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A Guide to Lipedema Treatment Established and New Management Strategies

Medically reviewed by Alana Biggers, M.D., MPH — By Corey Whelan on October 4, 2022Lipedema is a chronic medical condition characterized by an unusual buildup of fatty tissue under your skin. It causes large amounts of hard, painful fat to accumulate in your lower body. It typically affects your hips, thighs, and calves but may also affect your upper arms. This condition usually affects people assigned female at birth. It runs in families and may be linked to hormones. It typically appears at times of significant hormonal change, such as puberty, pregnancy, and menopause. Lipedema can worsen over time. Your treatment plan will depend on the stage and severity of your condition. There is no cure for lipedema, but research is ongoing. Current treatments aim to reduce symptoms and improve quality of life. Treatments may: reduce fatty tissueimprove lymphatic drainagerelieve pain and inflammationimprove mobilityreduce emotional distress In this article, we’ll review the various treatments for lipedema.

Lipedema vs lymphedema

Lymphedema is a condition in which lymph builds up in your soft tissues. Lymph is a clear fluid that travels through the arteries and capillaries of the blood system. It helps cleanse bodily tissue of toxins and unwanted substances. Both lymphedema and lipedema cause swelling, but they are different conditions. Lymphedema may also occur in the later stages of lipedema. When this happens, doctors call it secondary lymphedema or lipo-lymphedema. The excess fatty tissue that lipedema causes can create blockages in your lymphatic system that stop lymph from draining properly. Lymphedema is sometimes a side effect of breast cancer treatments.

Stages of lipedema

Lipedema treatments range from lifestyle strategies to surgery. A doctor may use multiple strategies at the same time to reduce symptoms and the discomfort they cause. Lipedema can progress over time. Effective treatment will depend on how severe your symptoms are. To clarify how much the condition has progressed, doctors classify symptoms into four stages:Stage 1: The surface of your skin looks typical, with minimal swelling. The fatty tissue under your skin, called subcutaneous adipose tissue (SAT), is soft. Stage 1 lipedema usually responds well to treatment.Stage 2: Your skin’s surface is hard and uneven, with fat nodules and more swelling. SAT is also hard. Treatments may still be effective.Stage 3: Your skin’s surface is thick and hard, with hard SAT under it. You have continuous swelling and large overhanging masses of tissue. This stage may be less responsive to treatment.Stage 4: You have very hard skin and SAT. You also have lymphedema. This stage is the least responsive to treatment, but pain management techniques and surgery may help.

Dietary changes

Fatty buildup due to lipedema does not respond well to calorie restriction or dieting. However, it is possible to be overweight or have obesity in addition to having lipedema. Changes to your diet may help reduce the amount of fat that is not a result of lipedema. Dieting alone may not help you attain a thinner all-over appearance. But if you have excess weight to lose, doing so may help reduce pain and inflammation and increase your mobility. Since lipedema causes inflammation, an anti-inflammatory diet may be especially helpful. Anti-inflammatory eating plans include:low carb dietsvegetarian dietsMediterranean diet Anecdotal evidence also indicates that the ketogenic diet may help reduce and soften fat from lipedema. Some research suggests that a diet rich in antioxidants may help treat early-stage lipedema. According to a 2021 case series, the following as antioxidants may help treat lipedema:hesperidindiosminquercetinpycnogenol (pine bark extract)flavonoidsrutosidesbutcher’s broom

Lipedema vs obesity

Lipedema causes hard, inflamed fatty tissue to form in specific areas under your skin’s surface. This can be painful. In contrast, obesity and weight gain cause fat to form in both deep and subcutaneous body tissues. These fatty tissues don’t cause pain or inflammation. Fat forms all over your body, not just in specific, pocketed areas.

Exercise

Exercising can help you feel stronger and more in control of your body. Exercises that strengthen the muscles in your lower body may especially help reduce pain and improve mobility. Your lymphatic system relies on your muscles to pump and move fluid through your body. Exercise and physical activity are integral for muscle pumping. This may help reduce swelling caused by lipedema and lymphedema. If you have excess fat that’s not due to lipedema, exercise may help shrink areas of your body affected by lipedema. Beneficial exercises include cycling and quad exercises that build muscle, such as squats. As lipedema progresses, you may find it harder to walk and move, but physical activity is still important and helpful. Water aerobics and swimming are good options that may be easier than walking. Water acts as a type of compression. Water exercise supports your joints, allowing for a greater range of movement. It may also help soften hardened connective tissue, which may enhance lymphatic flow. Gentle yoga may help you build muscle strength and improve flexibility. It may also help you relax and improve your mood. There’s not a lot of research into how yoga specifically benefits people with lipedema. But, in a 2021 review of studies, researchers concluded that yoga had moderate benefits for reducing the pain and swelling caused by lymphedema.

Elevation

Elevating your legs periodically throughout the day may help relieve orthostatic swelling, which is caused by standing. This type of swelling is common during stage 1. Elevation may also help during later stages when combined with more aggressive treatments.

Medication

There’s no medication to treat lipedema, but a doctor may include certain medications as part of a conservative treatment plan. You might take these in combination with other treatments. According to a 2019 review, options include:beta‐adrenergic agonistscorticosteroidsdiureticsflavonoidsselenium The review authors also point out that there is little available research to say whether these are effective. Additionally, some diuretics, such as furosemide, can worsen lipedema.

Psychotherapy

It can be challenging to live with lipedema. About 85% of people with lipedema say that it affects their mental health. Studies have also linked mental health conditions to an increase in perceived pain. Talking with a mental health professional, such as a therapist, may help you learn coping skills and address body image issues, if you experience them. Lipedema can also affect social relationships. A 2021 review suggests that many people with lipedema have decreased social functioning. Psychosocial therapy can help people manage and cope with group interactions. If being around family members, friends, or co-workers is challenging for you, psychosocial therapy may help.

