Stages of Lipedema
As Lipedema develops in stages, the level of pain, tenderness, swelling and fat accumulation may increase. The images below provide a visual guide of the four stages of Lipedema, showing the location of fat build up and resulting body shape at each stage. Depending on the person, different parts of the body can be affected in different ways at each stage.
These images depict the stages of Lipedema as characterized by Prof. Dr. Wilfried Schmeller and Dr. Karen Herbst. They are protected by copyright law and should not be reproduced or distributed without permission. (For additional images, please visit lipedema.org/photo-stories.
It's important to note that while these staging criteria are commonly employed, they do not factor in pain levels, the size of the affected areas, the impact on joint health, limitations in mobility, or other significant effects on the individual's quality of life. Alternative criteria are also sometimes used. The Lipedema Foundation is committed to supporting research aimed at establishing a more comprehensive and accurate method for staging Lipedema.
The Lipedema Foundation aims to provide education on how some clinicians and researchers stageLipedema. Below you will find information on stage 1, 2, 3 and 4 as well as photos that show commonly affected areas of the body.
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Stages of Lipedema
Lipedema in Arms
Lipedema in Legs
STAGE 1
According to the US Standard of Care for Lipedema, Stage 1 skin typically has a smooth texture with a pebble-like feel in the sub-dermal tissue, likely due to fibrosis.
Image depicts Stage 1 Lipedema in arms, legs and lower trunk.
Fat buildup around pelvis, buttocks, and hips. For more images of stage 1 Lipedema, go here.
Fat buildup from buttocks to knees, with folds of fat around the inner side of the knee. For more images go here.
Fat buildup from buttocks to ankles. For more images go here.
stage 2
According to the US Standard of Care for Lipedema, Stage 2 consists of an increase in overall tissue and skin dimpling due to increased fibrotic changes. There may be more nodules that are larger in size in this stage.
Image depicts Stage 2 Lipedema in arms, legs and lower trunk.
Fat buildup around pelvis, buttocks, and hips. For more images go here.
Fat buildup from buttocks to knees, with folds of fat around the inner side of the knee. For more images go here.
Fat buildup from buttocks to ankles. For more images go here.
stage 3
According to the US Standard of Care for Lipedema, Stage 3 features of an even more pronounced increase in overall tissue, fibrosis, amount of nodules, and nodular size. There is also the presence of overhanging skin/lobule formation in this stage.
Image depicts Stage 3 Lipedema in arms, legs and lower trunk.
Large extrusions of fat tissue causing buildup from buttocks to knees, with folds of fat around the inner side of the knee. For more images go here.
Large extrusions of fat tissue causing buildup from buttocks to ankles. For more images go here.
stage 4 - Now referred to as Lipolymphedema
According to the US Standard of Care for Lipedema, people with lipolymphedema may need to continue compression garments for life, and should have complete decongestive therapy (CDT) focusing on an intense volume reduction phase and be assessed for chronic venous insufficiency (CVI) prior to lipedema reduction surgery.
Large extrusion of fat tissue on legs with progression to lipolymphedema. For more images go here.
Large extrusion of fat tissue on legs with progression to lipolymphedema. For more images go here.
staging of lipedema in arms
According to the Lipedema Foundation’s Technical Review, many women with Lipedema show overt evidence of upper arm involvement, variously reported as 24-90%. This fatty tissue can be localized in the upper arms, lower arms, or extend throughout the entire arm.
Stage 1
Fat buildup in upper arms (front view). For more images go here.
Fat buildup in lower arms (rear view). For more images go here.
Stage 2
Fat buildup in upper arms (front view); For more images go here.
Fat buildup in the lower arms (side view); For more images go here.
Stage 3
Fat buildup in upper arms (side view). For more images go here.
Fat buildup in upper arms (rear view). For more images go here.
Stage 4
Fat buildup in entire arm (rear view). For more images go here.
Fat buildup in entire arm (front view). For more images go here.
Fat buildup in entire arm (side view). For more images go here.
Staging of Lipedema in Legs
Lipedema typically presents bilaterally in the legs, impacting both lower extremities from the hips to the ankles. A distinctive characteristic is the "lipedema cuffing effect," where Feet/hands are typically spared, presenting with a raised ridge or fold of fat, possibly a “cuff” at wrists and ankles.
Stage 1
Stage 2
Stage 3
Stage 4
As our research continues, we have more photos of Lipedema that aim to educate our community and help understanding.
Information about Lipedema treatment can be found here.
References
1. Schmeller, W. & Meier-Vollrath I. Lyphedema. Diagnosis and Therapy. 3 Edition. Chapter 7. (2007).
2. Herbst, K.L. Rare adipose disorders (RADs) masquerading as obesity. Acta Pharmacol. Sin. 33, 155-172 (2012).
3. Herpertz U. Das Lipoedem und seine Kombinationen. Vasomed; 9, 301-307 (1997).
4. Fife, C.E., Maus, E.A. & Carter, M.J. Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome. Adv. Skin Wound Care 23, 81-92 (2010).
5. Herbst, K.L. et al. Lipedema fat and signs and symptoms of illness, increase with advancing stage. Archives of Medicine. 7, 1-8 (2015).