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BACKGROUND: Lipedema is a chronic adipose tissue disorder primarily affecting women, characterized by abnormal fat accumulation, pain, and reduced mobility. Its impact on sexual function remains underexplored. This study aimed to evaluate sexual function in women with lipedema and examine its associations with anxiety, depression, lower extremity function, and quality of life. METHODS: In this cross-sectional study, 100 sexually active women were recruited: 50 with lipedema and 50 age- and Body Mass Index-matched healthy controls. Sexual function was assessed with the Female Sexual Function Index (FSFI); anxiety and depression with the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); quality of life with the EuroQOL 5-Dimensional 5-Level (EQ-5D-5L) instrument; lower extremity function with the Lower Extremity Functional Scale (LEFS); and pain intensity with the Visual Analog Scale (VAS). Multiple linear regression analysis was conducted to identify the factors associated with the total FSFI score. RESULTS: Women with lipedema had significantly lower total FSFI scores compared to controls (21.58 ± 3.99 vs. 25.86 ± 3.21, P < .001), with 76% having FSFI scores below the cut-off (≤ 26.55) compared to 36% of controls. All FSFI domain scores were significantly lower in the lipedema group (all P < .05). In the lipedema group, there was a significant correlation between total FSFI scores and age (P = .002), pain intensity (VAS; P = .022), depression (HADS-D; P = .010), quality of life (EQ-5D-5L index; P = .027), and lower extremity function (LEFS; P < .001). Multiple linear regression analysis identified depression (HADS-D; P = .047), perceived health status (EQ-5D-5L VAS; P = .033), and lower extremity function (LEFS; P = .011) as independent variables that had a significant relationship with the total FSFI score. DISCUSSION: Lower sexual function is common among women with lipedema and is associated with anxiety and depressive symptoms, lower extremity function, and pain intensity. These findings highlight the importance of incorporating sexual function assessment into the routine evaluation of patients with lipedema and support the need for comprehensive multidisciplinary treatment approaches addressing physical, psychological, and sexual health aspects of care.

BACKGROUND: Lipedema is a prevalent chronic condition in women, characterized by a painful and symmetrical accumulation of adipose tissue primarily in the lower limbs. Its diagnosis is based on specific clinical characteristics; however, these characteristics lack robust scientific validation. Furthermore, lipedema is frequently misdiagnosed as obesity. This study aims to compare quality of life and physical and psychological characteristics between patients with obesity with and without lipedema. METHODS: This cross-sectional study included 30 patients with obesity and lipedema (Lip-Obes group) and 29 patients with only obesity (nonLip-Obes group). Quality of life, body composition (BMI, fat free mass, fat mass, waist-to-hip ratio, waist-to-height ratio, leg volume), pain (pain pattern, pressure pain thresholds, pain interference, pain distribution, symptoms of neuropathic pain), physical functioning (hand grip strength, quadriceps strength, functional exercise capacity, functional mobility and physical activity level), and psychosocial functioning (pain catastrophizing, depression, anxiety, and stress, body image dissatisfaction, self-efficacy, and eating difficulties) were assessed using clinical measurements and self-reported outcomes. Statistical analyses were performed using independent t-tests or Mann-Whitney U tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables. A two-sided p-value of < 0.05 was considered statistically significant. RESULTS: Compared to the nonLip-Obes group, the Lip-Obes group showed greater impairments in quality of life (p < 0.05). Despite similar body composition variables, the Lip-Obes group had lower waist-to-hip, waist-to-height, upper leg-to-waist, and lower leg-to-waist ratios, as well as higher total limb volume than the nonLip-Obes group. Additionally, the Lip-Obes group reported higher pain intensity, lower pressure pain thresholds in the arms and legs, and greater pain interference than the nonLip-Obes group (p < 0.05). Although hand-grip strength and physical activity levels were comparable, the Lip-Obes group exhibited lower quadriceps strength, functional exercise capacity, and functional mobility (p < 0.05). Additionally, the Lip-Obes group reported higher pain catastrophizing, greater body image dissatisfaction, and more severe eating difficulties than the nonLip-Obes group (p < 0.05). No significant differences were found in depression, anxiety, stress, or self-efficacy between groups (p > 0.05). CONCLUSION: This cross-sectional study highlights the complex nature of lipedema, providing preliminary evidence of differences in quality of life and distinct body composition and physical and physiological characteristics between patients with obesity with and without lipedema. These results emphasize the need for further research to identify diagnostic biomarkers for lipedema through in-depth investigations. Future studies should also focus on developing and optimizing a multidisciplinary treatment approach tailored to the unique characteristics of patients with lipedema.

