Do I have lipedema? (photos)

I am going to start off by qualifying myself as a specialist in lipedema surgery. Most of my colleagues would describe me as one of the pioneers of lipedema surgery in the United States, I’ve performed lipedema surgery for over 10 years, I’ve performed close to 1,000 surgeries, and currently perform 6-8 lipedema surgeries per week. I work closely with other lipedema specialists around the country, such as Dr. Karen Herbst from the University of Arizona. I have extensive knowledge of the condition itself, and I’m very involved in the lipedema community. I lecture about the condition and do what I can to increase awareness for lipedema, not only in the united states but around the world. Sadly, this is definitely a very under recognized condition in the United States. We are seeing more information available via the internet, as awareness is growing, on sites such as the Fat Disorder Research Society, and I personally have a website: “advancedlipedematreatment.com” that provides a lot of good information about lipedema. To answer your specific question, I do a lot of photo/phone consultation to diagnose the condition based on the way in which it looks, but symptoms are very important to consider along with the patient’s history. We don’t learn about lipedema in medical school, but it affects about 11% of the female population. It usually presents in puberty, and tends to progressively get worse as time goes on and can commonly worsen with hormonal changes due to pregnancy or menopause. The diseased fat tissue is not very responsive to diet or exercise. It is a combination of fat distribution in a certain way along with swelling. The lipedema patient commonly has a characteristic disproportionate fat distribution with a “tree-trunk” look to the legs, puffy and often painful fat distributed from the buttock down to the ankles, circling all the way around the legs, and in most of the cases I’ve seen it also affects the upper arms. Usually there’s a family history of similar symptoms, as it tends to run in families. Most patients find the condition painful, limiting their quality of life, and often easily bruise.



As time goes on, there is a lot of fibrotic changes in the subcutaneous area that makes the swelling worse. It is a combination of both what we see and the symptoms specifically. In your case specifically, just looking at the photographs it is difficult to tell. You do not have the characteristic type of lipedema fat distribution that usually goes all the way around and down from the outer buttock area to the ankles. It does look like your thighs are full , but the majority of fullness is in the outer and inner thighs, with some cellulitic changes. Based on the photographs alone, I would say it is unlikely you have lipedema and more likely just genetic disproportion of fat distribution. On the other hand, if you told me you experience some of the common symptoms such as pain or swelling, and if those symptoms ran in your family, I would say it could be likely that you have lipedema. Really a proper evaluation and diagnosis with someone who understands lipedema well is the way to go about getting properly diagnosed and if recommended, proper treatment.

Lipedema affects nearly 25 million women in the US. As a board certified plastic surgeon and a board certified lymphedema expert, I manage complex lip edema cases with a combination of liposuction and skin tightening procedures. 
Most cases of lipedema improve with liposuction and fat lipolysis with laser and Coolsculpting. A combination approach is ideal. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Lipedema is a very underdiagnosed condition in the US and the world. This is mainly from a lack of understanding. There are a lot of symptoms and differences from just weight gain. However, I would need to understand a lot more about your particular case. As an FYI, there is a small group of us that is working very closely with the lipedema community to educate as well as develop Standard of Care Guidelines for the US. 
For more information please visit our lipedema educational website.
Hope this helps!
Jaime S. Schwartz, MD, FACS

Diplomate, American Board of Plastic Surgery 
Fellow, American College of Surgeons
Associate Clinical Professor of Surgery
USC Keck School of Medicine
Division of Plastic and Reconstructive Surgery
#RealSelf100Surgeon 

#RealSelfCORESurgeon