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BACKGROUND: Lipedema is a chronic disorder of adipose tissue that predominantly affects women and is frequently misdiagnosed as obesity or lymphedema. Traditionally associated with the lower extremities, lipedema can also involve the abdominal region, although there are currently no established diagnostic criteria for abdominal lipedema. This study aims to propose a diagnostic algorithm for abdominal lipedema based on clinical features, macroscopic observations, and ultrasound findings. METHODS: This retrospective study analyzed data from 327 patients treated between March 2018 and March 2024 for lipedema, including those with abdominal involvement. Clinical evaluations, ultrasound imaging, and surgical outcomes were examined to assess the prevalence and characteristics of abdominal lipedema. Patients were classified based on lipedema severity, and criteria for abdominal lipedema diagnosis were established through clinical and imaging data. RESULTS: The study identified that abdominal involvement increases with the severity of lipedema, with 31% of patients with stage II lipedema and 70% of those with stage III lipedema exhibiting abdominal manifestations. The proposed diagnostic algorithm includes maximum, major, and minor criteria, such as symmetrical fat deposition, pain, and non-responsiveness to diet and exercise. Specific threshold values for each category were defined to establish the diagnosis. The findings highlight the existence of both ascending (from legs to abdomen) and descending (from arms to abdomen) centripetal progression patterns, challenging traditional notions that limit lipedema to the extremities CONCLUSION: Abdominal lipedema is a significant and underrecognized manifestation of the condition, requiring specific diagnostic criteria to ensure accurate diagnosis and appropriate treatment. The study proposes a diagnostic framework based on clinical and imaging features that can improve the recognition and management of abdominal lipedema. Multidisciplinary treatment approaches, including both conservative measures and surgical interventions such as abdominoplasty and liposuction, are recommended to improve patient outcomes. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

BackgroundLipedema is a chronic disorder involving abnormal accumulation of subcutaneous fat, primarily in the lower limbs. Liposuction is an effective treatment, but postoperative complications such as fluid retention and seroma formation are common. While the use of surgical drains is well established in other areas of plastic surgery, their role in lipedema liposuction remains unclear.MethodsThis prospective observational study involved 50 consecutive patients with stage II or III lipedema who underwent lower leg liposuction. A novel passive drainage technique was used, involving glove drains fashioned from sterile, powder-free nitrile gloves and inserted through existing liposuction incisions. Drain duration, postoperative swelling, and complications, particularly seroma formation, were evaluated.ResultsAll patients completed follow-up with no major complications. Glove drains remained in place for an average of 2.4 ± 0.5 days. Only 2 patients (4%) developed seromas requiring single aspiration. No infections, hematomas, or lymphatic complications were recorded. Patients reported reduced swelling and discomfort compared to historical cases without drains.ConclusionPassive glove drains appear to be a simple, safe, and effective method to manage postoperative fluid collections after lipedema liposuction of the lower legs. The technique may lower the risk of seroma formation and promote early recovery, characterized by reduced postoperative edema, improved patient comfort, and an uncomplicated short-term postoperative course. Further controlled studies are needed to validate these findings and establish standardized drainage protocols in lipedema surgery.

BACKGROUND: Postoperative fibrosis is a frequent complication following liposuction for lipedema. Serrapeptase, a proteolytic enzyme with purported anti-inflammatory and antifibrotic effects, is used empirically, but robust evidence supporting its efficacy is lacking. This study aimed to assess the clinical effectiveness of postoperative serrapeptase supplementation in reducing fibrosis following lower limb liposuction for lipedema. METHODS: This retrospective, observational cohort study included 50 female patients with a confirmed diagnosis of lipedema undergoing tumescent liposuction. Patients were allocated to either a serrapeptase group (n = 25), receiving 60,000 IU daily for 4 weeks, or a control group (n = 25) receiving standard care alone. The primary outcome was tissue stiffness measured by quantitative ultrasound elastography (QUS). Secondary outcomes included B-mode ultrasonography, patient-reported pain (VAS), and clinical assessment of induration. Evaluations were performed at baseline, 4 weeks, and 3 months. RESULTS: Baseline characteristics were comparable between groups. No statistically significant differences were observed in the primary outcome of tissue stiffness at 4 weeks (14.8 ± 3.1 kPa vs. 15.2 ± 3.0 kPa; p = 0.62) or 3 months (13.7 ± 2.9 kPa vs. 14.0 ± 3.2 kPa; p = 0.78). Similarly, no significant benefits were seen in secondary outcomes, including fibrotic changes on ultrasound, VAS pain scores, or clinical induration (p > 0.05 for all). Serrapeptase was well-tolerated with no adverse events reported. CONCLUSIONS: Oral serrapeptase supplementation did not demonstrate measurable efficacy in preventing postoperative fibrosis or improving patient-reported outcomes following liposuction for lipedema. These findings do not support its routine use in this clinical setting. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

