Lipoedema is a chronic fat distribution disorder that causes symmetrical fat accumulation, primarily in the legs and sometimes the arms, while typically sparing the hands and feet. It occurs almost exclusively in women and is often misdiagnosed as obesity or lymphoedema, which can delay effective treatment and lead to disease progression.

Unlike ordinary weight gain, lipoedema fat is painful to touch, bruises easily, and often does not respond to diet or exercise. The condition has a strong hormonal component, with many cases beginning or worsening during puberty, pregnancy, or menopause, and it often runs in families, indicating a possible genetic link.

As the condition progresses, excess fatty tissue can impair venous return, increasing the risk of chronic venous insufficiency (CVI). Patients may develop leg swelling, heaviness, varicose veins, or skin changes that resemble venous disease.

In advanced stages, the lymphatic system may also become compromised, leading to secondary lymphoedema. This complication, called lipo-lymphoedema, involves persistent swelling that extends to the feet and ankles—a key sign that distinguishes it from early-stage lipoedema.

Because the symptoms of lipoedema overlap with obesity, primary lymphoedema, and venous disease, accurate diagnosis is essential. This often involves a clinical examination, venous Doppler ultrasound to exclude reflux, and lymphoscintigraphy in selected cases to evaluate lymphatic drainage.

Treatment focuses on symptom management and slowing disease progression. Conservative strategies include:

• Compression garments

• Manual lymphatic drainage

• Low-impact exercise (e.g., swimming or walking)

• Nutritional counseling and skin care

In selected patients, liposuction using tumescent or water-assisted techniques may offer lasting improvements in pain, mobility, and quality of life.