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Body Treatment

Lipedema Surgery

Getting Here
By Car/Taxi

Public parking available or drop off along Arab Street, Village Hotel Bugis (Previously known as Golden Landmark Hotel)

By Public Transport

Buses (2, 12, 32, 33, 130, 133, 133A, 520, 960, NR7)  MRT (alight at Bugis MRT station)

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Get In Touch

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Many grappling with lipedema often encounter remarks such as "You're just big-boned" or "It's just your body shape." Larger bodies may be attributed to genetic inheritance, suggesting little can be done about it.

While it's common for women to naturally accumulate fat in areas like the thighs, hips, and buttocks, it's essential to discern when it exceeds the typical range. When does it transcend being merely "curvy"? This distinction is critical in recognising the potential presence of lipedema and seeking appropriate medical attention.



Lipedema (lipoedema), also known as "adiposis dolorosa" or "painful fat" [1], is a chronic condition predominantly affecting women; it is thought to affect approximately 11% of adult women [2].

This medical condition is characterised by the abnormal accumulation of excessive fat tissue in a particular pattern, in specific areas of the extremities, disproportionate to the rest of the body. This fat build-up typically occurs bilaterally and symmetrically, affecting the hip, upper and lower legs and arms.  

Patients with lipedema commonly experience pain, ranging from mild to severe, and they are described as "dull," "throbbing," or "tearing."

Other symptoms include fatigue, attention and memory difficulties, heightened susceptibility to bruising, swelling, cold skin, spider veins, enlarged knee fat pads, and hypermobile joints.

What causes lipedema?

Despite ongoing research efforts, the exact cause of lipedema remains elusive. Lipedema can affect people who are of healthy weight too, not just people who are obese.

Lipedema progression varies among individuals. While some may experience minimal or no progression, others may advance more rapidly. Hormonal changes, childbirth, menopause, weight fluctuations, and stress can accelerate progression, though other illnesses may also contribute, albeit rarely.

Symptoms of lipedema (lipoedema) can lead to psychological issues, such as low self-esteem.

Key characteristics of lipedema

  • Fatty deposits primarily in the legs, occasionally in the arms

  • Symmetrical involvement of both legs and/or arms

  • Exacerbated by obesity, though it may or may not be directly associated with it

  • Lipedema (Lipoedema) may sometimes be worsened by lymphedema

  • Patients may have increasingly worsened swelling in the legs during the day and improve overnight


Lipedema Singapore | Amaris B. Clinic

Examine if you have bat wings

Start by examining if you have “bat wing” appearances in the upper arms, as approximately 80% of women with lipedema have this characteristic [2].

Lipedema Singapore | Amaris B. Clinic

Disproportionate body proportions

Individuals with lipedema often notice a significant disproportionate difference between the lower and upper half of their body. This discrepancy may result in wearing different top and bottom sizes. Some may experience an extreme pear-shaped body, with a slim waist but larger lower body proportions.

Lipedema Singapore | Amaris B. Clinic

Observe the shape of your legs

Observe the shape of your legs. Are they thick and column-like [3], lacking definition around the knees? This characteristic is common in those with lipedema and can be a key indicator.

Lipedema Singapore | Amaris B. Clinic

Pay attention to your ankles and feet

In lipedema, fat accumulates around the back of the ankles, forming “cankles”. This unique pattern is a clinical sign exclusive to lipedema, although not all patients may experience it.

Lipedema Singapore | Amaris B. Clinic

Large fat deposits on the outer thighs

Large fat deposits that extend outward beyond the normal curve of the hips, resembling “football saddlebags” or enlarged buttocks that protrude significantly from the lower back (from the side view), are commonly observed in women with lipedema.

Lipedema Singapore | Amaris B. Clinic

Easy bruising and skin hypersensitivity

Those with lipedema often experience easy bruising and sensitivity in the affected areas [7], and even gentle touches may cause pain.


Scroll to view the table
Gold arrow
SymptomsPainless. Characterised by dimples and depressions, resulting in an irregular surface texture of the skin giving the skin a “cottage cheese” or “orange peel” kind of appearanceCharacterised by pain, tenderness, and  excessive clustering of fat cells
Type of conditionAesthetically troubling skin conditionMedical condition
Severity4 grades of cellulite5 types and 3 stages
Treatment ApproachesNon-invasive treatment, topical agents, energy-based therapy, massage, subcision, cosmetic injectables, exercise and dietCompression therapy, exercise, lymph drainage and massage, nutrition & supplements and liposuction
Gender Affects women mostlyAffects women mostly


Lipedema Stages Singapore | Amaris B. Clinic

Lipedema is categorised into 3 stages. The different stages present different levels of pain swelling, fat build-up and tenderness in the patient.

