Lipedema: Understanding and Managing this Chronic Condition
Medically reviewed by Mohamed T. Hassan, MD, DABVLM, RPVI, on March 27, 2024
Lipedema is not lymphedema. It's crucial to understand that lipedema and lymphedema are distinct conditions despite their similar sounding names. Our focus today is on lipedema (also known as lipoedema), a relatively rare chronic condition that predominantly affects women.
Dr. Mohamed Hassan is a highly experienced vein physician specializing in venous and lymphatic diseases. He is the lead Center for Vein Restoration (CVR) vein doctor in Hoover, Alabama, and Trussville, Alabama. Board-certified in internal medicine, he completed his fellowship training at CVR’s prestigious Venous and Lymphatic Medicine Fellowship program and is a member of medical societies, including the American Vein and Lymphatic Society.
His dedication to patient education and personalized treatment plans underscores Dr. Hassan’s commitment to improving the quality of life for people with vein disorders.
Dr. Hassan: Historically, lipedema has been overlooked by healthcare professionals, often mistaken for a variant of gynoid obesity. Now, we recognize it as a disease characterized by the progressive, symmetrical, and subcutaneous accumulation of adipose tissue (fat) and water in certain areas, typically the lower limbs, but it can also affect the arms (though less commonly, about 30 percent of cases). The primary symptoms include an increase in the volume of the lower limbs and heightened sensitivity to touch.
Today, we have a better understanding of this condition, and it is less frequently confused with lymphedema, obesity, or chronic venous insufficiency of the lower limbs. However, it's crucial to note that these conditions remain important differential diagnoses that must be carefully ruled out to ensure the accuracy of the diagnosis.
What is lipedema?
Lipedema is a chronic condition with bilateral (both sides), symmetrical (the same shape, size, and relative position of parts on opposite sides of a body), and progressive clinical manifestations. It is important to note that this pathology persists even after significant weight loss, dispelling the misconception that it is simply a consequence of being overweight.
Lipedema is a genuine disease involving complex pathophysiological mechanisms, including:
Increased Limb Volume:
The first sign that strikes physicians when facing a patient with lipedema is an increase in limb volume. While the lower limbs are most commonly affected, other areas of the body may also be involved (such as the hips, saddlebags, and arms in about a third of cases). It is important to note that during lipedema, the volume of the affected limbs is disproportionate to the rest of the body. Unlike with general overweight, where adipose tissue is evenly distributed throughout the body.
Pain and Extreme Sensitivity to Touch:
Patients with lipedema often complain of varying degrees of pain. This pain can be spontaneous or triggered by touch or pressure. In advanced stages, the pain can be so intense that it significantly affects the patient's quality of life, especially due to reduced mobility.
The increased pain and sensitivity during this condition are primarily due to adipose tissue masses and local inflammatory processes compressing nerve fibers.
Swelling and Feeling of Heaviness:
All components of lipedema combine and intertwine to produce swelling and a feeling of heaviness in the limbs. Fat accumulation in the affected areas leads to a local increase in limb volume, disrupting blood capillaries with increased permeability. Water and proteins then escape and accumulate in the interstitial space, resulting in swelling and heaviness. Moreover, in advanced stages, lymphatic circulation is disrupted, leading to secondary lymphedema.
Limited Mobility, Muscle Weakness:
Lipedema is asymptomatic in most cases in the early stages of the disease. As the condition progresses, manifestations gradually appear, and in the most advanced stages, patients complain of joint problems, muscle weakness, and intense pain. This results in increasingly limited mobility and an abnormal gait.
Tendency to Bruise:
Bruising is the extravasation of blood from capillaries. Lipedema is characterized by frequent bruising, often occurring spontaneously (without external trauma or with minimal pinching). It is not a coagulation disorder that causes this but instead increased permeability of fragile capillaries compressed by fatty deposits.
Changes in Appearance, Skin Temperature, and Texture:
The skin in areas affected by lipedema is altered in terms of texture. Due to the accumulation of fat and water beneath the skin, the skin becomes smoother in some areas and takes on an "orange peel" appearance in others. Various nodules form, which can significantly impair mobility when located near joints.
The skin may also feel cool to the touch. Most patients, especially those in advanced stages, experience this coolness mainly due to poor blood circulation in areas affected by lipedema.
What Should You Do if You Suspect Lipedema?
If you're experiencing symptoms such as heavy-feeling or swollen or painful legs, it's important to get the correct diagnosis and treatment. Talking to a healthcare professional is critical to getting the help you need. If you think you might have lipedema (or lymphedema or any other disorder of the lower extremities), don't wait! Getting the right medical advice can make all the difference in restoring your quality of life.
Center for Vein Restoration Can Help!
Center for Vein Restoration (CVR) is America's largest physician-led vein center. Established in 2007, CVR's 110+ vein doctors are committed to significantly improving lives by providing safe, personalized, and positive outpatient treatment options for various leg-related issues.
And CVR consistently boasts a 98% patient satisfaction rating.
Call 240-965-3915 to speak to a Patient Services Representative or schedule your consultation online at a CVR near you today.