Understanding Lipedema: Comprehensive FAQ for Diagnosis, Treatment, and Management

We recommend starting with a proper diagnosis by a doctor knowledgeable about lipedema. If the diagnosis is confirmed, start with non-surgical treatment and consider surgical reduction if the non-surgical/conservative measures do not control symptoms.

Learn more about Lipedema:

• Lipedema Treatment
• Liposuction for Lipedema

Lipedema is a congenital connective tissue disease that affects the subcutaneous tissue (adipose and surrounding tissue), primarily in women. Lipedema is relatively resistant to weight loss. The exact cause of Lipedema is unknown, but there is a clear genetic predisposition.

Learn more about Lipedema causes:

• What Causes Lipedema
• Family History of Lipedema

Distinguishing between normal fat and lipedema fat can be challenging as they can appear similar. However, there are several characteristics and symptoms specific to lipedema that can help differentiate it from normal fat accumulation. Here’s how to identify lipedema:

Key Characteristics of Lipedema Fat:

1. Symmetrical Fat Distribution:
   • Lipedema fat is typically distributed symmetrically on both legs, hips, buttocks, and sometimes arms, sparing the hands and feet.
2. Pain and Tenderness:
   • Lipedema fat is often painful and tender to the touch. Women with lipedema may experience discomfort, bruising, and swelling.
3. Texture and Feel:
   • The affected areas may feel nodular or lumpy due to the uneven distribution of fat. Lipedema fat often has a different texture than normal fat.
4. Bruising:
   • Women with lipedema bruise easily and may have frequent, unexplained bruises due to increased fragility of blood vessels in the affected areas.
5. Resistance to Diet and Exercise:
   • Lipedema fat is resistant to weight loss through diet and exercise. While overall body weight may decrease, the affected areas often remain disproportionate.
6. Swelling:
   • Swelling in the legs and arms, especially by the end of the day, is common. This swelling does not usually reduce with elevation or compression.

Learn more about Lipedema:

• Normal Fat vs. Lipedema Fat
• Do I Have Lipedema?

It can be controlled or managed with proper diet and exercise, but there is no cure or prevention for those who develop lipedema.

Learn more about Lipedema non-surgical treatments:

• Living with Lipedema
• Lipedema Non-Surgical Treatments
• Lipedema Reduction Surgery

The basic recommendation for the best diets for lipedema includes avoiding processed foods, especially refined carbohydrates.  Emphasize eating low carb vegetables, healthy fats like olive and avocado oils, and quality protein sources.  For more information on diet, we have several pages on our website devoted to diet and nutrition.

Learn more about the best diet for Lipedema:

• Lipedema Anti-Inflammatory Diet
• Lipedema Nutrition

No, the diagnosis of lipedema or lipoedema cannot be determined without a physical exam. Competing diagnoses must be ruled out, and diagnostic clinical signs need to be palpated to make a proper diagnosis of lipedema. Likewise, the stage of lipoedema/lipedema cannot be determined without a physical exam. A physician experienced with lipedema diagnosis will detect nodularity in the skin and subcutaneous tissue and the presence of edema/lymphedema.

Learn more about Lipedema diagnosis:

• Getting a Lipedema Diagnosis

Unfortunately, there is no blood test to confirm a lipedema diagnosis. The only way to diagnose lipedema is with a physical exam and tests to rule out other diagnoses. However, new research indicates different genetic markers such as platelet factor 4 (“PF4”) and some genes identified as possible candidates to aid in diagnosis. These tests have not been validated and may or may not be specific enough to be helpful for diagnosis in a general population.

Learn more about Lipedema diagnosis:

• Getting a Lipedema Diagnosis

Many patients are surprised at how thorough the in-office diagnosis and evaluation is. You should expect to spend several hours in the office. We provide in-depth evaluations, including an ultrasound of the affected areas, measurements, full-body photos, symptom questionnaires, and an in-depth consultation to determine the best treatment options.

Learn more about Lipedema diagnosis:

• Getting a Lipedema Diagnosis

Medical or nonsurgical management of lipedema consists of treating secondary lymphedema if present, as well as diet, medications, supplements, and lifestyle changes. Management of secondary lymphedema focuses on compression garment use, manual lymphatic massage, and pneumatic compression pumps. A low carbohydrate diet emphasizing whole foods with a low glycemic index is recommended. Supplements like Diosmin, guaifenesin, and amphetamines are sometimes used. An active lifestyle with cardiovascular and resistance exercises, particularly water-based exercises, is also recommended.

