Understanding lipoedema
When fat is more than just fat
A chronic condition that affects up to 10% of all women – often unrecognised and wrongly treated for years.
Medically reviewed byDr. med. Martin Reifenrath, Specialist in Plastic and Aesthetic SurgeryLast reviewed:
What is lipoedema?
A recognised disease – not a question of discipline
Lipoedema is a chronic condition that affects almost exclusively women. It typically occurs on the legs, hips and buttocks, and often on the arms as well, while the hands and feet remain unaffected.
The pathologically altered fatty tissue responds neither to diets nor to exercise and is accompanied by persistent pain, tenderness to pressure and swelling. Without targeted treatment, the condition usually progresses steadily.
Symptoms & stages
The 3 stages in detail
Lipoedema vs. other conditions
Comparison table
Causes
Genetics, hormones & more
Since October 2025
Liposuction covered by German statutory health insurance – at all stages
In July 2025, the Federal Joint Committee (G-BA) decided: since October 2025, German statutory health insurers have covered the cost of liposuction – regardless of the stage. This applies to patients insured in Germany. The complicated application procedure no longer applies.
No more applications
The complicated application procedure with the health insurer no longer applies at all. Eligibility is checked directly by the doctors.
All stages
Until October 2025 only at stage III – since then, patients with stage I and II also benefit from statutory cover.
6 months of prior treatment
Compression, lymphatic drainage and exercise therapy must be documented – we coordinate this for you.
Two-doctor principle
The diagnosis is made by a different doctor from the one who operates; only then does the surgeon establish the indication for surgery.
What you need for statutory cover – we take care of it
6 months of conservative therapy, a BMI of no more than 35, the two-doctor principle (diagnosis and indication for surgery by different doctors) – sounds complicated? It doesn’t have to be. At Lipo Doctors, we coordinate every step: from diagnosis and conservative therapy to surgery and aftercare. You don’t have to worry about a thing.
The most important signs
Symptoms at a glance
Many of those affected go through years of suffering, both physical and emotional. These symptoms may indicate lipoedema.
Symmetrical fat deposits
On both legs or both arms – hands and feet stay slim
Chronic pain
Extreme sensitivity to pressure and touch in the affected areas
No response to diets
The diseased fatty tissue responds neither to exercise nor to changes in diet
Frequent bruising
Many of those affected bruise easily – often reported, but not a reliable sign on its own
Heaviness & swelling
In the arms and legs, especially worse in the evening
Disproportionate body shape
The torso usually stays slim while the arms and legs become larger
Flexible & no obligation
Your consultation – the way you want it
Get to know us – in person, by phone or by video. Every consultation is 100% without obligation.
Patients at heart:
quality with dedication
What our patients say
Our clinics are regularly recognised by independent review portals. Our patients’ satisfaction is our most important benchmark.
Stages
The three stages of lipoedema
The usual classification describes three stages – based on appearance and what can be felt on examination, not on the severity of symptoms. Lipoedema does not necessarily progress through them.
I
The hidden burden
The skin is smooth and the fatty tissue is evenly thickened. Pain on pressure and touch can already be considerable, even though little is visible from the outside.
Statutory cover in Germany possible since October 2025
II
Visible changes
The skin surface becomes uneven and wavy, and the circumference increases more noticeably. A “cuff” can form above the ankles, while the feet stay slim.
Statutory cover in Germany possible since October 2025
III
Marked limitations
Extensive fat deposits and pronounced folds of fat place additional strain on the joints. Common accompanying problems are chafing wounds, fungal infections and inflammation caused by mechanical friction.
Statutory cover in Germany possible
An important distinction
Lipoedema vs. lymphoedema vs. obesity
Not all fatty deposits are the same. The following overview shows the most important differences at a glance.
Lipoedema
- Symmetrical on the limbs
- Hands & feet slim
- Very tender to pressure
- Stemmer’s sign negative
- No effect from dieting
- Torso not affected
Lymphoedema
- Usually one-sided/asymmetrical
- Hands & feet can swell
- Usually not painful
- Stemmer’s sign positive
- No effect from dieting
- Bruising rare
Obesity
- Evenly across the whole body
- Hands & feet often affected
- Usually not painful
- Stemmer’s sign negative
- Weight loss possible
- Bruising rare
Important note:
This overview can help you recognise initial signs, but it does not replace a professional diagnosis by a specialist approved for this purpose (e.g. in angiology or dermatology).