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 [14].

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) [14].

Stage 3: There are folds of tissue and the lipedema fat usually extends down to the ankles [14].


The distribution of fat accumulation in individuals with lipedema varies depending on the type of lipedema they have.  There are five types of lipedema, and they are not necessarily exclusive [13].

Type I

Buttocks, hips (saddlebags)

Type II

Buttocks, hips, thighs

Type III

Thighs, calves, ankles

Type IV


Type V

Ankles, calves


Joint immobility

Mobility limitations and joint issues, such as accelerated arthritis in the knees and ankles due to excess adipose tissue [4].

Gait limitations

Gait limitations, especially around the knee and ankle joints. Secondary obesity may exacerbate mobility impairments [4].

Vascular risks

Vascular risks associated with lipedema include an increased likelihood of varicose veins, secondary lymphedema, and a higher risk of blood clots, particularly when combined with obesity [4].

Small vein vasculopathy

Small vein vasculopathy, resulting in easy bruising, spider veins (telangiectasias), and varicose veins [4].

Blood clots

Secondary obesity further raises the risk of deep vein thrombosis (DVT) or blood clots.


Lipedema often goes undiagnosed or misdiagnosed as standard obesity, leaving patients grappling with ongoing pain and disappointment. It does not respond to diet and exercise [3], thus requiring surgical intervention.

Lipedema Surgery with the MDC-Sculpt®️ Lipo Technique removes “diseased” fat deposits, alleviates swelling and relieves patients from pain. Lipedema surgery (via liposuction) [1] differs from cosmetic liposuction. Individuals with lipedema often have impaired lymphatic function, thus leading to additional fat cells proliferation and potential lymphatic system strain.

Lipedema Surgery with the MDC-Sculpt®️ Lipo Technique by Dr Ivan Puah uses a three-dimensional liposuction approach and the use of specialised cannulas with tumescent anaesthesia to minimise injury to the lymphatic system.  He focuses on reducing and removing the “sick” fat tissues, alleviating physical symptoms.

Lipedema Surgery potentially improves patients’ overall well-being, and not just for cosmetic purposes. It not only enhances the patients’ quality of life but also offers long-term pain relief, improved mobility, and opens the door to a more active lifestyle they may not have experienced previously [6].


Having trained in to perform liposuction is only the beginning. Dr Ivan Puah believes it is crucial to understand and master the technicalities of the procedure, including the potential complications that may arise. To be meticulous in approach, with a detailed overview and foresight capabilities, are essential must-haves for a doctor.

Dr Ivan Puah

Dr Ivan Puah is an accredited liposuction doctor and Chairman of Lipo Peer Review Committee in Singapore with nearly two decades of surgical body contouring experience. He has completed fundamental and advanced Vaser Liposuction body sculpting surgical training under Dr John Milard and Dr Alfredo Hoyos in Argentina and Colorado.

Dr Puah is also trained in laserlipolysis (laser liposuction) in Italy and has received dedicated gynecomastia surgery training in San Francisco.

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What are the non-surgical treatment options for lipedema, and do they effectively manage the condition?

Non-surgical management focuses on addressing secondary lymphedema, if present, through compression garment use or manual lymphatic massage.

What role do diet and exercise play in managing lipedema?

Dietary adjustments, including a low carbohydrate diet emphasising whole foods with a low glycemic index, can help to manage lipedema.

Maintaining an active lifestyle with cardiovascular and resistance exercises is crucial. Water-based exercises are particularly beneficial as they offer resistance and cardiovascular benefits, as well as support lymphatic flow.

Can you diagnose and determine my lipedema stage online?

Unfortunately, diagnosing lipedema requires a physical examination as the doctor will need to assess your clinical condition, such as skin nodularity and texture, oedema, etc., and these cannot be done virtually.

Do I need to put on a compression garment post-surgery?

Yes, after the lipedema surgery, you will be required to put on a surgical compression garment for a minimum of 8 weeks.

Can lipedema go away with weight loss?

Lipedema does not respond well to restrictive diets, contrary to usual forms of obesity. Thus, lipedema leads to a disproportionate increase in lower body tissue that stubbornly retains its shape (waist to ankles) after diets or bariatric surgery [9]. Lipedema is not restricted to just subcutaneous adipose connective tissue. In fact, women with lipedema had significantly lower muscle strength and a non-significant, but clinically relevant lower exercise-endurance capacity than women with obesity [10].

