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Summary: Lipedema is a chronic disease characterized by the disproportionate and symptomatic accumulation of fat in the lower limbs and arms. Women with lipedema experience heaviness, fatigue and p...

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.

Lipedema is a chronic disorder characterized by the symmetrical accumulation of subcutaneous adipose tissue, predominantly affecting women. Despite increasing recognition, the pathophysiological mechanisms underlying adipose tissue dysfunction in lipedema remain incompletely understood. This mini review combines current knowledge about adipose tissue biology in lipedema, highlighting recent discoveries, ongoing controversies, and future research directions. A comprehensive literature review was conducted focusing on adipose tissue-related research in lipedema with emphasis on pathophysiological mechanisms, cellular composition, and therapeutic implications. Recent studies reveal that lipedema adipose tissue exhibits distinct characteristics, including M2 macrophage predominance, stage-dependent adipocyte hypertrophy, progressive fibrosis, and altered lymphatic/vascular function. The inflammatory profile differs markedly from obesity, with an anti-inflammatory M2-like macrophage phenotype rather than the pro-inflammatory M1 response seen in classic obesity. Emerging evidence suggests lipedema may represent a model of “healthy” subcutaneous adipose tissue expansion with preserved metabolic function despite increased adiposity. Current research proposes menopause as a critical turning point, driven by estrogen receptor imbalance and intracrine estrogen excess. Lipedema represents a unique adipose tissue disorder distinct from obesity, characterized by specific cellular and molecular signatures. Current research gaps include the need for validated biomarkers, standardized diagnostic criteria, and targeted therapeutics. Future research should focus on elucidating the molecular mechanisms driving adipose tissue dysfunction and developing precision medicine approaches.

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 .

This article aims to summarize contemporary understanding and management strategies of lipedema. It will elucidate recent advancements in diagnostic methodologies, the role of imaging technologies, and evolving therapeutic interventions. The article will further delineate critical areas that warrant further investigation.

Introduction: Lipedema is a chronic, progressive loose–connective-tissue disorder characterized by painful, disproportionate subcutaneous adipose tissue, functional limitations, and impaired quality of life, prompting growing interest in evidence-based management strategies. Objective: To systematically review contemporary human studies on surgical and non-surgical treatments for lipedema, with emphasis on symptom control, functional outcomes, complications, and quality of life, and to synthesize comparative effectiveness across modalities. Methods: We planned a PRISMA-compliant search of PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP for the last five years, expanding to ten years only if fewer than ten eligible studies were found; inclusion criteria prioritized human clinical trials and observational studies, with basic science excluded from synthesis; risk of bias and certainty of evidence (GRADE) were prespecified; data were extracted for populations, interventions, comparators, outcomes, and follow-up. Results and Discussion: Recent literature suggests that compression therapy, exercise, and pneumatic compression can reduce pain and edema and improve patient-reported outcomes, while liposuction techniques including tumescent, power-assisted, and water-assisted approaches generally show substantial improvements in symptoms and health-related quality of life with acceptable complication rates; however, heterogeneity in diagnostic criteria, outcome measures, and follow-up limits certainty of pooled estimates. Conclusion: Contemporary evidence supports a stepped, individualized approach beginning with optimized conservative care and progressing to lipedema reduction surgery in appropriately selected patients, with shared decision-making and standardized outcome measurement essential for practice and future research. &nbsp;

Lipedema is a painful disease of subcutaneous adipose tissue (SAT) in women. This study determined whether an advanced pneumatic compression device (APCD) improved lipedema SAT depth, swelling, and pain. Women with lipedema started 20–30 mm Hg compression leggings then were randomized to an APCD (Lympha Press Optimal Plus) group for 30 days (treatment; n = 22) or a no APCD (Control; n = 24) group. APCD treatment significantly reduced left leg volume (3D imaging, LymphaTech; p < 0.043) and fluid in the left (p = 0.0018) and right legs (p = 0.0476; SOZO, bioimpedance spectroscopy); controls showed no change. Treatment significantly decreased extracellular fluid (ECF) and intracellular fluid (ICF) in left (p = 0.0077; p = 0.0060) and right legs (p = 0.0476; p ≤ 0.025), respectively. Only ECF decreased significantly in the left (p < 0.0183) and right legs (p = 0.0009) in controls. SAT depth decreased significantly by ultrasound after treatment at the anterior (p ≤ 0.0234) and medial thigh (p ≤ 0.0052), medial knee (p ≤ 0.0002) and posterior calf (p ≤ 0.0118) but not in controls. All signs and symptoms of lipedema improved in the treatment group including swelling (p = 0.0005) and tenderness (pain) of right (p = 0.0003) and left legs (p < 0.0001); only swelling improved in controls (p = 0.0377). In total, 87.5% of RAND SF-36 quality of life improved after treatment (p ≤ 0.0351) compared to 37.5% in controls (p ≤ 0.0475). APCDs are effective treatment for lipedema.