Your first step
An end to pain and uncertainty
Get advice from our specialists – with no obligation and with empathy. We take your symptoms seriously.
Where does lipoedema come from?
Causes & risk factors
The exact triggers have not yet been fully clarified scientifically. However, current research shows clear links between genetic predisposition and hormonal factors.
Lipoedema typically appears during phases of hormonal change – in puberty, during or after pregnancy, or during the menopause. In up to 60% of cases, it runs in the family.
60%
Runs
in the family
10%
Of all women
possibly affected
Hormonal triggers
- Puberty – the most common time of onset
- Pregnancy – can make it worse
- Menopause – symptoms may increase
- Hormonal contraception – its influence is debated
The decisive step
Professional diagnosis by specialists
For a medically confirmed diagnosis – especially for German statutory insurance cover – a written report by a specialist in angiology, dermatology or physical and rehabilitation medicine, or a doctor with additional training in phlebology, is essential.
We examine you and discuss your findings with you – and tell you who is eligible to make the confirmed diagnosis.
- Detailed medical history
- Physical examination
- Duplex ultrasound
- Written medical report
Lipoedema affects more than the body
Impact on everyday life
The condition affects not only the body, but also everyday life and quality of life in the long term.
Limited mobility
Climbing stairs & longer walks become difficult
Problems with clothing
Finding clothes that fit becomes a challenge
Pain at work
Walking, standing & working become a strain
Psychological burden
Shame, withdrawal & frustration after unsuccessful therapies
The good news:
Even though lipoedema means a long ordeal for many of those affected, effective treatment options are available today that can help reduce pain, regain mobility and enjoy life more again.
Frequently asked questions
Lipoedema FAQ
Can men get lipoedema too?
Only in very rare exceptional cases. According to the medical guideline, lipoedema affects almost exclusively women; in men, only isolated cases have been described, usually together with a hormonal disorder. In men, large, painful legs almost always have other causes.
Can lipoedema be cured?
Lipoedema is a chronic condition that cannot be cured completely, but it can be treated very well. Conservative therapy (compression, lymphatic drainage, exercise) and surgical measures (liposuction) can significantly relieve the symptoms and considerably improve quality of life.
How can I tell whether I have lipoedema?
Typical signs are: symmetrical fat deposits on the legs and/or arms with slim hands and feet, pain on pressure and touch, a feeling of heaviness, and proportions that barely change even when you lose weight. Bruising is often reported, but it is not a reliable sign. A definite diagnosis can only be made by a specialist approved for this purpose (e.g. in angiology or dermatology).
Will health insurance cover the treatment?
For patients with German statutory health insurance: since October 2025, liposuction for lipoedema at all stages (I, II and III) has been covered. The complicated application procedure no longer applies – eligibility is checked directly by the treating doctors. The requirements are: 6 months of conservative therapy, a BMI of no more than 35, and the two-doctor principle (diagnosis and indication for surgery by different doctors). With a BMI between 32 and 35, the waist-to-height ratio (WHtR) must also be appropriate for your age. We perform operations covered by statutory health insurance at our NATIONALKLINIK Wertheim – preparation and aftercare remain at the location near you. At Lipo Doctors, we coordinate every step for you.
What is the difference between lipoedema and being overweight?
In obesity (being overweight), fat is distributed evenly across the whole body and responds to diet and exercise. Lipoedema involves pathologically altered fatty tissue that appears symmetrically on the limbs, is painful and does not respond to diets. In lipoedema, the hands and feet typically stay slim.
Personal & no obligation
Your lipoedema consultation – the way you want it
Talk to our lipoedema specialists – in person, by phone or by video. With no obligation.
- Treatment
- Location
- Type
- Time
- Your details
- Confirm
Which treatment are you interested in?
No matching treatment found. Choose “Not sure yet?” in an area and we will call you back.
Where would you like your consultation?
How would you like to be advised?
Who would you like to see?
Choose your appointment
Prefer to call? +49 231 54 504 900Mon–Fri 8 am–8 pm · Sat 9 am–3 pm (CET)