Lipedema

Lipedema can cause pain, a feeling of heaviness and an uneven distribution of fatty tissue, which makes everyday activities difficult. Recognising this condition allows treatment to be focused on relieving symptoms, improving mobility and enhancing quality of life, without reducing the condition to a matter of weight or appearance.

What is lipoedema?

Lipedema affects the fat located beneath the skin, which is referred to in medical reports as subcutaneous adipose tissue. In the affected areas, the volume of this tissue increases and pain, tenderness to touch or a feeling of tightness may occur.

It occurs almost exclusively in women and usually affects both legs in a similar way. It can be distributed across the hips, thighs and calves; in some people it also affects the arms. The feet and hands are usually unaffected.

The combination of body distribution and symptoms is crucial. Having bulky legs is not sufficient to diagnose lipoedema, just as the appearance of the skin does not indicate how much pain a person is experiencing. The 2026 international consensus of the Lipoedema World Alliance recognises this distinction between body shape and the condition.

Although its name contains the term ‘oedema’, lipoedema is not simply a matter of fluid retention. Its primary abnormality affects the fatty tissue. If a problem with lymphatic drainage also arises, both processes may coexist and require different treatments.

Symptoms of lipoedema

Pain may occur when pressure is applied to the area, following minor knocks, or without any obvious trigger. Some people find that certain items of clothing cause discomfort, as does the legs rubbing against each other or standing for long periods.

A feeling of heaviness, tightness and a tendency to bruise easily are also common, sometimes following minor knocks. When the area is touched, small lumps may be felt beneath the skin, the size and texture of which vary from person to person.

Discomfort is not always related to the size of the swelling. A barely visible condition may be painful, whilst a more obvious one may interfere less with daily activities. The NHS’s clinical information on lipoedema describes this range of symptoms and their potential impact on mobility.

Changes requiring urgent attention

Lipedema alone does not explain why a leg might suddenly swell, become red or hot, or start to hurt in a different way. These changes need to be assessed to rule out an infection or deep vein thrombosis – a blood clot forming inside a vein.

If shortness of breath or chest pain occurs, immediate medical attention is required. The NHS guidance on deep vein thrombosis lists these warning signs, which must also be taken into account when a diagnosis of lipoedema has already been made.

Causes and risk factors of lipoedema

The cause of lipoedema is not yet fully understood. Research is investigating the role of genetic predisposition, the characteristics of adipose tissue, small blood vessels and pain-related mechanisms.

In some families, several people are affected. Furthermore, the onset of symptoms or changes in them may coincide with stages such as puberty, pregnancy or the menopause.

This association suggests a possible hormonal influence. This does not mean that it can be attributed to a specific hormone, nor that there is a hormonal test capable of confirming the diagnosis.

The international consensus on lipoedema distinguishes these associations from proven causes and recognises that there are still aspects of the condition that require further research.

Lipedema can occur with or without obesity. When both conditions are present, it is advisable to treat them separately: excess weight may add to the difficulties, but it does not necessarily explain the pain, tenderness or the characteristic distribution of the affected areas.

When further tests are needed

Tests are requested to answer specific questions. The aim is not to carry out a series of tests for the sake of it, but to clarify what is causing the symptoms and what factors may be contributing to them.

When it is necessary to examine the veins

A venous Doppler ultrasound allows the veins to be visualised and the blood flow through them to be analysed. It may be requested when there are signs of venous disease, unusual swelling, a medical history that makes it necessary to assess circulation, or a suspicion of thrombosis.

In a person with lipoedema, it helps to answer a specific question: whether there is also a venous problem contributing to the heaviness, swelling or discomfort, which should be taken into account when planning treatment.

A Doppler ultrasound scan alone does not confirm or rule out lipoedema.

A tissue ultrasound scan can describe the thickness and structure of the tissues. Tests are requested based on medical history and findings when it is necessary to investigate other conditions that may contribute to the swelling or symptoms.

