Lipedema or just fat legs? – How to recognize the difference

What is lipedema?

A lipedema is a chronic fat distribution disordera condition in which too much fatty tissue accumulates symmetrically on certain parts of the body – mainly the legs and hips, sometimes also the arms. The condition almost exclusively affects women and usually only occurs
after puberty
on.

Typically, the feet and hands slender in the case of lipedema, so that a conspicuous disproportion between a narrower upper body and more massive legs. The affected areas often feel sensitive to pressure, soft or swollen, because fat as well as fat is deposited. fluid in the tissue stored in the tissue.

Important: Lipedema is not to be confused with simple obesity. The fat deposits in lipoedema develop not by overeating or lack of exercise – accordingly, they are also very difficult to reduce by dieting or exercise.

This is a pathological Changes in the fatty tissue for which those affected cannot do anything. Even with the greatest discipline, women hardly lose any weight in the lipoedema areas, which is understandably frustrating.

Not every unusual distribution of fat in the legs is the same as lipoedema. For example, if there are symmetrically increased fat deposits on the thighs or hips without the typical pain, doctors speak of lipohypertrophy.
lipohypertrophy
– In contrast to lipoedema, this increase in fat is not considered pathological. And last but not least
pure overweight
or water retention (edema) can lead to large leg circumferences, but the causes and characteristics are different from those of lipedema.

How does lipedema develop?

The exact causes The causes of lipoedema are not yet fully understood. Presumably genetic factors play a major role – often several women in the family are affected or a corresponding predisposition is inherited.

Also hormonal changes often act as triggers: Many sufferers notice the first symptoms in phases such as puberty, pregnancy or menopausewhen the hormone balance changes. This explains why almost exclusively women – according to estimates up to 10 % of all women – develop lipoedema, although the disease is often only recognized late.

Lipoedema is not a consequence of being overweightbut can also be accompanied by obesity. In addition to lipoedema, many patients are also overweight or obese – excess kilos tend to accumulate in the already affected areas due to the disturbed fat metabolism.

At the same time, lipoedema makes it difficult to lose weight: Even with weight loss, the disproportionate fat deposits on the legs and hips often remain. This vicious circle of lipoedema and weight problems is very stressful for women and can lead to frustration.

Typical symptoms

The clinical picture of lipoedema can be recognized by a number of characteristic symptoms. Especially the combination of visible changes and pain symptoms distinguishes lipoedema from ordinary “fat legs” without disease value. The typical characteristics include

• Disproportionate fat distribution: Lipoedema leads to a disproportionate distribution of body fat – legs, hips and possibly also arms. legs, hips and possibly also arms become significantly stronger, while the upper body remains comparatively slim. The fat pads appear symmetrically on both halves of the body.
  It is also noticeable that feet and hands (at least in the early stages) not affected The fat deposits usually end abruptly at the ankles or wrists. This gives the legs a columnar appearance, often with pronounced “riding breeches” on the thighs.
• Pain and tenderness: An essential characteristic of lipedema is the painfulness of the fatty tissue. The affected legs (or arms) are sensitive; even light pressure, bumps or touch can pressure pain trigger.
  This persistent sensitivity to pain is not present with normal obesity and is therefore an important indication of lipedema.
• Feeling of heaviness and tension: Those affected often describe a constant feeling of heaviness and tension in the legs (or arms). The limbs feel swollen and tired, as if they are becoming “heavy as lead”. This feeling of tension usually increases during the course of the day – in the evening the legs are often even heavier than in the morning.
• Tendency to bruise: Women with lipedema get bruises very easily hematomas (bruises). Even minor bumps or pressure are enough to cause blood vessels under the skin to burst. This increased susceptibility to bruising is another important distinguishing feature compared to “normal” fatty tissue.
• Physical and emotional stress: The complaints described have a negative impact on everyday life and the quality of life off. Many sufferers can only do limited sport or stand for long periods because of the heavy, aching legs. There is also the psychological component: The altered body image and often the belief that it is “their own fault” often lead to shame, social withdrawal and even depression.

Treatment options

If you suspect that you are suffering from lipoedema, it is important to have a specialist diagnosis to catch up. Specialists like Phlebologists (specialist for vein medicine), lymphologists or specialized vascular surgeons are familiar with the clinical picture and can clearly diagnose lipoedema.

