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Background Lipoedema is a condition of abnormal accumulation of painful adipose tissue, usually in the lower body of women. The disproportionate subcutaneous adipose tissue may negatively impact health-related quality of life (HRQoL). There are currently no patient reported outcome measures (PROM) specifically designed to assess the HRQoL in individuals with lipoedema. The aim of this study was to compare scores on validated lower limb lymphoedema PROMs between females with lipoedema and lymphoedema. Methods In a private lymphoedema clinic in Australia between 1 October 2021 and 22 August 2023, individuals assigned female at birth, aged 18 years and older who consented to the entry of de-identified data into a research databank and completed the Lymphoedema Quality of Life tool (LYMQOL-leg) and/or Lymphoedema Symptoms Intensity and Distress Survey (LSIDS-L) for the legs were included in this study. Between group analysis was conducted on 151 participants who were either diagnosed with lipoedema (N = 90) or bilateral leg lymphoedema (N = 61). Participants with both conditions were excluded. Results Participants with lipoedema reported significantly higher burden scores for symptoms (p = 0.003), appearance (p = 0.003) and mood (p = 0.011) in the LYMQOL-leg survey when compared to participants with bilateral leg lymphoedema. Participants with lipoedema also reported significantly worse LSIDS-L scores for neurological sensation (p = 0.003), biobehavioral (p = 0.016) and resource (p = 0.008) questions compared to participants with lymphoedema. Conclusions This study highlights that although females with lipoedema and lymphoedema experience similar symptoms, their experiences differ in specific outcomes that influence their HRQoL. These findings warrant further investigation into the HRQoL concerns of individuals with lipoedema.

BACKGROUND/OBJECTIVES: Lipedema is a chronic and progressive adipose tissue disorder characterized by the abnormal accumulation of subcutaneous fat, predominantly in the legs and occasionally in the arms. The symptom that most significantly affects the quality of life is pain. Ultrasound elastography is an imaging technology that allows for measuring tissue stiffness quantitatively. This study aims to evaluate the relationship between accompanying pain in patients with lipedema and tissue elasticity measured using shear-wave elastography (SWE). METHODS: Our study was designed as an observational, analytical and cross-sectional study. The visual analog scale (VAS) was used to assess pain, while the PainDetect questionnaire was utilized to evaluate neuropathic pain. The evaluation of tissue elasticity and fibrosis was conducted using the SWE method. RESULTS: This research assessed thirty-five patients, revealing an average age of 45.2 years and an average body mass index (BMI) of 33.6 kg/m². 60% of the patients had a lipedema diagnosis in their family history. Both age (p < 0.01) and BMI (p < 0.001) values were moderately correlated with all subcutaneous adipose tissue measurements, while no correlation was observed in SWE measurements. Only the level of the thigh in the SWE-Elasticity (SWE-E) values was related to VAS (r = 0.35, p = 0.03). Additionally, PainDetect scores demonstrated significant positive correlations with both SWE-velocity (SWE-V) and SWE-E measurements in the thigh region. Specifically, SWE-V showed moderate correlations with PainDetect scores in the right thigh (r = 0.38, p = 0.02) and left thigh (r = 0.47, p = 0.004), while SWE-E was also significantly correlated in both the right (r = 0.44, p = 0.007) and left thighs (r = 0.44, p = 0.008). CONCLUSIONS: While SWE measurements were not correlated with skin adipose tissue, SWE measurements were correlated with pain and neuropathic pain in patients with lipedema. This finding highlights a potentially important relationship between tissue elasticity and pain, which may warrant further exploration. SWE offers a novel, non-invasive approach to quantifying tissue stiffness, providing valuable insights into tissue alterations in women with lipedema.

