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March 19, 2026
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Lipedema SURGERY in Singapore
Lipedema is one of the most commonly misunderstood conditions affecting women in Singapore, and one of the least talked about.
Characterised by a disproportionate accumulation of fat in the lower body, particularly the hips, thighs, calves, and sometimes arms, it is frequently mistaken for obesity or dismissed as a consequence of poor lifestyle habits.
Diet, exercise, and weight management do not address the underlying problem because lipedema fat is not ordinary fat. It is a painful fat disease. The disproportion persists regardless of how much weight is lost elsewhere.
Affecting an estimated 11% of adult women, lipedema is also a painful condition characterised by tenderness, easy bruising, and heaviness in the affected limbs.
At Amaris B. Clinic, lipedema surgery using Dr Ivan Puah's MDC-Sculpt® Lipo Technique targets diseased fat tissue directly, aiming to relieve symptoms and restore function.
Book a consultation now.
WHAT IS LIPEDEMA (LIPOEDEMA)?
Lipedema (lipoedema), also known as "adiposis dolorosa" or "painful fat" [1], is a chronic condition predominantly affecting women; it is thought to affect approximately 11% of adult women [2].
This medical condition is characterised by the abnormal accumulation of excessive fat tissue in a particular pattern, in specific areas of the extremities, disproportionate to the rest of the body.
WHAT ARE THE SYMPTOMS OF LIPEDEMA (LIPOEDEMA)?
LIpedema is a fat build-up typically occurring bilaterally and symmetrically, affecting the hip, upper and lower legs and arms.
Other symptoms include
- Chronic pain and tenderness
- Progressive mobility restrictions
- A substantial decline in the overall quality of life
- Heightened susceptibility to bruising, swelling, cold skin, spider veins, enlarged knee fat pads, and hypermobile joints
Symptoms of lipedema (lipoedema) can lead to psychological issues, such as low self-esteem.
What causes lipedema?
Despite ongoing research efforts, the exact cause of lipedema remains elusive.
Lipedema can affect people who are of healthy weight too, not just people who are obese.
Lipedema progression varies among individuals. While some may experience minimal or no progression, others may advance more rapidly.
Hormonal changes, childbirth, menopause, weight fluctuations, and stress can accelerate progression, though other illnesses may also contribute, albeit rarely.
What are the Key characteristics of lipedema?
Fatty deposits primarily in the legs, occasionally in the arms
Symmetrical involvement of both legs and/or arms
Exacerbated by obesity, though it may or may not be directly associated with it
Lipedema (Lipoedema) may sometimes be worsened by lymphedema
Patients may have increasingly worsened swelling in the legs during the day and improve overnight
What Should You Look for During a Visual Self-Observation for Lipedema?
Examine if you have bat wings
Start by examining if you have “bat wing” appearances in the upper arms, as approximately 80% of women with lipedema have this characteristic [2].
Disproportionate body proportions
Individuals with lipedema often notice a significant disproportionate difference between the lower and upper half of their body.
This discrepancy may result in wearing different top and bottom sizes. Some may experience an extreme pear-shaped body, with a slim waist but larger lower body proportions.
Observe the shape of your legs
Observe the shape of your legs. Are they thick and column-like [3], lacking definition around the knees?
This characteristic is common in those with lipedema and can be a key indicator.
Pay attention to your ankles and feet
In lipedema, fat accumulates around the back of the ankles, forming “cankles”.
This unique pattern is a clinical sign exclusive to lipedema, although not all patients may experience it.
Large fat deposits on the outer thighs
Large fat deposits that extend outward beyond the normal curve of the hips, resembling “football saddlebags” or enlarged buttocks that protrude significantly from the lower back (from the side view), are commonly observed in women with lipedema.
Easy bruising and skin hypersensitivity
Those with lipedema often experience easy bruising and sensitivity in the affected areas [7], and even gentle touches may cause pain.
HOW TO PERFORM A SELF-CHECK FOR LIPEDEMA? THE PINCH TEST FOR LIPEDEMA
The pinch test is the only self-check for lipedema to evaluate skin texture, pain response, and tissue consistency.
During the pinch test, if you experience pain or notice a different texture in the affected area compared to other parts of your body, you may have lipedema. However, it is important to remember that the pinch test should NOT be considered a definitive diagnosis.
WHAT ARE THE LIPEDEMA SYMPTOMS IN THE LEGS & ARMS?