The vascular assessment described in the US consensus on lipoedema incorporates these investigations into a targeted evaluation.

When it is appropriate to investigate lymphatic drainage

The lymphatic system collects excess fluid from the tissues and returns it to the bloodstream. If the examination raises suspicions that this drainage is also impaired, it may be necessary to investigate it specifically.

One of the tests available is indocyanine green lymphography. Small amounts of a fluorescent dye are administered via superficial injections, and a special camera allows its path through the lymphatic vessels close to the skin to be observed.

In reports, this may be referred to as ICG lymphography, after the dye’s name, indocyanine green.

Research into indocyanine lymphography in people with lipoedema has investigated its usefulness in mapping this superficial network. It can provide information in selected cases, but it is not a mandatory test nor does it confirm lipoedema on its own.

When further information is required, lymphoscintigraphy allows the transport of a tracer through the lymphatic system to be tracked, whilst a specialised MRI scan can provide additional information about the vessels and tissues.

These tests do not form a mandatory sequence. They are selected according to the specific issue that needs to be clarified.

What other conditions might resemble lipoedema?

Obesity involves excess body fat, which can be distributed in various ways. It can co-exist with lipoedema, but does not necessarily explain the combination of pain, tenderness and the characteristic distribution in the limbs.

Lipohypertrophy describes a disproportionate increase in fatty tissue without the characteristic painful symptoms. This distinction is important because a particular body shape, without symptoms or other findings, should not automatically lead to a diagnosis of lipoedema.

In lymphoedema, the main problem is the lymphatic system’s insufficient capacity to collect and transport fluid. It can affect the feet or hands and may present asymmetrically between the two sides, although these characteristics are not universal.

Chronic venous disease can also cause heaviness, swelling and discomfort in the legs. It may co-exist with lipoedema and, where a physical examination raises suspicion of this, a Doppler ultrasound scan helps to assess how the venous circulation is functioning.

The European consensus on lipoedema distinguishes between these conditions and recognises that some may coexist. In such cases, treatment must be tailored to each component: treating fluid accumulation is not the same as treating fatty tissue, and reducing fat does not necessarily resolve a venous or lymphatic problem.

Treatment of lipoedema

Treatment does not aim to achieve a specific body shape. Its aim is to reduce pain and heaviness, maintain mobility and minimise the impact of the condition on daily life.

There is no one-size-fits-all approach for everyone. Some people find relief through compression, exercise and physiotherapy; others also require nutritional support or treatment for associated conditions.

Where symptoms remain significant and there is a suitable clinical indication, liposuction specifically planned for lipoedema may be considered.

Compression garments

Compression stockings, tights and other garments exert controlled pressure on the tissues. They can relieve heaviness and pain; where fluid has accumulated, they also help to manage it. Their function is not to remove fatty tissue.

The garment must be adapted to the shape of the limb and the wearer’s tolerance. It is also important that it can be put on easily and worn for the recommended duration. The aim is to find a level of compression that is both effective and comfortable, not to apply as much pressure as possible.

Studies on compression and exercise in lipoedema have observed improvements in certain symptoms, although some of the evidence comes from small-scale research.

If a garment causes new pain, numbness or changes in skin colour, it needs to be checked rather than assuming that such discomfort is an inevitable part of the treatment.

Exercise and physiotherapy

Exercise is aimed at improving strength, mobility and endurance. It starts from each person’s current ability and progresses gradually, particularly when pain has led to reduced activity for a period of time.

Walking, cycling, strength training or exercising in water are all options that can be combined. Where there is joint pain or difficulty walking, physiotherapy helps to adapt movements, regain activity and find forms of exercise that can be sustained.

The consensus of the Italian societies for movement sciences and phlebology on exercise for lipoedema recommends this individualised approach.

The benefits are not solely dependent on changes to body shape: moving with less pain, regaining strength or completing an activity with less fatigue are also significant outcomes.

