Lipedema Academy

Stage 1: The Forgotten Face of Lipedema

Prof.Dr. Mustafa SAÇAR

What is Stage 1 Lipoedema?

Lipoedema is a condition that primarily affects women and is characterized by asymmetric fat accumulation in the lower extremities. The earliest stage of this disorder, stage 1, is often overlooked; as the symptoms are not yet apparent and can typically be confused with weight gain or genetic factors [1].

In stage 1, a slight thickening and thinning of the subcutaneous tissues are observed. Patients often feel a mild fullness in their legs, which can be associated with factors such as family structure or obesity [2].

Early diagnosis at this stage is critically important; as lipoedema is a progressive condition that can evolve into more serious stages over time. Early detection can contribute to the management of symptoms and the preservation of patients' quality of life [3].

Common Symptoms of Lipoedema

The most common symptoms of lipoedema include symmetrical fat accumulation in the legs, pain, sensitivity, and easy bruising. However, in stage 1 lipoedema, these symptoms are usually very mild, making diagnosis more difficult [4].

Individuals may report a feeling of heaviness in their legs and tenderness upon touching. These symptoms may become more pronounced when standing or sitting for extended periods [5].

Moreover, the skin surface in lipoedema-affected areas is typically smooth, and the appearance of cellulite is rare. This characteristic is an important factor that distinguishes lipoedema from other fat accumulation problems [6].

Challenges in Diagnosis

Diagnosing stage 1 lipoedema often requires the attention of an experienced specialist. This condition is frequently confused with obesity or lymphedema, which can delay access to the appropriate treatment [7].

Diagnosis is made based on the patient's medical history, physical examination, and sometimes imaging methods. However, in stage 1, these methods may not always yield clear results [8].

Therefore, it is important for patients to carefully monitor their symptoms and consult a specialist. Changes noticed in the early stage play a vital role in accurate diagnosis and treatment [9].

Lipoedema and Genetic Factors

There is evidence that lipoedema has a genetic component; individuals with a family history of lipoedema have a higher likelihood of developing this condition. However, genetic factors may not fully explain lipoedema on their own [10].

While genetic predisposition plays an important role in the development of lipoedema, it is believed that environmental factors are also influential. Hormonal changes, particularly during puberty, pregnancy, and menopause, are among these factors [11].

Therefore, individuals with a family predisposition may accelerate diagnosis and treatment processes by noticing symptoms early on [12].

Alternative and New Theories

In addition to traditional methods in the treatment of lipoedema, alternative and new approaches have emerged in recent years. The role of ketogenic diets and physical exercise in managing lipoedema is being investigated [13].

Some studies have shown that ketogenic diets may be effective in reducing pain and improving quality of life in patients with lipoedema. This diet aims to provide the body's energy source from fats with low carbohydrate and high fat content [14].

Additionally, regular physical activity is said to relieve lipoedema symptoms and improve patients' overall health. Exercise can help reduce edema by increasing lymphatic flow [15].

Diagnosis and Treatment Methods

The diagnosis of lipoedema typically begins with a physical examination and evaluation of the patient's symptoms. However, in stage 1 lipoedema, this process can become more complex. Therefore, it is crucial to consult a specialist for accurate diagnosis [15].

Treatment options include conservative methods and surgical interventions. Conservative treatments generally involve lifestyle changes, diet, and exercise programs. Surgical interventions aim to reduce fat tissue through procedures such as liposuction [15].

Both options should be evaluated based on the patient's overall health status and the stage of lipoedema [15].

The Importance of Early Diagnosis

The early diagnosis of stage 1 lipoedema can help patients better manage their symptoms and prevent progression. Early detection is vital for improving quality of life and preventing complications [15].

Patients should be encouraged not to ignore changes they notice in their bodies and to consult a specialist. This will be the first step in the process of accurate diagnosis and treatment [15].

Early diagnosis ensures that treatment options are more effective and allows patients to live a healthier life in the long term [15].

5/2/2026
5/3/2026
Mustafa SAÇAR
Prof.Dr. Mustafa SAÇARKalp ve Damar Cerrahisi UzmanıÖzel Cerrahi Hastanesi, Denizli, TURKEY