Learn more about Lipedema treatment options:

• Lipedema Non-Surgical Treatments
• Lipedema Reduction Surgery

Lipedema Reduction Surgery LRS is a specialized type of surgery that is related to liposuction. However, the goal of LRS  is the maximal removal of diseased tissue for functional improvements, not cosmetic or aesthetic changes   The target of  Lipedema Reduction Surgery is not only the fat but also the fibrous tissue, it uses specialized cannula techniques that protect the lymphatics and requires generous tumescent anesthesia. For the best and most durable surgical outcomes, lipedema must be treated comprehensively and not as a stand-alone surgical procedure.  Dr. Wright’s comprehensive treatment protocols, which include weight control, an anti-inflammatory diet, compression, and exercise, before and after surgery, have resulted in significant improvements in mobility, pain, swelling, and quality of life that have been maintained for years. On average, LRS improves the quality of life and overall health of the women who had the surgery. 

Learn more about Lipedema Reduction Surgery:

• Lipedema Surgery Improves Quality of Life
• Lipedema Reduction Surgery

The likely benefits of lymph-sparing liposuction include decreased pain, heaviness, tenderness, and swelling and improved mobility, stance, and leg alignment. The potential risks of the surgery are rare but include a decreased likelihood of lymphatic and skin injury and/or scarring. Less than one in ten thousand risks include blood loss, deep vein thrombosis, complications from anesthesia, infection, and, very rarely, death.

Surgical Considerations for Patient Safety Patients with lipedema often have other medical conditions that increase their risk for complications. Therefore, all efforts must be made to minimize risk:

• Use lymph-sparing liposuction with a generous tumescent technique that avoids general anesthesia.
• Generally, one surgical procedure should treat no more than 5%- 8% of the total body surface area.
• Use small liposuction cannulas.
• Surgical technique is very important. Intimate knowledge of the locations and anatomic variations of the lymphatic drainage in the limb or body area being treated is crucial.
• Treat significant underlying venous reflux before lymph-sparing liposuction.

Learn more about Lipedema Reduction Surgery:

• Lymphatic Injury After Liposuction
• Lymphatics and Lipedema Surgery
• Who is the Best Lipedema Surgeon?
• Lipedema Treatment
• Improved Mobility and Quality of Life

Compression after surgery is generally recommended for two months. The compression garment is best combined with compression stockings for optimal lymphatic flow and prevention of blood clots. If there is secondary lymphedema, compression may be required lifelong, and the longer patients continue compression therapy, the better their outcomes will be.

Learn more about Lipedema compression therapy:

• Compression Garments for Lipedema

Studies have shown that Class 2 (20-30mmHg) medical-grade compression can reduce pain and swelling in lipedema. We have found Sigvaris, Solidea, and Czsalus open-toe pantyhose fit best and are typically the most comfortable for our lipedema ladies.

Learn More about Lipedema compression therapy:

• Compression Garments for Lipedema

Lipedema has no cure, but it can be effectively managed with nonsurgical treatment, including an anti-inflammatory diet and medical-grade compression. Exercise, especially water exercise, can also help. For some women with lipedema whose symptoms are not controlled by non-surgical treatments, Lipedema Reduction Surgery, a specialized type of liposuction, can significantly reduce pain and swelling and improve mobility and quality of life. 

Learn more about Lipedema treatment:

• Lipedema Treatment
• Improved Mobility and Quality of Life
• Who is the Best Lipedema Surgeon?

Lipedema is a chronic and progressive disease. For the best and most durable surgical outcomes, lipedema must be treated comprehensively and not as a stand-alone surgical procedure. Dr. Wright’s comprehensive treatment protocols, which include weight control, an anti-inflammatory diet, compression, and exercise, before and after surgery, have resulted in significant improvements in mobility, pain, swelling, and quality of life that have been maintained for years.  It is important that these non-surgical measures be implemented fully before surgery and strictly and continuously maintained after surgery. However, many surgeons, especially in the US, treat lipedema as a few isolated liposuction surgeries and not as part of a comprehensive treatment of a systemic disease. This approach is not as effective as Dr. Wright’s comprehensive treatment approach. Many German surgeons who treat lipedema comprehensively like Dr. Wright have not seen progression or recurrence in lipedema for up to 12 years. [Baumgartner https://pubmed.ncbi.nlm.nih.gov/32847472/]

Learn more about Lipedema treatment options:

• Lipedema Non-Surgical Treatments
• Lipedema Reduction Surgery
• Lipedema Surgery Improves Quality of Life

Lipedema can be significantly reduced with a specialized type of liposuction. Lipedema Reduction Surgery has led to many improvements, including decreased pain and swelling. Lipedema Reduction Surgery (LRS) improves mobility, knee flexion, and joint alignment. LRS has been shown to improve gait and functional capacities like climbing stairs and walking and running short distances. LRS improves the quality of life and overall health of women undergoing surgery. 