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 .

OBJECTIVE: To compare central sensitization (CS), pressure pain threshold (PPT), and psychosocial factors between women with lipedema and healthy controls and to identify variables associated with CS in lipedema. METHODS: In this cross-sectional study, 30 women with clinically diagnosed lipedema and 30 age-matched healthy controls were assessed.CS was measured with the Central Sensitization Inventory (CSI), and PPT was recorded bilaterally at the deltoid, lateral thigh, and medial knee using an algometer, pain-related cognitions with the Pain Catastrophizing Scale (PCS), and mood with the Hospital Anxiety and Depression Scale (HADS). RESULTS: Compared with controls, the lipedema group had lower PPTs at all sites (all p ≤ 0.001) and higher CSI scores (p ≤ 0.001). CS prevalence (CSI ≥ 40) was 70.0% in lipedema versus 23.3% in controls (p≤ 0.001). HADS-Depression (p = 0.001), HADS-Anxiety (p = 0.017), and PCS helplessness, magnification, rumination, and total scores (all p ≤ 0.006) were higher in lipedema. In the total sample, CSI correlated negatively with all PPT values (all p ≤ 0.003) and positively with HADS-Depression/Anxiety and PCS scores (all p < 0.001). In multivariable analysis among patients with lipedema, higher CSI was associated with greater BMI (β = 1.117, p=0.018), hypertension (β = 15.918, p = 0.009), diabetes mellitus (β = 16.663, p = 0.002), higher VAS pain (β = 0.368, p = 0.002), lower right medial knee PPT (β = - 3.891, p = 0.011), and higher HADS-Depression (β = 1.307, p = 0.038). CONCLUSIONS: Lipedema is associated with lower pain thresholds and higher CS, alongside greater depressive and anxiety symptoms and pain catastrophizing. CS in lipedema appears linked to pain intensity, depressive symptoms, and cardiometabolic comorbidities. These findings suggest that management should complement peripheral approaches with strategies targeting central pain mechanisms and psychosocial factors. 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 .

Lipedema is a chronic, painful, estrogen-sensitive disorder of subcutaneous adipose tissue whose persistence is poorly explained by linear cause-effect models. Patients, clinicians and affected relatives frequently report that symptom flares track periods of sustained psychological stress, yet the 2026 international Delphi consensus records no formal role for stress, and a controlled study found normal stress scores with no stress-pain association, leaving the observation unexplained and exposed to a stigmatizing reading. We propose that lipedema chronicity is better understood as a self-sustaining attractor of a neuroimmune-stress feedback loop than as the product of any single root cause. In the proposed circuit, sustained hypothalamic-pituitary-adrenal and sympathetic activation promotes adipose mast-cell mediator release, neurogenic inflammation (CGRP, NGF), sensitization, pain and distress, which feed back onto the stress axis; genetic predisposition and estrogen act as the constraint landscape rather than as linear causes. We formalize the loop as a low-dimensional dynamical system with saturating feedback and a slow, near-irreversible tissue-remodeling variable. The model exhibits bistability above a critical loop gain and hysteresis, recasting the acute-to-chronic transition as a saddle-node bifurcation and chronicity as a high-burden basin maintained by a fibrotic ratchet. It yields falsifiable predictions-flare hysteresis, estrogen as a bifurcation parameter, a stage-dependent reversibility window, and super-additive combination therapy-and an explicit, non-stigmatizing map of which weak causal edges to measure. It reframes early, multimodal intervention as leverage on a loop rather than treatment of a symptom.

