Lipoedema is a long-term condition in which fat builds up symmetrically in the legs (and often the arms), typically sparing the feet, and the tissue tends to feel tender and bruise easily. Ordinary fat on the legs is usually spread more evenly across the body, is not painful and reduces with weight loss. A GP assessment is the first step, and liposuction may be considered for selected people once the diagnosis is clear.
What is lipoedema?
Lipoedema is a chronic disorder of fat tissue that affects almost exclusively women. It commonly begins or worsens at times of hormonal change, such as puberty, pregnancy or the menopause, and often runs in families. The fat collects in a characteristic pattern over the hips, buttocks, thighs and lower legs, and sometimes the upper arms, while the waist, hands and feet stay comparatively slim. It is not caused by overeating or lack of exercise, and many women describe years of dieting that changed their upper body but left their legs almost untouched.
Signs that point to lipoedema
- Symmetry: both legs are affected to a similar degree.
- Cuff at the ankle: the fat stops abruptly above the ankle, leaving the feet slim.
- Pain and tenderness: the legs may ache, feel heavy or be sore to touch.
- Easy bruising: bruises appear after minor knocks.
- Resistance to diet: the legs stay disproportionately large even after weight loss elsewhere.
- Texture: the tissue may feel nodular, like small beads under the skin, in some stages.
None of these features on its own confirms lipoedema; the overall pattern and history matter.
How ordinary leg fat differs
Fat stored on the thighs and calves is normal and varies hugely from person to person because of genetics, hormones and lifestyle. With ordinary fat, the feet are usually in proportion with the legs, the tissue is not tender, bruising is not unusual, and weight loss tends to reduce the legs along with the rest of the body. Some women have naturally pear-shaped figures with generous hips and thighs; this is a body shape, not a medical condition. Stubborn pockets such as the outer thighs, inner thighs and inner knees are common and can persist in otherwise slim people.
Lipoedema, lymphoedema and obesity
Lymphoedema is swelling caused by fluid that the lymphatic system cannot drain. It is often one-sided, usually involves the foot, and pressing the skin may leave a dent. Lipoedema involves fat rather than fluid in its early stages, although long-standing lipoedema can affect lymphatic drainage. Obesity can occur alongside lipoedema and can make diagnosis harder. See your GP promptly if one leg swells more than the other, and seek same-day advice from your GP or NHS 111 for sudden one-sided leg swelling or calf pain, which can signal a blood clot.
Getting a diagnosis
There is no single blood test or scan that confirms lipoedema. Diagnosis rests on the history and examination by a clinician familiar with the condition, and your GP may refer you to a specialist lymphoedema or vascular service to rule out other causes. Keeping a record of when the changes began, how your legs have responded to weight changes and any family history is helpful.
Non-surgical management
Conservative care aims to reduce symptoms and protect mobility. It can include well-fitted compression garments, regular low-impact exercise such as swimming, walking or cycling, skin care, and support with a healthy weight, since additional weight gain can worsen the load on the legs. Manual lymphatic drainage is used by some specialists. These measures can ease heaviness and discomfort, but they do not remove lipoedema fat.
Where liposuction fits in
Liposuction has been used to reduce lipoedema fat in selected patients, using techniques designed to protect lymphatic vessels. It is a significant undertaking, often needs staged operations, and the evidence base is still developing, so careful selection and honest discussion are essential. Mr Nassab can assess whether your leg shape reflects ordinary stubborn fat, which cosmetic liposuction may help, or features of lipoedema, in which case he may recommend input from a specialist service before any surgery is considered. Cosmetic liposuction costs from £7,500 for one area, £8,500 for two and £9,500 for three, with the £150 consultation charged separately. Surgery is for adults aged 18 and over.
Frequently Asked Questions
Can you lose lipoedema fat by dieting?
Lipoedema fat is typically resistant to diet and exercise, although keeping a healthy weight helps limit extra load on the legs and can improve symptoms.
Is lipoedema the same as cellulite?
No. Cellulite is a common dimpling of the skin surface seen in most women, whereas lipoedema is a disorder of fat distribution with pain and a characteristic pattern.
Does lipoedema affect the feet?
Usually not. The fat often stops above the ankle, creating a cuff, which is one of the features that distinguishes it from lymphoedema.
Should you see your GP first?
Yes. Your GP can examine you, look for other causes of swelling and refer you to a specialist service if lipoedema is suspected.
Is liposuction for lipoedema cosmetic surgery?
It uses similar techniques, but the aims and planning differ. Suitability depends on a detailed assessment, and further specialist input may be advised.
