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Objectives: This study aimed to evaluate the clinical efficacy of transfer energy capacitive and resistive (TECAR) therapy in females with Stage 2 lipedema, focusing on limb circumference, pain, functional status, and quality of life. Patients and methods: A prospective, randomized controlled trial was conducted with 30 female patients diagnosed with Stage 2 lipedema between September 2024 and May 2025. Participants were randomized to a TECAR group (n=15; mean age: 52.7±13.1 years; range 39 to 66 years) or a control group (n=15; mean age: 45.9±12.9 years; range, 37 to 59 years). Both groups received compression garments and a structured exercise program. The TECAR group additionally underwent six TECAR sessions over three weeks. Outcomes included lower limb circumference, Visual Analog Scale for pain, Lower Extremity Functional Scale, and Lymphedema Quality of Life Questionnaire-Leg, assessed at baseline and at one and three months after treatment. Results: The groups were comparable at baseline for age (p=0.163) and body mass index (31.85±4.08 kg/m² in the TECAR group and 30.02±4.08 kg/m² in the control group; p=0.112). The TECAR therapy resulted in greater reductions in lower limb circumference compared to standard care, with a statistically significant and sustained improvement observed only in the supramalleolar region at three months (p<0.05). A significant short-term reduction in pain was observed at one month (p=0.003) only in the TECAR group, but this effect was not maintained at three months (p>0.05). Functional scores showed a nonsignificant trend toward improvement (p=0.058). The overall quality of life score improved significantly in the TECAR group (p=0.002), although no individual Lymphedema Quality of Life Questionnaire subdomain reached statistical significance (p>0.05). Conclusion: As an adjunct to standard care, TECAR therapy appears to reduce pain and limb volume and enhance overall quality of life in Stage 2 lipedema. Further long-term studies are needed to confirm these findings.

Background: Lipedema is a progressive adipofascial disorder marked by painful nodular fat deposition that is often mistaken for obesity. While tumescent liposuction reduces limb volume with relative lymphatic safety, persistent large, painful lobules frequently remain, and excisional strategies risk iatrogenic lymphatic injury. We evaluated the application of intraoperative indocyanine green (ICG) lymphography to identify and preserve lymphatic channels during debulking surgery for symptomatic lipedema. Methods: We conducted a single-center case series (University of Pittsburgh Medical Center, July 2023–December 2024) of adults with lipedema refractory to conservative therapy who underwent a selective dermato-lipectomy (lobule/skin excision) with or without tumescent liposuction. Patients with clinical lymphedema or dermal backflow in ICG were excluded. Near-infrared ICG (SPY-PHI) was used for pre-incision mapping and real-time intraoperative guidance; lymphatic trajectories were marked and spared during lobule excision. Primary measures included dermal backflow patterns and lymph node transit time; secondary outcomes were complications and symptom burden (Lymphedema Life Impact Scale, LLIS) through ≥24 months. Results: Eight patients (five female/three male; mean age 49.5 ± 14.4 years; median BMI 52.65 kg/m2) underwent ICG-guided surgery. Preoperatively, linear lymphatic patterns were visualized up to the knee in all patients, but dermal backflow patterns could not be visualized in 83% from the level of the knee to the groin. Still, 67% demonstrated inguinal nodal uptake (mean transit 24 min), suggesting preserved lymphatic transport. All cases achieved intraoperative confirmation of intact lymphatic flow after debulking. The mean liposuction aspirate was 925 ± 250 mL per lower extremity; the mean excision mass was 2209 ± 757 g per lower extremity. Complications included two superficial cellulitis events (25%) and one wound dehiscence (12.5%); no hematomas or skin necrosis occurred. No patient developed clinical or imaging evidence of iatrogenic lymphedema during follow-up. Conclusions: Intraoperative ICG lymphography is a practical adjunct for lymphatic-sparing debulking of symptomatic lipedema, enabling real-time identification and preservation of superficial collectors while addressing focal lobules. This hybrid approach—targeted tumescent liposuction followed by ICG-guided superficial dermato-lipectomy—was associated with meaningful symptom improvement and a low morbidity in this early series.