Lipedema is a lipodystrophic disease characterized primarily by a disproportionate increase in lower body subcutaneous fat. Although moderate weight loss decreases lower body fat mass in women with obesity and lipedema, it is possible that this decrease is due to a reduction in normal subcutaneous fat, rather than lipedema-affected fat. We evaluated the effect of moderate (11%) diet-induced weight loss on body fat mass and distribution, assessed by dual-energy X-ray absorptiometry and magnetic resonance imaging, in a 56-year-old woman with lipedema who was normal weight (body mass index: 23.9 kg/m2) at baseline. Approximately 85% of the decrease in body weight comprised body fat. The relative reduction in upper body fat (abdominal subcutaneous, arm and trunk fat) was similar to the relative reduction in lower body (total leg fat and thigh subcutaneous fat). Accordingly, weight loss did not change the proportion of total body fat comprising leg fat (44.8% and 45.1% before and after weight loss, respectively) or arm fat (9.1% and 9.6% before and after weight loss, respectively). These data suggest weight loss decreases lipedema-affected adipose tissue and demonstrate the therapeutic effect of weight loss on body composition in women with lipedema even if they are normal weight.

Introduction & Objectives Lipedema is a chronic and underdiagnosed adipose tissue disorder characterized by disproportionate lower limb fat distribution, pain, and edema. Despite increasing awareness, diagnostic uncertainty persists due to heterogeneous semiological definitions and limited attention to the patient's subjective experience. Methodology This study aims to explore how patients with lipedema verbally represent their symptoms and bodily sensations, and how these narratives correlate with established semiological criteria. By analyzing spontaneous language, we seek to identify potential linguistic markers that could enhance diagnostic characterization and favor earlier recognition of the condition. We conducted an observational, multicenter qualitative study involving adult women with clinically confirmed lipedema. Semi-structured interviews were recorded and transcribed verbatim. Lexical and semantic analyses were performed using natural language processing software and manual thematic categorization. Semiological assessment included tissue consistency, pain distribution, symmetry, and evolution. Cross-analysis explored correlations between verbal descriptors (pain, heaviness, swelling, injustice, shame, sensitivity) and clinical stage or subtype. Results Preliminary findings from revealed recurrent lexical fields expressing bodily dysmorphia, hyperalgesia, and emotional distress. Distinct linguistic patterns emerged according to semiological criteria: patients with stage II–III lipedema frequently used affective and metaphorical language (“weight anchored in my legs”), whereas earlier stages emphasized mechanical sensations (“tension,” “tightness”). A strong convergence was observed between the richness of expressive language and subjective pain scales. Discussion Linguistic analysis of patient verbatim provides novel insight into the semiological complexity of lipedema. Integrating qualitative linguistic descriptors into diagnostic frameworks may refine clinical classification and improve therapeutic communication. Conclusion Linguistic analysis of patient verbatim provides novel insight into the semiological complexity of lipedema. Integrating qualitative linguistic descriptors into diagnostic frameworks may refine clinical classification and improve therapeutic communication. These preliminary results suggest that the words patients use may serve as semiological markers supporting a more holistic understanding of lipedema.

Background: The aim of the study was to verify the effectiveness of a 5-week intensive protocol of multilayer bandaging alone or in combination with diet, applied to the clinical practice of lipedema. Methods: 114 women with lipedema were studied, divided into three groups: 35 women were treated with multilayer bandaging in biweekly sessions for 5 weeks, 48 were treated with the same bandaging protocol combined with an anti-inflammatory diet, and 31 women received no treatment. The effect on anthropometry, lower limb volume, pain caused by the tissue fold, and subjective symptoms were evaluated. Results: Women who completed the 5-week intensive protocol of multilayer bandaging showed a statistically significant reduction in all observed parameters: body weight, waist and hip circumference, lower limb volume, pain, and subjective symptoms. The group of women treated with multilayer bandaging and diet showed a significantly greater reduction in lower limb volume and body weight. The treatments were effective regardless of age, BMI, clinical stage, and the presence of fovea in both groups. The wearing time with the multilayer bandage had a positive correlation in the group treated with bandage in combination with diet. Conclusion: A 5week intensive protocol of multilayer bandaging of the lower limbs is an effective treatment for reducing the symptoms and clinical signs of lipedema at all stages of the disease, even in the absence of edema. Adding nutritional therapy during the bandaging cycle increases the effectiveness of the treatment on the volume of the affected extremities and body weight.

