Artigos

Phlebology. 2025 Dec 23:2683555251410002. doi: 10.1177/02683555251410002. Online ahead of print.ABSTRACTIntroductionCompression pressure is the key factor determining effectiveness in compression therapy for venous and lymphatic disorders. Despite its clinical importance, few studies report the actual applied pressure, and national standards for compression classes differ. This review aims to identify the optimal compression pressure at different stages of venous disease.MethodsA literature search was conducted in PubMed, Scopus, and Web of Science (January 1980-October 2025) using MeSH terms related to compression therapy and chronic venous disease, edema, thrombosis, post-thrombotic syndrome, lipedema, and lymphedema. Only English-language studies reporting compression pressure or class were included.ResultsLow pressures (10-21 mmHg) are enough to relieve symptoms in CEAP C0s-C1. For uncomplicated varicose veins (C2), 18-32 mmHg offers optimal symptom control. In venous edema (C3), pressures of 15-21 mmHg help prevent edema, while around 40 mmHg is more effective for treatment. Lipodermatosclerosis (C4) requires about 40 mmHg, and healed ulcers (C5) benefit from pressures greater than 30 mmHg to prevent recurrence, although compliance decreases with higher pressures. Active ulcers (C6) heal fastest under 40-50 mmHg, preferably with short-stretch materials or adjustable wraps. For lymphedema, effective reduction occurs at more than 50 mmHg (up to 120 mmHg briefly), while in the maintenance phase, 23-32 mmHg with flat-knit garments may be enough. Data on thrombosis, post-thrombotic syndrome, and post-procedure compression remain inconsistent.ConclusionsOptimal compression pressure depends on disease severity. Early CVD stages and lipedema benefit from a compression pressure <30 mmHg, while severe venous or lymphatic disease requires ≥40 mmHg. Standardized reporting and pressure-based recommendations are essential to improve therapeutic consistency and patient outcomes.PMID:41432038 | DOI:10.1177/02683555251410002

Clin Obes. 2026 Feb;16(1):e70062. doi: 10.1111/cob.70062.ABSTRACTLipoedema is a chronic, progressive condition characterised by disproportionate fat accumulation in the lower extremities, often misdiagnosed due to symptom overlap with obesity. Weight management is a key component of lipoedema treatment, yet the role of bariatric surgery remains unclear. This systematic review evaluates the impact of bariatric and metabolic surgery (BMS) on lipoedema symptoms, weight loss outcomes, and the need for further interventions. A systematic search of PubMed, Scopus and the Cochrane Library was conducted up to January 2025 following PRISMA guidelines. Studies reporting on patients with lipoedema (or equivalent diagnoses) who underwent BMS were included. Quality was assessed using the Joanna Briggs Institute (JBI) checklist for case reports and the National Heart, Lung and Blood Institute (NHLBI) tool for case series. Seven studies met the inclusion criteria (five case reports, two cohort studies), comprising 51 patients. All underwent BMS, primarily sleeve gastrectomy or Roux-en-Y gastric bypass. One study (n = 31) reported a significant reduction in thigh volume and weight loss comparable to controls. The remaining studies found persistent or worsened lower body disproportionality and no improvement in pain. Postoperative lipoedema diagnoses were common, raising concerns over diagnostic accuracy. Overall weight loss averaged 33.9% total weight loss. Bariatric and metabolic surgery achieves meaningful weight reduction in patients with lipoedema and obesity but does not consistently improve core lipoedema symptoms. Its role remains adjunctive rather than primary. Preoperative identification and documentation of lipoedema features are recommended, with a postoperative plan for adjunct conservative therapies and selective consideration of lymph-sparing liposuction where symptoms persist. Larger prospective studies using standardised definitions and outcome measures are needed to clarify its therapeutic value in this population.PMID:41432544 | DOI:10.1111/cob.70062

J Clin Lipidol. 2025 Nov 9:S1933-2874(25)00510-0. doi: 10.1016/j.jacl.2025.11.004. Online ahead of print.NO ABSTRACTPMID:41436310 | DOI:10.1016/j.jacl.2025.11.004

