liposuction to remove lipidemic fat. In this technique there is minimal bleeding and damage of superficial lymphatic vessels. The application of blunt microcannulas measuring 2mm – 4mm allows surgeons to use a gentler technique and avoid damaging important structures, which results in a faster recovery and a significant net improvement of lipedema symptoms.  This lymphatic sparing liposuction yields good long term results in reduction of pain from lipedema and in controlling its progression. The need for conservative therapies such as MLD and compression can be greatly reduced in most patients.

Dieting and exercise will not reduce the fat accumulation involved in lipedema. But it is important to do so because they can help you to reduce weight from non-lipedema fat and reduce inflammation.


Dr Ashish Dutta performs the following procedures for Lipedema / Lipoedema:


Vaser Liposelection

Smartlipo / Laser Lipolysis

Compression Therapy

Our team of professional doctors and nurses will discuss the procedure before any treatment, explaining any possible side effects.