ObjectiveLipedema, which mainly affects women, is a chronic and progressive disorder characterized by abnormal adipose tissue accumulation in the limbs. Despite its clinical importance, research on lipedema remains limited. Bibliometric analysis provides a quantitative way to evaluate the literature, identify trends, and assess research impact.Materials and methodsGlobal lipedema research was analyzed in the Web of Science database using the terms "lipedema", "lipoedema", and "lipolymphedema" for publications indexed through March 2025. Articles were classified by publication type, year, country of origin, journal quartile, and citation count. Citation analyses excluded publications from 2024 and 2025 because citation accumulation was incomplete. Only English original articles and reviews were included, while editorials, meeting abstracts, and non-indexed sources were excluded.ResultsOf 610 records identified, 382 met the inclusion criteria. The analysis identified the main contributing countries and highlighted knowledge gaps and opportunities for multidisciplinary collaboration in the evolving field of lipedema research.ConclusionsThis study provides a global overview of lipedema-related research and its scholarly development. It also highlights the need for further studies on the pathophysiology, diagnosis, and treatment of lipedema.

BACKGROUND/AIM: Although various distinctive morphological features such as hyperproliferation of adipocytes, fibrosis, and inflammation have been described in the progression of lipedema, the underlying mechanisms of these changes are not yet fully understood. In this study, we aimed to investigate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW) to demonstrate the role of inflammation in lipedema. METHODS: The retrospective study consisted of 60 lipedema patients (Group 1) and 40 healthy controls (Group 2). The age, height, weight, and body mass index (BMI) of all participants were recorded, along with the lipedema type and stage for Group 1. Laboratory results, including complete blood count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were obtained for all participants. Hemoglobin, leukocyte, lymphocyte, neutrophil, and platelet counts, NLR, PLR, MPV, PDW, CRP, and ESR were evaluated. RESULTS: The mean age was 45.45 ± 10.17 years in Group 1 and 44.90 ± 10.69 years in Group 2; the BMI was 32.15 ± 5.05 in Group 1 and 30.94 ± 4.98 in Group 2, with no significant difference between the groups (p > 0.05). The most common type was Type 2 lipedema. Platelet counts, CRP, NLR, and PLR levels were significantly higher in Group 1 than in Group 2 (p < 0.05). There was no difference between groups in MPV and PDW values (p > 0.05). There was a positive correlation between BMI and both leukocyte count and CRP levels (p < 0.05). CONCLUSION: In our study investigating inflammation in lipedema-an etiology that is still not fully understood-NLR, PLR, platelet count, and CRP levels were found to be significantly higher in the patient group. The increase in BMI was correlated with leukocyte count and CRP levels. This finding is important for elucidating the etiopathogenesis of the disease, and we believe it may guide future research in this area.

ObjectivesLipedema is a chronic disorder characterized by pain and disproportionate fat distribution, and its diagnosis is frequently overlooked. The aim of this study was to evaluate and compare the responses generated by contemporary artificial intelligence models-ChatGPT-5o, Gemini-3, and Perplexity AI-to structured clinical questions developed in accordance with the 2024 S2k Lipedema Guideline. The models were analyzed in terms of clinical accuracy, readability, and reference reliability to assess their performance in delivering guideline-based medical information.MethodsThis cross-sectional and comparative study was conducted by submitting 30 structured clinical questions, prepared on the basis of the relevant guideline, to three large language models. Responses collected on 10 February 2026, were evaluated using a seven-point Likert scale (reliability) and a five-point scale (accuracy). Text readability was assessed using six established indices, including the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFOG). Reference reliability was examined by analyzing hallucination tendencies as defined in the literature.ResultsA statistically significant difference in reliability was observed among the models (p = .041); Perplexity (4.95 ± 1.20) achieved significantly higher scores than ChatGPT-5o (4.38 ± 1.05) (p = .038). In readability analyses, Perplexity (12.80 ± 2.10) required a significantly higher educational level according to FKGL scores compared to both ChatGPT-5o (p = .041) and Gemini-3 (p = .036). Regarding reference reliability, ChatGPT-5o outperformed Perplexity in source verifiability (p = .031), bibliographic precision (p = .044), and total RHS scores (p = .027), emerging as the most robust model in this domain. No statistically significant differences were found among the models in terms of clinical accuracy and usefulness (p > .05). Inter-rater agreement was excellent (Kappa: 0.92-0.97).ConclusionIn this study, ChatGPT-5o distinguished itself in reference quality, whereas Perplexity demonstrated superior reliability. However, the complex linguistic structures accompanying efforts to maintain high medical accuracy may constitute a significant barrier for individuals with limited e-health literacy. Although these systems show strong potential as medical information resources, they cannot yet replace expert physician oversight in terms of patient safety. A balanced approach between technical reliability and patient-centered simplification remains necessary.

