As a Lymphoedema therapist, I often get asked what the difference is between Lymphoedema and Lipedema. In this blog, we will explore the differences, the similarities, and what can be done for prevention, management and treatment of those presentations.
Furthermore, we will look into how Lipoedema can degenerate into a Lipo-Lymphoedema, and why this is not the case for everyone.
What is Lipoedema?
Lipoedema is a chronic adipose tissue disorder that primarily affects women. On a global scale, we know that about 11% of women are affected by this presentation, and it often runs in families as it has a strong genetic component.
The major characteristics of Lipoedema are an abnormal and symmetrical accumulation of fat around the hips, buttocks, thighs, and legs, and upper arms. On the leg area, the fat appears in abundance in the medial side of the knee, too. Where feet are completely untouched by the fat accumulation, this fat is resistant to diet and exercise and is often painful to touch. The pain is due to the cutaneous nerve entrapped in the fatty tissue, and so delivers a pain response when stimulated.
Other Lipoedema key features:
Often triggered or worsened by hormonal changes
Symmetrical fat distribution
Soft, nodular, or lumpy tissue
Pain and easy bruising – as per the pain, bruising is due to blood capillary compression from the fat, and so, is easily damaged by touch
No skin thickening or pitting in the early stages
Nowadays, there is increasing awareness about this presentation, and more and more women find benefit from a management protocol that is not only about cardio and exercise.
Part of the Lipoedema management includes:
- Movement
- Compression stocking
- Antiinflammatory diet
- Skin care
- Where and if needed, cosmetic surgery intervantion
What is Lymphoedema?
Lymphoedema, on the other hand, is a condition where lymphatic fluid builds up in the tissues due to a malfunctioning lymphatic system, 
causing chronic swelling. Compared to Lipoedema, Lymphoedema is strictly related to the Lymphatic system. It can be primary (congenital or hereditary) or secondary (due to trauma, surgery, radiation, or infection affecting the lymphatic system).
Lymphoedema characteristics:
Unilateral or asymmetrical swelling (though it can be bilateral)
Pitting edema – It consists of deep indentation (pitting) left behind on the skin when pressure is applied
Skin changes over time (fibrosis, hyperkeratosis, papillomatosis)
Affects feet and hands as well – primary lymphedema would start from the extremity
Heaviness or tightness in the affected area – can potentially be pain-free, but the limb/s may feel very heavy
It does affect men and women – only primary lymphedema has a genetic component
Lymphoedema Management
The management of Lymphoedema is more tricky than lipoedema, as everyone may react differently to the management, it can be related to other health issue which needs to be considered, and requires the patient to be active in the management side of things.
At Melbourne Massage and Treatment, I treat different types of lymphedema, as per the upper and lower body, focusing on an initial reduction of the swelling via a combination of Manual Lymphatic Drainage (MLD) and compression with Combined Decongestive Therapy (CDT).
The management of this presentation can take anywhere between 3 and 5 or more appointments, depending on the severity of the presentation. The treatments are better done in close proximity, 24 to 48 hours one after the other, so that we give no time to the body to accumulate fluid back under the skin.
Once the combination of treatment allows us to achieve the desired result, which is bringing the limb/s to a thinner size, you will be scheduled for a custom garment wear compression, which will guarantee to maintain the results achieved. This is usually done at other clinics, like Sigvaris or Juzo clinics. Those clinics are specialised in the making of garment wear.
Custom garments wear last about 6 months, so twice a year, you will need to change them, and if needed, because the limb/s may start swelling again (especially in summer, when there is a change of atmospheric pressure, due to the heat), a short series of MLD and CDT therapy may be needed.
Key Differences between Lymphoedema and Lipoedema
| Feature | Lipedema | Lymphoedema |
|---|---|---|
| Cause | Abnormal fat metabolism | Lymphatic dysfunction |
| Gender prevalence | Almost exclusively women | Affects both sexes |
| Onset | Often at puberty, pregnancy, or menopause | Can be congenital or triggered by injury/surgery |
| Distribution | Symmetrical, lower limbs and arms | Can be asymmetrical; any body part |
| Feet/Hands | Spared | Usually involved |
| Pain | Tender, painful fat | Often painless, heavy feeling |
| Skin texture | Soft, nodular fat | Skin thickens over time (fibrosis) |
| Pitting | Rare (early) | Common (early) |
| Response to elevation | Minimal improvement | Often improves with elevation (if early stage) |
| Bruising | Common | Not typical |
Common Characteristics of Lymphoedema and Lipoedema
As seen above, the characteristics of Lipoedema and Lymphoedema are different, but, both conditions share chronic swelling, potential functional limitations, and a need for long-term management:
Both can cause leg discomfort, heaviness, and swelling
Both may lead to reduced mobility
Neither condition improves with calorie restriction or exercise alone – it is more about stop the intake of inflammatory food
Compression therapy is often used for both
Both can have a progressive nature if not managed properly – especially lymphoedema
Misdiagnosis is common, often delaying effective treatment
When Lipedema Becomes Lipo-Lymphoedema
If we stick to a vision of Lipoedema progression, that is possible when no management is put in place, this presentation can degenerate into secondary lymphatic impairment, resulting in a combined condition known as Lipo-Lymphoedema.
