The questions we are asked in the consultation, answered by the medical team that sees the patients. Without promising what cannot be promised, and saying plainly what is not known.
The questions are grouped into six blocks. Each answer is deliberately short and, where the subject deserves more, it links to the page where it is developed. If your question is not here, write to us and we will answer it: a good part of what is on this page arrived that way.
It is a chronic disease of the adipose tissue that causes a disproportionate increase of fat, almost always in the legs and often in the arms too, with pain or tenderness to the touch. It is not being overweight and it is not cellulite: the tissue behaves differently, which is why it responds differently. The WHO recognises it in ICD-11 with its own code (EF02.2). British spelling is lipoedema; both refer to the same condition. Full detail in what is lipedema.
No. Lipedema is chronic and no treatment cures it today, neither conservative nor surgical. What does exist is treatment for its symptoms: compression, drainage and self-care measures reduce pain and heaviness, and surgery can remove part of the affected tissue and improve pain and volume. Any clinic promising a cure is telling you something that does not hold up.
Pain or tenderness to the touch is part of what defines the disease, but the intensity varies enormously between patients and across the day. Some women live with constant pain; others only notice discomfort on pressure, heaviness at the end of the day, or pain when something rubs. Mild pain does not rule lipedema out, and severe pain does not mean it is more advanced.
The cause is not known. What is consistently observed is that it affects almost exclusively women, that it tends to appear or worsen at moments of hormonal change, which points to a hormonal component, and that many patients have other women in the family with the same legs. The detail is in causes of lipedema.
A family history is very common: mother, grandmother, sisters or aunts with the same leg pattern. That points to a familial predisposition, but the specific hereditary mechanism has not been identified and there is no genetic test that confirms or rules it out. Having relatives with lipedema raises the suspicion, not the certainty, and not having them does not rule it out.
It usually shows up alongside a significant hormonal change: puberty, a pregnancy or perimenopause. Puberty is the most common, and many patients describe legs that changed at 13 or 14 and a condition nobody named for decades. It can also become evident later, after hormone treatment or a change in weight.
Yes, and it is one of the reasons it goes undiagnosed. Lipedema exists at a normal weight: the feature that counts is not the weight but the disproportion between trunk and limbs, together with the pain and the consistency of the tissue. A woman with a small waist and legs that will not change can have lipedema, and has often been told for years that it is a matter of persistence.
Yes. The arms are affected in a substantial share of patients, sometimes at the same time as the legs and sometimes later. The typical pattern is a symmetrical increase on the back of the upper arm that stops at the wrist, just as in the leg it stops at the ankle. More in why arms thicken with lipedema.
Many patients report a worsening through perimenopause and menopause: more volume, more pain, or new areas involved. That fits the role oestrogens appear to play in the disease, although the exact mechanism is not established and not everyone experiences it the same way. Where it coincides with weight gain, treating that weight is what helps the leg volume most.
The assumption that lipedema always progresses, inevitably, is being questioned in recent literature: some patients remain stable for years. What we do know is that added excess weight makes the picture worse, and that controlling it, alongside compression and movement, is what can be offered today to keep it in check. There is no way to guarantee it will not advance.
Cellulite is a cosmetic change on the surface of the skin, it does not hurt, and most women have it. Lipedema is a disease: the volume is disproportionate, the tissue hurts when pressed, and there are usually palpable nodules under the skin. You can have both at once. The full comparison, with images, is in lipedema vs cellulite.
Lymphoedema is a build-up of lymph caused by failed drainage: it pits when pressed, it is usually asymmetrical, and it involves the foot or the hand. Lipedema is a build-up of fat: it is symmetrical, it spares the foot and the hand, and it hurts. They can overlap, and when they coexist over time it is called lipo-lymphoedema. Telling them apart changes the treatment entirely, which is why the assessment includes a vascular study.
Water retention fluctuates: it improves when you elevate the legs, worsens with heat or salt, and changes from one day to the next. Lipedema does not disappear overnight or with rest, because what lies underneath is fatty tissue, not water. Many patients have both, and the fluid component responds to drainage and compression while the fat volume stays.
No, they are different things, although they can coexist. Obesity affects the body globally and responds to energy balance; lipedema is a localised, painful alteration of the adipose tissue that is not distributed in the same way. That said, where there is associated excess weight it is worth treating, because losing weight does reduce leg volume and improve symptoms, even though it does not remove the lipedema.
Four signs orient the most: disproportion between trunk and legs, pain or discomfort on pressure, bruising easily, and a sharp cut-off at the ankle or wrist that leaves the foot or the hand unaffected. If several of those sound familiar, it is worth consulting. You can use the lipedema test on this page to organise your symptoms before the visit.