BACKGROUND: Recent studies have consistently shown that patients with lipedema are at a higher risk for depression and anxiety. The aim of this study is to identify the psychological factors associated with lipedema syndrome (LS) and their link to the patient's psychological symptomatology. METHODS: A mixed-methods approach was employed, combining quantitative and qualitative components. The quantitative component involved anonymous online questionnaires, including a Health and Demographic Questionnaire, the body satisfaction and global self-perception questionnaire (BSGSPQ), the lymphedema quality of life questionnaire (LYMQOL), and the Hospital Anxiety and Depression Scale (HADS). The qualitative component consisted of oral interviews to explore the complexity of the phenomenon. Participants included those with "easy bruising," a waist-to-hip ratio ≤0.7 (W/H), and pain levels ≥4/10 on the visual analogue scale (VAS). RESULTS: Our findings indicate that the level of depression is positively correlated with spontaneous pain (p = 0.002; r = 0.331) and the lack of medical understanding (p = 0.011; r = 0.229). Anxiety scores are inversely correlated with body satisfaction (r = -0.317) and global self-perception (r = -0.393); similarly, depression scores show similar correlations with body satisfaction (r = -0.445) and global self-perception (r = -0.608), all with p value of <0.0001. DISCUSSION AND CONCLUSION: This study highlights significant connections between the physical symptoms and mental health in patients with LS. The more affected the self-perception, the greater the depression and anxiety levels. These multiple contributing factors may explain the decline in quality of life (QOL) and deterioration of mental health. It is therefore crucial to proactively integrate mental health management into the care of LS patients. Future research should focus on identifying concrete, actionable methods to support women experiencing LS.

BACKGROUND: Lipedema is a chronic adipose tissue disorder predominantly affecting women, often misdiagnosed as obesity or lymphedema. Emerging evidence points to microvascular dysfunction and chronic inflammation in its pathophysiology. This study aimed to compare complete blood count (CBC) parameters and derived inflammatory indices between women with lipedema and age-matched healthy controls, focusing on the potential diagnostic value of platelet indices such as PDW and MPV. METHODS: We conducted a retrospective observational study including 45 women with clinically confirmed lipedema and 40 age matched healthy controls. CBC parameters and derived inflammatory indices were compared between groups without adjustment for body mass index (BMI). RESULTS: The study included 45 women with lipedema and 40 healthy controls with similar age distributions. No statistically significant between group differences were observed in complete blood count parameters after correction for multiple comparisons, although PDW and MPV were numerically higher in the lipedema group. CONCLUSION: In this exploratory study, PDW and MPV were numerically higher in women with lipedema than in controls, but these differences lost statistical significance after correction for multiple comparisons. These findings argue against PDW or MPV as standalone diagnostic markers of lipedema and indicate that future research should prioritize larger, BMI-matched cohorts and multimodal approaches that integrate platelet indices with tissue-level or imaging markers.

BackgroundLipedema is a chronic and progressive disorder of subcutaneous adipose tissue that predominantly affects women and is frequently misdiagnosed as obesity, lymphedema, or venous disease. Increasing evidence indicates that lipedema represents a systemic vascular-lymphatic-inflammatory disorder rather than a cosmetic or metabolic condition. Delayed diagnosis often results in progressive fibrosis, lymphatic dysfunction, chronic pain, and functional impairment.ObjectiveThis review aims to present a structured, clinically applicable framework for the diagnosis and multimodal management of lipedema within phlebology practice, with an emphasis on stage-specific assessment and integrated therapeutic strategies.MethodsA narrative clinical review of peer-reviewed literature in phlebology, vascular medicine, lymphatic disorders, and adipose tissue pathology was conducted. Diagnostic criteria, clinical staging, and differential diagnostic features were synthesized into a practical, stage-based framework. A multilayer therapeutic approach targeting inflammation, lymphatic function, adipose tissue pathology, extracellular matrix remodeling, and post-treatment rehabilitation is proposed.ResultsAccurate diagnosis of lipedema relies primarily on clinical evaluation, including pain assessment, tissue palpation, characteristic fat distribution, and exclusion of lymphedema and simple obesity. Early-stage identification enables effective intervention focused on inflammation control and lymphatic unloading, potentially preventing irreversible fibrosis. Advanced stages require targeted adipose tissue interventions, fibrosis management, and structured rehabilitation to preserve mobility and quality of life.ConclusionLipedema should be recognized as a systemic vascular-lymphatic-inflammatory disorder within phlebology practice. Early diagnosis and implementation of a structured, stage-specific multimodal treatment framework may significantly alter disease progression and reduce the risk of long-term disability.