Scroll to view the table
| Symptoms | Lipedema in the arms | Lipedema in the legs |
|---|---|---|
| Body part affected | Uncommon, but when it occurs, it usually affects the upper arms. Can occur in one or both arms. | Hips, inner thighs, outer thighs, calves, buttocks, and ankles but not the feet. Can occur in one or both legs. |
| Appearance | Swelling in lower arms but never affects the hands. | Lipedema in the legs often show a column-like appearance. |
| Dimpled skin | ✓ In more severe cases | ✓ In more severe cases |
| Loose skin | ✓ Can lead to skin folds | ✓ Can cause loose skin |
| How it feels | Feels soft, 'spongy' and cool | Feels soft, 'spongy' and cool |
| Bruising | ✓ Easily bruises even from minor bumps | ✓ Easily bruises even from minor bumps |
| Varicose or spider veins | X | ✓ |
| Swell, pain, tenderness & fatigue | ✓ Pain varies from dull to sharp | ✓ Swelling may worsen later in the day, after physical activity, or in hot weather. |
| Limited mobility | ✓ | ✓ |
| Impact on quality of life | ✓ Including low self-confidence and self-image | ✓ Including low self-confidence and self-image |
LIPEDEMA VS CELLULITE: WHAT ARE THE KEY DIFFERENCES?
Scroll to view the table
| Differences | CELLULITE | LIPEDEMA |
|---|---|---|
| Symptoms | Painless. Characterised by dimples and depressions, resulting in an irregular surface texture of the skin giving the skin a “cottage cheese” or “orange peel” kind of appearance | Characterised by pain, tenderness, and excessive clustering of fat cells |
| Type of condition | Aesthetically troubling skin condition | Medical condition |
| Severity | 4 grades of cellulite | 5 types and 3 stages |
| Treatment Approaches | Non-invasive treatment, topical agents, energy-based therapy, massage, subcision, cosmetic injectables, exercise and diet | Compression therapy, exercise, lymph drainage and massage, nutrition & supplements and liposuction |
| Gender | Affects women mostly | Affects women mostly |
WHAT'S THE Difference BETWEEN Lipedema & Lymphedema?
Lipedema is often mistaken for an obesity issue or lymphedema due to its similar appearance.
While lipedema and lymphedema are both medical conditions that can cause swelling in the arms and legs, they have different causes, symptoms, and treatments.
Here is a clear comparison of the differences between lipedema and lymphedema.
Scroll to view the table
| Differences | Lymphedema | LIPEDEMA |
|---|---|---|
| Symptoms | Buildup of lymphatic fluid | Buildup of fatty tissue |
| Appearance | Often unilateral and may appear to be either symmetrical or asymmetrical | Appears bilaterally and symmetrically |
| Types | Two main types of lymphedema: primary (inherited) and secondary (acquired) | Four stages and five types of lipedema |
| Causes | Causes of primary lymphedema include Milroy’s disease, Meige’s disease, and late-onset lymphedema. Secondary lymphedema is caused by lymphatic system damage | A connective tissue disorder |
| Body parts | Commonly found in the legs and arms | Commonly found in the arms, hips and legs |
| Pain | An overall feeling of pain of heaviness or tightness | Pain felt from the inflamed and hardened, fat nodules beneath the skin |
| Skin infection and open wounds | Common | Rare |
WHAT MEDICAL CONDITIONS CAN BE MISTAKEN FOR LIPEDEMA?
Lipedema shares symptoms with several other disorders, leading to frequent confusion.
Lymphedema
Lymphedema results from lymphatic fluid accumulation, while lipedema involves abnormal fat deposition.
Acquired Lipodystrophy
This condition causes fat loss or changes in fat distribution and can look like lipedema.
Lipohypertrophy
Localised, rubbery fat buildup at sites of repeated insulin injections, distinct from lipedema's bilateral, genetic pattern.
Fibromyalgia
Those with lipedema may be misdiagnosed with fibromyalgia because they have similar symptoms, like pain and fatigue.
Chronic Venous Insufficiency (CVI)
Causes swelling, heaviness, and skin changes (like varicose veins) due to poor blood return, which can co-exist with or be confused for lipedema.
WHAT ARE THE THREE STAGES OF LIPEDEMA?
Lipedema is categorised into 3 stages. The different stages present different levels of pain swelling, fat build-up and tenderness in the patient.
Stage 1: The skin is smooth, and the legs can appear normal but there is pain, easy bruising and a nodular feel to the fat tissue [14].
Stage 2: The lipedema fat exhibits a mattress-like pattern indicating fibrosis under the skin that tethers on the skin that can be found on the upper legs (Type II) or extend down to the ankles (Type III)[14].
