Cellulite or Lipedema? Understanding the Differences (and Where Lymphedema Fits)

Many women notice changes in their legs, hips, or arms and are told it’s “just cellulite”. But for some, these changes may actually reflect lipedema - a chronic, under‑diagnosed condition with hormonal, inflammatory, and lymphatic drivers.

Understanding the differences between cellulite, lipedema, and lymphedema is essential for choosing the right support strategies and avoiding unnecessary self‑blame.

What is Cellulite?

Cellulite is a cosmetic change in skin appearance caused by fat cells pushing up against connective tissue beneath the skin. Cellulite typically develops after puberty, coinciding with oestrogen exposure and female connective tissue patterning. Its appearance may change across the lifespan, particularly during periods of hormonal change, and is independent of overall body fat for many women.

Key features:

• Very common (affects ~80–90% of women)

• Appears as dimpling or an “orange peel” texture

• Common on thighs, hips, and buttocks

• Not painful

• Fat distribution remains proportionate

• Can fluctuate with hydration, hormones, and body fat levels

What drives cellulite?

• Oestrogen‑mediated fat storage

• Reduced collagen and connective tissue integrity

• Impaired microcirculation

• Genetic predisposition

Cellulite does not indicate disease and is not associated with inflammation or fluid accumulation.

What is Lipedema?

Lipedema is a chronic adipose tissue disorder characterised by abnormal fat accumulation, most commonly in the legs and sometimes the arms.

It is frequently misdiagnosed as obesity or cellulite. Lipedema follows a similar hormone-linked timing to cellulite but differs fundamentally in mechanism. It typically first appears around puberty and may worsen during other periods of hormonal change.

Key features:

• Almost exclusively affects women

• Typically appears or worsens at puberty, pregnancy, or perimenopause/menopause

• Disproportionate fat accumulation (lower body larger than upper body)

• Fat is painful or tender to touch

• Easy bruising

• Swelling that worsens through the day

• Feet are usually spared ("cuff sign" at the ankles)

• Resistant to calorie restriction and exercise

Lipedema is not caused by excess calorie intake or lack of physical activity.

Hormonal influences:

• Heightened sensitivity of fat tissue to oestrogen

• Oestrogen dominance or impaired oestrogen clearance

• Progesterone decline (common in perimenopause)

• Insulin resistance within lipedema fat tissue

Other drivers:

• Chronic low‑grade inflammation

• Impaired lymphatic flow

• Altered adipocyte (fat cell) growth and fibrosis

• Genetic predisposition

This explains why lipedema often progresses during hormonal transitions rather than with calorie excess.

Treatment & Management Strategies for Lipedema

Lipedema is a chronic, progressive condition, meaning management focuses on reducing symptoms, improving quality of life, and slowing progression rather than cure or weight loss.

Effective care is typically multi-disciplinary and individualised, often combining conservative therapies with medical support.

Compression therapy

Compression garments are a cornerstone of lipedema management. When properly fitted, compression may help to reduce daily swelling and heaviness, improve comfort and mobility, and support lymphatic and venous circulation. While compression does not remove lipedema fat, many women report meaningful improvements in pain, fatigue, and functional capacity with consistent use.

Manual lymphatic drainage (MLD)

Manual lymphatic drainage is a gentle, specialised massage technique designed to stimulate lymph flow. In people with lipedema, MLD may help reduce tissue tenderness, improve swelling that worsens throughout the day, and support overall lymphatic function. MLD is often used alongside compression therapy for best results.

Movement & exercise (including rebounding)

Movement plays an important role in lipedema management, but the type of exercise matters.

Low-impact, joint-friendly activities are generally best tolerated, including walking, swimming or water-based exercise, resistance training, and gentle lymphatic-style movement.

Rebounding can support lymphatic flow through rhythmic muscle contraction and pressure changes, but it should be introduced gradually and discontinued if it increases pain, heaviness, or swelling. Exercise should feel supportive - not punishing.

Surgical options

In some cases, specialised lipedema-aware liposuction may be considered. This is not cosmetic surgery. When appropriately selected, surgery may help reduce pain and pressure, improve mobility and function, and slow disease progression. Surgical outcomes are best when combined with ongoing conservative care, including compression, movement, and nutrition support.

Nutrition support

Nutrition does not reverse lipedema fat, but it can significantly influence symptom severity and progression. Nutrition strategies focus on reducing chronic inflammation, supporting hormone metabolism and insulin sensitivity, improving gut and liver function, and supporting lymphatic health.

Importantly, aggressive calorie restriction and repeated dieting can worsen symptoms and are not recommended for lipedema management.

1. Anti‑inflammatory foundation

• Omega‑3 rich foods (fatty fish, flax, chia)

• Colourful polyphenol‑rich vegetables and berries

• Extra virgin olive oil

  
  

2. Blood sugar regulation

• Adequate protein at each meal

• Lower glycaemic carbohydrate choices

• Avoid extreme calorie restriction

  
  

3. Support oestrogen clearance

• Cruciferous vegetables (broccoli, kale, cabbage)

• Adequate fibre for gut‑hormone clearance

• Liver support nutrients (B vitamins, magnesium)

  
  

4. Reduce fluid retention triggers

• Adequate hydration

• Sodium–potassium balance

• Limit ultra‑processed food

Lipedema vs Lymphedema: What’s the Difference?

While they are often confused, lipedema and lymphedema are different conditions.

Lymphedema explained:

• Caused by impaired lymphatic drainage

• Leads to fluid accumulation

• Often affects one limb more than the other

• Can occur after surgery, radiation, infection, or injury

• Feet and hands are involved

• Swelling may pit when pressed

Advanced lipedema can progress into secondary lymphedema (sometimes called lipo‑lymphedema).

Why Awareness Matters

Women with lipedema are often told to:

• “Eat less”

• “Train harder”

• “Accept cellulite”

This can lead to frustration, shame, and disordered eating.

Correct identification allows for compassionate care, targeted nutrition support, reduced progression and pain --> Improved quality of life.

Final Thoughts

Cellulite is common and cosmetic.

Lipedema is medical, hormonal, and inflammatory.

If you’d like support navigating lipedema, hormones, and nutrition in perimenopause or menopause, personalised guidance matters.

By: Tracy O'Brien, Clinical Nutritionist & business owner of RAW Human Nutrition.