BACKGROUND: Lipedema is an abnormal accumulation of subcutaneous fat that usually affects the lower extremities. Inflammation due to adipose tissue may negatively affect body structure and functions. OBJECTIVE: This case-control study aimed to assess lower extremity muscle strength, endurance and function, functional exercise capacity, pressure pain threshold, and edema in women with lipedema and compare with healthy women. METHODS: Women with lipedema and healthy women of similar age and body mass index (BMI) were included in the study. Lower extremity muscle strength, muscle endurance, functionality, functional exercise capacity, pressure pain threshold, and edema (local tissue water) were assessed with digital dynamometer, 30-Second Sit to Stand Test (30-SSTS), Lower Extremity Functional Scale (LEFS), 6 Minute Walk Test (6MWT), manual algometer and skin moisture meter, respectively. RESULTS: Twenty-four women with lipedema (mean age: 47.9 ± 1.8 years, median BMI: 30.62 (19.03-41.20) kg/m2) and 20 healthy women (mean age: 47.2 ± 12.1 years, median BMI: 28.12 (23.23-39.66) kg/m2) participated in the study. Muscle strength for all assessing lower extremity muscles, 30-SSTS repetition number, LEFS score, pressure pain threshold of all assessing regions, percent of predicted 6MWT distance (p < .001) and 6MWT distance (p = .001) were significantly lower in women with lipedema compared to healthy controls. No significant difference was in terms of local tissue water percentage (p > .050). CONCLUSION: Lower extremity muscle strength, muscle endurance, functionality, functional exercise capacity and pressure pain threshold decrease in women with lipedema. It is recommended that these changes be taken into account when developing rehabilitation strategies.

Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat accumulation, pain, and low-grade systemic inflammation, primarily affecting women. This study investigated the relationship between the Dietary Inflammatory Index (DII), adherence to the Mediterranean diet scores (MDS), inflammatory biomarkers (TNF-α and IL-6), and clinical outcomes in women with lipedema.

Introduction: Lipedema is a chronic female disease, characterized by an excessive accumulation of subcutaneous adipose tissue in the limbs and is commonly mistaken for obesity, although the two conditions often coexist. Obesity is associated with increased hedonic hunger and dysfunctional eating behavior. However, these aspects have not been investigated in females with lipedema and obesity. Objectives: The objective of this secondary analysis from a randomized controlled trial was to compare changes in hedonic hunger and eating behavior following two different low-energy diets , low-carbohydrate (CHO) or low-fat, in females with lipedema and obesity. Methods: Females with lipedema and obesity (body mass index (BMI) 30-45 kg/m2) were randomized to two different low-energy diets (1200 kcal), low-CHO diet (LCD) (75 g CHO) or low-fat diet (180 g CHO) for 8 weeks. Hedonic hunger was assessed using the power of food scale (PFS) and eating behavior was assessed using the Dutch Eating Behavior Questionnaire (DEBQ) pre- and post-intervention. Results: A total of 70 females were included with a mean age of 47 years, and a BMI of 37 kg/m2. The LCD group reported a reduction in Food Present (P <0.001) and in Aggregated Score (P = 0.035) from the PFS, while no changes were seen in the low-fat diet group, with changes in Food Present over time being significantly different between groups (P = 0.050). The low-fat diet group reported increases in Restrained Eating from the DEBQ (P = 0.036) while only the LCD group reported decreases in Diffuse Emotions (P = 0.040), however, no differences between groups were found. Conclusion: A LCD may induce more favorable changes in hedonic hunger and eating behavior than an isocaloric low-fat diet in females with lipedema, which may be related to altered metabolic signaling pathways related to satiety and reward.

Objectives This double-blind, randomized clinical trial sought to demonstrate the effectiveness of Pycnogenol® in the symptomatic control and body composition management of patients with lipedema. Methods This was a double-blind, randomized clinical trial with 60 days of follow-up involving one hundred patients. The study utilized a quality-of-life questionnaire (QuASiL), bioimpedance analysis, and clinical monitoring. Results Of the one hundred patients initially included, seven were lost to follow-up; however, monotonic multiple imputation was applied for data analysis. The two groups were similar in all aspects except for initial weight. The placebo group showed an increase in mean QuASiL scores after 30 and 60 days from the first assessment, representing a worsening of symptoms over time. In contrast, the intervention group demonstrated a progressive and significant reduction in scores, with means of 69.5 ± 28 at 30 days and 63.2 ± 27 at 60 days (p < 0.001). This group also showed a statistically significant reduction in weight, BMI, and body fat percentage. Conclusions Pycnogenol® appears to be a promising therapeutic option to support the clinical management of lipedema, a condition that exerts numerous negative physical and emotional impacts throughout the lives of affected patients.