The diagnosis is clinical: it rests on the history and the physical examination by a doctor experienced in lipedema. There is no imaging test or blood test that confirms it. What the tests do is rule out what resembles it, above all venous and lymphatic disease. The full process is in lipedema diagnosis.
Ultrasound does not give the diagnosis, but it is useful: duplex ultrasound rules out venous insufficiency, varicose veins or the after-effects of thrombosis, all of which change both the diagnosis and the planning of any surgery. In our clinic the vascular study is done by an angiologist on the team within the same assessment, not in a separate circuit.
It is mostly diagnosed and treated by angiology and vascular surgery and by plastic surgery, and what matters most is not the specialty but specific experience in lipedema. In our study of 969 participants, the specialty that signed off the most diagnoses in Spain was vascular surgery, at 50.4%. You can see the medical team.
Four stages, which describe how far the appearance of the tissue has advanced, and five types, which describe where the fat sits. They are two separate, complementary classifications: you can have stage 1 with type III, for example. Each one is explained in stages of lipedema.
Because for years it has been read as excess weight or as a lack of willpower. In our study, 51.2% of participants had to consult three or more different specialists before receiving a diagnosis. That is not a patient problem: it is a recognition problem, and it explains why so many women arrive at the consultation already fairly clear about what they have.
Enter your details once and get your BMI, your waist-to-hip ratio (WHR), your waist-to-height ratio (WHtR) and the indicative result of the lipedema test. This is an educational tool: it does not replace medical diagnosis.
This tool is indicative and educational. It does not constitute a medical diagnosis nor replace the assessment of a healthcare professional. Lipedema Advanced Care | Medical direction: Dr. Alexo Carballeira.
The test is not a diagnosis: it organises your symptoms so the consultation starts from something concrete. Lipedema is diagnosed clinically, by a doctor.
In 2023 we published The Advanced Care Study in the International Journal of Environmental Research and Public Health, a descriptive study of 969 participants with lipedema in Spain. These three figures explain why half a page of frequently asked questions is really about reaching a correct diagnosis.
You can read the full study. The existence of research behind us does not guarantee a surgical outcome and we do not present it as such: what it indicates is the rigour with which the diagnosis is approached.
Treatment has two legs. The conservative one, which is the foundation and is never abandoned: compression, lymphatic drainage, movement, and weight management where there is associated excess weight. And the surgical one, considered when the above does not control the pain or when the volume limits daily life. Neither cures. Developed in lipedema treatment.
Two things need separating. Diet does not remove lipedema fat: it does not respond like normal fat, which is why many patients lose weight from the waist and the face while the legs stay put. But where there is associated excess weight, losing weight does reduce leg volume and improve symptoms, which is why it is part of the treatment. Both sentences are true at the same time.
No diet has been demonstrated for lipedema, neither ketogenic nor anti-inflammatory nor elimination-based. What there is evidence for is a healthy eating pattern and managing excess weight where it exists. If a particular pattern eases your swelling, it makes sense to keep it, but be wary of anyone selling a diet as a treatment for lipedema, or banning whole food groups without a medical reason.
Whatever you can sustain over time without increasing your pain. Water-based activity works particularly well, because the water pressure supports drainage and unloads the joints, and so does properly prescribed strength work. The aim is not to slim the leg down, which is what usually causes frustration: it is to maintain mobility, muscle mass and drainage.
They are the foundation of conservative treatment: they reduce swelling, contain the tissue, and many patients notice less pain and less heaviness at the end of the day. They do not slim the leg or remove fat. Lipedema usually calls for flat-knit fabric and firm compression, often made to measure. Classes, types and use are covered in compression garments for lipedema.
It helps with the fluid component and the sense of heaviness, and it is usually combined with compression. It does not reduce lipedema fat. Done properly it should not hurt: it is a very superficial, gentle technique, nothing like a deep-tissue or reducing massage. If it hurts or leaves bruises, it is not lymphatic drainage. More in manual lymphatic drainage.
It is one of the things patients report most in summer: more swelling, more heaviness, more pain. The reasonable explanation is that heat dilates the vessels and pushes fluid into a tissue that already has a drainage problem. What helps: a cool shower over the legs, elevating them, keeping the compression on even when it is uncomfortable, and staying out of the hottest hours.
No drug is approved to treat lipedema. Diuretics are not indicated and can be counterproductive, because the problem is not retained water. Painkillers are used for the pain, not for the disease. Any supplement offered to you as a lipedema treatment deserves a great deal of scepticism and a conversation in the consultation first.
Frequently yes, and it deserves saying. Living with pain, with a body that does not respond to effort, and with years of being read as a question of willpower carries a real emotional cost. It is not a side issue or a matter of appearance: it is part of the picture and it is worth treating, with psychological support where needed.
No. Surgery is neither the compulsory step nor the first one: it is considered when well-delivered conservative treatment does not control the pain, or when the volume limits mobility and daily life. Some patients stay on conservative treatment for years and never need an operation. And there are situations where we do not operate, on medical grounds. Explained in lipedema surgery.
