If you've ever struggled to get rid of the dimply fat in your legs, hips or arms -- despite how...

If you've ever struggled to get rid of the dimply fat in your legs, hips or arms -- despite how much you diet or exercise -- with no luck, it may not be from stubborn weight.

Similarly, women on GLP-1 medications have found that, despite losing a significant amount of weight, their legs (and sometimes even arms) may continue to look the same. If this sounds like you, it's possible you may have lipedema, a chronic condition that causes fat cells to accumulate in your lower body, especially your legs.

"Lipedema is underdiagnosed, and many patients are told their symptoms are due to obesity or lifestyle choices," says Dr. Thomas Su, a lipedema liposuction specialist and cosmetic surgeon. "This misinformation leads to delayed care and unnecessary suffering."

Understanding what causes lipedema -- and how to treat it -- can improve your self-confidence and quality of life.

Lipedema is a chronic fat disorder that primarily affects women. It causes an asymmetrical buildup of fibrotic fat, most often in the legs, hips, butt, thighs and calves.

Lipedema progresses over time. The stages of lipedema are:

-- Stage 1. The skin on your legs looks normal, but underlying fat feels thicker and slightly rubbery. This may appear as bumps directly under the skin. It may also be painful to touch, and skin may bruise more easily.

-- Stage 2. The skin begins to grow unevenly around the subcutaneous fat, which is what creates the classic dimpled appearance and lumpy skin texture.

-- Stage 3. In addition to noticeable indentations in the skin, legs begin to look swollen or inflated at this stage. Larger fat masses develop around the thighs and knees, which can impair mobility, making it more challenging to walk normally. It can also contribute to joint pain.

-- Stage 4 (also known as lipolymphedema). This stage often involves a secondary lymphedema diagnosis, characterized by excess fluid buildup -- in addition to the fat buildup. It's when the lymphatic system (a group of organs, vessels and tissues that play a role in your immune and circulatory systems) becomes compromised. This causes significant swelling in the legs that impairs movement to an even greater degree than stage 3 lipedema. Secondary lymphedema is extremely difficult to treat through conservative approaches.

-- Disproportionate fat accumulation in the lower body

-- Difficulty losing weight from diet and exercise modifications

Not everyone will experience the same symptoms with lipedema. In fact, some may have lipedema in their upper body, primarily the upper portion of the arms, though it's not as common.

Lipedema can often be mistaken for cellulite, a very common (and harmless) skin condition that affects up to 90% of females, primarily around the thighs, butts and hips. While it also leads to dimples and depressions in the skin, it's very different from lipedema.

While lipedema causes swelling and is often painful, cellulite doesn't cause any symptoms -- it's more of an aesthetic concern for folks.

The treatments for each are also very different. For instance, the most effective treatment for lipedema is liposuction. But for cellulite removal, liposuction can worsen dimpling from cellulite. Instead, it often becomes less noticeable with more conservative treatments, like weight loss, increased muscle mass from exercise and even certain creams and lotions.

Causes

While the exact cause is not fully understood, lipedema appears to have a strong link to:

Since the exact cause of lipedema isn't fully understood, its risk factors are also somewhat uncertain.

However, there are certain known risk factors, including:

Lipedema isn't just a cosmetic issue -- it can pose real health risks. These include:

-- Secondary lymphedema, which can lead to lymph (fluid) buildup

There are often two key prongs of a physical examination.

-- Notable size differences between the upper and lower body

-- Fatty deposits that form small bulges around the hips, inner knees, ankles or above the elbows

-- A distinctive fold or "cuff" of fat at the ankles or wrists

Your doctor will use their hands and fingers to assess your skin texture and its tenderness. They will also be looking for signs of fibrosis, or hardened, scar-like connective tissue that replaces normal tissue and fat in the affected areas.

-- Tissue that feels soft and fluffy with small nodules in it

-- Pain or tenderness when applying light pressure to the affected area

-- Unusual coolness around the affected skin (compared to surrounding tissues)

"However, it's important to rule out other causes for lower extremity swelling, such as deep venous thrombosis or chronic venous insufficiency," says Dr. William Shutze, a board-certified vascular and general surgeon at Texas Vascular Associates in Dallas.

If the ultrasound shows no signs of these vascular conditions, they can make a lipedema or secondary lymphedema diagnosis depending on the severity of your condition.

Treatment and Management

There is no cure for lipedema, but that doesn't mean you can't manage the condition or reduce its physically (and emotionally) debilitating effects. Making certain lifestyle modifications and doing a combination of medical and surgical interventions can help ease pain and even improve your self-image.

Lifestyle modifications

Research has identified an association between lipedema and inflammation in the body. Making the following modifications may help you manage the condition and improve inflammation levels. These include:

You can also explore alternative or adjunctive therapies to help reduce inflammation. The Lipedema Foundation recommends the following:

These medical treatments can help tame lipedema symptoms and prevent the condition from worsening.

-- Manual lymphatic drainage (MLD). Lymphatic drainage massage is a gentle, noninvasive massage technique designed to encourage lymph fluid movement and drainage. This can help reduce swelling and discomfort.

-- Compression garments and accessories. Compressive tools -- like stockings, bandages, wraps and inflatable devices -- for your legs can all help manage inflammation, reduce fibrosis, and improve lymphatic flow in your lower body.

-- GLP-1 medications. If you're overweight and you qualify for one of these powerful weight loss drugs, it can help reduce inflammation and even potentially remove lipedema nodules. It will also help reduce harmful types of fat, such visceral fat, though it won't directly reduce subcutaneous fat associated with lipedema, the Lipedema Foundation suggests.

Surgical treatments

Despite the health benefits associated with the above complementary and medical treatments, surgical interventions are necessary to completely rid your body of lipedema fat.

"Liposuction is currently the only proven method for removing lipedema fat," Su says. "For lipedema patients, this cosmetic improvement is especially important because of the deep psychological toll the condition can take."

Apart from cosmetic improvements in both shape and proportion, patients also find significant relief in lipedema symptoms, such as a reduction in pain and heaviness in their legs.

"Lipedema fat does not respond to diet or exercise, and early surgical intervention can make a significant difference -- not only in preventing progression, but also in how quickly patients begin to feel relief and see improvement," Su says.

Bariatric surgery may also be a part of the conversation you have with your doctor, especially if your BMI exceeds 35.

Bottom Line

Lipedema isn't just a cosmetic inconvenience; it can severely hinder your mobility and ability to engage in everyday activities. This chronic condition is often overlooked in the clinical setting, which is why it's so important you stay vigilant of the signs and know your family history. If you're experiencing pain, fatigue and swelling, be sure to talk to your doctor. Often surgical interventions are the key to removing lipedema fat, though other medical and complementary treatments can help manage symptoms in the interim.