BACKGROUND: Lipedema is a chronic and progressive adipose tissue disorder that is often misdiagnosed and notoriously resistant to weight loss. Liposuction remains the most effective surgical treatment, but it requires precise technique to preserve the fragile lymphatic system. This study investigates the utility of pre-, intra- and postoperative ultrasound (US) to objectively assess fat reduction and the selective removal of pathological adipose tissue in patients undergoing liposuction for lipedema. METHODS: A retrospective, single-center study of 24 female patients with lipedema who underwent liposuction of the lower extremities. Perioperative US was used to measure the thickness of the superficial subcutaneous fat (D1) and the deep fat layer (D2) at a standardized anatomical site. Intraoperative US was employed to verify that fat aspiration was performed in the correct superficial plane. A paired t-test was conducted to assess the statistical significance of the change in D1 thickness. RESULTS: The mean patient age was 38 years, with a mean BMI of 25.3 kg/m2. The mean volume of liposuction aspirate was 4.5 L. Statistical analysis showed a significant reduction in mean D1 thickness from 9.9 mm preoperatively to 6.3 mm immediately postoperatively (p < 0,05). This reduction was sustained at the 3-month follow-up, with a mean D1 thickness of 5.8 mm. CONCLUSION: Our pilot study suggests that the perioperative use of ultrasound is a valuable tool for objectively documenting the selective fat reduction achieved with liposuction in lipedema patients. Intraoperative US not only enhances surgical precision, but also reduces the risk of complications by confirming correct cannula positioning in the superficial plane. This technique enhances surgical precision by allowing for the quantifiable removal of pathological superficial fat, confirming its potential to improve outcomes with a low complication rate. 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 an adipose disorder associated with multiple impairments. Conservative treatments remain the mainstay of management, yet evidence regarding the effects of physical therapies on clinical, imaging, and body composition outcomes is limited. Radial extracorporeal shock wave therapy (rESWT) has been proposed as a non-invasive therapeutic option, although its impact is not fully established.MethodsThis was a prospective, longitudinal, within-patient study conducted in women with clinically diagnosed lipedema. One lower limb was treated with radial extracorporeal shock wave therapy (rESWT), whereas the contralateral limb served as an internal control. A total of 16 patients were initially assessed, of whom 12 completed the full follow-up and were included in the final analysis. rESWT was applied over six sessions (two sessions per week) using standardized parameters. Clinical outcomes (LEFS, EQ-5D, SF-36 Physical Function, and IPAQ) were assessed at baseline, 6 weeks, and 3 months. Ultrasound and elastography were used to evaluate subcutaneous tissue thickness and stiffness at predefined leg and thigh sites, while segmental bioimpedance analysis assessed body composition and fluid distribution. Longitudinal changes were analyzed using mixed-effects models.ResultsSignificant improvements were observed in functional capacity, quality of life, and physical activity levels at both 6 weeks and 3 months compared with baseline (p < .05). In contrast, no statistically significant changes were detected in ultrasound-derived tissue thickness, elastography measurements, or bioimpedance parameters over time, and no significant differences were detected between treated and control limbs within the constraints of the available sample size.ConclusionsrESWT was associated with meaningful clinical and functional improvements in patients with lipedema, despite the absence of detectable changes in tissue thickness, stiffness, or body composition. These findings suggest that the benefits of rESWT may be mediated through symptom modulation and functional adaptation rather than structural tissue modification, supporting its role as part of conservative, symptom-oriented treatment strategies in lipedema.

