Stages and Types of Lipedema: How to Identify Them

Lipedema is a progressive disease of the fat tissue that affects almost exclusively women. It is characterised by an abnormal, disproportionate build-up of fat, mainly in the arms and legs.

The key thing to understand is that lipedema is classified in two different ways: by stage (three levels that describe how the tissue has changed) and by type (categories that describe which part of the body is affected). They are not the same thing, and they are constantly confused.

Symptoms of lipedema: how to recognise it

The diagnosis has to be made by a specialist. That said, these are the symptoms that will tell you whether it is worth having yourself assessed.

Increased volume

Seen mainly in the legs (around 97% of cases). It is usually bilateral and almost symmetrical, on both legs or both arms. The hands and feet are typically spared, which produces the characteristic cut-off at the ankle or wrist.

Swelling and heaviness

A constant feeling of pressure and heaviness in the legs that does not improve by raising them or with localised massage.

Spider veins (telangiectasia)

Red, purple or blue marks on the surface of the skin caused by dilated capillaries.

Firm tissue under the skin

The skin of the legs and arms feels hard because of the fatty nodules underneath.

Tenderness to the touch

It is common to feel pain on contact: when someone leans on your legs or takes you by the arm.

Loss of skin elasticity

The tissue becomes stiffer, and bending the knee or the ankle can become difficult.

Pain

Discomfort that becomes more marked over time. It is spontaneous, it can be present at rest, and it usually increases with physical exercise.

Skin changes

These appear at the more advanced stages. The most common are hyperpigmentation and dermatosclerosis, where the skin hardens.

Family history

You may have relatives with the same picture, including on your father’s side.

The three stages of lipedema

The stages describe the structure of the tissue and the texture of the skin:

• Stage 1: the surface of the skin is smooth, the subcutaneous fat is thickened, and the fat has a fine, small-nodule structure.
• Stage 2: the surface of the skin becomes uneven, with dents and lumps, and the fat structure has coarser nodules.
• Stage 3: the tissue is coarser and harder, with wide, lobular pockets forming under the skin.

The types of lipedema

The types are defined by which areas of the body are affected:

• Type 1: fat builds up around the buttocks and hips. It is routinely mistaken for cellulite.
• Type 2: fat builds up mainly between the knees and the buttocks, settling in the thighs.
• Type 3: fat builds up along the whole leg.
• Type 4: lipedema also affects the arms, while the wrists are spared.

Lipedema treatment in Málaga

Treatment should be directed by a specialist. If the assessment confirms lipedema, there are two routes:

Conservative treatment

It helps reduce some of the symptoms. It combines manual lymphatic drainage with therapies that reduce fibrosis and improve fluid movement through the skin. Compression garments and exercise in water are also recommended.

Surgical treatment

Water-jet assisted liposuction (WAL). The pressurised water detaches the diseased fat while protecting the lymphatic vessels and nodes during surgery, which is precisely what a conventional liposuction cannot guarantee.

Dr. María Lourdes Yagües assesses and operates on lipedema personally at her clinic in Málaga. Consultations are available in English.