What Is Lipoedema? Symptoms, Stages and Treatment in the UK

Lipoedema is a long term condition in which fat builds up unevenly in the legs, and often the arms, in a way that diet and exercise do not change. It affects women almost exclusively and is thought to affect around one in ten women to some degree, yet many go years without a diagnosis. This guide explains what lipoedema is, how to recognise it, how it differs from lymphoedema and ordinary weight gain, and what treatment options are available in the UK.

It has been written by Dr Edwin Anthony, a Lipoedema UK Recognised Clinician and Active Physician member of the International Lipoedema Association, who treats lipoedema patients at Langham Hospital in Marylebone, London.

What is lipoedema?

Lipoedema is a disorder of fat tissue. Fat collects symmetrically on both sides of the body, usually from the hips or waist down to the ankles, and sometimes on the upper arms. The hands and feet are normally spared, which can create a visible “cuff” or ring of tissue just above the ankle or wrist.

The affected fat behaves differently from normal fat. It tends to be painful or tender to touch, bruises easily and often feels heavy. Because it does not respond well to calorie restriction, many women lose weight from the face and upper body while their legs stay the same size. The World Health Organization lists lipoedema as a distinct condition in its ICD 11 classification.

Lipoedema symptoms

Symptoms vary from person to person, but the most common signs are:

• Disproportionately large legs, hips or arms compared with the rest of the body
• Fat on both sides of the body in a matching pattern
• Pain, aching or tenderness in the affected areas
• Bruising easily, often without remembering a knock
• A feeling of heaviness or tiredness in the legs, often worse by the end of the day or in hot weather
• Feet and hands that stay slim, with a cuff of tissue above the ankles or wrists
• Little or no change in leg size after dieting or exercise
• Skin that feels cooler, softer or nodular, sometimes described as feeling like rice grains or small beads under the skin

Lipoedema usually starts or gets worse at times of hormonal change, such as puberty, pregnancy or the menopause. It often runs in families, so many patients recognise the same leg shape in a mother, aunt or grandmother.

What causes lipoedema?

The exact cause is not yet known. The strong link with female hormones and with family history suggests that both hormones and genetics play a part. Lipoedema is not caused by overeating or lack of exercise, and it is important that patients are not made to feel that it is their fault.

The stages of lipoedema

Clinicians commonly describe lipoedema in three stages, based on how the skin and tissue look and feel:

• Stage 1: the skin surface is smooth, but the tissue underneath feels thickened or nodular
• Stage 2: the skin surface becomes uneven, with larger nodules and dimpling
• Stage 3: larger lobes of tissue form, especially around the thighs and knees, and these can affect walking

Lipoedema is also described by where the fat sits, for example hips and thighs only, the whole leg, the lower leg, or the arms. The stage and pattern help guide which treatments are likely to help.

Lipoedema, lymphoedema or weight gain?

Lipoedema is often mistaken for obesity or for lymphoedema. The key differences are:

• Lipoedema affects both legs equally, usually spares the feet, and the tissue is tender and bruises easily
• Lymphoedema is swelling caused by fluid. It often affects one limb more than the other, usually includes the foot and toes, and pressing the skin may leave a dent
• General weight gain is spread across the whole body, is not usually painful, and responds to diet and exercise

Lipoedema and obesity can exist together, and in later stages lipoedema can affect the lymphatic system, a combination known as lipo lymphoedema. This is one reason why an accurate assessment by an experienced clinician matters.

How is lipoedema diagnosed?

There is no single blood test or scan for lipoedema. Diagnosis is made by a clinician who takes a careful history and examines the shape, feel and symmetry of the tissue, along with your symptoms of pain and bruising. Your GP may refer you to a specialist, or you can arrange a private consultation directly.

Lipoedema treatment options in the UK

Conservative treatment

Most patients start with non surgical care, which can ease symptoms and help prevent progression:

• Compression garments, fitted properly, to reduce aching and heaviness
• Manual lymphatic drainage massage
• Low impact exercise such as swimming, aqua aerobics, walking and cycling
• A balanced, anti inflammatory style of eating to help manage overall weight and wellbeing
• Emotional and peer support, for example through the charity Lipoedema UK

These measures help many women feel better, but they do not remove the lipoedema fat itself.

Lymph sparing liposuction

Liposuction is currently the only treatment that removes lipoedema fat. For lipoedema it must be performed with techniques designed to protect the lymphatic vessels, using tumescent fluid and gentle, vibration or ultrasound assisted cannulas that move along the length of the limb rather than across it.

At Contoura Medical, Dr Edwin Anthony uses lymph sparing VASER liposuction for lipoedema, usually under local anaesthetic, so that patients remain awake and can often walk out of the clinic the same day. Treatment is commonly planned in stages, one area at a time, to keep each procedure safe and recovery manageable. You can see examples of results in our lipoedema before and after gallery.

Patients often report less pain, fewer bruises and easier movement after surgery, although results vary and compression and healthy lifestyle habits remain important afterwards.

Is lipoedema surgery available on the NHS?

NHS funding for lipoedema liposuction is very limited and varies by area, so most UK patients who choose surgery do so privately. Lipoedema treatment at Contoura Medical starts from £4,850 for the first area under local anaesthetic. Full details are on our price list, and the exact cost is confirmed at your consultation once your treatment plan is agreed.

When to seek help

Consider speaking to a specialist if your legs or arms are much larger than the rest of your body, if the tissue is painful or bruises easily, or if your legs have not changed despite sustained weight loss. Early assessment means you can start compression and other measures sooner and make an informed decision about surgery.

If you would like an assessment, you can book a lipoedema consultation with Dr Edwin Anthony at Langham Hospital, Marylebone.

Frequently asked questions

Can you lose lipoedema fat with diet and exercise?

Not usually. Healthy eating and exercise improve general health, mobility and any ordinary fat on top of lipoedema, but the lipoedema fat itself is resistant to weight loss.

Does lipoedema get worse over time?

It can. Lipoedema tends to progress, often during hormonal changes, although the speed varies a great deal between individuals. Compression, activity and weight management may help slow it down.

Can men get lipoedema?

It is extremely rare in men and, when it does occur, is usually linked to hormonal conditions.

Is lipoedema the same as cellulite?

No. Cellulite is a common change in the skin surface that is not painful. Lipoedema is a condition of the fat tissue that causes disproportionate size, tenderness and bruising.

How many operations will I need?

This depends on how many areas are affected and the stage of your lipoedema. Many patients need two or more procedures planned over several months. Dr Anthony will explain a personalised plan at your consultation.