Diet and management of excess weight

Nutritional care should aim for an adequate, balanced and sustainable diet. No diet has been shown to cure lipoedema, and severe restrictions can hinder a healthy relationship with food without resolving the symptoms.

Where obesity is present, clinically indicated weight loss can reduce fat tissue in the legs as well, and provide metabolic and functional benefits.

A study published in *Diabetes* in 2025 observed this reduction in women with obesity and lipoedema.

This does not mean that losing weight cures lipoedema, nor that everyone with this condition needs to lose weight. Pain, tenderness and the characteristic distribution of the tissue may still require a specific approach even if weight is reduced.

Manual lymphatic drainage and pressotherapy

Manual lymphatic drainage uses gentle, specific movements on the skin. It can be used to relieve certain symptoms or treat associated fluid build-up, but it does not remove fatty tissue.

Medical pressotherapy, also known as intermittent pneumatic compression, uses a sleeve or boot connected to a device whose chambers inflate in succession to exert pressure on the limb.

These techniques are considered complementary. Not everyone with lipoedema requires a full decongestive treatment programme.

The consensus on exercise and conservative treatment for lipoedema envisages their use within combined programmes tailored to the specific issue being addressed.

Pain management and associated conditions

When pain persists, it is advisable to assess whether it stems solely from lipoedema or whether the joints, veins or other structures are also involved. Treating these additional causes can significantly improve the overall symptoms.

Medicines are used when there is a specific clinical indication. There is no single drug capable of generally eliminating the affected tissue.

Diuretics – medicines that increase the excretion of water in the urine – are not a standard treatment for lipoedema. They may be indicated for another condition, but require a specific medical justification, as outlined in the US consensus on lipoedema care

When might surgery for lipoedema be considered?

Surgery may be considered when pain or functional limitations continue to have a significant impact and, following a thorough assessment, it is deemed that reducing the affected tissue may provide a benefit that justifies the risks.

Before a decision is made, the diagnosis is confirmed, the treatment provided to date is reviewed, and the expected improvement is specified.

The assessment includes the patient’s general health, circulation, risk of thrombosis and the possible presence of a lymphatic condition. Consideration is also given to what the recovery will be like and what support may be needed at home.

The 2024 German guidelines on lipoedema recommend liposuction for selected patients.

The indication depends on the clinical problem and its impact, not on achieving a specific leg circumference or an isolated severity score.

Liposuction for lipoedema: what it involves

Liposuction removes fat using small tubes called cannulas, which are inserted through small incisions. In lipoedema, the procedure is planned with a therapeutic aim: to reduce tissue that contributes to the symptoms and improve function, as well as to alter body contour.

Before the fat is suctioned out, a solution is usually injected to help prepare the tissue and control bleeding. This preparation is known as the tumescent technique.

There are different ways of assisting the extraction process. In PAL (power-assisted liposuction), a mechanical system facilitates the movement of the cannula. In WAL (water-assisted liposuction), on the other hand, a flow of fluid helps to separate the tissue whilst suction is being applied.

These acronyms describe how the instruments work. They do not, on their own, indicate which technique will yield the best result for a particular individual.

The German guidelines for the surgical treatment of lipoedema emphasise the importance of protecting tissues and lymphatic vessels during the procedure. Planning and the team’s experience are key factors.

What improvement can surgery offer?

The LIPLEG trial, published in The Lancet in 2026, provides a randomised comparison between liposuction and conservative treatment in 410 women who continued to experience pain following a period of non-surgical care.

After one year, approximately 7 out of 10 women assigned to liposuction had achieved a clinically significant reduction in pain, compared with fewer than 1 in 10 in the conservative treatment group. Quality of life also improved more significantly with surgery.

In exact figures, a reduction in pain of at least two points on a scale of zero to ten was achieved in 68 per cent of the liposuction group and in 8 per cent of the conservative management group.