The earlier the diagnosis is made, the better the lipoedema can be treated and the sooner consequential damage (such as joint problems due to incorrect weight-bearing) can be avoided.

For therapy of lipedema are usually conservative measures with possibly surgical interventions combined. Initially, the focus is on decongestion and pain relief. manual lymphatic drainage and consistent compression therapy (wearing special compression stockings) can reduce swelling and slow its progression.

Specialists also recommend plenty of exercise (adapted to the patient’s physical capabilities) and a healthy diet to reduce or avoid excess weight. In advanced stages of lipoedema, a liposuction (liposuction) can be useful: This involves surgically removing the abnormal fat cells, which often leads to a significant reduction in symptoms.

Even if lipoedema will not disappear by losing weight alone, the above-mentioned therapies can significantly improve the symptoms. significantly improve the symptoms. Many women report that after suitable treatment they are able to more mobile and feel less pain – which has a positive effect on your enjoyment of life. It is crucial that you feel that your complaints are taken seriously and that you receive professional support.

VenaZiel Lipedema Center: As a specialized center for lipoedema, we know how stressful this disease can be. We support you with empathy, experience and modern therapeutic approaches to alleviate your symptoms and improve your quality of life.

You are not alone with these problemsand there are ways to improve the situation – we will be happy to help you.

Which areas of the body are affected?

Lipoedema affects certain areas of the body – usually symmetrically on both sides. Typical are the legsstarting at the hips over the thighs to the ankles ankles. The Poorespecially the upper arms, can also be affected. This reveals a conspicuous Fat distribution disorderwhich gives the body a “pear-shaped” appearance.

What is striking: Hands and feet always stay slim. The fatty tissue usually ends abruptly at the ankle joints – a typical sign that distinguishes lipoedema from other diseases. It is also referred to as “Cuff sign”a visible transition between the swollen leg and the slender foot.

For a better description, a distinction is made between different types of lipedema:

• Type I: Increased fat in the buttocks, hips and pelvis (often referred to as “saddlebags”).
• Type II: The fat accumulation extends from the hips to the knees. Fat pads often form on the inside of the knees.
• Type III: The fat extends from the hips to the ankles. ankles – the entire leg is affected, the feet are left out.
• Type IV: In addition, the armsespecially the upper arms, are affected. This type often occurs together with type II or III.

Some patients show characteristics of several types. Important: The Type classification only describes the distribution of the fatty tissue – not the severity or stage of the disease. However, it does help with individual assessment when planning treatment at the VenaZiel Lipedema Center.

You can find out more about diagnosis and treatment in our specialist articles.

How does lipedema develop over time?

Lipoedema is a chronically progressive diseasewhich changes over the years. For orientation, the course is shown in three stages depending on the appearance of the skin and the nature of the fatty tissue.

Overview of the stadiums:

• Stage I:
  The skin is still smooth, the fatty tissue feels soft. There is already a symmetrical increase in volume – usually on the legs and/or arms. The first symptoms such as pressure pain or a feeling of tightness appear.
• Stage II:
  The tissue becomes uneven, lumpy and the skin appears dimpled – similar to cellulite. Bruising occurs more quickly, pain intensifies.
• Stage III:

  The following develop coarse fat bulges and overhanging tissue folds, e.g. in the knee area. Movement may be restricted and psychological pressure increases.

But: The severity of the symptoms does not depend directly on the stage.
Many patients in stage I have severe pain, while others in stage III feel only a little. The Medical classification alone says nothing about the quality of life or the level of suffering.

It is therefore early diagnosis is particularly important. The earlier lipoedema is detected, the better the progression can be slowed down. At the VenaZiel Lipoedema Center, we rely on an individual assessment – based on Stage, symptoms and life situation.

You can find out more about treatment in the early stages here.

What is not lipoedema? – Differentiation from other diseases

Many women live with undiagnosed lipoedema for years – because it is often confused with other diseases. Here we explain how lipoedema can be clearly differentiated:

Lymphoedema

A lymphedema is caused by a build-up of lymph fluid. It often affects only one side of the body (asymmetrical) and includes feet feet or hands – different to lipoedema. The skin appears doughy and the so-called Stemmer test (skin fold on the toe palpable?) is positive.
→ Lipedema: symmetrical, no vascular involvement, usually with pressure pain and a tendency to bruising.