How this happens:
As the fat keeps accumulating under the skin, and there is an increase in inflammation, the lymphatic vessels are put under major load and potential damage
Over time, this leads to fluid retention and swelling due to the lymphatic system failing to do its job
As the lymphatic system becomes overwhelmed, the person may start experiencing lymphedema symptoms (Example: swelling in the extremities, feet and or hands)
Patients now experience both fat deposition and fluid buildup, making treatment more complex
Signs that Lipedema has progressed:
Swelling starts in the feet or hands
Pitting edema begins to appear
Skin changes develop, such as pulled skin, fibrosis or thickening
Why Early Diagnosis Matters
As with many degenerative conditions, the earlier they are detected and the earlier the intervention, the better it is.
Still nowadays, I get to hear and see patients who have visited many specialists and doctors, without coming up with a conclusion to their presentation.
Indeed, most often Lipoedema but occasionally even Lymphoedema, can be diagnosed via a diagnosis of exclusions, which means that when any other possible cause of the swelling is ruled out, the only explanation left for the presentation is Lipoedema or Lymphoedema.
Identifying Lipedema early can prevent or delay lymphatic system damage and the onset of Lipo-Lymphoedema. Early treatment, such as manual lymphatic drainage, laser therapy, compression, and proper exercise, can reduce pain and swelling and improve mobility and quality of life.
A diagnostic tool that can tell us a lot about the health of the lymphatic system is the lymphoscintigraphy, which is a nuclear medicine scan that takes a direct look at the lymphatic system and the lymph flow in the body. This scan can tell us if there is any lymphatic system interruption, confirming a lymphedema presentation.
Treatment Considerations for Lymphoedema and Lipoedema
When looking at treatment options for those presentations, there are some similarities (e.g., compression, lymphatic drainage, exercise), but it’s essential to tailor the approach:
Lipedema: Focus on pain management, manual therapy, mobility, and understanding the emotional impact. Surgical options like liposuction may be considered in severe cases.
Lymphoedema: Emphasis on fluid management through complete decongestive therapy (CDT), compression garments, and infection prevention.
Lipo-Lymphoedema: A combined approach targeting both fat deposition and lymphatic flow is needed.
How Melbourne Massage and Treatment can help
At Melbourne Massage and Treatment, in Fitzroy North, I specialised in Lymphoedema therapy, offering tailored treatment to those who need it, starting with MLD and following with CDT therapy. My approach to those presentations also includes an informative and educative aspect, so I do my best to follow up the presentation with the patient, networking with other practitioners, to incorporate a 360-degree approach.
I also offer fitness classes that focus on exercises to help manage lymphoedema and/or lipoedema, while maintaining a healthy body state to improve mobility and strength.
If you are not sure if what you are experiencing is either a lymphoedema or a lipoedema, book a free online consultation. This way, you can ask me some questions directly about your presentation, and we can go through your clinical history to get a better understanding of what you may be experiencing.
FAQ – Lymphoedema and Lipoedema
A: Lipoedema cannot be completely cured, but it can be effectively managed through a combination of movement, compression garments, skin care, anti-inflammatory nutrition, and, where indicated, cosmetic surgery such as liposuction.
A: Lipoedema usually presents as symmetrical fat accumulation in the legs (and sometimes arms) with the feet spared, often painful and bruising easily. Lymphoedema, instead, involves swelling due to lymphatic dysfunction, often affecting the feet or hands, and may cause pitting and skin changes.
A: Yes. If Lipoedema is left unmanaged, the excess fat and inflammation can damage the lymphatic system, leading to a combined condition known as Lipo-Lymphoedema, which has both fat accumulation and fluid retention.
A: Lipoedema treatment focuses on pain management, mobility, and targeted fat reduction, while Lymphoedema treatment centres on fluid reduction using complete decongestive therapy (CDT), compression garments, and infection prevention.
A: Early diagnosis is essential. Timely intervention can prevent progression, reduce pain and swelling, and help maintain mobility. In the case of Lipoedema, early management can prevent lymphatic damage and Lipo-Lymphoedema.
A: While diet alone cannot cure Lipoedema or Lymphoedema, an anti-inflammatory diet can help reduce symptoms, improve tissue health, and support overall management when combined with other therapies.
A: I offer tailored Manual Lymphatic Drainage (MLD) and Combined Decongestive Therapy (CDT), fitness classes for mobility and strength, and ongoing education to help you manage your condition. I also collaborate with garment specialists and other practitioners for a complete approach.
Giovanni La Rocca
Giovanni moved to Melbourne, Australia, from Italy in 2008 and became a citizen in 2017. He started studying massage therapy in 2016, then completed a Bachelor of Health Science in Clinical Myotherapy in August 2024. During those years, he also specialised in Thai Massage and Manual Lymphatic Drainage for presentations like Lipoedema and Lymphoedema. Nowadays, he runs his clinic in Fitzroy North, Melbourne, where he integrates movement therapy into his practice to enhance overall well-being. He also values meditation, having completed several Vipassana courses. Committed to continuous learning, he aims to share his expertise in integrated therapies to help others achieve balance and resilience.