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Lipedema is a chronic disorder of subcutaneous adipose tissue characterized by symmetrical fat accumulation of the extremities and resistance to conventional weight loss. Therapeutic options remain limited, and clinical data on nutritional interventions are scarce. A 37-year-old woman with stage II lipedema underwent a ten-day medically supervised fasting program embedded in a multimodal intervention that also included physical activity after limited response to standard conservative management. Body weight decreased from 78.7 to 73.7kg, and C-reactive protein from 22.5 to 0.82mg/L. Limb circumferences decreased at the calves (48 to 44–44.5cm) and thighs (65 to 58cm). Subcutaneous tissue thickness, measured by ultrasound, decreased at the medial malleolus (22 to 12–15mm) and at the mid-thigh (44 to 34.5mm), while remaining stable in the gluteal region (98mm). Elastography showed a persistent heterogeneous fibrosclerotic pattern. The patient reported a marked reduction in pain (approximately 80% during fasting, sustained at ~50% for over one month). No adverse events occurred. Altogether, this case is notable because objective ultrasound measurements and inflammatory biomarkers improved after a structured fasting intervention in a condition usually considered resistant to weight loss. Because the intervention was multimodal, the contribution of fasting cannot be isolated and controlled studies are warranted. This suggests that medically supervised fasting may improve inflammatory status and tissue structure in lipedema and warrants further investigation in controlled studies.