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Numerous women are affected by lipedema for years without receiving a correct diagnosis. Often, lipedema, especially in its early stages, is not identified as such and is mistakenly considered ordinary weight gain or obesity (adiposity). This lack of awareness leads to those affected feeling misunderstood and losing trust in doctors, which often prevents timely treatment. To make your path to a life without complaints easier, we at LIPOCURA® offer various tests that allow you to make an initial self-assessment. For a detailed diagnosis and the creation of a treatment plan tailored to you—whether through conservative methods or liposuction (fat removal)—our team of experienced specialists is at your disposal.
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As the founder of LIPOCURA®, Dr Dominik von Lukowicz has dedicated himself to developing the best possible treatment method (maximum volume reduction with optimal aesthetic results) and has made the PAL method widely known. He is considered one of the key pioneers in modern lipedema treatment.
Dr. med. Dominik von Lukowicz
Founder Specialist for plastic and aesthetic surgery
Table of contents
A symmetrical increase in subcutaneous fatty tissue, especially above or below the knees and in the triceps area of the arms, is typical of lipoedema. This increase in fat (“dewlap”) causes pain and tenderness, among other things.
A typical feature of lipoedema is the pronounced accumulation of fat on the inside of the knee. These fat pads can cause pain and visually deform the knee. The fat pads also make it difficult to bend and stretch the knee.
A typical fat distribution in lipoedema is the increased accumulation of fat in the hips and thighs. This increase in fat leads to an appearance reminiscent of saddlebags. Those affected often experience a disproportionate figure with a narrow waist and wide hips. The conspicuous waist-hip ratio characterizes the disproportion in lipoedema, in contrast to a generally increased BMI.
The legs tend to swell more in the evening as lymphatic fluid collects around the fatty tissue. This leads to an unpleasant feeling of tension and tenderness. The swelling can increase during the course of the day and is not equally pronounced in all lipoedema patients.
Lipoedema causes a disproportionate increase in fatty tissue, particularly on the arms and legs. The rest of the body often remains slimmer, which leads to an unbalanced body image. Those affected therefore do not gain weight over their entire body, but mainly on the extremities.
The legs look like columns due to the uniform accumulation of fat from top to bottom, hence the term “columnar leg”. The feet often remain slim, while a muff-like widening becomes visible from the joints. This accumulation of fat on the ankles of the feet and hands is also referred to as caliber jump.
Axial misalignment of the knee joints, also known as knock-knees or genoa valga, is a common consequence of lipoedema with a pronounced increase in volume in the thigh. This misalignment leads to increased strain on the knees and can cause skin irritation due to friction.
As lipoedema progresses, the swollen fatty tissue stretches the skin and connective tissue considerably. This results in visible indentations, making the skin look like a mattress. This phenomenon is visually similar to cellulite, but is caused by the particular fat distribution of lipoedema.
Lipoedema patients tend to bruise quickly, even with light touches or bumps. This is due to the fragile capillaries, which are particularly vulnerable to increased fat and lymph retention. The bruises can be painful and slow to heal.
In the advanced stages of lipoedema, the fatty tissue can harden. This so-called liposclerosis is a sign of scar tissue remodeling and can lead to a further worsening of the symptoms, such as an increase in lipoedema pain.
Mental strain such as stress or depression can exacerbate lipoedema symptoms. Some sufferers experience symptoms for the first time in times of great emotional stress, which indicates the interaction between the psyche and the body. The hormone cortisol can often play a role. If the cortisol level is elevated for a long time, temporary swelling or even a lipoedema flare-up can be caused.
Some areas of the body, particularly the arms and legs, often feel colder than other areas. This is due to poorer blood circulation in the fatty tissue. Those affected report that it takes significantly longer for these areas to warm up again, which is particularly unpleasant in winter.
Even without external influence or movement, many sufferers experience pain that can be felt during periods of rest. This pain at rest can be caused by the pressure of the fatty tissue on the nerves. Those affected report dull, aching pain that significantly impairs their quality of life. This pain can also be an expression of chronic inflammation in the fatty tissue.
The fatty tissue tends to become chronically inflamed, which manifests itself as permanent pain in the connective tissue. This inflammation leads to further damage to the tissue and makes the healing process more difficult. They contribute significantly to an increase in the sensation of pain.
There is evidence that an imbalance of steroid hormones, particularly oestrogen and progesterone, influences lipoedema. These hormones can influence both the volume of fatty tissue and the perception of pain.
A common symptom of lipoedema is the feeling of tingling or numbness in the affected areas of the body. This tingling can intensify over time and is often uncomfortable. It indicates impaired nerve function due to the increase in fatty tissue.
The joints of lipoedema patients are often hypermobile, i.e. excessively mobile. This can lead to further problems such as joint pain and an increased susceptibility to injury.
The fat cells in lipoedema patients are significantly enlarged compared to healthy people with a similar BMI. These enlarged cells store more fat and contribute to the characteristic fat accumulation.
Even light pressure, such as pinching the skin, causes pain. This is characteristic of lipoedema and is often described as burning or stabbing and sometimes also unnaturally long-lasting. The pain can intensify as the lipoedema progresses.
Lipoedema often manifests itself for the first time or worsens during periods of hormonal changes such as puberty, hormone treatments, pregnancy or the menopause. These phases intensify the increase in fat and the sensation of pain.
The pain associated with lipoedema is multifaceted and varies from patient to patient. Some sufferers describe the pain as a dull ache, while others experience stabbing or burning pain. As the disease progresses, both the frequency and intensity of the pain can increase.
