When Is Cellulite Actually Lipedema?

Getty Images / Collage by Bella Geraci

You might be hearing about lipedema lately. Searches for the term “lipedema surgery” have recently spiked by 400%. That means more people are not only learning about the condition — in which abnormal fat collects in the legs and sometimes the arms and is often painful — they’re also seeking solutions for it.

It’s hard to pinpoint just one reason for this spike. Perhaps it’s been a slow build of several things, including the the social media factor: With people posting about their surgeries on apps, and spreading awareness of the differences between lipedema and other conditions it may be mistaken for, such as cellulite and lymphedema (the latter being a build-up of fluid in soft body tissues). Lipedema has also been in the news more, due to class-action lawsuits over insurance companies denying payment for surgery for this medical condition. And there’s the body positivity movement, which has been encouraging the medical community to look beyond advising people to just lose weight to fix every body ailment. (This is especially important for people with high BMIs, which many people with lipedema have.)

The overall impact here is that lipedema is finally getting some attention. And those who have the condition are discovering that lipedema surgery, a specialized form of liposuction, could be a help in their day-to-day lives. Here’s what to know.

Meet the experts:

  • Peter Neligan, MB, FACS, FRCSI, FRCSC, is professor emeritus in the division of plastic surgery at the University of Washington.

  • Dr. Lyle Leipziger, MD, is a board-certified plastic surgeon and chief of plastic surgery at North Shore University Hospital and Long Island Jewish Medical Center.

In this story:

What is lipedema?

Lipedema is a chronic condition in which abnormal fat builds up under the skin that impacts an estimated 11% of women. “Abnormal fat” may sound odd, but one of the distinguishing characteristics of lipedema is that the affected areas “tend to be lumpy and often very tender; a woman will tell you that she doesn’t let her cat sit on her lap because it hurts,” says Peter Neligan, MB, FACS, FRCSI, FRCSC, professor emeritus in the division of plastic surgery at the University of Washington. “Lipedema is most common in females and most common in the lower extremities — in the legs.” Lipedema may affect the arms as well, though that’s less common.

Typically, people gain and lose weight all over their body. But with lipedema, areas of fat are disproportionate to the rest of the body — and may stop abruptly. Says Dr. Neligan, “The feet are completely spared, and often there is a cuff where lipedema of the leg stops at the ankle.”

Weight loss doesn’t seem to help. Unlike how fat behaves normally, reducing in appearance as the number on the scale goes down, lipedema is more stubborn and does not respond to diet and exercise, according to the Cleveland Clinic. However, while lipedema can impact people at any weight, obesity is a factor: “The prevalence of lipedema increases progressively with the increase in weight,” as was explained in a study published in the journal Cureus.

The exact cause of lipedema is unknown, but it may develop during times of hormonal changes, such as puberty and pregnancy, according to a study published in the journal Hormone Molecular Biology. And, says Dr. Neligan, “there is a familial element.” That complicates things, and is one reason lipedema has historically been so underdiagnosed: Since it tends to run in families, “people often don’t know they have it. They think, My mom had [legs like this]. It’s just the way our family is,” says Dr. Neligan.

Another complicating factor is that doctors have tended to miss making a lipedema diagnosis. It may be misdiagnosed as obesity, according to the American Society for Plastic Surgery. Or, because it presents as swollen legs, “it’s often misdiagnosed as lymphedema, which is a different condition with a similar appearance in which there is a blockage of the flow of lymphatic fluid,” says Dr. Neligan.

All of this can make lipedema a difficult condition to manage. Stubborn weight gain in the legs may start for someone as a teenager or young adult, diet and exercise don’t help, and the weight can be accompanied by painful swelling and easy bruising, according to the American Society of Plastic Surgeons. One survey of 209 lipedema patients found that the condition was commonly associated with depression and migraines.

Lipedema and cellulite: How are they different?

The fat in lipedema is different from cellulite. In the most basic terms, cellulite is cosmetic and does not cause pain, while lipedema is a medical condition. “Cellulite is more easily recognizable,” says Dr. Neligan. “With lipedema, you often can’t really see the lumpiness unless you gently rub your hand along the thigh, then you get the impression of lumpiness underneath.”

Liposuction is used to treat both, but liposuction for cellulite gets mixed reviews when it comes to complications and reported satisfaction levels. Patients who get liposuction to treat lipedema, however, do so largely to minimize discomfort and correct a chronic condition, and fairly consistently they report an increase in quality of life and a decrease in pain after surgery. For lipedema patients, liposuction can lead to decreased pain, bruising, and swelling; it’s also associated with mitigating migraine attacks in lipedema sufferers.

Lipedema and lymphedema: How are they different?

