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Table of Contents
Lipedema, lymphedema, and cellulite are distinct medical and skin conditions, although they can appear quite similar, often presenting as skin dimpling and uneven, bumpy skin texture.
Adding to the confusion are the similar conditions that sound the same: "lipedema" and "lymphedema." That plus 15 to 17 percent of patients with lymphedema ALSO have lipedema, making distinguishing between these two even more challenging[1].
Recognising the symptoms of lipedema, lymphedema, and cellulite is the first step toward obtaining an accurate diagnosis to receive the appropriate treatment.
What lipedema, lymphedema and cellulite look like, including their stages, types and grades
Lipedema stages and types
According to Herbst KL et. al,
- Lipedema Stage 1: The skin looks smooth but feels pebbly underneath due to loose connective tissue.
- Lipedema Stage 2: There is more lipedema tissue, causing skin dimpling and larger nodules. The arms may show sagging tissue and a noticeable cuff around the wrists.
- Lipedema Stage 3: The lipedema tissue is thicker with many large nodules and hanging lobes of tissue. Patients (e) and (f) have lipedema, obesity and lipo-lymphedema.
Note: A tissue cuff around the ankles or wrists can appear in all stages.
Types I to V describe the locations of lipedema tissue.
- Type I Lipedema: Lipedema tissue around the hips and buttocks
- Type II Lipedema: From just under the belly to the knees
- Type III Lipedema: From just under the belly to the ankles
- Type IV Lipedema: In the arms
- Type V Lipedema: In the lower legs (not shown)
Lymphedema Grades & Stages
Stage 1 lymphedema: Swelling occurs during the day but subsides overnight when lying flat. The affected area may indent when pressed but may return to normal by morning. Treatment isn't usually needed.
Stage 2 lymphedema: Swelling does not go away overnight and requires management. The tissue becomes soft and bouncy rather than indented when pressed. This stage shows signs of hardening in the limbs.
Stage 3 lymphedema: Swelling is permanent, and the affected area becomes larger and harder. Some people consider surgery to remove excess tissue, but it can be risky and might worsen lymphedema.
Stage 4 lymphedema: The affected limb becomes noticeably larger with bumps or lumps on the skin.
Cellulite grades
The classification of cellulite, as proposed by Nürnberger and Müller, is based on four distinct grades according to clinical presentation:
- Cellulite Grade 0: No skin dimpling under any circumstances
- Cellulite Grade 1: Dimpling when pinched
- Cellulite Grade 2: Visible skin dimpling while standing
- Cellulite Grade 3: Visible skin dimpling both when standing and lying
Differences & Similarities in Lipedema, Lymphedema & Cellulite
| Lipedema | Lymphedema | Cellulite | |
|---|---|---|---|
| Definition | Painful fat disease with high output lymphatic failure | Localised subcutaneous tissue swelling | Skin dimpling and indentation of the subcutaneous fat |
| Occurrence | In females only | Males and females alike | More common in females than males |
| Causes | • Genetic • Hormones • Inflammation • Fibrosis • Fluid build-up in tissues |
• Genetic defect • Cancer Treatment • Infection • Lymphatic system injury • Disrupted lymphatic system • Health conditions | • Hormonal fluctuations • Significant weight gain • Poor diet • Unhealthy lifestyle • Dehydration • Medical conditions • Ageing |
| Limbs affected | Both limbs affected by cuffs, including the arms and shoulders | One limb affected | In the outer and inner thighs, buttocks, abdomen |
| Symptoms | • Pain and tenderness • Symmetrical swelling • Easy bruising • Heaviness in the affected area • Unusual or sudden fatigue • Reduced range of movement • Irregular fat distribution • Skin Changes |
• Pain and tenderness • Swelling in affected area, including fingers/toes • Heaviness and tightness in the affected area • Unusual or sudden fatigue • Reduced range of movement • Infections • Skin Changes |
• No pain, no tenderness • Skin Changes |
| Skin | Tender to the touch | Thickened skin | Dimpled skin texture |
| Would a compression garment improve the appearance? | ✓ | X | X |
| Medical condition | ✓ | ✓ | X |
| Danger to health | • Immobility • Disability due to impaired daily activities • Orthopaedic changes |
• Immobility • Disability due to impaired daily activities • Recurring infection • Increased risk of cancer • May lead to other health or skin problems |
• Limited clothing choices |
| Diagnosis | • Physical examination • Medical history • Ultrasound |
• Physical examination • Medical history • Ultrasound • NIRF lymphatic imaging • CT scans • Lymphoscintigraphy • MRI scans |
• Visual examination • Pinch test • Lifestyle history |
| Treatment | • Manual lymphatic drainage • Exercise • Compression garment • Lipedema Surgery with Liposuction |
• Manual lymphatic drainage • Exercise • Lymphedema Surgery |
• Manual lymphatic drainage • Exercise • Weight loss programme • Cellulite Reduction with Liposuction with Fat Grafting |
Self-assessment on Lipedema, Lymphedema & Cellulite at home
How to self-diagnose lipedema: Pinch test
How to do: Gently pinch the affected area and pay attention to any feeling of pain or if there's a difference in texture compared to other places. Pain or unusual texture could suggest lipedema.
Limitation: Not fully reliable, as non-essential and overlapping conditions can affect results.
Red flag: Pain, tenderness, swelling, or feelings of heaviness impacting mobility
How to self-diagnose lymphedema: The Stemmer's Sign test
How to do: Stemmer's Sign test is used to assess the ability to pinch and lift the skin, particularly on the base of the second toe or middle finger. If you can lift the skin easily, it is likely not lymphedema (negative sign). If it's a challenge, it might be lymphedema (positive sign).
Limitation: This test can give false positives and negatives, and it can't differentiate lymphedema from other conditions.
Red flag: Signs of infection (redness, warmth, pain, fever), worsening swelling, pain, or difficulty moving the affected area
How to self-diagnose cellulite: Pinch test
How to do: Pinch areas with dimpled skin, usually on the thighs and buttocks. If dimples show more when pinched, it's likely cellulite.
Limitation: This test measures temporary changes and may not accurately reflect the overall condition due to factors such as skin slackness or body type.
Red flag: Pain or swelling in the dimpled areas
If you've been wondering whether those painful thighs and arms are more than just stubborn fat, don’t wait in doubt. Let Dr Ivan Puah take a closer look and guide you with the right solution — book your appointment today!