Learn more about Lipedema treatment:

• Research on Improved Mobility and Quality of Life

Many insurance companies have medical policies to cover lipedema surgery possibly; however, individual policies are complex, and the process for submitting for insurance authorization can be lengthy. We have staff onsite to help you with the process and answer your questions at no charge. 

Dr. Wright’s office is in the metropolitan St. Louis, MO area. We do accept most insurance plans. Please contact our office at 636-397-4012 or email dawn@wrightvein.org. We are happy to answer any questions you have.

Learn more about Lipedema insurance coverage:

• Coverage of Lipedema Surgery
• Lipedema Surgery and Insurance Coverage

The general rule of thumb for lipedema insurance coverage claims reimbursements is that any given claim must be deemed “medically necessary.” However, lymph-sparing liposuction is often considered a cosmetic surgical procedure or experimental, meaning it is elective and not deemed a medical necessity. This misclassification, combined with the general under-education and lack of awareness in the medical community, has led to the current battle for coverage.

Patients often face two difficult decisions: paying out-of-pocket for necessary surgeries and hoping for reimbursement later or delaying treatment until their insurance provider agrees to cover the cost. This process can take years, involves educating the insurance company on the medical seriousness of the disease, and requires several levels of appeal.

Learn more about Lipedema insurance coverage:

• Coverage of Lipedema Surgery
• Lipedema Surgery and Insurance Coverage

No. Medicare and Medicaid do not cover cosmetic procedures. Lipedema reduction surgery does not have its own code and is instead coded under cosmetic liposuction codes (15877, 15878, 15879), which makes it easier for insurance carriers to deny coverage.

Learn more about Lipedema insurance coverage:

• Coverage of Lipedema Surgery
• Lipedema Surgery and Insurance Coverage

There is no specific CPT code for lipedema reduction, so medical insurers use cosmetic codes, making treatment easier to deny. Even if coverage is approved, the reimbursement may be insufficient, discouraging patients and providers from pursuing treatment.

Essentially, medical insurance carriers disagree with the diagnosis and necessity for treatment. Even though your doctor and many doctors may diagnose you with lipedema and say you may benefit from lipedema surgery, their doctors or reviewers can disagree. In addition to the above reasoning about covering poorly or denying coverage, an insurance provider can disagree with the diagnosis and/or that surgical treatment is necessary. Their determination of what is “impairing” a patient’s quality of life is very different from what a patient with lipedema would confirm is impairing them. As a result, they deny surgical coverage. When looking at images of a patient with lipedema, providers have argued against lipedema and decided patients need to simply “lose weight” and diagnosed them with obesity, rather than their actual diagnosis of lipedema by their provider.

Learn more about Lipedema insurance coverage:

• Coverage of Lipedema Surgery
• Lipedema Surgery and Insurance Coverage

When you’re treating larger areas like lipedema, procedures are more prolonged, removing larger volumes than usual, and special care must be taken to care for the lymphatics. All of this must happen and is reflected in the average cost, but none is reflected without going out of network. Average liposuction takes 1-2 hours and costs about $7,000. Lipedema surgery takes 4-5 hours and costs the provider about $10- $15k.

Learn more about Lipedema insurance coverage:

• Coverage of Lipedema Surgery
• Lipedema Surgery and Insurance Coverage

We highly recommend speaking with your lipedema provider before working with lawyers or advocates. Some parties/people are predatory and charge large sums to help get procedures covered but ultimately are unsuccessful, leaving patients with legal fees and no reimbursement.

Cellulite is a common, harmless skin condition that causes dimpled skin. It occurs when fat cells push up against connective tissue beneath the skin, creating an uneven surface. Lipedema is a systemic connective tissue disease affecting all the cellular and extracellular components of the subcutaneous adipose space. In addition to altered adipocyte biology, there are increases in extracellular proteins and alterations in the subdermal microcirculation and lymphatics.