Stage 3: There are folds of tissue and the lipedema fat usually extends down to the ankles[14].
WHAT ARE THE FIVE TYPES OF LIPEDEMA?
The distribution of fat accumulation in individuals with lipedema varies depending on the type of lipedema they have. There are five types of lipedema, and they are not necessarily exclusive[13].
Type I
Buttocks, hips (saddlebags)
Type II
Buttocks, hips, thighs
Type III
Thighs, calves, ankles
Type IV
Arms
Type V
Ankles, calves
WHAT ARE THE HEALTH IMPLICATIONS OF LIPEDEMA?
Joint immobility
Mobility limitations and joint issues, such as accelerated arthritis in the knees and ankles due to excess adipose tissu [4].
Gait limitations
Gait limitations, especially around the knee and ankle joints.
Secondary obesity may exacerbate mobility impairments[4].
Vascular risks
Vascular risks associated with lipedema include an increased likelihood of varicose veins, secondary lymphedema, and a higher risk of blood clots, particularly when combined with obesity[4].
Small vein vasculopathy
Small vein vasculopathy, resulting in easy bruising, spider veins (telangiectasias), and varicose veins[4].
Blood clots
Secondary obesity further raises the risk of deep vein thrombosis (DVT) or blood clots.
CONSERVATIVE VS SURGICAL LIPEDEMA TREATMENT COMPARISON: WHICH ONE SUITS YOU?
Scroll to view the table
| Treatment Type | Best For | Results |
|---|---|---|
| Conservative (Physical therapy, compression, exercise) | Symptom management, early stages, pre/post surgery support | Cannot remove diseased fat tissue; requires ongoing commitment |
| Surgical (Liposuction) | Stages 2 to 3, pain that limits daily life, failed conservative treatment | Remove diseased fat tissue, alleviate physical symptoms such as pain and tenderness. Improve range of motion and quality of life |
Important: Liposuction is clinically proven to be the effective treatment for lipedema. However, many doctors recommend establishing healthy conservative treatment habits before surgery, as these routines will be important for long-term results.
WHAT is the CLINICAL DIAGNOSIS OF LIPEDEMA BY DR IVAN PUAH IN SINGAPORE?
Visual Inspection
The doctor will assess for:
- symmetrical limb enlargement
- a disproportionate body shape
- skin changes
Palpation
Lipedema-affected tissue feels like peas or rice under the skin
Negative Stemmer Sign Test
Negative sign = Being able to pinch the skin suggests lipedema.
Positive sign = Indicate presence of lymphedema AND lipedema.
Detailed Medical History
Share with doctor your:
- family history
- medical history
- symptoms
- mobility limitations
- underlying medical conditions
WHO ARE THE SUITABLE CANDIDATES FOR LIPEDEMA SURGERY?
Tried other alternative remedies
Those whose conditions do not improve with regular exercise, compression therapy, or dietary changes seek proven solutions to relieve lipedema symptoms.
General Health
Candidates should be in good health, physically and mentally, without any underlying medical conditions.
Pregnant or breastfeeding women are not suitable to undergo the procedure.
Realistic Expectations
Lipedema surgery with liposuction helps alleviate symptoms.
It also improves quality of life and relieves painful physical symptoms.
Commitment To Post-Op Care
Patients need to follow the doctor's advice for a smooth recovery.
This includes wearing compression garments and attending regular MLD therapy.
WHAT IS LIPEDEMA SURGERY WITH MDC-SCULPT®️ LIPO TECHNIQUE?
Lipedema often goes undiagnosed or misdiagnosed, leaving patients grappling with ongoing pain and disappointment. It does not respond to diet and exercise [3], thus requiring surgical intervention.Lipedema Surgery with the MDC-Sculpt®️ Lipo Technique removes “diseased” fat deposits, alleviates swelling and relieves patients from pain.
Lipedema surgery (via liposuction)[1] differs from cosmetic liposuction. Individuals with lipedema often have impaired lymphatic function, thus leading to additional fat cells proliferation and potential lymphatic system strain.
Lipedema Surgery with the MDC-Sculpt®️ Lipo Technique by Dr Ivan Puah uses a three-dimensional liposuction approach and the use of specialised cannulas with tumescent anaesthesia to minimise injury to the lymphatic system.
He focuses on reducing and removing the “sick” fat tissues, alleviating physical symptoms.
Lipedema Surgery potentially improves patients’ overall well-being, and not just for cosmetic purposes.
It also opens the door to a more active lifestyle they may not have experienced previously [6].
WHAT ARE THE GOALS OF LIPEDEMA SURGERY?