The procedure, however, also resulted in more serious adverse events during the study period: 8 per cent compared with 3 per cent in the conservative group.

These results support a benefit of liposuction in selected patients, but do not make the procedure an automatic solution nor do they demonstrate a definitive cure. The duration of the benefit and subsequent care requirements warrant further monitoring.

NICE’s assessment of liposuction for lipoedema had adopted a more restrictive stance in 2022 based on the evidence available at that time. The LIPLEG trial is more recent; therefore, any older recommendations that may be found online should be interpreted in the context of when they were drawn up. All care measures.

Recovery and risks

Where several areas are affected, treatment may be spread over more than one procedure. The type of anaesthesia, the extent of each procedure and the interval between operations are tailored to each individual case. During recovery, compression garments, progressive mobilisation, physiotherapy and follow-up appointments may be required.

Being aware of these requirements before the operation helps with organising recovery, support at home and a return to work. The hospital’s information on planning and follow-up for lipoedema surgery outlines this process.

Possible risks include bleeding, anaemia, infection, fluid build-up, changes in sensation, contour irregularities, thrombosis and damage to lymphatic vessels.

The procedure requires an assessment of these risks alongside the expected benefits, and there is no guarantee that all symptoms will disappear or that all aftercare measures can be discontinued.

Progression and prognosis of lipoedema

Lipedema does not progress in exactly the same way in everyone. In some people, symptoms and swelling remain relatively stable for years; in others, the symptoms or treatment requirements change.

Therefore, receiving a diagnosis does not necessarily mean that the condition will progress to severe forms.

A Spanish prospective study published in *Vascular Medicine* in 2025 followed 100 people with lipoedema for an average of 4.6 years and observed stable volume in the majority.An increase in volume was linked to changes in weight and the distribution of abdominal fat, although this association does not allow us to predict how a specific individual will progress.

Furthermore, maintaining a stable volume does not necessarily mean being free from pain. Follow-up should take into account mobility, discomfort, skin condition and the ease of adhering to treatment, not just measurements.

Risk reduction and long-term care

There is currently no proven way to prevent all cases of lipoedema. Its onset cannot be attributed simply to poor diet or a lack of exercise.

Long-term care aims to maintain mobility, support general health and treat any problems that may cause additional discomfort. Where obesity, venous disease or lymphoedema are present, each of these conditions requires its own assessment and treatment.

The management plan should be reviewed if circumstances change or if it becomes difficult to follow. The European consensus on lipoedema recommends a holistic approach that integrates symptoms, physical activity, nutritional needs and emotional wellbeing.

Specialists who treat lipoedema

The assessment begins by confirming that the symptoms and tissue distribution do indeed correspond to lipoedema. From there, the team examines which issues most significantly affect daily life and whether there are any associated venous, lymphatic, metabolic or musculoskeletal disorders.

Depending on the findings, professionals with expertise in vascular diseases, rehabilitation, physiotherapy, nutrition and surgery may be involved. A surgical assessment is carried out when there is a specific indication and a reasonable benefit to be expected, not as an automatic consequence of the diagnosis.

At the Publio Cordón Memorial Hospital, the surgical assessment is carried out within the Department of Plastic and Reconstructive Surgery.

The Advanced Breast Reconstruction and Lymphoedema Unit is headed by Dr Jaume Masià Ayala, whose institutional profile specifically highlights his specialisation in lipoedema surgery.

The assessment links symptoms, tissue distribution, functional impact and previous treatments with the available options. Where indicated, a vascular or lymphatic study is carried out to complete the planning, as explained by the hospital in its information on the diagnosis and specialised treatment of lipoedema.

If there are signs of venous disease, the Department of Angiology and Vascular Surgery may be involved. Where obesity or metabolic disorders are present, the Obesity and Cardiometabolic Risk Unit, which forms part of the Department of Endocrinology and Nutrition, enables these needs to be addressed specifically.

Not everyone requires the same tests or needs to be referred to all these departments. The care pathway is tailored to each patient’s findings and objectives.