Learn more about Lipedema lookalikes:

• Am I overweight, or do I have Lipedema?
• Lipedema Lobules
• Lipedema Nodules
• Where does lipedema fat accumulate?

Lipedema nodules are similar to lipomas.  With lipomas, the adipocytes/fat cells are completely encased by fibrous tissue whereas lipedema nodules are only partially enclosed in fibrous tissue. 

Learn more about Lipedema Nodules and Lipomas:

• Lipedema Manual Extraction

Lymphedema is a disease caused by obstruction or absence of lymphatic flow from an area of the body. It affects all layers of the dermis. Lipedema is a congenital connective tissue disease that affects the subcutaneous tissue (adipose and surrounding tissue, primarily in women. The cause of lipedema is unknown, but there is a clear genetic predisposition.

Learn more about Lipedema lookalikes:

• Lipedema vs. Lymphedema
• What causes Lipedema?

Lifestyle-induced obesity accumulates centrally in the abdomen. It is metabolically different than lipedema, which accumulates on the legs and arms. Obesity usually responds to calorie restriction, but lipedema is relatively resistant to calorie deficits. Lipedema is a congenital connective tissue disease that affects the subcutaneous tissue (adipose and surrounding tissue), primarily in women. The cause of lipedema is unknown, but there is a clear genetic predisposition for lipedema. 

Learn more about Lipedema lookalikes:

• What causes Lipedema?
• Normal Fat vs. Lipedema Fat
• Am I overweight, or do I have Lipedema?

Lipedema nodules are similar to lipomas. With lipomas, the adipocytes/fat cells are completely encased by fibrous tissue, whereas lipedema nodules are only partially enclosed in fibrous tissue.

Learn more about Lipedema lookalikes:

• Lipedema Lobules
• Lipedema Nodules

Lipedema tends to worsen during hormonal changes such as pregnancy and menopause. It is aggravated by weight gain. Other medical and mental stressors can worsen lipedema. Vein disease can worsen lipedema. Arthritis and lipedema can make each other worse.

Learn more about Lipedema progression:

• Lipedema Comorbidities
• Types and Stages of Lipedema
• Lipedema Non-Surgical Treatments

What are the complications of Lipedema? Untreated lipedema causes pain and disability. More significant cases of lipedema affect mobility, leading to impairments in the ability to do activities of daily living. Complications of lipedema include joint injuries, accelerated arthritis in the hip, knee, and ankle, secondary lymphedema, and decreased mobility, which can lead to secondary obesity.

Learn more about Lipedema progression:

• Lipedema Comorbidities
• Types and Stages of Lipedema

The most common complications or health implications caused by lipedema are mobility limitations, accelerated arthritis of the knee and ankles, gait limitations from excess adipose around the joints, and secondary obesity. Vascular risks include an increased risk of varicose veins, secondary lymphedema, and blood clots when combined with obesity. Lipedema can cause a small vein vasculopathy that leads to increased bruising, spider veins, and varicose veins.

Learn more about Lipedema progression:

• Lipedema Comorbidities
• Types and Stages of Lipedema

The progression of lipedema is variable. Some women have little or no progression, while others progress more rapidly. Rapid progression is associated with hormonal and stressful events such as childbirth, menopause, weight gain, and rarely other illnesses.

Learn more about Lipedema progression:

• Lipedema Comorbidities
• Types and Stages of Lipedema

We have created a whole website with information about this disease. For selected candidates, surgery can be a very effective treatment. We recently published our research on the improvements in mobility, knee mechanics, and quality of life that can be achieved with Lipedema Reduction Surgery. 

Learn more about Lipedema:

• Improved Mobility and Quality of Life

Crystal’s Story Crystal is the patient who courageously agreed to do this video. She is proud of her contribution to spreading awareness for this disease. She is a warrior battling lipedema with diet, exercise, compression, and surgery and was able to transform her life and improve her mobility. See her follow-up and learn about her journey from difficulty climbing stairs to running a half marathon within a few years.

Learn more about Crystal’s Lipedema Success Story:

• Crystal’s Journey
• Crystal’s Facebook Group: Lady Lipedema

Dr. Wright’s office is in the metropolitan St. Louis, MO area. We do accept most insurance plans. Please contact our office at 636-397-4012 or email dawn@wrightvein.org. We are happy to answer any questions you have.

Follow us on our many socials for Lipedema updates and information!

• Follow us on Facebook!
• Join us on Instagram!
• Find us on Tiktok!
• Pin us on Pinterest!
• Watch us on YouTube!