Water-assisted liposuction is the technique with the longest track record in lipedema, with years of use in countries such as Germany, and the available evidence points to sustained improvement in pain and volume. That said, it is surgery: it carries risks, it requires prior assessment, and no result can be guaranteed. The specific risks in your case are explained in the consultation before any decision.
Fat removed from an area does not re-form there in the same way, and the improvement in pain and volume holds over time in most published series. But the lipedema is still there: it is chronic, it can show up in other areas, and conservative treatment continues afterwards. Having surgery is not closing the subject, it is changing the starting point.
Yes, it is the same technique under three names. WAL stands for water-assisted liposuction, Bodyjet is the best-known device it is performed with, and ACualipo is what we call it, to make it more understandable: it is the clinic's own naming, not a different medical term. The technique is in WAL liposuction.
No. It can be done under local anaesthesia with sedation, epidural or general, depending on the areas treated, the volume planned and your medical history. The anaesthetist decides it with you at the pre-operative assessment, and it is one of the things worth asking about before choosing where to have surgery.
Sometimes yes. Circumferential calves combined with the inner thigh and saddlebags is a frequent combination, and in some cases full thighs and calves can be done in the same procedure. It depends on how much tissue has to be removed and on the safety of the procedure, so we work by priorities: whatever limits you most comes first.
If a different area is to be treated, waiting around three months is reasonable, which is what the body takes to recover haematologically. If it means revisiting the same area, longer: the tissue keeps settling for months and the skin retracts for up to around eight, so operating sooner means judging a result that is not final yet.
There is no universal figure: it depends on your weight, your general health, the type of anaesthesia and the anaesthetist's judgement. In our planning we use a safety reference of around 10% of body weight, counting settled fat and not saline, which is why high-volume cases are resolved across several sessions rather than forcing a single one.
It has to be taken into account and it demands more care during the procedure, even when the varicose veins are superficial. That is why the duplex ultrasound study is done before surgery is indicated and not after: if venous disease shows up, it changes the planning, the order of treatments, and in some cases the indication itself.
It is advisable, and as a reference we do not usually operate above a body mass index of 32. This is not a cosmetic preference: it affects the safety of the anaesthesia, the healing and the quality of the result. In some cases, when excess skin remains after the liposuction, complete treatment of the area includes a later skin-removal procedure.
The skin retracts on its own over months, so the first thing is to wait and not judge the result too early. In the meantime non-invasive treatments such as radiofrequency, carboxytherapy or lymphatic drainage help: the effect is real but moderate. If excess skin remains at the end and bothers you, a skin-removal procedure is assessed.
It depends on your circumstances, and it is a conversation for the consultation. As general guidance, operating beforehand avoids the skin being stretched by pregnancy over an area that has already been treated. In areas treated deeply the same volume does not usually return, although pregnancy is a major hormonal change and can affect untreated areas.
Any affected area can be treated. The usual order is to start with calves and thighs, which is where the limitation is greatest, and treat the arms afterwards. In the arms the technique and the recovery are similar to the legs, with the advantage that the volume is usually smaller and the return to activity faster.
It depends on the area, the volume removed and your job. You walk from day one but with restrictions, and compression is worn continuously for weeks. Desk work usually means an earlier return than work on your feet or with physical effort. The realistic timeline for each phase is in recovery after surgery.
We do not publish price lists, because the cost depends on the areas, the volume to be treated, the number of sessions needed and the type of anaesthesia, and quoting a figure without having seen the case would mean inventing it. What we do is provide the quote in writing after the assessment, with areas and sessions itemised, so you can compare it calmly.
Clinical history and examination with the surgeon, vascular study with duplex ultrasound by the team angiologist, 3D body scan and body indices, all within the same visit. You leave knowing whether you have lipedema, at what stage and type, the state of your venous system and what your options are. The full process is in the Advanced Care Method.
In Valencia, Spain, at Gran Vía del Marqués del Turia, 20, by appointment only, Monday to Friday. You can book on +34 665 027 006 or by leaving your details in the form on this page. Valencia has an international airport with direct connections to most of Europe.
Yes, and it is common. The diagnostic assessment has to be in person, because it relies on the physical examination and the duplex ultrasound. What can be resolved beforehand by phone or video is whether your case fits and what to expect, so the trip is worthwhile. The schedule is arranged so that everything is resolved in a single journey.
Consultations are held in Spanish and English. If you would prefer another language, tell us when you book so we can arrange it.
You will be told, and pointed towards where it does belong. Ruling out is part of the diagnostic work: distinguishing lipedema from lymphoedema, from venous insufficiency or from other causes of increased volume is precisely what justifies two specialties assessing the same case.
