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Stages & Types of Lipedema

As patients work through getting an official lipedema diagnosis, experts will first need to determine what stage the lipedema is currently at. There are three different stages, or levels of progression used to evaluate how far the disease has progressed in the affected areas of the body – the first stage being the earliest onset, and the third stage the most progressed. 

The 3 Stages of Lipedema

As lipedema progresses through these three stages, the level of pain, tenderness, swelling, and fat accumulation may increase. The images below provide an overview of the three stages of lipedema, showing the location of fat build-up plus the resulting body shape at each stage. Depending on the person, different parts of the body can be affected in different ways at each stage.

These images demonstrate the stages of lipedema as described by Prof. Dr. Wilfried Schmeller and Dr. Karen Herbst (1, 2). This staging criteria, although often used, does not take into consideration pain, size, impact on joints, loss of mobility, or other important considerations and impacts the patient’s quality of life. 

Other criteria are sometimes used, and ultimately LF would like to fund research that determines a better way to determine and diagnose stages of lipedema patients.

These images are protected by copyright laws and the reproduction or distribution of any of these photos is strictly prohibited.

While the stages are pretty straightforward, there’s actually more to the story, and a bit of controversy and uncertainty over who initially described these stages. There are a handful of experts who feel strongly that there should be four stages of lipedema, rather than just three.

Where Did The Lipedema Stages Originate?

The first description of the Stages of lipedema appears in a German paper by Stößenreuther in 2001. In this paper, Stage 1 is classified as the early, “smooth” stage, Stage 2 as the visibility nodular stage, and Stage 3 as the lobular stage.  In 2004, Schmeller also described similar stages of lipedema in 3 parts. 

However, in a 2016 paper in PRS Global Open, Lipedema experts Buck and Herbst described the 4th stage of lipedema for the first time. As Buck and Herbst describe it, a would-be 4th stage of lipedema would be classified by the existence of 

Lipolymphedema, or when there is a degree of secondary lymphedema from the lipedema. However, this supposes that lipedema edema progresses linearly with the stages, and it clearly does not. Isabella Cordero, Gould, and Van De Pas have shown there are impaired lymphatic flow and function in stage 2 and stage 3 lipedema.  Crescenzi showed that there is increased tissue sodium consistent with tissue edema in stage 2 and 3 lipedema. Therefore, there is not a separate stage of lipedema 4 where lymphedema occurs, rather lymphedema or impaired lymphatics flow can occur in at least stage 2 and 3 lipedema. 

Another important consideration of the stage of lipedema is that the stage of lipedema does not equal the severity of the lipedema.  To put it another way, the stage of lipedema does not account for the volume of affected extremities, the pain experienced by the individual, and do not consider the impairment of mobility or quality of life. In summary, the stages of lipedema are descriptive of the appearance of lipedema and are somewhat descriptive of the progression tissue, but do not fully describe the severity of the lipedema disease. 

The 5 Types of Lipedema

The Types of lipedema describe the body areas where the lipedema disease is present. More simply, these types refer to the location of the lipedema fat.  The 5 types of lipedema were first described by Scmeller and Meier Vollrath, and the criteria by  Meier-Volarath in 2007, as described below. 

References:

Buck DW 2nd, Herbst KL. Lipedema: A Relatively Common Disease with Extremely Common Misconceptions. Plast Reconstr Surg Glob Open. 2016;4(9):e1043. Published 2016 Sep 28. doi:10.1097/GOX.0000000000001043 

Crescenzi R, Marton A, Donahue PMC, Mahany HB, Lants SK, Wang P, Beckman JA, Donahue MJ, Titze J. Tissue Sodium Content is Elevated in the Skin and Subcutaneous Adipose Tissue in Women with Lipedema. Obesity (Silver Spring). 2018 Feb;26(2):310-317. doi: 10.1002/oby.22090. Epub 2017 Dec 27. PMID: 29280322; PMCID: PMC5783748.

Forner-Cordero I, Olivan-Sasot P, Ruiz-Llorca C, Munoz-Langa J. Lymphoscintigraphic findings in patients with lipedema. Rev Esp Med Nucl Imagen Mol. 2018;37(6):341-8. doi: 10.1016/j.remn.2018.06.008. Epub  Aug 28.

Gould DJ, El-Sabawi B, Colletti PM, Patel KM. Abstract: Uncovering Lymphatic Transport Abnormalities in Patients with Lipedema. Plast Reconstr Surg Glob Open. 2017;5(9 Suppl):215. Published 2017 Oct 2. doi:10.1097/01.GOX.0000526475.17829.6b

Meier-Vollrath I, Schneider W, Schmeller W. Lipödem: Verbesserte Lebensqualität durch Therapiekombination. Dtsch Ärztebl 2005; 102: A 1061-1067. 

Meier-Vollrath I, Schneider W, Schmeller W. Lipödem: Verbesserte 

Lebensqualität durch Therapiekombination. Dtsch Ärztebl 2005; 102: A 1061-1067. 

 

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Meet Dr. Wright

Dr. Wright

Meet Dr. Thomas Wright, medical director of Laser Lipo and Vein Center. Dr. Wright is a board certified Phlebologist and cosmetic surgery specialist, with over 15 years of practicing experience. A graduate of the University of Missouri Columbia medical program, Dr. Wright was one of the first two hundred surgeons to become a diplomate in Phlebology.

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