BackgroundLipedema is a chronic, progressive adipose tissue disorder affecting mainly women, characterized by bilateral, disproportionate fat accumulation in the lower extremities. The condition is often associated with pain, heaviness, and functional limitations. While the adipose tissue changes in lipedema are well-described, its impact on muscle mass, strength, and functional performance remains underexplored. This study aimed to evaluate the prevalence of sarcopenia and its relationship with lipedema severity.Materials and methodsA cross-sectional observational study was conducted on 48 women with clinically diagnosed lower-extremity lipedema. Diagnosis followed the International Lipoedema Association and German S2k guidelines. Sarcopenia was assessed using a multidimensional approach, including ultrasonographic rectus femoris thickness, handgrip strength, the Five Times Sit-to-Stand Test, and four-m walking speed. The lipedema stage was determined using morphological criteria. Statistical analyses evaluated the relationships between sarcopenia, functional parameters, and lipedema stage.ResultsParticipants had a mean age of 47.2 ± 8.4 years and a BMI of 33.0 ± 4.3 kg/m2. Sarcopenia was identified in 33.3% of participants, with 14.6% classified as severe. Those with sarcopenia exhibited lower rectus femoris thickness and slower walking speed (p < .05). Advancing lipedema stage correlated with reduced muscle thickness, weaker handgrip strength, slower gait, and prolonged Five Times Sit-to-Stand Test duration (p < .05). Stage 3 patients demonstrated the highest prevalence of sarcopenia, indicating progressive impairment in muscle mass and functional performance with disease severity (p < .05). No significant associations were found between age or BMI and muscle parameters (p > .05).ConclusionsSarcopenia is prevalent in women with lower-extremity lipedema and increases with disease stage. Comprehensive musculoskeletal assessment should be integrated into lipedema management to address functional impairment and optimize patient care.

BACKGROUND: Lipedema is a chronic adipose tissue disorder characterized by abnormal and disproportionate fat accumulation in the extremities, leading to pain, edema, and functional impairment. Liposuction has become a central component of surgical management. However, postoperative complications, particularly seroma formation, remain a concern. OBJECTIVES: To evaluate the incidence of postoperative seroma and associated risk factors in patients undergoing liposuction for lipedema treatment, based on procedures performed by a single surgical team in a single institution. METHODS: This retrospective observational study included 93 female patients who underwent liposuction for lipedema between April 2019 and January 2024. Data collected included demographic variables, body mass index (BMI), anesthesia type, volume of aspirated fat, percentage of body weight removed, use of adjunct technologies (ultrasound or laser), association with other surgeries such as varicose vein surgery, and prior conservative treatment. The primary outcome was the development of postoperative seroma. Statistical analysis included Chi-square and Student's t-tests and multivariable logistic regression, with significance set at p ≤ 0.05. RESULTS: Among 93 cases, 17 patients (18.3%) developed postoperative seroma. Higher volumes of aspirated fat (% body weight) were significantly associated with seroma formation (7.27% vs. 5.84%, p = 0.005). Concomitant minor procedures were also linked to increased seroma incidence (p = 0.035). No seromas occurred in patients treated using ultrasound-assisted liposuction. Minor complications included one infection and one hematoma (1.07%). CONCLUSIONS: Liposuction for lipedema is a safe and effective surgical option with a low rate of major complications, but seroma remains a relatively frequent postoperative finding. Higher aspirated fat volumes relative to body weight and the presence of concomitant procedures increase the risk of seroma. No seromas were observed in the ultrasound-assisted group; however, this difference did not reach statistical significance and should be considered only as hypothesis-generating. Further studies are needed to validate these findings and guide surgical decision-making. 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 .

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 .