References

  1. Forner-Cordero Isabel, Forner-Cordero Angeles, Szolnoky Győző (2021). Update in the management of lipedema.. International angiology : a journal of the International Union of Angiology. PubMed.doi:10.23736/S0392-9590.21.04604-6
  2. Reich-Schupke Stefanie, Schmeller Wilfried, Brauer Wolfgang Justus, Cornely Manuel E, Faerber Gabriele, Ludwig Malte, Lulay Gerd, Miller Anya, Rapprich Stefan, Richter Dirk Frank, Schacht Vivien, Schrader Klaus, Stücker Markus, Ure Christian (2017). S1 guidelines: Lipedema.. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. PubMed.doi:10.1111/ddg.13036
  3. Sørlie Vilde, De Soysa Ann Kristin, Hyldmo Åsne Ask, Retterstøl Kjetil, Martins Catia, Nymo Siren (2022). Effect of a ketogenic diet on pain and quality of life in patients with lipedema: The LIPODIET pilot study.. Obesity science & practice. PubMed.doi:10.1002/osp4.580
  4. Kruppa Philipp, Georgiou Iakovos, Biermann Niklas, Prantl Lukas, Klein-Weigel Peter, Ghods Mojtaba (2020). Lipedema-Pathogenesis, Diagnosis, and Treatment Options.. Deutsches Arzteblatt international. PubMed.doi:10.3238/arztebl.2020.0396
  5. Herbst Karen L, Kahn Linda Anne, Iker Emily, Ehrlich Chuck, Wright Thomas, McHutchison Lindy, Schwartz Jaime, Sleigh Molly, Donahue Paula Mc, Lisson Kathleen H, Faris Tami, Miller Janis, Lontok Erik, Schwartz Michael S, Dean Steven M, Bartholomew John R, Armour Polly, Correa-Perez Margarita, Pennings Nicholas, Wallace Edely L, Larson Ethan (2021). Standard of care for lipedema in the United States.. Phlebology. PubMed.doi:10.1177/02683555211015887
  6. Verde Ludovica, Camajani Elisabetta, Annunziata Giuseppe, Sojat Antoanstefan, Marina Ljiljana V, Colao Annamaria, Caprio Massimiliano, Muscogiuri Giovanna, Barrea Luigi (2023). Ketogenic Diet: A Nutritional Therapeutic Tool for Lipedema?. Current obesity reports. PubMed.doi:10.1007/s13679-023-00536-x
  7. Faerber Gabriele, Cornely Manuel, Daubert Constance, Erbacher Gabriele, Fink Jodok, Hirsch Tobias, Mendoza Erika, Miller Anya, Rabe Eberhard, Rapprich Stefan, Reich-Schupke Stefanie, Stücker Markus, Brenner Erich (2024). S2k guideline lipedema.. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. PubMed.doi:10.1111/ddg.15513
  8. Vazirnia Aria, Smart David R, Mohseni Yasmine, Amron David M (2026). Lipedema Diagnosis, Clinical Manifestations, and Therapeutics: A Systematic Review.. International journal of dermatology. PubMed.doi:10.1111/ijd.70227
  9. Annunziata Giuseppe, Paoli Antonio, Manzi Vincenzo, Camajani Elisabetta, Laterza Francesco, Verde Ludovica, Capó Xavier, Padua Elvira, Bianco Antonino, Carraro Attilio, Di Baldassarre Angela, Guidetti Laura, Marcora Samuele Maria, Orrù Stefania, Tessitore Antonio, Di Mitri Roberto, Auletta Lucia, Piantadosi Angela, Bellisi Mario, Palmeri Edmondo, Savastano Silvia, Colao Annamaria, Caprio Massimiliano, Muscogiuri Giovanna, Barrea Luigi (2024). The Role of Physical Exercise as a Therapeutic Tool to Improve Lipedema: A Consensus Statement from the Italian Society of Motor and Sports Sciences (Società Italiana di Scienze Motorie e Sportive, SISMeS) and the Italian Society of Phlebology (Società Italiana di Flebologia, SIF).. Current obesity reports. PubMed.doi:10.1007/s13679-024-00579-8
  10. Kruppa, Philipp; Crescenzi, Rachelle; Faerber, Gabriele; Forner-Cordero, Isabel; Cornely, Manuel; Shayan, Ramin; Karnezis, Tara; Simarro, Jose Luis; de Souza, Paula Frederichi; Herbst, Karen Louise; Ghods, Mojtaba; Michelini, Sandro (2026). Lipedema World Alliance Delphi Consensus-Based Position Paper on the Definition and Management of Lipedema: Results from the 2023 Lipedema World Congress in Potsdam. Nature Communications. Crossref.doi:10.1038/s41467-025-68232-z
  11. Mortada Hatan, Alhithlool Abdulmalek W, AlBattal Nouf Z, Shetty Rashika K, Al-Mekhlafi Ghaleb A, Hong Joon Pio, Alshomer Feras (2025). Lipedema: Clinical Features, Diagnosis, and Management.. Archives of plastic surgery. PubMed.doi:10.1055/a-2530-5875
  12. Di Renzo Laura, Gualtieri Paola, Zomparelli Samanta, De Santis Gemma Lou, Seraceno Silvia, Zuena Claudia, Frank Giulia, Cianci Rossella, Centofanti Domenico, De Lorenzo Antonino (2023). Modified Mediterranean-Ketogenic Diet and Carboxytherapy as Personalized Therapeutic Strategies in Lipedema: A Pilot Study.. Nutrients. PubMed.doi:10.3390/nu15163654
  13. Cifarelli Vincenza (2025). Lipedema: Progress, Challenges, and the Road Ahead.. Obesity reviews : an official journal of the International Association for the Study of Obesity. PubMed.doi:10.1111/obr.13953
  14. Amato Alexandre Campos Moraes, Amato Juliana Lelis Spirandeli, Benitti Daniel Augusto (2024). The Efficacy of Ketogenic Diets (Low Carbohydrate; High Fat) as a Potential Nutritional Intervention for Lipedema: A Systematic Review and Meta-Analysis.. Nutrients. PubMed.doi:10.3390/nu16193276
  15. van la Parra Raquel F D, Deconinck Christine, Krug Bruno (2024). Diagnostic imaging in lipedema: A systematic review.. Obesity reviews : an official journal of the International Association for the Study of Obesity. PubMed.doi:10.1111/obr.13648

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