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Understanding lipedema

Lipedema stages and types: what do they mean in practice?

The stages describe how the skin and tissue change: at stage 1 the skin is smooth, with more nodular tissue underneath; at stage 2, the skin develops dimples and the nodules get larger; at stage 3, the tissue becomes more fibrous, with large nodules and hanging lobules. Some classifications describe a stage 4, lipolymphedema, when lymphedema appears as a complication of the lipedema itself. The types describe where the buildup appears. Neither stage nor type measures pain, and the classification is made by a professional.

In short

  • Stage is about the skin and tissue, not how intense the pain is
  • Type is about where the buildup appears
  • Someone at an early stage can have a lot of pain
  • Classification is done in a physical exam, not from a photo

The stages

The stages look at the skin, the tissue just beneath it and the shape of the legs. In each drawing, on the left, the legs seen from behind; in the circle, the skin up close: the top line is the surface, and the lilac shapes are the nodular tissue underneath.

  • Stage 1

    Legs seen from behind, with hips and thighs slightly fuller and a smooth outline. In the circle, the skin up close: a smooth surface and small nodules in the tissue beneath it.

    Smooth skin surface, with increased fat tissue that is more nodular underneath.

  • Stage 2

    Legs seen from behind, with fuller hips, thighs and calves, an uneven outline, a pad on the inner side of the knee and a small step at the ankle. In the circle, a wavy skin surface and larger, more numerous nodules.

    Dimpled skin, more tissue and larger, more numerous nodules that you can feel to the touch.

  • Stage 3

    Legs seen from behind, with much more volume, lobules of tissue on the thighs and knees and a pronounced step at the ankle; slim feet. In the circle, deep folds in the surface and larger clusters of nodular tissue.

    More tissue, more fibrous, with large nodules and lobules that hang over the skin.

  • Stage 4

    Legs seen from behind with the same shape as stage 3, but with swollen feet and ankles and teal droplets representing associated lymphedema. In the circle, the same folds and lobules, with the droplets in the tissue.

    Used in some classifications: lipolymphedema, when lymphedema appears as a complication of the lipedema itself. Unlike lipedema, which usually spares the feet, lymphedema can affect them. The Brazilian Lipedema Consensus treats lipolymphedema as a stage only in this case.

On the left, the legs seen from behind. In the circle, the skin up close: the plum line is the surface, the lilac shapes are the nodular tissue. Teal droplets: associated lymphedema. Diagrams not to scale, and they do not indicate a required progression. They are not meant for classifying yourself: the stage is determined in a physical exam, by touch and by your history.

The types

The types look at where the buildup appears. Highlighted, and with more volume, is the region described in each type.

  • Schematic silhouette seen from behind, with the hips, buttocks and upper thighs fuller and highlighted in plum with hatching; the rest of the body slim and not highlighted.

    Type I

    Below the navel, hips, buttocks and the upper thighs.

  • Schematic silhouette seen from behind, with the hips and thighs down to the knees fuller and highlighted, and a pad on the inner side of the knee; legs below the knees and feet slim and not highlighted.

    Type II

    From below the navel down to the knees.

  • Schematic silhouette seen from behind, with the whole legs, from the hips to the ankles, fuller and highlighted, and a step just above the ankle; feet slim and not highlighted.

    Type III

    From below the navel down to the ankles.

  • Schematic silhouette seen from behind, with both arms fuller and highlighted from the shoulders to the wrists, extra tissue at the elbow and a step at the wrist; hands slim and not highlighted.

    Type IV

    Arms. Usually appears together with type II or III.

  • Schematic silhouette seen from behind, with only the area between the knees and the ankles fuller and highlighted, and a step just above the ankle; thighs and feet not highlighted.

    Type V

    Only the lower legs.

Seen from behind. The region described appears with more volume, in plum with hatching. Types can combine, and the feet and hands are usually spared. Diagrams not to scale, only to illustrate the distribution.

What the classification does not tell you

Stage is not a measure of suffering. Some people at stage 1 have a lot of pain and some people at stage 3 have little. The classification helps describe the condition and plan care, but it does not sum up your experience.

That is why it is not worth trying to classify yourself from photos: the assessment depends on touch, on your history and on ruling out other conditions.

What we know and what we don't know yet

What we know

  • The stages describe skin and tissue changes observed in a physical exam
  • The types help describe how the buildup is distributed

What we don't know yet

  • How, and in whom, lipedema progresses from one stage to another
  • Why two people at the same stage can have such different levels of pain

When to seek professional care

  • If you notice changes in texture or volume over the months
  • If the swelling has started to affect your feet or hands
  • If the pain has increased or has started to limit your mobility

Frequently asked questions

Is stage 3 more serious than stage 1?+

It describes more skin and tissue changes, but not necessarily more pain. How serious it is for you also depends on your symptoms and how much they limit your daily life.

Can the stage go down?+

Conservative treatment can relieve pain and swelling, but it does not remove lipedema tissue. According to the US guideline, only surgery removes this tissue, and it has its own indications and risks. Talk with your professional about what to expect in your case.

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