Women with lipedema in the legs live with unbearable pain and invisible symptoms. We need to raise awareness in Singapore so patients can get proper care.
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CC BY 4.0 | Lipedema, type III, stage 1. 42-year-old woman.
Lipedema is a medical condition that is often misunderstood for obesity and misdiagnosed as lymphedema or cellulite [1] and commonly occurs in females.
Also spelt as lipoedema, lipedema is characterised by abnormal fat build-up distributed unevenly in the limbs, such as the buttocks, thighs, and entire lower limbs, as well as the arms and legs.
It comes in 5 distinctive types and patterns, each in 3 stages.
Stages & Types of lipedema in the legs
Figure 1: Three stages of legs of women with lipedema with subcategories of types. In Stage 1, the skin is smooth, and the legs can appear normal but there is pain, easy bruising and a nodular feel to the fat tissue. In Stage 2, the lipedema fat exhibits a mattress-like pattern indicating fibrosis under the skin that tethers on the skin that can be found on the upper legs (Type II) or extend down to the ankles (Type III). In lipedema Stage 3, there are folds of tissue and the lipedema fat usually extends down to the ankles.
Lipedema is categorised into 3 stages. The different stages present different levels of pain, swelling, fat build-up and tenderness in the patient.
Stages of lipedema
Symptoms
Stage 1 (Mild)
The skin is smooth, and the lipedema in the legs at this stage can appear normal, but there is pain, easy bruising and a nodular feel to the fat tissue [2].
Stage 2 (Moderate to severe)
The lipedema fat exhibits a mattress-like pattern, indicating fibrosis under the skin that tethers to the skin that can be found on the upper legs (Type II) or extends down to the ankles (Type III) [2].
Stage 3 (Advanced)
There are tissue folds, and the lipedema in the legs usually extends down to the ankles [2].
Figure 2: Types of lipedema fat. Lipedema fat may be located from the umbilicus down to the bottom of the hips (Type I), down to the medial knees usually including a pad of fat on the inner knee and below the knee (Type II), and down to the ankle (Type III) where a “cuff” of fat develops but spares the dorsal foot. Rarely only the lower legs are affected (Type V). Lipedema affecting the arms alone is rare (Type IV) and, instead, usually is found in combination with Type II or III lipedema. The arms can be variably affected with nodular lipedema fat around the cubit nodes, over the brachioradialis, down the medial arm to the wrist in line with the thumb or 5th digit, the entire lower arm, or the entire arm.
Types of lipedema
Appearance
Type I
Lipedema in the legs accumulates in the buttocks, pelvis and hips.
Type II
Lipedema in the legs accumulates from the buttocks to the knees with fat folds around the knees.
Type III
Lipedema in the legs accumulates from the pelvis down to the ankles.
Type IV
Lipedema in the legs accumulates from the shoulders to the wrists.
Type V
Lipedema in the legs accumulates around the calves.
Common lipedema type combinations are type 2 and 4 and type 3 and 4.
How do I know if I have fat legs or lipedema in the legs?
"Fat legs" is a common complaint among ladies with pear-shaped body types; it refers to an excess accumulation of localised, stubborn fat in the lower extremities compared to other body regions.
Genetics, dietary habits and physical activity levels generally influence it.
In patients with lipedema, pain and tenderness are typically present in the affected areas, whereas "fat legs" are often devoid of these sensations.
Lipedema also manifests as disproportionate swelling in the affected areas and tends to bruise easily, whereas those affected by "fat legs" do not experience these issues.
Lipedema is not the same as normal "fat legs" or obesity; it is a chronic medical condition.
Key differences in lipedema in the legs, normal fat legs and fat gain due to obesity
Lipedema
Obesity
Fat Legs
What is it?
A chronic medical condition that primarily affects women, causing symmetrical fat build-up in the legs and sometimes in the arms and lower body.
A chronic medical disease marked by harmful levels of body fat. BMI over 25 is considered overweight, and over 30 is obese.
Fat legs or localised fat build-up on the inner and outer thighs, knees or calves can affect anyone with a BMI below 25 or above.
Is it harmful?
Lipedema is also known as a painful fat disease. If lipedema remains untreated, it can lead to severe mental health issues and potentially life-threatening complications.
It increases risks of Type II diabetes, heart disease, and certain cancers, as well as affects bone health, reproduction, sleep, and mobility.
Usually an aesthetic concern.