BACKGROUND: Lipedema is a chronic adipose tissue disorder characterized by abnormal fat accumulation, pain, often necessitating surgical intervention. While liposuction is the primary treatment to remove pathological fat, postoperative skin laxity poses a significant challenge, particularly in advanced stages. OBJECTIVE: This study evaluates the efficacy of helium plasma technology as an adjunct to liposuction of the lower limbs across the three clinical stages of lipedema, with a focus on its impact on skin tone, elasticity, and the necessity for dermolipectomy. METHODS: A prospective study was conducted on 90 female patients with lower limbs lipedema, divided equally across Stages I, II, and III. Helium plasma technology was applied post-liposuction to enhance skin tightening. Outcomes included postoperative skin elasticity, dermolipectomy incidence, and patient satisfaction RESULTS: In Stage I, skin tone and elasticity increased by 25%, though the already low need for dermolipectomy remained largely unchanged. In Stage II, skin elasticity improved by 40%, reducing the incidence of dermolipectomy from 30 to 10%. In Stage III, while the need for dermolipectomy was unaffected, helium plasma contributed to improved skin elasticity and patient satisfaction. No major adverse events were reported. This study is limited by the absence of a randomized control group and the lack of blinding in outcome assessments, which may introduce observer bias. These factors should be considered when interpreting the results and highlight the need for future controlled trials. CONCLUSIONS: Helium plasma technology offers stage-specific benefits in liposuction for lipedema of the lower limbs. It enhances skin tone and elasticity in early stages, reduces dermolipectomy requirements in intermediate stages, and improves skin quality in advanced stages when combined with dermolipectomy. Further research is needed to validate these findings and optimize protocols for clinical use. 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/Objectives: Lipedema is a chronic disorder characterized by disproportionate fat accumulation in the extremities, causing pain, bruising, and reduced mobility. When conservative therapy fails, liposuction is considered an effective treatment option. Prior studies often relied on subjective or non-standardized measures, limiting precision. This study aimed to objectively assess volumetric changes after liposuction in stage III lipedema using high-resolution 3D imaging to quantify postoperative changes in circumference and volume, providing individualized yet standardized outcome measures aligned with precision medicine. Methods: We retrospectively analyzed 66 patients who underwent 161 water-assisted liposuctions (WALs). Pre- and postoperative measurements were performed with the VECTRA© WB360 system, allowing reproducible, anatomically specific quantification of limb volumes and circumferences. Secondary endpoints included in-hospital complications. Results: Liposuction achieved significant reductions in all treated regions, most pronounced in the proximal thigh and upper arm. Thigh volume decreased by 4.10–9.25% (q < 0.001), while upper arm volume decreased by 15.63% (left) and 20.15% (right) (q = 0.001). Circumference decreased by up to 5.2% in the thigh (q < 0.001) and 12.27% (q = 0.001) in the upper arm. All changes were calculated relative to baseline values, allowing personalized interpretation of treatment effects. Conclusions: This is the first study to objectively quantify postoperative lipedema changes using whole-body 3D surface imaging. By capturing each patient’s contours pre- and postoperatively, this approach enables individualized evaluation while permitting standardized comparison across patients. It offers a precise understanding of surgical outcomes and supports integration of precision medicine principles in lipedema surgery.

Lipedema is a chronic and potentially progressive fat distribution disorder. Disease-related symptoms, such as pain and discomfort, can require surgical intervention when conservative therapies are exhausted. These megaliposuctions are functional in nature and need to be distinguished from esthetic liposuctions. This new surgical approach, the hybrid technique combining power-assisted liposuction (PAL) with manual extraction (ME), has been developed to more effectively treat fibrotic nodules, particularly in the lower legs, where conventional liposuction techniques often fall short.