BACKGROUND: Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that mainly affects women. It is characterized by disproportionate fat hypertrophy, pain, bruising, and marked resistance to diet and exercise. Tumescent liposuction remains the only effective treatment to slow or reverse disease progression, but involves large volumes and fragile microvasculature, increasing bleeding risk. OBJECTIVE: This study aimed to evaluate whether perioperative tranexamic acid (TXA) reduces intraoperative blood loss, postoperative bruising, and early complications in lipedema liposuction. METHODS: We retrospectively analyzed 230 staged liposuction procedures for lipedema performed between 2021 and 2024 at a single center. Patients received TXA intravenously, locally, or in combination, or no TXA. Primary outcomes were estimated intraoperative blood loss and postoperative ecchymosis. Secondary endpoints included hematoma, transfusion need, thromboembolic events, infections, and recovery time. RESULTS: All TXA groups showed significantly lower intraoperative blood loss and hemoglobin drop versus controls (p < 0.01). Local and combined routes were most effective, with the combined approach yielding the lowest ecchymosis scores. Hematoma rates dropped from 12% (no TXA) to 0-6.7% (TXA), and no thromboembolic or infectious complications were observed. No TXA-treated patients required transfusions, while 6% of controls did. CONCLUSIONS: TXA use in lipedema liposuction significantly reduces bleeding and bruising without increasing thromboembolic risk. Combined systemic and local administration appears most beneficial. These findings support TXA as a safe, effective adjunct in multistage, high-volume liposuction for lipedema. Prospective trials are needed to confirm the optimal protocol in this unique population. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

INTRODUCTION: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat deposition, pain, and progressive functional impairment. Although diagnosis remains primarily clinical, ultrasound has emerged as a valuable adjunctive tool for diagnosis, surgical planning, intraoperative guidance, and postoperative monitoring. The aim of this review was to provide a comprehensive overview of the current and potential applications of ultrasound throughout the entire surgical management pathway of patients with lipedema. MATERIALS AND METHODS: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, and Google Scholar databases. Articles published up to January 2026 were screened using the keywords "lipedema," "lipoedema," "ultrasound," "ultrasonography," "lipedema diagnosis," "lipedema imaging," "lipedema surgery," and "liposuction." Studies addressing ultrasound-based diagnosis, differential diagnosis, surgical planning, intraoperative guidance, and postoperative monitoring in lipedema patients were included. Both original investigations and review articles published in English were considered. RESULTS: Ultrasound demonstrated significant utility across all phases of lipedema management. In the preoperative setting, it improved diagnostic accuracy by identifying characteristic sonographic features, quantifying tissue thickness, differentiating lipedema from obesity and lymphedema, and enabling vascular mapping for surgical safety. Advanced techniques, including three-dimensional ultrasound, provided additional information regarding fascial alterations, fibrosis, and fluid accumulation. Intraoperatively, ultrasound off ered real-time visualization of anatomical structures, facilitated identification of fibrotic tissue, and supported more precise liposuction by improving cannula guidance andassessment of tissue homogeneity. Postoperatively, ultrasound enabled early detection of complications such asseromas and hematomas, assessment of fi brosis and tissue remodeling, and long-term monitoring of disease recurrence or progression. DISCUSSION: The available evidence suggests that ultrasound represents a versatile, accessible, and reproducible imaging modality capable of enhancing both diagnostic and surgical aspects of lipedema care. By integrating ultrasound intopreoperative evaluation, intraoperative decision-making, and postoperative follow-up, clinicians may improve surgical precision, patient safety, and treatment outcomes. Nevertheless, the current literature remains limited by heterogeneity, operator dependency, and the absence of standardized imaging protocols. Larger multicenter studiesare needed to validate diagnostic criteria and establish evidence-based guidelines for ultrasound utilization in lipedema management. CONCLUSION: Ultrasound has the potential to become an integral component of modern lipedema management. Its applications extend beyond diagnosis to encompass surgical planning, intraoperative guidance, and postoperative surveillance. The increasing availability of portable, high-resolution ultrasound devices may further facilitate its routine incorporation into clinical practice, ultimately contributing to safer procedures, more personalized treatment strategies, and improved long-term outcomes for patients with lipedema. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .