Step 1: Diagnose
Diagnosing my lipoedema
The first and most important step on your journey: a confirmed diagnosis by specialised doctors – the basis for all further treatment and, in Germany, a requirement for cover by statutory health insurance.
Medically reviewed byDr. med. Martin Reifenrath, Specialist in Plastic and Aesthetic SurgeryLast reviewed:
Why diagnosis matters so much
Clarity is the first step towards feeling better
Many women live with unexplained symptoms for years before they are diagnosed with lipoedema. The problem: the longer the condition goes unrecognised, the further it progresses – and the harder everyday life becomes.
A confirmed diagnosis by a specialist is not only important for your treatment – for patients insured in Germany, it is also a requirement for the costs to be covered by statutory health insurance. At Lipo Doctors we examine you, discuss your findings and tell you which specialist can make the diagnosis for the insurer.
First signs
Could it be lipoedema?
These signs may point to lipoedema – but only a specialist can make a reliable diagnosis.
Symmetrical fat distribution
Both legs or both arms are affected equally – while the hands and feet stay slim
Pain when touched
Even light pressure on the affected areas causes disproportionate pain
Diets don't help
Despite eating fewer calories and exercising, the affected areas stay the same
Frequent bruising
Many women bruise easily – often reported, but not a reliable sign on its own
Self-tests do not replace a diagnosis
Online questionnaires and self-tests can give you a first indication, but they cannot replace a medical diagnosis. A confirmed diagnosis – and cover by German statutory health insurance – requires written findings from an authorised specialist (e.g. in angiology or dermatology).
Patient experience
Elena shares her journey
From diagnosis to successful treatment – a patient describes how she experienced her personal journey with Lipo Doctors.
The right specialist
Who can reliably diagnose lipoedema?
Not every doctor is qualified to diagnose lipoedema. For cover by German statutory health insurance, only these specialists may make the diagnosis.
Angiology
Specialists in internal medicine and angiology are experts in blood vessels. They can rule out vein disorders and make the lipoedema diagnosis.
Dermatology
Specialists in dermatology and venereology may also make the lipoedema diagnosis – even without an additional qualification.
Physical and Rehabilitation Medicine
Specialists in physical and rehabilitation medicine are also authorised to make the lipoedema diagnosis.
Additional qualification in phlebology
Specialists with the additional qualification in phlebology (the treatment of vein disorders) can also make a recognised lipoedema diagnosis.
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.
Diagnostic methods
How lipoedema is diagnosed
The path to a diagnosis involves specialised examination methods – our doctors carry out the examination at your first appointment.
01
Detailed medical history
We take time to hear your story: when did the symptoms begin? Is there lipoedema in your family? How does your body respond to diets? This information is crucial.
02
Physical examination
Assessment of your proportions, palpation and specific tests such as the pinch test. The doctor checks how sensitive the tissue is to pain – in lipoedema it is disproportionately high.
03
Duplex ultrasound
Ultrasound is used to rule out vein disorders and lymphoedema. At the same time, the structure and thickness of the fatty tissue are measured.
04
Determining the stage
Lipoedema is divided into three stages. Determining the exact stage is important for planning treatment – and it is documented in the medical report.
05
Differential diagnosis
Lymphoedema, venous insufficiency or obesity? These conditions must be reliably ruled out – they call for different treatment approaches.
06
Written findings
You receive a medical report with your findings, stage and treatment recommendation – the basis for all further steps and for your records.
Since October 2025
The two-doctor principle
For cover by German statutory health insurance, the diagnosis and the decision that surgery is indicated are made by different doctors. We will tell you which specialist can make the diagnosis.
For patients insured in Germany, the two-doctor principle is one of the requirements for the costs to be covered by statutory health insurance. It means: the diagnosis and the indication for surgery are made by different doctors.
What matters: the diagnosis is made by a different doctor from the one who operates; only after a referral does the surgeon confirm that surgery is indicated. This ensures that the indication is made objectively and independently.
- A first specialist makes the diagnosis
- The operating specialist then confirms the indication for surgery
- The diagnosing doctor may not perform the operation
- Both doctors must judge independently
- We tell you who can make the diagnosis
Why this principle?
Quality assurance in the interest of patients
The two-doctor principle protects you from unnecessary procedures and ensures that the operation is genuinely medically necessary.
We examine you and discuss your findings with you. The confirmed diagnosis for the insurer is made by a specialist who is authorised to do so – we will tell you who is suitable.
At Lipo Doctors
Your diagnostic appointment with us
At your first appointment we examine you thoroughly. After about 45–60 minutes you will know your findings – in writing, for your records.
- A detailed conversation about your symptoms
- Physical examination by our doctors
- Discussion of the next steps towards a diagnosis
- Determination of the stage and treatment recommendation
- Written findings for your records
Telling them apart
Lipoedema, lymphoedema or obesity?
These three conditions are often confused – even though they require different treatments. A reliable diagnosis is therefore essential.
Lipoedema
Symmetrical fat distribution on the legs/arms, slim hands and feet, pain when touched, does not respond to diets. Affects women only.
Lymphoedema
Often one-sided, also affects the hands/feet, positive Stemmer sign (skin fold cannot be lifted), no pain on pressure. Affects both sexes.
Obesity
Even fat distribution across the whole body, responds to calorie reduction, no pain when touched. Affects both sexes.
Covered by German statutory insurance since October 2025
The diagnosis is the key
Since October 2025, liposuction for lipoedema has been covered by German statutory health insurance (for patients insured in Germany) – but only with a confirmed diagnosis by an authorised specialist. We perform these insurance-covered operations at our NATIONALKLINIK Wertheim – preparation and aftercare remain at the location near you.
All stages
Until October 2025 only stage III was covered – since then, statutory insurers in Germany also cover stages I and II.
No application
The complicated application procedure no longer applies – the doctors assess the requirements directly.
BMI of no more than 35
One of the requirements for statutory cover – between 32 and 35 only if your waist-to-height ratio (WHtR) is appropriate for your age. If needed, we support you in losing weight.
6 months of therapy
Prior conservative treatment is required – we coordinate and document everything for you.
Your journey with Lipo Doctors
What comes after the diagnosis
The diagnosis is only the beginning. We support you through every further step – from conservative therapy to aftercare.
Frequently asked questions
FAQ on lipoedema diagnosis
Which doctor diagnoses lipoedema?
For treatment covered by German statutory health insurance, only certain specialists may make the diagnosis: specialists in internal medicine and angiology, in dermatology and venereology, in physical and rehabilitation medicine, or doctors with the additional qualification in phlebology. We examine you and discuss your findings with you. The confirmed diagnosis for the insurer is made by a specialist who is authorised to do so – we will tell you who is suitable.
Do I need a phlebologist for a lipoedema diagnosis?
Not necessarily. A phlebologist – a doctor with the additional qualification in phlebology, i.e. the treatment of vein disorders – is one of several options. Under German statutory health insurance, the confirmed diagnosis may also be made by specialists in internal medicine and angiology, in dermatology or in physical and rehabilitation medicine. GPs and plastic surgeons are not among them. We examine you, discuss your findings and tell you who can make the diagnosis.
What does the diagnosis involve?
At your first appointment we examine you thoroughly: your medical history, a physical examination including a pain test, and determination of the stage. After about 45–60 minutes you will know your findings and receive them in writing. For German statutory health insurance, the confirmed diagnosis is made by a specialist who is authorised to do so – we will tell you who is suitable.
What is the two-doctor principle?
For cover by German statutory health insurance, the diagnosis must be made by a different doctor from the one who operates; only then does the surgeon confirm that surgery is indicated. We will tell you which specialist can make the diagnosis.
How much does the diagnosis cost?
For patients with German statutory health insurance, the initial examination by an authorised specialist (e.g. in angiology or dermatology) is usually covered by the insurer; you will need a referral from your GP. For self-pay patients, we provide a transparent cost estimate in advance.
Can I be diagnosed online?
No. A reliable lipoedema diagnosis is only possible through a personal examination. Online questionnaires and self-tests can give you a first indication, but they do not replace a diagnosis by a specialist – and they are not accepted by German health insurers.
What happens if lipoedema is not confirmed?
Even then, the appointment was not wasted. We look into what else might be causing your symptoms – for example lymphoedema, a vein disorder or obesity. Depending on the findings, we recommend the appropriate further treatment.
Do I need a referral for the diagnosis?
If you have German statutory health insurance, you will usually need a referral from your GP for the initial examination by an authorised specialist. This ensures that your insurer covers the costs. As a self-pay patient, you can book an appointment with us without a referral.
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)