Lipoedema is a chronic fat distribution disorder. An apparent disproportion between the trunk and the extremities is evident. 


Differences between lipoedema and lymphoedema

Lipoedema and lymphoedema are diagnosed with the help of these three main characteristics:


  • Lipoedema always occur symmetrically, i.e. both legs are affected.
  • The backs of hands and feet are unaffected.
  • Lipoedema is tender to pressure and touch.


  • Lymphoedema usually occurs unilaterally or asymmetrically.
  • The back of the hands and feet are also affected.
  • Lymphoedema does not usually cause pain.


Effective treatment options are needed to relieve discomfort, such as tissue pain. Flat-knit medical compression stockings are an essential part of the therapy.


Lipoedema – a chronic disease 


Lipoedema always occurs symmetrically: in the hip area, on the upper and lower legs, and sometimes on the arms. 


The exact cause of lipoedema still needs to be clarified. In addition to a genetic component, the assumption is that there is also a hormonal component since it almost exclusively affects women. 


A typical presentation includes, for example, so-called 'riding pants', which describe the fat pads on the buttocks, hips and the inside of the knees. 


Sufferers tend to "bruise" quickly, even from slight bumps. In addition, patients with lipoedema experience sensitivity to pressure and touch.


Causes and risk factors: How does lipoedema develop?

Lipoedema almost exclusively affects women and girls. Men, in contrast, rarely suffer from lipoedema. Research is still underway as to the specific causes of lipoedema. The timing of hormonal changes is often associated with the onset of lipoedema.

Are hormones a cause of lipoedema?

Experts suspect the influence of hormones as a cause because symptoms often manifest or worsen during phases of hormonal changes. In addition, observations show the tendency for lipoedema to be genetically determined, as familial disposition results show. 


Lipoedema usually appear

  • towards the end of puberty,
  • during pregnancy or
  • during menopause


The symptoms of lipoedema: Are you overweight, or do you have a fat distribution disorder? 


It requires close observation to detect a lipoedema and to distinguish it from being 'normally' overweight or obese. Lipoedema should not be confused with obesity.


In contrast to obesity (a generalised increase of fat tissue of the entire body), diets or more exercise do not reduce the pathological fat tissue in lipoedema patients. 


The nature of the symptoms is very individual. Typical symptoms, especially of lipoedema of the legs, are:

  • Unequal proportions from the torso to legs: rather slim upper body with thicker legs (often a difference of several clothing sizes)
  • Blue spots occur quickly and easily (bruising, haematomas)
  • Tenderness on palpation and touch
  • Orange-peel or wavy skin with nodules under the skin
  • tenderness on palpation and touch
  • Asymmetrical, relatively spontaneous 'unexplained' increase in volume on both legs leads to 'columnar' changes, and over time, to deformations of the legs.
  • Further progression: bead formations mainly on the inner thigh



Saddlebags: Diet-resistant fat deposits


The fat pads on the buttocks, hips and the inside of the knees are called saddle bags. The so-called saddlebags can indicate lipoedema if the fat pads resist any diet and sporting activity.


Quick Check: Detecting lipoedema yourself


1. Are your arms or legs equally affected by the changes/swelling, and are the backs of your hands or feet not swollen?


2. Are there pockets of fat on the hips 'saddlebags' and the inside of the knees?


3. Is the entire leg up to the ankle 'suave pants effect' affected?


4. Do bruises form quickly without significant injury or spider veins?


5. Do you have pain when you apply slight pressure to swollen areas?


Please seek medical attention if you have answered at least one question with 'yes'.


Stages and pictures of lipoedema

Stage 1 – Orange-peel skin

  • orange-peel skin: smooth skin surface with evenly thickened subcutis (not to be confused with cellulite)
  • saddle bag


Stage 2 – Mattress skin

  • uneven, mostly wavy skin surface
  • knot-like structures in the thickened subcutaneous skin


Stage 3 – Dewlap formation

  • coarse nodular skin with larger dimples
  • pronounced size increase with overhanging, roughly distorted tissue parts (dewlap formation)


Mixed forms of lipoedema treatment


Lipoedema is different from lymphoedema (accumulating lymphatic fluid in the tissue due to a flow disorder in the lymphatic vessel system). 


Lipo-lymphoedema: When a lymphoedema develops in addition to a lipoedema 


Depending on its severity, lipoedema strains the lymphatic system: the transport capacity of the lymphatic vessels can be limited to such an extent that fluid accumulates in the tissue. Consequently, lipoedema can cause secondary lymphoedema. This symptom is called lipo-lymphoedema. 


Lipoedema with accompanying obesity


This mixed form displays the symptoms of lipoedema plus a generalised increase in fat throughout the whole body.


Treating lipoedema: Diagnosis and Therapy


Until lipoedema diagnoses, many people affected have a long history of suffering, often accompanied by severe mental stress. The right therapy can do a lot to alleviate the symptoms. 


People usually seek medical advice only when sports, exercise and diets fail to bring success, pain is an added factor, and the mental stress becomes too great.


There are two main aims of lipoedema therapy:

  1. We are eliminating or improving the findings and symptoms (especially pain, oedema and disproportion).
  2. It prevents complications. If the severity progresses, a risk of dermatological issues can occur. (e.g. infections such as erysipelas), lymphatic (e.g. lymphoedema) and orthopaedic (gait abnormalities or impairments, axillary malformations) complications increase.


Various therapeutic approaches are available for this.


Complex decongestive therapy (CDT)

Complex decongestive therapy (CDT) is a comprehensive therapy that consists of the following pillars:


Manual lymph drainage

  • Depending on the diagnosis, tissue is decongested by manual lymph drainage: The lymph drainage is activated by specific physiotherapeutic approaches.



Compression therapy with medical compression stockings

Seamless round-knit medical compression stockings are available in most cases for Stage I.


In stages II and III, experts recommend flat-knit compression treatment​​​​​​​.