Stages Of Lipedema

Once it develops, lipedema generally will slowly worsen with time. The development of lipedema can be categorized within one of four progressively worse stages. The four stages of lipedema are as follows:

Stage 1: In the earliest and mildest form of lipedema, the skin looks normal, but small nodules (feel like pebbles) develop within fatty deposits under your skin. Mild tenderness, discomfort or pain and bruising can appear at this stage. While the lymphatic system will generally continue to function adequately, you may begin to experience minor fluid retention alongside the fatty deposits. Normally lipedema can be treated with compression, diet and exercise at this stage.

Stage 2: As the fatty tissue builds up, the texture of the skin surface changes to having an uneven or “dimpled” appearance similar to but more pronounced than cellulite, and the underlying nodules grow larger in both size and number. Pain levels increase with more widespread tenderness, along with constant aching or heaviness in the limbs and increased fatigue. Since lipedema generally does not affect the feet, the appearance of an “ankle cuff” will develop as the fatty tissue within the calves begins to accumulate. At this stage, the symptoms of lipedema begin to extend beyond just the physical appearance and begin to affect mobility and comfort. At this stage lipedema treatment becomes increasingly more important, requiring more rigorous compression and lymphatic massage to prevent progression to stage 3 lipedema where irreversible tissue changes begin to occur.

Stage 3: This is the advanced stage of lipedema, which is characterized by fatty tissue volumes that have significantly increased and increasingly become hardened and firm, referred to as lipedema fibrosis. Significant distortion of the fatty tissue begins to develop, along with large overhanging folds or lobes of skin and fatty tissue, particularly around the knees and thighs. The fatty tissue on legs may begin to stick out, making it hard to find properly fitting clothes, to walk and negatively impacts overall mobility. Severe bruising can occur from even minor contact, while the affected tissues become extremely painful and tender. During this stage, the lymphatic system oftentimes becomes compromised, leading to the accumulation of fluid within the tissues. On top of the physical symptoms, stage 3 lipedema oftentimes leads to significant emotional distress, which manifests in depression, anxiety and social isolation. Treatment at this stage will likely be more aggressive to help manage the symptoms and slow progression. The effects of having stage 3 lipedema cannot be reversed, but proper treatment will help reduce the discomfort and improve quality of life. In addition to pain medications and anti-inflammatories, complete decongestive therapy combined with layered compression probably will be introduced. Treating stage 3 lipedema will often require surgical treatment such as liposuction and skin reduction surgery.

Stage 4: The final advanced stage of lipedema development is referred to as lipo-lymphedema, which means that you have both lipedema and lymphedema at the same time. With lipo-lymphedema there exists both lymphatic blockage as well as excessive fatty tissue accumulation. Lipo-lymphedema requires specialized combined therapy for treating both lipedema as well as lymphedema, such as manual lymphatic drainage (MLD), complete decongestive therapy (CDT).

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