Can lipedema be cured naturally?

Most often, the most commonly used diet strategies are anti-inflammatory, low-carbohydrate, and ketogenic diets [11]. Lymphatic drainage can also be used as a strategy to manage lipedema.  However, it cannot be cured through natural means.

What should I look out for post-surgery?

After the lipedema surgery, it's crucial to understand that recovery is a gradual process spanning several months. In the initial weeks post-surgery, expect swelling and tenderness, with recovery duration influenced by the extent of the surgery.

Strict adherence to compression garments is essential for proper healing and restoration of lymphatic function. Additionally, incorporating manual lymphatic massage can significantly aid in recovery and maintain results post-surgery.

Will lipedema recur after surgery?

While a small percentage of individuals may experience symptom recurrence in treated areas, ongoing adherence to dietary and non-surgical lipedema maintenance treatments may mitigate or prevent recurrence [5].

Adopting a lifelong diet rich in whole foods and limited refined carbohydrates remains crucial for long-term management.Most patients observe improvements in pain, swelling, mobility, and overall quality of life following lipedema surgery [6].


[1] Damstra, RJ. First Dutch guidelines on lipedema using the international classification of functioning, disability and health. Phlebology. 2017 Apr;32(3):152-159.

[2] Torre YS, Wadeea R, Rosas V, Herbst KL. Lipedema: friend and foe. Horm Mol Biol Clin Investig. 2018 Mar 9;33(1):/j/hmbci.2018.33.issue-1/hmbci-2017-0076/hmbci-2017-0076.xml. doi: 10.1515/hmbci-2017-0076. PMID: 29522416; PMCID: PMC5935449.

[3] Tartaglione G, Visconti G, Bartoletti R, Ieria FP, Salgarello M. Rest/stress intradermal lymphoscintigraphy in diagnosis of lipedema. World J Nucl Med. 2020 Jun 27;19(4):376-381. doi: 10.4103/wjnm.WJNM_5_20. PMID: 33623507; PMCID: PMC7875021.

[4] Buck, D. W. & Herbst, K. L. Lipedema: a relatively common disease with extremely common misconceptions. Plast. Reconstr. Surg. Glob. Open 4, e1043 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055019/

[5] Wright T, Babula M, Schwartz J, Wright C, Danesh N, Herbst K. Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report. Plast Reconstr Surg Glob Open. 2023 Nov 30;11(11):e5436. doi: 10.1097/GOX.0000000000005436. PMID: 38046224; PMCID: PMC10688775.

[6] Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012 Jan;166(1):161-8. doi: 10.1111/j.1365-2133.2011.10566.x. Epub 2011 Nov 17. PMID: 21824127.

[7] Anne Warren Peled A, Kappos E. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016;8:389-395 https://doi.org/10.2147/IJWH.S106227

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

[9] Bonetti G, Herbst KL, Dhuli K, Kiani AK, Michelini S, Michelini S, Ceccarini MR, Michelini S, Ricci M, Cestari M, Codini M, Beccari T, Bellinato F, Gisondi P, Bertelli M. Dietary supplements for lipedema. J Prev Med Hyg. 2022 Oct 17;63(2 Suppl 3):E169-E173. doi: 10.15167/2421-4248/jpmh2022.63.2S3.2758. PMID: 36479502; PMCID: PMC9710418.

[10] van Esch-Smeenge J, Damstra RJ, Hendrickx AA. Muscle strength and functional exercise capacity in patients with lipoedema and obesity: a comparative study. J Lymphoedema 2017;12:27-31.

[11] Amato ACM, Benitti DA. Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases. Am J Case Rep. 2021 Dec 6;22:e934406. doi: 10.12659/AJCR.934406. PMID: 34871293; PMCID: PMC8667633.

[12] Herbst KL, Kahn LA, Iker E, et al. Standard of care for lipedema in the United States. Phlebology. :2021. [Online ahead of print]

[13] Földi, E., and Földi, M. (2006) Lipedema. In Földi’s Textbook of Lymphology (Földi, M., and Földi, E., eds) pp. 417-427, Elsevier GmbH, Munich, Germany

[14] Herbst KL. Subcutaneous Adipose Tissue Diseases: Dercum Disease, Lipedema, Familial Multiple Lipomatosis, and Madelung Disease. [Updated 2019 Dec 14]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.

Figure 2. [Three stages of legs of...]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK552156/figure/obesity_subcut_adip.F2/


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