Living with lipoedema

The impact of lipoedema isn’t measured solely in centimetres. It can become apparent when choosing clothes, after standing for several hours, whilst exercising, or when trying to follow a self-care routine that takes up part of the day.

The aim is for treatment to be integrated into everyday life. A garment that won’t fit, an exercise that increases pain or a routine that’s impossible to maintain all need to be reviewed: adapting the treatment is also part of managing the condition effectively.

A treatment that fits in with everyday life

An uncomfortable garment, an exercise routine that’s hard to stick to, or discomfort that interferes with rest can mean that a plan which looks good on paper proves of little use in practice.

Explaining these difficulties makes it possible to adapt the care plan rather than abandon it altogether. The goals can be very specific: to be able to go for a walk again, to climb stairs more comfortably, to return to an activity you used to enjoy, or to end the day feeling less sluggish.

The personalised care described in the consensus on exercise for lipoedema specifically encourages this progression based on each person’s individual abilities and needs.

Body image and emotional wellbeing

Everyone’s relationship with their own body is different. Some people are particularly affected by changes in body shape; others are more concerned about pain, uncertainty or limitations. Care should allow room for these differences, without making assumptions about how the diagnosis should be experienced.

Research into stress and quality of life in women with lipoedema highlights the importance of also considering emotional wellbeing.

Where there is persistent distress or a difficult relationship with food, psychological support can be incorporated into treatment. Addressing this aspect does not detract from the importance of physical symptoms.

Preguntas frecuentes

Does having wide legs mean you have lipoedema?

No. The diagnosis requires correlating the distribution of the tissue with the pain, tenderness and findings on examination. The size of the legs or a photograph, on their own, are not sufficient to establish this.

Are lipoedema and lymphoedema the same thing?

No. Lipoedema mainly affects fatty tissue; lymphoedema occurs when the lymphatic system is unable to drain enough fluid. They can occur at the same time, but they are not treated in exactly the same way.

Does lipoedema go away when you lose weight?

In cases of obesity, losing weight can reduce fat tissue in the legs as well and bring health benefits. However, it does not guarantee that the pain, tenderness or characteristic distribution will disappear. Having lipoedema does not mean that everyone needs to lose weight.

What test confirms lipoedema?

There is no single test that can confirm this. The diagnosis is made on the basis of symptoms, medical history and a physical examination. Ultrasound, blood tests or lymphatic tests are used when it is necessary to investigate associated problems or resolve a specific uncertainty.

Do all people with lipoedema need liposuction?

No. Surgery is considered when the symptoms or limitations justify considering a procedure and there is an expected benefit that outweighs the risks. The size or shape of the legs alone are not sufficient grounds for making a decision.

Does surgery provide a permanent cure for lipoedema?

Liposuction can reduce the affected tissue and improve pain and function in selected patients, but it does not guarantee a permanent cure. Some people continue to require compression or other care, and follow-up is part of the treatment.

Medical information for general guidance

Lipedema requires an assessment that links changes in fatty tissue to pain, mobility and difficulties in daily life. Understanding what each treatment offers helps patients make decisions with realistic expectations: relieving symptoms, restoring function and reducing tissue are related objectives, but they are not identical.

At the Publio Cordón Memorial Hospital, we believe it is important for medical information to be accurate, understandable and useful in guiding each person through their care journey. Our specialists devote part of their work to explaining conditions, tests and treatment options in an accessible way, helping patients and their families to better understand each stage and participate with greater confidence in decisions about their health. This commitment to knowledge and public outreach also forms part of our commitment to research and scientific dissemination.

This information is intended to provide guidance on the condition and is not a substitute for an individual assessment. Sudden swelling, new and severe pain, redness or warmth require medical attention. If you experience shortness of breath or chest pain, you must seek immediate medical attention; these symptoms should not simply be attributed to a known case of lipoedema. and quality of life.