Background Lipedema is characterized by disproportionate gluteofemoral adiposity with anti-inflammatory properties. We hypothesized that this phenotype may confer immunological protection against T-helper 1 (Th1)-mediated autoimmunity ("Immunological Shield Hypothesis"). Objective The objective of this study is to explore whether women with a dual-energy X-ray absorptiometry (DXA)-defined lipedema-like phenotype, characterized by disproportionate gluteofemoral fat accumulation, exhibit distinct immunometabolic profiles and lower prevalence of celiac disease (CD) autoimmunity in a nationally representative sample. Methods The cross-sectional analysis included 3,833 women from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Celiac disease (n=11, 0.56% weighted prevalence) was defined by strict serology (tissue transglutaminase {tTG}-IgA+/endomysial antibody {EMA}-IgA+); lipedema phenotype was defined as leg-to-trunk fat ratio of &gt;90th percentile via DXA. Results Women with celiac disease exhibited 7.4% lower gynoid fat (39.5% versus 42.6%, p=0.0007), persisting in overweight/obese strata. Conversely, the lipedema phenotype demonstrated superior metabolic health: 44.2% lower homeostatic model assessment of insulin resistance (HOMA-IR) (p&lt;0.001) and 7.6% lower neutrophil-to-lymphocyte ratio (NLR) (p=0.012). Conclusions This exploratory population-based analysis identifies phenotypic divergence in fat distribution between the DXA-defined lipedema phenotype and celiac disease autoimmunity, yielding observations consistent with, but not confirmatory of, the "Immunological Shield Hypothesis." While limited by the small number of celiac cases (n=11), a sample size insufficient to detect prevalence differences for a ~7%-9% phenotype, for which approximately 225-600 celiac cases would be required, the observed differences in gynoid adiposity (7.4% reduction, p=0.0007) and the favorable metabolic profile of the lipedema phenotype (44.2% lower HOMA-IR and 7.6% lower NLR) suggest biological plausibility warranting validation in larger, targeted cohorts. These findings motivate targeted studies to evaluate whether dietary exposures, including gluten-related immune activation, interact with gluteofemoral adipose biology in lipedema.

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 .

Lipoedema is a chronic disorder primarily affecting women. Often mistaken for obesity due to its characteristic build-up of fat cells in the legs and sometimes arms, lipoedema leaves women vulnerable to social stigma. This study investigated the role of fears of compassion and depressive symptoms in the context of weight stigma and internal weight bias in women with lipoedema.

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Background: Lipedema is a chronic adipose tissue disorder predominantly affecting women and is frequently misclassified as obesity. While its physical manifestations are increasingly recognized, less attention has been paid to eating attitudes and psychological well-being in this population. The objective of this study was to descriptively explore eating attitudes and psychological well-being in women with lipedema.Methods:This exploratory cross-sectional study used an anonymous online survey to describe eating attitudes and psychological well-being in women with lipedema. A total of 47 participants completed the Eating Attitudes Test (EAT-26) and the World Health Organization-5 Well-Being Index (WHO-5). Descriptive statistics were used to summarize screening indicators of disordered eating risk and reduced psychological well-being.Results:Approximately two-thirds of participants scored at or above the EAT-26 screening cut-off, reflecting elevated screening indicators of disordered eating risk. When behavioral risk indicators were included, over 70% screened positive according to EAT-26 criteria. Reduced psychological well-being (as indicated by a WHO-5 score of ≤50) was observed in about one-fifth of the sample.Conclusion:In this exploratory sample of women with lipedema, elevated screening indicators of disordered eating risk and reduced psychological well-being were commonly observed. These findings offer preliminary insights suggesting that eating-related risk and reduced well-being may be prevalent in this population. Further research using larger, clinically verified samples is needed to better understand the psychological aspects of lipedema.

