Lipedema is a chronic and painful fat distribution disorder that almost exclusively affects women. The condition is characterized by an abnormal accumulation of fat in the legs and arms, often combined with pain, tenderness, and a tendency to bruise easily. For many patients, lipedema develops gradually over time. From mild symptoms to more pronounced changes in the body's shape and function.

Different stages of lipedema

Lipedema is currently classified into several stages to describe the progression of the disease. Each stage has characteristic findings in the skin and fatty tissue, as well as differences in pain, swelling, and movement restriction.
For many women, this provides a better understanding of how lipedema develops and what treatment options are available. In addition to stages, there are different types of lipedema. Read more about lipedema types -> Lipedema types

The classification of lipedema into stages was first developed by German physicians Professor Etelka Földi and Professor Michael Földi, pioneers in the field of lymphology and fat distribution disorders.
They described how the fat tissue and skin gradually change throughout the course of the disease and, in the 1990s, introduced a three-part classification (stages I–III) that still forms the basis for diagnosis today.

The classification has since been further developed by Dr. Stefan Schmeller, Dr. Meier-Vollrath, and Dr. Bertsch at the Földi Clinic in Germany —one of the world's most renowned centers for lipedema research and treatment. These researchers added stage 0 (pre-lipedema) for early symptoms without visible changes, and stage 4 (lipolymphedema) for cases where the lymphatic system is secondarily affected. Therefore, a classification from 1 to 4 is currently used for lipedema.

Lipedema in four different stages

Classification of lipedema

Stage 1 – early lipedema

• The skin is smooth and even, but the fatty tissue underneath may feel soft and thickened.
• Typical symptoms include discomfort and tenderness in the legs, especially after standing or sitting for long periods of time.
• Many people experience a feeling of heaviness and that their legs become larger without necessarily gaining weight.
• At this stage, conservative treatment with compression garments and lymphatic therapy can provide good symptom relief.

Stage 2 – uneven skin and increasing discomfort

• The fatty tissue becomes lumpy with small irregularities under the skin, often described as cellulite-like, but more extensive and painful.
• The skin may appear wavy or bumpy, especially on the thighs and calves.
• Many now experience constant pain or pressure, as well as easy bruising.
• At this level, surgery with WAL liposuction can be considered to reduce fat volume, pain, and improve mobility.

Stage 3 – clear contour changes

• The fatty tissue is significantly thickened, and sagging skin folds and pronounced unevenness occur.
• The skin's elasticity is reduced, and movement can become difficult.
• Swelling and pressure sores are common.
• At this stage, surgical treatmentis often necessary for functional and aesthetic improvement.
  WAL technology makes it possible to gently remove fatty tissue while preserving the lymphatic vessels as much as possible.

Stage 4 – lipolymphedema (advanced stage)

• Untreated lipedema can develop into lipolymphedema, which affects both fatty tissue and the lymphatic system.
• There is pronounced swelling, fluid accumulation, and reduced lymph drainage, often combined with pain and reduced mobility.
• Treatment must be tailored and combined with surgery, compression, and physical therapy.
• WAL liposuction can reduce volume and pressure, but close medical monitoring is essential.

How is your stage assessed?

During a consultation at TBL Medical, our surgeons conduct a thorough assessment of fat distribution, skin structure, pain level, and any signs of lymphatic problems.
This forms the basis for classifying the disease and planning treatment.

The surgeon also considers factors such as BMI, comorbidity, and skin elasticity to ensure that the treatment is safe and effective.

Treatment at TBL Medical

At TBL Medical in Bergen, we use WAL liposuction (Water Assisted Liposuction) – a modern and tissue-sparing method developed specifically for lipedema surgery.
The technology uses a controlled water jet to gently loosen fat cells, while preserving lymph and blood vessels as much as possible.

Advantages of WAL liposuction:

• Less swelling and bruising
• Shorter recovery time
• Better fitness improvement and comfort
• Low risk of lymphatic damage

After surgery, we closely monitor patients with compression guidance, check-ups, and individual follow-up to ensure the best possible results.

Lipedema develops in several stages – from early, subtle symptoms to more extensive changes in fatty tissue with significant discomfort.
Recognizing which stage you are in is crucial for choosing the right treatment.

At TBL Medical in Bergen, we offer modern, safe, and proven effective surgery for lipedema using WAL liposuction, individually tailored to each patient's needs and disease progression.

Frequently asked questions:

Yes, in the early stages, compression garments, lymphatic drainage, and lifestyle changes can help relieve symptoms. In more advanced stages, surgery such as WAL liposuction provides the best and most lasting results.

Are lipedema and lymphedema the same thing?
No. Lipedema is caused by abnormal fat distribution, while lymphedema is caused by reduced drainage in the lymphatic system. At stage 4, both conditions can overlap.

Are the results of WAL liposuction permanent?
The fat cells that are removed do not return. However, to maintain the results, it is important to maintain a stable weight, use compression correctly, and follow up.

How many operations are needed?
It varies. Many people achieve good results after one or two operations, while some with more extensive lipedema may need several procedures.