Lipedema occurs in different patterns, depending on which parts of the body are affected.
In this article, we review the five anatomical types of lipedema, focusing on where the fat accumulation is located, clinical findings, and implications for treatment.

The types describe where on the body the lipedema is located (e.g., hips, legs, or arms), while the levels —or stages—describe how severe the condition is, i.e., how much the fatty tissue and skin have changed. If you would like to know more about lipedema levels, you can read this article: Lipedema levels

The five types of lipedema

Lipedema is classified into five types based on where on the body the fatty tissue is most concentrated.
This classification helps healthcare professionals assess the clinical picture, differential diagnoses, and appropriate treatment.

Type 1 – Pelvis, hips, and buttocks

Description:
Fat accumulation around the pelvis, hips, and buttocks. Often results in a pronounced " saddlebag" shape, while the upper body remains slim.

Clinical features:

• Symmetrical increase in fatty tissue around the hips and buttocks
• Smooth skin in the early stages
• Tenderness and tendency to bruise

Differential diagnoses:
Gynoid fat distribution, gluteal lipohypertrophy.

Here you see an illustration of a woman with type 1 lipedema. Fat accumulation around the pelvis, hips, and buttocks.

Type 2 – Hips, thighs, and down to the knees

Description:
Covers the area from the hips and buttocks down to the knees, often with fat pads on the inside and outside of the knees that can affect mobility.

Clinical features:

• Uneven skin surface and cellulite
• Pressure sensitivity and feeling of heaviness
• Symmetrical fat accumulation

Differential diagnoses:
Venous insufficiency, lipohypertrophy.

Here you see an illustration of a woman with type 2 lipedema. Fat accumulation on the hips and buttocks down to the knees.

Type 3 – The entire leg from hip to ankle

Description:
The most common type of lipedema, where the fatty tissue extends from the hips to the ankles, but the feet remain unaffected – an important diagnostic criterion.

Clinical features:

• Characteristic "cuff" at the ankle
• Heavy, aching legs
• Mild edema without pitting

Differential diagnoses:
Primary lymphedema, fat distribution disorders.

Here you see an illustration of a woman with type 3 lipedema. Fat accumulation from the hip all the way down to the ankle.

Type 4 – Arms

Description:
Primarily affects the upper arms, and in some cases also the forearms.
Often occurs together with lipedema in the legs (type 2 or 3).

Clinical features:

• Symmetrical fat distribution in upper arms
• Pressure sensitivity and feeling of swelling
• Difficulties with tight sleeves

Differential diagnoses:
Post-mastectomy lymphedema, lipohypertrophy.

Here you see an illustration of a woman with type 4 lipedema. Symmetrical fat distribution in the upper arms.

Type 5 – Adds

Description:
A rarer variant where fat accumulation is limited to the calves, while the hips and thighs are normal.
The feet are not affected.

Clinical features:

• Fat accumulation along the calves, especially on the inside
• Pressure sensitivity and prone to bruising
• Normal foot anatomy

Differential diagnoses:
Lymphedema, venous stasis.

Here you see an illustration of a woman with type 5 lipedema. The fat accumulation is limited to the calves.

Surgical treatment at TBL Medical

The classification provides valuable information for diagnosis, surgical planning, and assessment of treatment results.

At TBL Medical in Bergen, surgical treatment of lipedema is performed by our experienced plastic surgeon using the proven and gentle WAL method (Water Assisted Liposuction).

The WAL method – precise and tissue-sparing

The WAL method uses a controlled water jet to loosen fat cells before they are sucked out.
This is a gentler process compared to traditional liposuction, and reduces the strain on connective tissue, nerves, and lymph vessels.

Advantages of WAL:

• Reduced bleeding and swelling
• Faster recovery
• More consistent and accurate results

The procedure is usually performed under local anesthesia or light sedation, and most patients can go home the same day.

Follow-up and compression

After surgery, the use of compression garments to reduce swelling, improve circulation, and support the skin during healing.
TBL Medical offers professional advice on the selection and fitting of compression garments, individually tailored to the patient's body and type of lipedema. Read also the article Why compression garments are important for lipedema

The classification into five anatomical types (Types I–V) was first developed in Germany by Prof. Dr. med. Wilfried Schmeller and later Dr. med. Josef Stutz, both pioneers in the surgical treatment of lipedema using the WAL method (Water Assisted Liposuction).

Background and references

The classification is based on clinical observations and was established to standardize the description of the disease's prevalence, thereby improving diagnostics, surgical planning, and research.
It has since been adopted and recommended in international professional guidelines, including the German S1 guideline for lipedema (Deutsche Gesellschaft für Phlebologie, 2021).