BackgroundEndothermal ablation (ETA) is a well-established treatment for chronic venous insufficiency (CVI). However, its effectiveness in patients with concomitant lipedema remains poorly described. Given the distinct pathophysiological features and symptom burden of lipedema, outcomes may differ in this subgroup.MethodsWe conducted a prospective cohort study of patients with CVI alone and those with CVI plus lipedema. All patients underwent ETA, with adjunctive phlebectomies as indicated. Quality of life (QoL) was assessed using the EQ-5D-VAS and CIVIQ-20 questionnaires before surgery and at 3 months postoperatively. Demographic and clinical variables included age, body mass index (BMI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and symptom profile. The primary outcome was the change in CIVIQ-20 score at 3 months. Secondary outcomes included changes in EQ-5D-VAS and postoperative complications (hematoma, paresthesia, superficial and deep vein thrombosis).ResultsA total of 48 patients were included (32 with CVI alone, 16 with CVI and lipedema). Preoperative QoL impairment was significantly greater in the lipedema cohort (median CIVIQ-20: 61.0 [49.5-69.5]) compared with CVI alone (46.0 [33.0-56.0], p = .001). At 3 months, both groups demonstrated significant improvement (p < .001 for within-group change). However, the magnitude of improvement was greater in CVI alone (median reduction: -13.5 [-19.5 to -5.0]) than in CVI plus lipedema (-4.0 [-7.0 to -1.5]; p = .012). Multivariable regression identified higher baseline CIVIQ-20 (β = 0.60; SE = 0.09; p < .001) and lipedema status (β = 12.44; SE = 2.43; p < .001) as independent predictors of poorer postoperative CIVIQ-20 outcomes. Paresthesia was more frequent in lipedema patients (25.0% vs 18.8% at 1 month; 12.5% vs 6.2% at 3 months).ConclusionWhile ETA significantly improves QoL in patients with CVI, those with concomitant lipedema experience smaller gains and a higher rate of postoperative paresthesia. These findings highlight the importance of setting realistic expectations and counseling lipedema patients regarding potential outcomes of venous interventions.

Lipedema is a multifactorial disorder with a negative evolutionary trend, influenced by genetic, hormonal, metabolic, and vascular factors that are not fully understood. Inflammation is a typical feature of lipedema and can be managed by limiting glycemic spikes. Herein, we report the case of a patient diagnosed with lipedema who followed a ketogenic diet (KD) for 6 months, resulting in a weight loss of 12 kg. Afterward, she transitioned to a low-carbohydrate (LC) diet for an additional 6 months, maintaining the good results achieved in terms of quality of life (QoL) improvement, weight control, and pain management. The patient regularly engaged in resistance training, which preserved and improved muscle mass. The primary and new outcome was due to the introduction of the second phase of the nutritional plan, specifically the low-carbohydrate diet, which could be an innovative approach. Often, diets that contain standard amounts of carbohydrates do not yield appreciable results.

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:  Lipedema is a progressive subcutaneous adipose tissue disorder predominantly affecting women. Characterized by painful nodules and inflammation, it impairs mobility and quality of life. Traditional nonsurgical treatments currently offer limited relief and necessitate additional interventions. This study aimed to evaluate the efficacy of SMiLE (Softening, Mobilization, Liposuction, Extraction), a lipedema reduction surgery (LRS) technique. This technique combines lymphatic-sparing liposuction with manual lipedema extraction to comprehensively remove lipedema nodules. Methods:  Sixty-two women who underwent LRS with the SMiLE technique by the primary author participated in the study and completed an online survey. Data were collected on prior medical history related to lipedema development and comorbidities and outcome measures such as pain, activities of daily living, and quality of life before and after surgery. Results:  The findings demonstrate significant improvements in patients’ daily lives following surgery. Pain levels decreased by an average of 73.9%, with the most notable reduction in the buttock shelf (81.3%). Mobility improved for 93% of participants who had faced challenges before LRS, and quality-of-life assessments indicated a 47.5% reduction in the negative impact of lipedema postsurgery. Conclusions:  The SMiLE technique offers an advancement in the surgical management of lipedema by enabling the effective removal of lipedema tissue. Alongside a reduction in pain and improvement in mobility, this method addresses physical and psychological burdens. This study suggested that the SMiLE technique could be considered an option as part of a comprehensive approach to treating patients with lipedema.