Patient education and emotional support

As with any other chronic condition, remaining informed and educated is key. Talking with your doctor about your symptoms and concerns is one way to educate yourself about lipedema. It may also help to stay connected to other people with lipedema. The Lipedema Project is a good resource for finding online educational resources and support groups.

Complete decongestive therapy CDT

CDT is a noninvasive treatment that aims to reduce swelling, support lymphatic function, and decrease pain. Healthcare professionals use it to treat lipedema and lymphedema. CDT consists of:Manual lymphatic drainage: This hands-on technique stimulates lymph flow and reduces swelling.Exercise: Exercise can help alleviate swelling and strengthen muscles.Compression bandaging and garments: Compression can help reduce swelling in later-stage lipedema.Skin care: Keeping your skin moisturized and healthy helps reduce the risk of infection.

Manual lymphatic drainage

This gentle massage technique reduces painful swelling in your arms and legs. A massage therapist will use specific hand movements during a two-step process. First, they will release lymph trapped in soft tissues. This is called clearing. Next, they will move the released lymph toward the lymph nodes. This is called reabsorption.

Compression therapy

In stage 3 and 4 lipedema, when swelling and SAT buildup are severe, you may need compression therapy. This includes wearing both compression bandages and compression garments. Compression therapy takes the place of your skin’s natural elasticity. It supports your tissues, which helps reduce pain. It also supports muscle pumping. If manual compression is not enough to reduce swelling, a doctor may recommend pneumatic compression. Pneumatic compression involves using a device that you wear over most of your body. The device contains air chambers that inflate sequentially to compress tissues. Pneumatic compression may help soften hard SAT and reduce swelling.

Liposuction

Liposuction is an invasive surgical procedure. Research shows it to be highly effective when conservative treatments fail. It’s usually an outpatient procedure, but you may need several treatments. A doctor may choose one of the following types of liposuction to treat lipedema. These procedures may cause less damage to lymph vessels than traditional liposuction or debulking surgery would. They may also be more effective for removing SAT.

Tumescent liposuction

During tumescent (local) liposuction, your surgeon will inject a solution containing epinephrine and lidocaine into the areas being treated. Epinephrine helps reduce bleeding and swelling. Lidocaine is an anesthetic. During surgery, vibrations break up the fat, and a vacuum-like device then removes the fat.

Water-jet liposuction

Water-jet liposuction uses a pressure-spray saline solution to dislodge fat. Healthcare professionals may use it to treat early or late stage lipedema. The spray also contains an anesthetic.

Laser-assisted liposuction

Laser liposuction removes fat in areas containing fibrosis (scarred, stiff tissue). Laser liposuction uses the heat from fiber-optic lasers to melt body fat so the surgeon can remove it.

Surgical debulking

In very advanced stages of lipedema, the fatty tissue may be too scarred for liposuction to be an option. A doctor may then recommend surgical debulking. In this procedure, a surgeon cuts out large portions of the fatty tissue.

Takeaway

Lipedema is a chronic condition that causes buildup of painful and inflamed fat under your skin. It is not caused by consuming too many calories. The condition runs in families and may have a hormonal cause. However, the exact cause is unknown. Lipedema worsens over time. In its early stages, it may respond well to conservative treatments. In its later stages, you may need liposuction, a surgical procedure. This condition can be painful and emotionally challenging. Patient education and support from peers may be highly beneficial. Last medically reviewed on October 4, 2022

How we vetted this article

SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Amato ACM, et al. (2021). Lipedema can be treated non-surgically: A report of 5 cases.
ncbi.nlm.nih.gov/pmc/articles/PMC8667633/Ashforth K. (2019). Understanding fibrosis in lipedema: Inflamed subcutaneous adipose tissue (SAT), and nodules.
lymphaticnetwork.org/news-events/understanding-fibrosis-in-lipedema-inflamed-subcutaneous-adipose-tissue-satBuso G, et al. (2019). Lipedema: A call to action.
ncbi.nlm.nih.gov/pmc/articles/PMC6790573/Cannataro R, et al. (2021). Management of lipedema with ketogenic diet: 22-month follow-up.
ncbi.nlm.nih.gov/pmc/articles/PMC8707844/Czerwińska M, et al. (2021). Lipoedema as a social problem. A scoping review.
ncbi.nlm.nih.gov/pmc/articles/PMC8508106/Di Renzo L, et al. (2021). Potential effects on a modified Mediterranean diet on body composition in lipoedema.
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ncbi.nlm.nih.gov/pmc/articles/PMC7465366/Romeijn JRM, et al. (2018). Exploration of patient characteristics and quality of life in patients with lipoedema using a survey.
ncbi.nlm.nih.gov/pmc/articles/PMC6002318/Saraswathi V, et al. (2021). Managing lymphedema, increasing range of motion, and quality of life through yoga therapy among breast cancer survivors: A systematic review.
ncbi.nlm.nih.gov/pmc/articles/PMC8023442/Treating lipedema. (n.d.).
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ncbi.nlm.nih.gov/books/NBK573066/Witte T, et al. (2020). Water-jet-assisted liposuction for the treatment of lipedema: Standardized treatment protocol and results of 63 patients.
pubmed.ncbi.nlm.nih.gov/32446570/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 4, 2022 By Corey Whelan Edited By A. L. Heywood Medically Reviewed By Alana Biggers, MD, MPH Copy Edited By Jill Campbell Share this articleMedically reviewed by Alana Biggers, M.D., MPH — By Corey Whelan on October 4, 2022

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