An expanding array of diagnostic techniques for lymphedema detection and monitoring constitutes a growing aspect of lymphedema care. This discipline includes both the development and the clinical integration of methods to optimize and tailor clinical care for individuals affected by (or at risk for) lymphedema. A case-based approach highlights the practical application of these diagnostic modalities.

Lipedema is a clinical entity that deserves special attention, as it predominantly affects women during specific hormonal phases such as menarche, pregnancy and menopause. Among the available treatments, surgery is considered the most invasive and is usually indicated for severe cases. As an alternative, conservative therapies may be recommended, including photobiomodulation therapy (PBMT), which still requires scientific substantiation to validate its effectiveness. We conducted a clinical study involving three patients who underwent dermolipectomy for previously indicated medical reasons. Prior to surgery, PBMT was applied using red and infrared LED irradiation on one side of the body, with the contralateral side serving as a non-irradiated control. PBMT was administered 3–4 h before the surgical procedure. The excised skin samples from both treated and control sites were subjected to histopathological analysis. Qualitative assessments (H&E staining) and adipocyte histomorphometry were performed, alongside immunohistochemistry using the following markers: caspase-3 (apoptosis), CD68 (macrophages), COX-2 and Cytochome P4501A1 (CYP1A1). Results demonstrate positive effects, including a reduced adipocyte size in irradiated sites modulation of inflammatory process and increasing COX-2 and macrophage activity in this early post-treatment phase, enhanced adipocyte apoptosis, and upregulation of aromatase (CYP1A1). These membrane-associated hemoproteins are known to catalyze mono-oxygenation of both endogenous and exogenous substrates such as hormones, fatty acids. This is the first study to investigate the effects of PBMT in lipedema patients. Despite is preliminary nature, the findings suggest that PBMT exerts beneficial biological effects on lipedema tissue when applied under the tested parameters.

Background: We aimed to assess the sleep quality and the relationship between sleep and fatigue and quality of life in female lipedema patients.Methods and Results: A total of 52 patients with lipedema (Group 1) and 40 healthy control subjects (Group 2) were enrolled. The type and stage of lipedema were recorded for Group 1. The quality of sleep was assessed by using the Pittsburgh Sleep Quality Index (PSQI). The Fatigue Severity Scale (FSS) was used for assessing fatigue. Quality of life was assessed with the World Health Organization Quality of Life. The mean age of the patient group was 45.26 ± 9.81, whereas it was 42.10 ± 6.36 years in the control group (p > 0.05). The mean body mass index was 30.23 ± 4.70 in Group 1 and 28.55 ± 4.14 in Group 2 (p > 0.05). The total PSQI score was 10 (range: 7–12.75) in Group 1 and 8 (range: 5–10) in Group 2 (p < 0.05). There was no difference between the groups in terms of FSS. In the assessment of quality of life, only the physical function domain was significantly poorer in Group 1 than in Group 2 (p < 0.05). Physical function was correlated with subjective sleep quality, sleep disorder, and daytime dysfunction; fatigue was correlated with sleep disorder, daytime dysfunction, and use of sleep medications (p < 0.05). There was a correlation between the total PSQI score and physical functioning and fatigue (p < 0.05).Conclusion: Female patients with lipedema have poor sleep quality and decreased quality of life. Sleep disturbance is associated with both physical function and fatigue. Quality of sleep should be questioned in every assessment of patients with lipedema.

Background: Lipedema, a chronic condition affecting mostly women, involves painful bilateral increase of subcutaneous adipose tissue. The societal impact of this disease is still poorly understood. This study aimed to validate the Lymphedema Quality-of-Life Questionnaire (LYMQOL) for lipedema patients in Germany, assessing its feasibility, reliability, and validity.Methods and Results: A total of 81 German-speaking stage II lipedema patients were asked to complete both the LYMQOL (arm and leg versions) and the Short Form Health Survey (SF-36) questionnaires twice, and this was 2 weeks apart. Feasibility was evaluated through response rates, scale structure via factor analysis, validity through SF-36 correlations, and reliability through internal consistency and test-retest reliability analysis. A valid 68% response rate was achieved. Both arm and leg versions demonstrated construct validity with significant correlations to SF-36 subscales. Internal consistency for the leg version was acceptable to excellent, and good to excellent for the arm version. Test-retest reliability was very good for both versions.Conclusions: This study validates the LYMQOL as a robust tool for assessing lipedema patients’ quality of life, and also validates the German translation contained in this article. We hope to fill a critical research gap and support future clinical studies aiming at enhancing patient care.