Obesity

Obesity is a generalized weight gainusually due to excessive calorie intake. The fat is distributed evenly over the body. It can be significantly reduced through diet and exercise.
With lipoedema, the fat deposits remain despite diet or exercise are preserved. In addition pain, a feeling of tension and hematomas do not occur with obesity.

Important: Many of those affected have both – obesity
and
Lipoedema. Only the excess weight can be influenced. The abnormal lipoedema fat requires targeted medical measures.

Cellulite

Cellulite is purely cosmetic. It affects many women and is characterized by a dimpled skin structure. There are No pain, no fat bulges and no functional restrictions.
Lipoedema, on the other hand, is medically relevantchronic and associated with noticeable discomfort.

Lipohypertrophy

This is a harmless increase in fatmostly on the thighs and hips. There are No pain, no bruising and no fluid retention.
Lipohypertrophy is not considered a disease – but can develop into lipedema if hormonal changes occur.

Why are so many lipedema cases misdiagnosed?

Lipoedema is a still underestimated disease. Many doctors do not recognize it immediately – or confuse it with obesity or lymphoedema. Patients often hear:
“You just have to lose weight.”
But that hardly brings any improvement in lipoedema.

The difference is not always easy to recognize visually either. Especially in the early stages, the figure appears “just a little stronger”, although the fatty tissue is pathologically altered.

This is why specialized centers such as the VenaZiel Lipedema Center, take the complaints seriously, take a close look and make individual diagnoses. Because only those who know the cause can treat it correctly – and improve the patient’s life in the long term.

How do I know if I am affected?

Correctly classify the first signs: Lipedema (colloquially also known as
saddlebags syndrome
) becomes noticeable through characteristic early symptoms. Many sufferers first notice an unusual swelling or pain in the legs – often coupled with a feeling of heaviness and tension. Typical early signs are

• Swelling in the legs (and sometimes arms), especially after prolonged standing
• Sensitivity to pressure and pain even with light touch
• Heavy, tired legs and the feeling of tension in the extremities
• Tendency to bruises for no apparent reason (high capillary fragility)
• Disproportionate fat depositsespecially on the hips and thighs, which are
  symmetrical
  (both sides of the body at the same time)
• Girth increase despite diet and exercise: Weight on legs/hips increases, although general weight loss has hardly any effect there

The disproportionate proportions are often striking: The upper body remains comparatively slim, while the legs and hips appear disproportionately large. Hands and feet are usually left out in lipoedema – in contrast to lymphoedema, for example, where feet also swell. The first symptoms often occur during times of hormonal changes (puberty, pregnancy, menopause).

It is important to take these warning signs seriously and to distinguish them from normal obesity or cellulite. Lipoedema develops gradually, but Early recognition can prevent those affected from wrongly accepting the pain and limitations as “self-inflicted”.

Why a medical diagnosis is important: A clear diagnosis by a specialist (such as a phlebologist or lymphologist) is crucial as soon as lipoedema is suspected. Only medical professionals can reliably differentiate lipoedema from other conditions – for example from lymphoedema or pure obesity.

The correct classification is important, as lipedema must be treated differently from pure obesity or water retention.

An incorrect diagnosis or a long wait can even worsen the course of the disease: If left untreated, the fatty tissue continues to increase and secondary problems (such as joint strain or secondary lymphoedema) can occur. However, if lipoedema is recognized at an early stage Initiate targeted therapiesthat slow down the progression of the disease and alleviate symptoms.

Timely diagnosis and consistent treatment can have a positive influence on the course of the fat distribution disorder – those who act early can prevent worse. Even if lipoedema as a chronic disease cannot be cured, many symptoms can be treated to significantly improve the patient’s quality of life.

Further information:
Details on the medical diagnosis (examination, differential diagnoses) and the different stages of the stages of the disease of lipoedema can be found in our article “Diagnosis & stages”.