Pain Relief
Reduce or eliminate chronic pain in affected limbs
Improved Mobility
Restore range of motion and ease of movement
Quality of Life
Improve physical and emotional wellbeing
Prevention of Progression
Stop or slow disease advancement
Body Proportion
Restore proportional body contours
Reduced Swelling
Decrease chronic edema and heaviness
WHAT ARE THE EXPECTED RESULTS & RECOVERY TIMELINE?
Scroll to view the timeline
Day 1 - 3
Rest at home; drainage from incisions are normal.
Return to work within 2-3 days.
Put on your compression garment 24/7 for 6-8 weeks.
Week 1 -2
Light walking is encouraged.
MLD therapy begins; most swelling and bruising.
Week 4 - 6
Light exercise permitted; significant swelling reduction.
Continue with compression garment.
Week 8+
Continue with compression garment.
Return to full gym work as advised by the doctor.
Month 3 - 6
Final results visible.
HOW MUCH DOES LIPEDEMA SURGERY COST IN SINGAPORE?
Lipedema is a chronic disorder that affects the legs and arms, causing them to be symmetrical, disproportionate and characterised by painful, tender fat. However, at the current moment, this procedure is not eligible for insurance claim.
What affects the cost?
Your total surgical fees vary based on several factors such as:
- Your doctor’s experience
- Anaesthesia type (Local or general)
- Duration of anaesthesia
- Specific surgical techniques employed
- Facility charges (Hospital or day surgery)
- Your unique anatomy and tissue complexity
- Miscellaneous Charges such as laboratory investigations, etc.
CAN I SEE BEFORE-AND-AFTER PHOTOS OF PREVIOUS PATIENT CASES DURING PRIVATE CONSULTATION?
We provide before-and-after photos privately during your one-on-one consultation with Dr Ivan Puah. You will be able to view anonymised images of actual patients who had undergone lipedema surgery.
They allow you to:
- Visualise potential outcomes specific to your condition
- Understand surgical approaches in detail
- Discuss realistic expectations for scarring, recovery, and results
Disclaimer: While these clinical visuals are shared in-clinic for your education, MOH strictly prohibits displaying before/after images in ANY public advertising (website, social media, brochures etc). We fully comply to ensure ethical patient communication, no unrealistic outcome promises and protection of patient privacy. Visual examples are for educational reference only - individual results vary based on your unique condition.
DR IVAN PUAH - LIPOSUCTION DOCTOR AND CREATOR OF MDC-SCULPT®️ LIPO TECHNIQUE
Having been trained to perform liposuction is only the beginning.
Dr Ivan Puah believes it is crucial to understand and master the technicalities of the procedure, including the potential complications that may arise. To be meticulous in approach, with a detailed overview and foresight capabilities, are essential must-haves for a doctor.
Dr Ivan Puah
Dr Ivan Puah is an accredited liposuction doctor and Chairman of Lipo Peer Review Committee in Singapore with over two decades of surgical body contouring experience.
He has completed fundamental and advanced Vaser Liposuction body sculpting surgical training under Dr John Milard and Dr Alfredo Hoyos in Argentina and Colorado.
Dr Puah is also trained in laserlipolysis (laser liposuction) in Italy and has received dedicated gynecomastia surgery training in San Francisco.
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FAQ
What role do diet and exercise play in managing lipedema?
Dietary adjustments, including a low carbohydrate diet emphasising whole foods with a low glycemic index, can help to manage lipedema.
Maintaining an active lifestyle with cardiovascular and resistance exercises is crucial. Water-based exercises are particularly beneficial as they offer resistance and cardiovascular benefits, as well as support lymphatic flow.
Can you diagnose and determine my lipedema stage online?
Unfortunately, diagnosing lipedema requires a physical examination as the doctor will need to assess your clinical condition, such as skin nodularity and texture, oedema, etc., and these cannot be done virtually.
Do I need to put on a compression garment post-surgery?
It is crucial for lipedema patients to put on compression garments 24/7 for 6-8 weeks minimally.
Can lipedema go away with weight loss?
Lipedema does not respond well to restrictive diets, contrary to usual forms of obesity. Thus, lipedema leads to a disproportionate increase in lower body tissue that stubbornly retains its shape (waist to ankles) after diets or bariatric surgery [9].
Can lipedema be cured naturally?
Most often, the most commonly used diet strategies are anti-inflammatory, low-carbohydrate, and ketogenic diets [11]. Lymphatic drainage can also be used as a strategy to manage lipedema. However, it cannot be cured through natural means.