Introduction:Lipedema is a progressive chronic condition that mainly affects women, and is characterized by disproportionate subcutaneous fat accumulation in the extremities, causing pain, edema, and impaired quality of life.Objective:This study evaluated the outcomes of the lipedema definition technique (LDT) for the treatment of lipedema, focusing on clinical efficacy, quality of life improvement, and patient satisfaction.Methods:A retrospective study was conducted with 67 women who underwent the LDT to treat lipedema (types II to V and stages 1 to 4). Analyzed variables included weight, body mass index, body fat percentage, total body water, InBody score, ideal weight, fat-free mass, basal metabolic rate, waist-to-hip ratio, visceral fat level, and percentage of obesity. The Lipedema Symptoms Assessment Questionnaire and complementary questionnaire were applied to assess satisfaction and clinical outcomes. Study assessments were conducted preoperatively, 90 days after surgery, and completed 2 years later.Results:A total of 34 patients (mean age of 40 years) were included; most had stage 2 lipedema (50.7%) and type IV (49.2%). After 90 days of the LDT, significant reductions were observed in weight (−2.5 kg, P = .001), body mass index (−0.9 kg/m2, P = .001), body fat percentage (−3.1%, P = .001), visceral fat (−1.8 points, P = .001), and percentage of obesity (−4.3%, P = .001). Moreover, fat levels in the upper and lower quadrants were significantly reduced, and bioimpedance analysis showed changes in all 5 body segments after LDT. Improvements in quality of life (89.4%) and pain reduction (87.2%) were reported. High satisfaction rates (91.5%) were observed, with 81.0% of patients reporting positive outcomes and 75.0% maintaining results in the long term.Conclusion:Lipedema definition technique was effective in reducing fat, improving quality of life, and achieving high patient satisfaction. This study reinforces the role of surgery as an intervention for lipedema, promoting important clinical and aesthetic benefits.

Lipedema is a chronic, progressive adipose connective tissue disorder characterized by symmetrical, disproportionate fat accumulation, typically affecting the lower extremities and arms, accompanied by pain, swelling, and a sensation of heaviness. This study introduces intermediate Stages 1.5 and 2.5 to the established lipedema classification (Stages 1, 2 and 3), and other affected areas, based on physical examination, a questionnaire, and photographic documentation. Bioelectrical Impedance Spectroscopy (BIS) was employed to quantify total body water (TBW) across stages. A significant and linear increase in BMI was observed from Stage 1 to 3, correlating with increased reported pain and heaviness in the thighs, calves, and upper arms. Systemic symptoms of brain fog, debilitating fatigue, and hypothermia were significantly prevalent. TBW demonstrated a significant, stage-dependent increase in the lower extremities. Adipose tissue accumulation over the knees and feet significantly increased with lipedema stage. In contrast, shin involvement was evident in early stages and remained consistently elevated throughout later stages. Skeletal Muscle Mass (SMM) exhibited a significant increase across lipedema stages, positively correlating with fat mass (FM) in Stage 3. This study elucidates previously underrecognized clinical features and distribution patterns of lipedema, offering a refined staging system to improve understanding of its progression and burden.

To determine the frequency of neuropathic pain in patients with lipedema and to assess the impact of neuropathic pain on quality of life and its correlation with clinical variables.