Causes
The exact causes are unclear, but it often starts or worsens during hormonal changes like puberty, pregnancy, or menopause.
Research is ongoing to understand the roles of hormones, genetics, inflammation, and metabolism in its development.
Genetics, lack of exercise, and unhealthy lifestyle.
Genetics, lack of exercise, and unhealthy lifestyle.
Common Fat Presentation
Fat accumulates symmetrically in both legs and sometimes the arms and lower body. The feet and hands are usually unaffected, creating a noticeable "cuff' at the ankles or wrists.
Noticeable fat accumulation, particularly around the abdomen, waist, hips, thighs, and upper arms.
Disproportionate body shape tends to affect pear-shaped body type.
Bruising
Easy bruising
X
X
Response to diet and exercise
X
✓
For individuals with fat legs but a normal BMI, diet and exercise may not always effectively reduce fat in those specific areas.
Other physical symptoms
Under the skin, you may feel lumpy or fibrous areas, leading to an uneven, dimpled appearance. Swelling (edema) and overly flexible joints (hypermobility) can also occur
Larger body frame, heavier limbs, protruding belly and prominent double chin.
Difficulty moving, shortness of breath, joint stiffness and skin issues such as stretch marks, chafing and skin folds.
Skin issues such as stretch marks and thigh chafing. May present with cellulite and skin folds.
Pain and tenderness
✓
✓
X
Swelling
✓
✓
X
Non-surgical treatment options
Compression therapy, manual lymphatic drainage, liposuction, and low-impact exercises such as water aerobic [4].
Lifestyle changes such as a calorie-deficit and nutritious diet and regular aerobic workouts.
Non-surgical treatment such as fat freezing (cryolipolysis) is an option for those who want to reduce localised fat from the legs.
Surgical treatment options
Liposuction is an effective and clinically proven solution to treat lipedema [5].
Bariatric surgery may be recommended for those who are classified as obese.
Liposuction
Seek help
Women with lipedema in the legs live with unbearable pain and invisible symptoms.
We need to raise awareness of lipedema in Singapore so that women affected by this chronic medical condition can receive the necessary care.
FAQ on lipedema of the legs in Singapore
How does pregnancy affect lipedema of the legs?
Pregnancy will naturally worsen the condition and appearance of lipedema in the legs.
Primarily due to the massive hormonal shifts and increased fluid retention during the 9 months, a pregnant mother may feel more heaviness, tenderness, soreness and swelling than usual in the affected area.
Note that not all experiences of pregnant women with lipedema are equal.
Can you stop leg lipedema from getting worse?
You may slow the progression of lipedema in the legs by:
Keeping a healthy lifestyle
Adopting a hygienic daily practice
Moving often through light exercises, such as walking while raising your arms
Regularly going for manual lymphatic drainage massages
Wearing compression garments to manage the swelling
Early intervention is key to better outcomes.
What type of liposuction can fix lipedema in the legs?
Liposuction for lipedema uses a gentle, specialised approach, such as VASER Lipo (UAL), combined with Dr Ivan Puah's novel design, Modern Liposuction With MDC-Sculpt® Lipo Technique, to effectively remove diseased fatty tissue in a multi-dimensional manner safely while leaving the surrounding tissues untouched.
This dual-strategy ensures minimal downtime and smoother results that maintain the body's natural curves with zero to minimal scarring.
What is the "cuff sign" in lipedema?
The cuff sign in lipedema is a visual indicator of the area where the painful fat accumulates in the legs.
The cuff tends to show around the ankle, indicating that the fat accumulation did not go beyond the feet.
Can lipedema in the legs affect vein health?
Yes, it does. Many patients with lipedema have been reported to experience venous insufficiency, depending on the stage and type of lipedema.
Chronic venous insufficiency happens when the veins in the legs struggle to return blood to the heart, leading to varicose veins, skin discolouration and even slow-healing leg ulcers.
Venous insufficiency can aggravate or worsen lipedema symptoms.
LEARN MORE ABOUT LIPEDEMA SURGERY
Lipedema can manifest as disproportionate swelling in legs or arms and tend to bruise while those affected by fat legs don't encounter such issues. Learn more.
At Amaris B. Clinic, we want you to know that it's always been about you. Deciding to embark on a journey toward skin, face, body treatment, or a fitness program is significant, and we are here to prioritise your results, well-being, and safety at every step.