Objective: The aim of this study was to identify the demographic and clinical characteristics of patients with lipedema who presented to our outpatient clinic in Çorum, thereby contributing to defining the lipedema case profile in our country. Material and Methods: We included 80 female patients diagnosed with lipedema at the physical medicine and rehabilitation outpatient clinic of our hospital between January 2020-July 2023. Data on age, body mass index (BMI), lipedema type-stage, and symptoms were collected from medical records. Laboratory evaluations, including hemogram, 25-OH vitamin D, vitamin B12, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lower limb venous doppler ultrasound results were also obtained from medical records. Results: The mean age was 46.46±9.72 years and BMI was 32.12±4.84. Type 2 lipedema was the most common, followed by Type 1 and Type 3. Stage 2 lipedema was seen in 63.8% of the patients, stage 1 in 21.2%, and stage 3 in 15%. Common symptoms included pain, swelling, fatigue, and leg heaviness. The mean CRP was 4.88±2.89 mg/L, ESR was 18.58±10.06 mm/h, 25-OH vitamin D was 18.73±12.95 ng/dl, and vitamin B12 was 359.74±155.12 pg/ml. Venous insufficiency was present in 50% of the patients. Lipedema stage showed significant positive correlations with age (r: 0.284, p: 0.011), BMI (r: 0.307, p: 0.006), and ESR (r: 0.271, p: 0.015).Conclusion: Patients presenting with swelling and pain in the lower limbs should always be assessed for lipedema, and it should also be considered that venous insufficiency and vitamin deficiencies may coexist in these patients.

Review Article Background: Lipedema and advanced lymphedema are chronic disorders of adipose and lymphatic tissues that remain frequently underdiagnosed. Their coexistence poses therapeutic challenges, particularly when conservative management fails. Although international guidelines support surgical intervention in selected cases, real-world data from resourcelimited hospital settings remain scarce. Objective: To report the experience of a Moroccan tertiary university hospital in the surgical management of advanced lipedema and lymphedema and to compare clinical outcomes with current international recommendations. Methods: A retrospective descriptive case series was conducted between 2021 and 2024. Three patients underwent surgical treatment using tumescent liposuction or en bloc tissue resection with skin grafting. Postoperative outcomes were assessed clinically and through a structured quality-of-life questionnaire inspired by the SF-36, focusing on pain, mobility, and overall satisfaction. Results: All procedures were completed without intraoperative or postoperative complications. The volume of aspirated adipose tissue ranged from 2.1 to 4.0 L. One patient with advanced secondary lymphedema required surgical resection, with evacuation of 1.2 L of lymphorrhea. Postoperative satisfaction ranged from moderate to high, with reported quality-of-life scores between 5 and 8 out of 10. These findings are consistent with outcomes reported in recent international series. Conclusion: Surgical treatment of advanced lipedema and lymphedema is feasible, safe, and clinically beneficial, even in resource-limited settings. An individualized, guideline-based approach allows satisfactory functional and quality-of-life outcomes. Further prospective studies with standardized assessment tools are required.

INTRODUCTION: Lipedema causes abnormal fat accumulation in the limbs, leading to pain, functional impairment, and body image disturbance. Nowadays, various liposuction techniques are available. The wet technique is increasingly being considered as the gold standard; however, comparative data between the dry and wet methods remain limited. We evaluated the efficacy of liposuction and compared outcomes between dry and wet approaches. Our analysis focused on surgical characteristics, complication rates, and clinical outcomes including pain relief, functional improvement, and esthetic satisfaction, with comparisons made between preoperative and 12-month postoperative results. METHODS: Besides surgical data extraction, patient-reported outcome measures (PROMs) were obtained through three different standardized questionnaires to assess pain relief, function gain, and esthetic satisfaction. RESULTS: Both techniques were effective, demonstrating overall improvements in pain, function, and body image, when comparing pre and postoperative outcomes. Lipoaspirate volumes were comparable between the groups. Operative time was significantly shorter in the wet technique group. Short-term complication rates did not differ between dry and wet techniques. While both techniques led to a global improvement, the wet technique showed greater potential in pain reduction and better esthetics satisfaction 12 months post-surgery. CONCLUSION: Lipedema is a complex disease that is still poorly understood. Liposuction may offer symptomatic relief regardless of the technique used, but the wet technique demonstrates better postoperative results, with improved PROMs and fewer complications. The treatment of lipedema requires a multidisciplinary approach, while conservative therapy remains the first-line option, surgical treatment by wet liposuction should be considered for its significant potential in improving functional outcomes and as an effective therapeutic option.