Lipoedema

Lipoedema is a long-term (chronic) condition typically involving an abnormal build-up of fat cells in the legs, thighs and buttocks.

The condition occurs almost exclusively in women, although there have been rare cases reported in men.

Signs and symptoms

In lipoedema, the legs become enlarged from the ankles up to the hips. Both legs are enlarged at the same time and to the same extent.

The feet are not affected and this creates a ‘bracelet’ effect or ‘band-like’ appearance just above the ankles.

The hands are not usually affected either, although the arms occasionally can be.

The degree of enlargement caused by lipoedema differs between individuals with the condition and it can gradually worsen over time.

As well as becoming enlarged, affected areas of the body may:

• feel soft, 'doughy' and cold
• be tender to touch
• bruise easily
• ache or feel painful
• have small broken veins under the skin

The condition can progress to cause fluid retention (lymphoedema) in the affected legs.

The combination of these symptoms can lead to reduced mobility and psychological issues, such as low self-esteem.

What causes lipoedema?

The cause of lipoedema is not known, but there is a family history of the condition in some cases and it seems likely that the genes you inherit from your parents play a role.

Lipoedema tends to start at puberty or at times of hormonal change, such as pregnancy or the menopause, which suggests hormones may also have an influence.

Although the accumulation of fat tends to be worse in people who are obese, the condition is not caused by obesity and can affect people who are a normal weight. It should not be mistaken for obesity, as dieting often makes little difference to the condition (see below).

Seeking medical advice

You should see your GP if you have symptoms of lipoedema so they can try to identify the cause.

This will usually involve examining the affected areas of your body to help determine whether you have lipoedema or lymphoedema.

Lymphoedema has similar symptoms to lipoedema, and can sometimes develop as a result of lipoedema, but it is caused by a build-up of fluid from the lymphatic system (a network of channels and glands distributed throughout the body) rather than a build-up of fat cells.

The skin of someone with lymphoedema will pit or indent when you press it, but this will not happen with lipoedema.

Treating lipoedema

As there has been little research into lipoedema, there is some uncertainty about the best way to treat the condition.

Generally, the main treatment options are non-surgical treatments and liposuction.

Non-surgical treatments

Non-surgical treatments can sometimes be helpful in improving pain and tenderness, preventing or reducing lymphoedema and improving the shape of affected limbs – although they often have little effect on the fatty tissue.

Several different treatments are designed to improve the flow and drainage of fluid in your tissues, such as:

• compression therapy – bandages or garments that squeeze the affected limbs
• exercise – usually low-impact exercises, such as swimming
• massage – techniques that help encourage the flow of fluid through your body

These treatments are similar to the treatments for lymphoedema.

Liposuction

The only treatment that appears to be effective in reducing the build-up of fatty tissue associated with lipoedema is a procedure called tumescent liposuction.

Tumescent liposuction involves injecting a liquid solution into the legs to help numb the area and reduce blood loss, before the unwanted fat is sucked out through a tube.

This procedure can be an effective treatment with good results, but several separate operations may be necessary to remove the fat from the different parts of your body.

Also, non-surgical treatments may still be needed for a long period afterwards. For example, compression garments need to be worn after surgery to prevent complications such as lymphoedema.

Liposuction is not generally available on the NHS, although it may be possible to apply for funding for cases of lipoedema.

Treatments that don't work

Treatments used for some types of tissue swelling are generally unhelpful for lipoedema.

Lipoedema does not respond to:

• raising the legs
• diuretics (tablets to get rid of excess fluid)
• dieting – this tends to result in a loss of fat from areas not affected by the lipoedema, with little effect on the affected areas