Not only do lipedema and lymphedema sound similar, but they present with similar symptoms, creating yet another layer of complication for those seeking a proper diagnosis. And there’s the fact that for 15 to 17% percent of people being treated for lymphedema, they also have lipedema, so it gets even more confusing. But while lipedema is an accumulation of abnormal fat, lymphedema is caused by tissue swelling that is triggered by a protein-rich fluid buildup that hasn’t been drained by the lymphatic system.

To help distinguish one from the other, doctors may look for swelling that ends abruptly at the wrist or ankle and assess the ability to pinch the skin on the feet without difficulty, both of which would indicate lipedema.

What is lipedema surgery?

In a word: liposuction. In a few more words: It’s a more specialized, and riskier, form of liposuction than the standard cosmetic procedure, because a) significantly more tissue is being removed and b) the fat that’s being removed is of a different quality. “The fat in lipedema tends to be quite fibrous, so it’s harder to remove, so we use different tubes, or cannulas, than the ones used in cosmetic liposuction,” explains Dr. Neligan. “And the amount of tissue you’re removing is quite enormous. The most I’ve removed from a leg is 11 liters — 11 liters is huge, and that’s beyond the recommendations for cosmetic liposuction.” (To help you understand how much that is: 11 liters is equal to 46 cups, or almost three gallons. By comparison, the average cosmetic liposuction session removes about 2 liters of tissue, according to the American Society of Plastic Surgeons.)

The risks are greater with this kind of liposuction. “One of the problems with extensive liposuction is excessive bleeding and fluid loss,” says Dr. Neligan. “We generally do it under a tourniquet so the patient is not bleeding, and before letting [the tourniquet] down, we wrap the extremity in excessive bandages and the risk of bleeding is significantly reduced.” He adds, “With [cosmetic] liposuction you go home [right after], but we generally keep patients overnight [after lipedema liposuction].”

In some cases, a patient may need skin tightening after the liposuction to remove excess skin. This could mean another surgery, such as a leg lift.

What kind of doctor is qualified to perform lipedema surgery?

Not all doctors who offer liposuction offer lipedema treatment — nor should they. Allure did come across some general practitioners and dermatologists offering newly popular lipedema surgery, but it is important to see a board-certified plastic surgeon because of the bleeding risks associated with extensive liposuction.

Says Dr. Neligan, “The actual doing of liposuction, you could teach a monkey to do that — but knowing how much tissue is safe to remove and the precautions to take when you remove that amount of tissue, and keeping an eye on the patient overnight [to watch for bleeding and fluid loss], that’s really important.”

Board-certified plastic surgeon Dr. Lyle Leipziger, MD, chief of plastic surgery at North Shore University Hospital and Long Island Jewish Medical Center, is one doctor who performs liposuction, but not liposuction for lipedema. When he diagnoses patients with lipedema, he then refers them to a specialist. He advises that patients should go to a board-certified plastic surgeon who not only says they have worked with lipedema patients, but can also show you before and after pictures of their work. “It shows that that particular physician has a track record of performing the procedure,” says Dr. Leipziger.

What are the risks of lipedema surgery?

There are serious risks of excessive bleeding and fluid loss. According to a survey of women who have had lipedema surgery, the most common complications were growth of loose skin, tissue fibrosis (a hardening of tissue), anemia, blood clots, and lymphedema. “Whether participants developed lymphedema due to the procedure, or whether they developed lymphedema over time due to underlying lymphatic dysfunction is unclear,” the 2021 survey found. “Close and long-term monitoring of patients with lipedema post-surgery is needed to determine the risks of these procedures in the USA.” Blood clots — a risk after any surgery — can be life-threatening.

How long do the results of lipedema surgery last?

In the survey referenced above, in which “quality of life improved in 84% and pain improved in 86% of patients” after surgery, more than 50% of patients reported they had some new adipose tissue growth after surgery both in and outside the treated areas. However, the results of a separate survey published that same year were more promising: In most cases, the patients self-reported that their results lasted at least 12 years.

Who is a candidate for lipedema surgery?

Nearly anyone diagnosed with the condition who is cleared for surgery according to the American Heart Association and American College of Cardiology guidelines and wants it is a candidate.

What is the cost of lipedema surgery?

The cost can vary widely by provider and is based on the number of areas and surgeries necessary to treat a particular case. One surgery can typically run from $7,500 to $20,000. In some cases, insurance may offer partial coverage, so check with your provider before you book an appointment. But, adds Dr. Neligan, “there’s a real problem for a lot of patients — because insurance companies see the word ‘liposuction,’ they assume it’s cosmetic, so they don't cover it. A lot of patients have difficulty getting coverage.”

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Originally Appeared on Allure