Background/Objectives: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat accumulation, pain, microvascular dysfunction, and low-grade inflammation. Although low-carbohydrate, high-fat (LCHF) dietary approaches are increasingly used in clinical practice, their longer-term associations with vascular, lymphatic, and immunometabolic pathways in lipedema remain insufficiently understood. This preliminary exploratory study evaluated clinical outcomes and circulating mediators during a 7-month LCHF dietary intervention. Methods: Twenty-four women with lipedema (median age: 39 years) underwent a 7-month individualized, calorie-restricted LCHF diet under medical supervision. Outcomes included body mass index (BMI), leg volume, and adipose tissue pain assessed using a visual analogue scale (VAS). Fasting serum samples collected at baseline and follow-up were analyzed for angiogenic, inflammatory, endothelial, and lipid mediators using Luminex assays and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: The intervention was associated with significant reductions in BMI, leg volume, and adipose tissue pain (p < 0.001). These changes were accompanied by increased vascular endothelial growth factor A (VEGF-A), vascular endothelial growth factor D (VEGF-D), and angiopoietin-2 (Ang-2), together with decreased pro-inflammatory cytokines and endothelial adhesion molecules. Several endocannabinoid-related lipid mediators, including oleoyl ethanolamide (OEA), arachidonoyl ethanolamide (AEA), and palmitoyl ethanolamide (PEA), also decreased. Baseline OEA and AEA concentrations, as well as reductions in OEA over time, were associated with greater BMI reduction. Change in interleukin-8 (IL-8) showed a nominal association with leg volume reduction, while pain improvement was associated with decreases in P-selectin and VEGF-A and increases in interleukin-13 (IL-13). Conclusions: A 7-month calorie-restricted LCHF dietary intervention in women with lipedema was associated with clinical improvement and changes in circulating vascular, inflammatory, and lipid mediators. These findings reflect systemic changes accompanying the intervention; however, causal relationships and specific mechanisms cannot be established.

Infragluteal deformities are a challenging complication following liposuction, particularly when injury occurs to the fibrous osteocutaneous bands of the gluteal crease. Various surgical solutions have been proposed, including autologous fat grafting, skin-lifting procedures, and flap reconstructions, yet a consistent, scar-free, and minimally invasive technique remains elusive. In this report, we present a new modified net suture technique, inspired by the hemostatic net used in aesthetic facial surgery, as a promising treatment for post-liposuction infragluteal deformities. After aggressive power-assisted liposuction to detach mispositioned adhesions within the gluteal crease, we apply a transcutaneous continuous-running suture using non-absorbable nylon, fixed along the newly established crease. The suture is laid loosely to preserve skin perfusion, cushioned by an ointment dressing, and supported with external compression. The technique is completed in approximately 15 minutes, with suture removal on postoperative day 4. In our experience, this approach leads to aesthetically satisfactory outcomes, restores gluteal symmetry, and avoids the formation of additional scars. Our technique is simple, cost-effective, and preserves lymphatic and vascular integrity. This manuscript describes our methodology, rationale, and early clinical observations supporting this low-risk intervention.

ObjectiveTo analyse and compare the prevalence of comorbidities associated with lipedema in Spanish women with that in the general population.MethodsA cross-sectional study was conducted using an anonymous online questionnaire distributed among lipedema patient associations in Spain. Sociodemographic variables, clinical aspects, and comorbidities were collected. These were then compared with data from the 2023 National Health Survey, which represents the general Spanish population. The prevalence of each pathology was compared using odds ratios (OR) with 95% confidence intervals. Age-group contributions were assessed using standardised residuals from expected/observed contingency tables, considering absolute values >1.96 (95% confidence) to be significant.ResultsA total of 1001 responses were obtained, with a mean age of 44.2 years. The most prevalent comorbidities were vitamin D deficiency (63.4%), lower limb venous insufficiency (47.2%), and migraine (43.1%). Compared to the general female population in Spain, patients with lipedema were more likely to suffer from venous insufficiency (OR= 5.05; 95% CI: 4.3-5.8), urinary incontinence (OR= 4.93; 95% CI: 4.1-5.8), migraine (OR= 3.9; 95% CI: 3.4-4.5), thyroid disease (OR= 2.21; 95% CI: 1.8-2.6), and asthma (OR= 2.09; 95% CI: 1.7-2.5). However, the probability of hypertension (OR= 0.38; 95% CI: 0.2-0.4) and diabetes (OR= 0.36; 95% CI: 0.2-0.6) was significantly lower.ConclusionsSpanish women with lipedema have a higher prevalence of certain pathologies that should be considered in their medical care. Understanding these relationships is crucial to improving the detection and treatment of patients.