What should I look out for post-surgery?
After the lipedema surgery, it's crucial to understand that recovery is a gradual process spanning several months. In the initial weeks post-surgery, expect swelling and tenderness, with recovery duration influenced by the extent of the surgery.
Strict adherence to compression garments is essential for proper healing and restoration of lymphatic function. Additionally, incorporating manual lymphatic massage can significantly aid in recovery and maintain results post-surgery.
Is lipedema surgery permanent?
While a small percentage of individuals may experience symptom recurrence in treated areas, ongoing adherence to dietary and non-surgical lipedema maintenance treatments may mitigate or prevent recurrence [5].
Adopting a lifelong diet rich in whole foods and limited refined carbohydrates remains crucial for long-term management.Most patients observe improvements in pain, swelling, mobility, and overall quality of life following lipedema surgery [6].
Reference
[1] Damstra, RJ. First Dutch guidelines on lipedema using the international classification of functioning, disability and health. Phlebology. 2017 Apr;32(3):152-159.
[2] Torre YS, Wadeea R, Rosas V, Herbst KL. Lipedema: friend and foe. Horm Mol Biol Clin Investig. 2018 Mar 9;33(1):/j/hmbci.2018.33.issue-1/hmbci-2017-0076/hmbci-2017-0076.xml. doi: 10.1515/hmbci-2017-0076. PMID: 29522416; PMCID: PMC5935449.
[3] Tartaglione G, Visconti G, Bartoletti R, Ieria FP, Salgarello M. Rest/stress intradermal lymphoscintigraphy in diagnosis of lipedema. World J Nucl Med. 2020 Jun 27;19(4):376-381. doi: 10.4103/wjnm.WJNM_5_20. PMID: 33623507; PMCID: PMC7875021.
[4] Buck, D. W. & Herbst, K. L. Lipedema: a relatively common disease with extremely common misconceptions. Plast. Reconstr. Surg. Glob. Open 4, e1043 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055019/
[5] Wright T, Babula M, Schwartz J, Wright C, Danesh N, Herbst K. Lipedema Reduction Surgery Improves Pain, Mobility, Physical Function, and Quality of Life: Case Series Report. Plast Reconstr Surg Glob Open. 2023 Nov 30;11(11):e5436. doi: 10.1097/GOX.0000000000005436. PMID: 38046224; PMCID: PMC10688775.
[6] Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012 Jan;166(1):161-8. doi: 10.1111/j.1365-2133.2011.10566.x. Epub 2011 Nov 17. PMID: 21824127.
[7] Anne Warren Peled A, Kappos E. Lipedema: diagnostic and management challenges. Int J Womens Health. 2016;8:389-395 https://doi.org/10.2147/IJWH.S106227
[8] Meier-Vollrath I, Schneider W, Schmeller W. Lipödem: Verbesserte Lebensqualität durch Therapiekombination. Dtsch Ärztebl 2005; 102: A 1061-1067.
[9] Bonetti G, Herbst KL, Dhuli K, Kiani AK, Michelini S, Michelini S, Ceccarini MR, Michelini S, Ricci M, Cestari M, Codini M, Beccari T, Bellinato F, Gisondi P, Bertelli M. Dietary supplements for lipedema. J Prev Med Hyg. 2022 Oct 17;63(2 Suppl 3):E169-E173. doi: 10.15167/2421-4248/jpmh2022.63.2S3.2758. PMID: 36479502; PMCID: PMC9710418.
[10] van Esch-Smeenge J, Damstra RJ, Hendrickx AA. Muscle strength and functional exercise capacity in patients with lipoedema and obesity: a comparative study. J Lymphoedema 2017;12:27-31.
[11] Amato ACM, Benitti DA. Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases. Am J Case Rep. 2021 Dec 6;22:e934406. doi: 10.12659/AJCR.934406. PMID: 34871293; PMCID: PMC8667633.
[12] Herbst KL, Kahn LA, Iker E, et al. Standard of care for lipedema in the United States. Phlebology. :2021. [Online ahead of print]
[13] Földi, E., and Földi, M. (2006) Lipedema. In Földi’s Textbook of Lymphology (Földi, M., and Földi, E., eds) pp. 417-427, Elsevier GmbH, Munich, Germany
[14] Herbst KL. Subcutaneous Adipose Tissue Diseases: Dercum Disease, Lipedema, Familial Multiple Lipomatosis, and Madelung Disease. [Updated 2019 Dec 14]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
Figure 2. [Three stages of legs of...]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK552156/figure/obesity_subcut_adip.F2/
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