What helps against lipedema? – First approaches to treatment

Early treatment of lipoedema makes sense for several reasons. Firstly, it can slow down the progression of the disease and delay the transition to more severe stages.

On the other hand, early therapeutic measures can significantly alleviate symptoms and prevent secondary damage – if left untreated, there is a risk of movement restrictions, inflammation or the development of lipo-lymphedema (combination of lipedema and lymphedema) in later stages.

There are basically two approaches that complement each other: conservative (non-surgical) measures and surgical Interventions. The treatment plan is put together individually depending on the stage and symptoms.

Overview: conservative and surgical options

Conservative treatment options: The cornerstones of lipedema treatment are
Complex physical decongestive therapy
(CDP). This combines several components to reduce swelling and relieve pain:

• Manual lymphatic drainage (MLD): Special medical massages that remove accumulated fluid in the tissue and thus reduce swelling.
• Compression therapy: Consistently wearing flat-knit compression garments (stockings, pants, etc.) exerts pressure on the tissue and reduces edema and pain. Compression helps to slow down the progression of lipoedema and should be applied daily.
• Exercise and sport: Regular exercise promotes lymph flow and prevents additional deposits. Endurance sports that are easy on the joints – such as swimming, aqua fitness or cycling – are particularly recommended, as the buoyancy of the water and even movement create a massage effect that supports lymphatic drainage.
  It is important to find activities that are fun so that they are maintained in the long term.
• Skin care: Intensive skin care (e.g. daily application of cream) keeps the skin barrier intact and prevents problems such as skin tears or infections, which can be promoted by swelling.
• Healthy eating and weight management: Even if dieting does not make lipoedema disappear, a normal body weight has a positive effect on the course of the disease. An unhealthy diet and being overweight, on the other hand, can increase oedema and inflammation.
  A balanced, anti-inflammatory diet (lots of vegetables, protein, little sugar) and sufficient fluids support the patient’s overall well-being.

Conservative measures aim to reduce pressure pain and swelling and increase mobility. They require active cooperation and patience on the part of those affected, as they must be applied permanently (sometimes for life).

However, many patients report that consistent physical therapy makes their everyday life considerably easier – their legs feel lighter and the pain decreases.

Surgical options: The only way to remove the abnormal fat deposits
permanently
remove the abnormal fat deposits is liposuction (liposuction). In one to several procedures, the fatty tissue under the skin is suctioned out of the affected areas.

Lipoedema liposuction can lead to significant symptom relief lead to significant symptom relief: Many patients report noticeably less pain and improved mobility after the operation. This procedure has been increasingly performed in Germany for several years; among suitable techniques, tumescent local anaesthesia, water-jet assisted liposuction (WAL) and lymph-sparing liposuction according to Dr. Stutz are considered to be particularly effective.

Several sessions are often necessary to treat all affected areas (legs, hips, arms if necessary) step by step – there is usually a break of a few weeks between the surgery appointments for recovery.

In advanced stages, a supplementary skin tightening become necessary. The volume caused by lipoedema and possibly weight loss can result in excess skin, which remains as sagging skin flaps after liposuction.

Here, plastic surgery tightening operations (e.g. a thigh lift or arm lift) can significantly improve the appearance of the skin and function. Such procedures are usually planned a few months after liposuction, when the tissue has had sufficient time to regenerate.

Just as important as the procedure itself is the aftercare following liposuction. Immediately after the operation, consistent measures must be taken to ensure that healing proceeds optimally and no new edema develops.

Above all, this includes wearing special compression clothing (compression pants or compression girdle) for several weeks at a time
day and night
. These post-operative compression pants are usually custom-made at the beginning and support the tissue in adapting to the reduced volume.

It is also recommended to start manual lymphatic drainage again as soon as possible to remove accumulated wound fluid and promote healing. Light exercise (walking) and elevating the legs also help during the recovery phase.

Aftercare requires discipline, but makes a decisive contribution to the success of the operation It reduces swelling, pain and the risk of complications.

Why early therapy makes sense

Lipoedema is a progressive disease. Without treatment, the fat deposits tend to grow steadily and symptoms increase. Early therapy can mitigate this progression. Studies and experience show that early, consistent treatment slows down the progression of the disease and prevents the development of secondary damage.