Many sufferers suffer from constant tiredness and exhaustion. This chronic exhaustion, also known as fatigue, can severely restrict daily life. It is often a result of chronic inflammation in the body and constant pain.
For many of our patients, lipedema initially manifests itself as a persistent feeling of heaviness in the legs, which increases particularly during the course of the day – for example, after prolonged standing, sitting or physical activity. A diffuse feeling of pressure is also typical, which can develop into clearly noticeable pressure pain over time.
Even in the early stages, those affected also report a slight increase in the circumference of their hips and thighs, which is usually symmetrical and cannot be influenced by classic measures such as diet or exercise.
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Lipedema manifests through a variety of typical symptoms. Of course, not every single sign is automatically an indication of a fat distribution disorder—the decisive factor is the combination of several complaints over a longer period. If our patient observes several of these characteristics in herself, a specialist evaluation is strongly recommended. In a medical consultation, it can be clarified whether lipedema is actually present or whether other causes for the complaints need to be considered.
If you recognize these symptoms in yourself, lipedema may be present. We are here to support you—contact us and let’s find the best path for you together. For an initial assessment, our self-developed lipedema self-test can also help.
Many individuals with lipedema report a feeling of heaviness in the arms and legs. This lipedema symptom cannot be clearly assigned to the stages of the disease and varies individually in its intensity. Various circumstances can temporarily intensify this feeling of heaviness (see symptom feeling of cold).
There is often an intense feeling of tension and increasing sensitivity to touch, as well as reduced mobility that is accompanied by severely swollen legs. Pressure-related pain results from fluid stored in fat cells and inflammatory processes under the skin. The increase in volume exerts pressure on neighboring tissue and causes tension, making the skin sensitive to touch and pressure. As lipedema progresses, complaints may worsen.
The skin of those affected by lipedema tends to form hematomas quickly. This is due to impaired capillary fragility, which causes fluids and red blood cells to be pressed more easily into adjacent tissue. Even minor bumps can lead to bruises.
The accumulation of water in the tissue leads to edema, which causes strong tension and ultimately pressure pain—a main feature of lipedema.
The mental state of those affected should not be neglected. It is often not recognized that they have lipedema and that fat accumulations are not simply due to being overweight or a lack of self-control. Even some doctors do not take the suffering of their patients with lipedema seriously enough, leading to uncertainty and a lack of trust in treatment options. Deviation from the societal ideal can result in reduced self-esteem, body image disturbances, and social isolation. Constantly dealing with pain and concern about appearance can also trigger stress, depression, and anxiety. These emotional burdens not only intensify psychological suffering but can also worsen physical symptoms by increasing tension in the affected body regions.
The intensity of pain resulting from lipedema is not necessarily tied to the stages of the disease. Even in the initial phase, when few visual changes are apparent and the tissue is still soft, those affected may experience pain. Typical sensations include stabbing and burning feelings. In addition to skin pressure sensitivity, wounds caused by friction and subsequent inflammation lead to further pain.
Lipedema is only pain-free in exceptional cases. Typically, the condition is accompanied by pressure sensitivity, feelings of tension, and pain, especially in the arms and legs. If there is a clear, symmetrical increase in subcutaneous fat without further complaints, it is most likely not lipedema but lipohypertrophy. This differs significantly from lipedema in that it does not cause functional limitations or pain and is considered a purely aesthetic appearance.
Feeling cold in the arms and legs is a sign that can occur with lipedema symptoms but is not directly assigned to the various stages of the condition. The intensity of this feeling of cold can vary greatly from person to person. Specific situations can temporarily intensify the feeling of cold, including high temperatures, sauna visits, prolonged standing or sitting, and especially toward evening.
While lipedema is not curable, its complaints can be noticeably alleviated through targeted measures. Whether pain, feelings of tension, or swelling—with individually tailored therapies, quality of life can be significantly improved.
Learn more about proven lipedema treatments such as manual lymphatic drainage, compression, exercise, nutrition, and liposuction.
Important: Lipedema can cause similar complaints to lymphedema or lipohypertrophy. However, pain, a feeling of heaviness, and symmetrical fat distribution are typical features that help identify lipedema. An accurate medical diagnosis is essential, as mixed forms such as lipo-lymphedema can also occur. Detailed differences can be found on our lipedema diagnosis page.
When symptoms such as pain, heaviness, or pressure sensitivity dominate everyday life, it means a significant reduction in quality of life for many affected individuals. You don’t have to accept that. Together, we develop an individual treatment plan tailored to your specific complaints—and accompany you step by step on the path to a noticeably lighter life.
Feel free to schedule a personal consultation with our lipedema specialist.
Yes, in Stage 1, lipedema can initially occur without pain. Typical complaints such as pressure sensitivity, feelings of tension, or pain often develop as the condition progresses. Early medical evaluation is still advisable to initiate targeted therapy.
In lipedema, the fine blood vessels in the subcutaneous tissue are more sensitive and permeable than usual. Even minor bumps or pressure can therefore cause small bleeding that appears as bruises (hematomas)—often without a visible trigger.
Unlike general overweight, lipedema is characterized by symmetrical fat accumulation in the legs and/or arms—often with a simultaneously slender upper body. Typical features also include pain, pressure sensitivity, and a tendency to bruise, which do not occur in the same way with simple overweight.
Yes, in many affected individuals not only the legs but also the upper arms are involved—usually symmetrically. Feelings of tension, pain, and fat accumulations in the upper arm area often occur, sometimes already in the early stages of the condition.
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