Objectives To identify research priorities related to the diagnosis, treatment and management of lipoedema. Design This was a research question priority-setting that ensured the involvement of patients, relatives and healthcare professionals in all parts. It consisted of the following steps: identifying research questions through an open survey, seeking input from patients, patient relatives and healthcare professionals. Prioritisation, including a Delphi exercise and a final priority-setting meeting. Setting Swedish healthcare and community. Participants A total of 255 participants submitted research questions. 130 participated in the prioritisation of the submitted questions. Of these, 89 were patients, 10 were relatives, 19 were healthcare professionals and 12 were representatives of patient organisations. Results 1314 potential research questions were submitted; 62 unique questions remained after analysis. 130 and 123 people answered the first and second Delphi surveys, respectively. 20 questions were discussed by 13 participants at the final priority-setting meeting. The following five research questions were selected as a top priority: (1) what criteria should apply for a diagnosis of lipoedema? (2) What outcomes are important in lipoedema research? (3) What effect does manual treatment, such as manual lymphatic drainage have on lipoedema? (4) What effect does liposuction have on lipoedema? (5) What are the effects of hormonal treatment on lipoedema? Conclusions We found a consensus between patients and healthcare professionals on topics that warrant priority in future research into lipoedema. The questions reflect both the diagnosis of the condition and research on treatment effects. We hope the results will inform researchers and research funders, and direct future studies towards important research questions. Data are available upon reasonable request.

Background: Lipedema is a chronic disease of subcutaneous adipose tissue that predominantly affects women and is frequently associated with endocrinopathies such as insulin resistance and obesity. Its pathogenesis is still unclear, and treatment, which requires a multi-disciplinary approach, is prolonged over time and is not always effective. There is currently no drug treatment available for this disease. Methods: Five different cases of women with lipedema and insulin resistance, treated with Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) and once-weekly exenatide, in association or not with lifestyle changes (diet or physical activity) for 3 to 6 months are described. Changes in anthropometric parameters, symptoms, clinical findings and the thickness of superficial adipose tissue measured by ultrasound were evaluated. Results: Treatment with exenatide, whether combined with a change in diet or physical activity, resulted in a reduction in the characteristic symptoms of lipedema, in pain evoked by pinching the adipose tissue fold and in the thickness of subcutaneous adipose tissue at the levels of the lower limbs, abdomen and upper limbs. In four out of five cases, a reduction in body weight was observed, particularly during the first three months of treatment and in cases with greater metabolic impairment. Clinical, instrumental and subjective improvements were also observed in cases where there was no reduction in body weight and in patients who had previously undergone lower limb liposuction. Conclusions: The improvement in symptoms and clinical signs of lipedema, in addition to the reduction in adipose tissue in patients with lipedema and insulin resistance with exenatide, suggests a novel pharmacological approach to the disease, which can be combined with other conservative and surgical treatments to promote weight reduction. These results also highlight the association of this disease with metabolic alterations and the fundamental role of an accurate diagnosis followed by the treatment of comorbidities and excess weight in these patients.

Background: Postoperative fibrosis is a common and significant complication following liposuction for lipedema, often leading to tissue induration, pain, and compromised aesthetic results. This fibrosis can jeopardize the overall success of the procedure by reducing skin elasticity and altering the intended body contour.Objective: This study aims to evaluate the efficacy of early shockwave therapy (SWT) initiated 1 week after surgery to reduce postoperative fibrosis and preserve the functional and aesthetic outcomes of liposuction in lipedema patients. Methods: A prospective study was conducted on 50 female patients with stage II–III lipedema who underwent power-assisted liposuction (PAL). Patients received SWT sessions three times per week for 3 weeks, starting 7 days postoperatively. Outcomes were compared to a control group of 25 patients who did not receive SWT. Primary endpoints included fibrosis severity assessed by ultrasound elastography, skin elasticity measurements, and patient-reported outcomes on pain and satisfaction. The SWT group exhibited a significant reduction in fibrosis (2.1 ± 0.3 vs 3.8 ± 0.5, p < .001), improved skin elasticity (1.5 ± 0.2 mm vs 1.0 ± 0.3 mm, p < .01), and lower pain scores (2.3 ± 0.8 vs 4.7 ± 1.2, p < .001) compared to the control group. Results: Patient satisfaction was also higher in the SWT group (92% vs 68%, p < .01). Conclusion: Early postoperative shockwave therapy is an effective and safe treatment to reduce fibrosis after liposuction for lipedema. By modulating fibroblast activity, reducing pro-inflammatory cytokines, and improving tissue perfusion, SWT preserves the surgical outcomes and enhances patient satisfaction. These findings suggest that integrating SWT into postoperative protocols could be a valuable strategy to optimize liposuction results in lipedema patients.