For example, the threat of lipo-lymphedema can be prevented by wearing compression stockings and exercising in good time. Starting treatment early also has a positive effect on the psyche: Those affected feel able to act and experience that they are not helplessly at the mercy of lipoedema.

Overall, the earlier treatment is started, the better pain and limitations can be controlled – in stage I the effort is less and the quality of life can be almost completely maintained, while in stage III often already have significant impairments. You should therefore seek advice as early as possible if you suspect this.

Further information:
You can find detailed information on the individual treatment methods in our guides on therapy, liposuction, skin tightening and aftercare. There you will find out what steps you need to take in detail and what you should pay attention to.

Living with lipoedema – and why education is so important

Take the clinical picture seriously: Lipedema is
not
is not just a cosmetic figure problem, but a chronic condition that must be taken seriously – by patients, doctors and the community alike. According to estimates, around Every tenth woman in Germany suffer from lipoedema, yet for a long time the disease was hardly researched and often misjudged.

Many sufferers have a veritable odyssey of visits to the doctor behind them until they finally receive the correct diagnosis. This makes it all the more important to educate people about lipoedema: The more people (both medical staff and laypeople) know about this condition, the sooner a sufferer will receive the correct diagnosis and help.

For the patient herself, the knowledge of her lipoedema also means relief – she recognizes that she is ill and not “herself to blame” for her disproportionate proportions. This understanding is the basis for actively tackling lipoedema and accepting support.

Physical & psychological consequences: Untreated lipoedema puts a strain on body and soul of those affected. Physically, there is sometimes severe pain (due to sensitivity to pressure and feelings of tension in the tissue), hematomas and edema. As the disease progresses, movements can become increasingly difficult; in advanced stages, the massive weight on the legs/arms significantly restricts mobility, which in turn overloads the joints and spine.

However, lipoedema also leaves psychological traces: the permanent pain and changes to the body can trigger depression, anxiety disorders and a distorted self-image.

Many women feel frustrated and ashamedbecause neither diets nor exercise reduce fat deposits – they struggle with the feeling of being “trapped” in their own body. In addition, there is often a lack of understanding in their social environment: sayings such as
“You just have to eat less”
or the assumption that you are simply overweight leads to withdrawal and isolation of those affected.

Studies confirm that lipoedema patients have significantly greater physical, emotional and social impairments than healthy women. It is important to recognize these psychological consequences should be taken seriously. In addition to the medical treatment of lipoedema, psychological support should therefore be provided if necessary – for example in the form of counseling, psychotherapy or exchanges in self-help groups.

Communication and professional help can reduce the emotional burden, which in turn can have a positive effect on the physical pain.

Quality of life is achievable again: Despite all the burdens, there is also good news: with the right therapy
can
the quality of life of lipoedema patients can be significantly improved.

Although lipoedema is chronic and currently incurable, almost all symptoms can be effectively treated or at least alleviated. After consistent treatment, many patients find that they can walk longer distances, climb stairs or do sport again without pain – activities that they were previously unable to do.

Body image also improves when proportions become more harmonious and clothes fit better again. It is important to have realistic expectations and to be patient: The road can be long (especially after surgical procedures that require healing time), but it
worthwhile
.

Thanks to modern treatment methods, it is now possible to lead a largely normal, active life with lipoedema. The key to this is the willingness to accept help and the knowledge that you are not alone with your symptoms.

Last but not least, the experience of many of those affected shows that Education creates understanding and hope. The more lipoedema is talked about publicly – whether in the media, in doctors’ surgeries or among family and friends – the less stigmatized patients feel. Instead, there is a growing acceptance that it is a legitimate condition that requires treatment.

This acceptance takes pressure off the shoulders of those affected and motivates them to seek treatment at an early stage. Education is therefore the key.

You are not alone. If you suspect you have lipoedema – or have already been diagnosed and are looking for support – we will be happy to assist you. Make an appointment now at our specialist lipoedema center to discuss your situation in person.

You can find further helpful information in our extensive Lipedema Knowledge Centerfrom medical backgrounds to everyday tips. You are also welcome to use our Podcastsin which experts and sufferers talk about life with lipoedema and give valuable advice. Together we will find a way to improve your quality of life and give you new hope!