Phlebology. 2025 Dec 23:2683555251410009. doi: 10.1177/02683555251410009. Online ahead of print.ABSTRACTObjectivesLipedema is a chronic condition that predominantly affects women, leading to painful, disproportionate fat distribution in the limbs. This systematic review and meta-analysis aimed to characterize health-related quality of life (HRQoL) across multiple domains in individuals with lipedema.MethodsWe systematically reviewed studies from inception to 3 July 2025 in MEDLINE (via PubMed) and Cochrane Controlled Register of Trials (CENTRAL) that primarily assessed HRQoL in individuals with lipedema. Data were extracted from studies using HRQoL assessment scales. The methodological quality of included studies was assessed using an adapted version of the Newcastle-Ottawa Scale for cross-sectional studies. The review protocol was pre-registered with PROSPERO (CRD42024590792). A random-effects meta-analysis was conducted to compute pooled mean HRQoL scores across various domains.ResultsFourteen cross-sectional studies involving nine countries and 3851 participants were included. The meta-analysis found significant impairments in multiple HRQoL domains: physical functioning (61.19, 95% CI: 56.77-65.60), pain (51.77, 95% CI: 45.01-58.53), social functioning (63.24, 95% CI: 58.44-68.04), emotional well-being (64.19, 95% CI: 59.86-68.52), and energy/fatigue (43.50, 95% CI: 39.32-47.68).ConclusionLipedema significantly affects HRQoL, with major deficits in physical, emotional, and social functioning. These findings highlight the need for greater clinical awareness and comprehensive management strategies, including both physical and psychological interventions, to improve the quality of life for individuals with lipedema. Further research is needed to explore long-term effects and optimize treatment approaches.PMID:41436421 | DOI:10.1177/02683555251410009

Cureus. 2025 Nov 19;17(11):e97213. doi: 10.7759/cureus.97213. eCollection 2025 Nov.ABSTRACTLipedema is a chronic, progressive disorder marked by the abnormal accumulation of subcutaneous adipose tissue, predominantly in the lower body and almost exclusively affecting women. In recent years, the off-label use of gestrinone – a synthetic steroid with androgenic, antiprogestogenic, and weak estrogenic activity, originally approved only for endometriosis – has gained attention as a potential therapy for lipedema, particularly in the form of subcutaneous implants. This systematic review aimed to assess the efficacy and safety of gestrinone for this indication. A systematic literature search was conducted in PubMed, MEDLINE, Cochrane Library, and LILACS; clinical trial registries (ClinicalTrials.gov and Brazilian Registry of Clinical Trials (ReBEC)); as well as national and international clinical guidelines and expert consensus documents published up to July 30, 2025, following PRISMA guidelines. Eligible studies included randomized trials, observational studies, systematic reviews, case series, and clinical guidelines. Study selection, data extraction, and quality assessment were performed independently by two reviewers, with a third resolving discrepancies. The search identified nine records across all databases, registries, and other sources. After removing one duplicate, eight unique records were screened. All four records from indexed databases underwent full-text assessment. After applying inclusion/exclusion criteria, no studies – randomized, observational, or otherwise – were identified that evaluated the use of gestrinone for lipedema. Likewise, no ongoing clinical trials were found. Clinical guidelines and position statements from professional societies and patient associations uniformly advise against the off-label prescription of gestrinone for lipedema, citing the absence of scientific evidence. There is no scientific basis for the use of gestrinone in the management of lipedema. Healthcare providers should rely on evidence-based treatments, including compression therapy, tailored physical exercise, nutritional counseling, and psychological support and restrict hormonal interventions to ethically approved research protocols.PMID:41426843 | PMC:PMC12715648 | DOI:10.7759/cureus.97213

Aesthetic Plast Surg. 2025 Dec 22. doi: 10.1007/s00266-025-05569-2. Online ahead of print.NO ABSTRACTPMID:41429971 | DOI:10.1007/s00266-025-05569-2

Lymphology. 2025;58(3):108-118.ABSTRACTThe Ketogenic Diet (KD) is currently the most widely studied nutritional approach for patients with lipedema, although its use may cause important drawbacks especially in case of comorbidities. A Modified Mediterranean Diet (MMed) is more easily adaptable, better tolerated, and can be temporarily replaced by a ketogenic diet for a short period of time if necessary using a sort of “sandwich” approach. We report 10 clinical cases with lipedema and comorbidities subjected to a hypocaloric MMed for 6 months. All patients were properly assessed by anthropometric measurements and body composition before and at the end of nutritional treatment. Only 2 patients needed a short period of KD due to poor response to MMed. At the end of 6-month follow-up, patients showed weight loss with reduction in body circumferences and improvement in body composition. In the two cases where it was necessary to resort to a period of KD, good results were achieved allowing a return to the MMed for the maintenance. In patients suffering from lipedema with associated comorbidities and concomitant pharmacological treatments, the use of MMed as first line treatment allows achievement of better metabolic balance, greater compliance, and improved body composition.PMID:41406420

Trends Mol Med. 2025 Dec 16:S1471-4914(25)00285-0. doi: 10.1016/j.molmed.2025.11.005. Online ahead of print.NO ABSTRACTPMID:41407589 | DOI:10.1016/j.molmed.2025.11.005

Cureus. 2025 Nov 11;17(11):e96589. doi: 10.7759/cureus.96589. eCollection 2025 Nov.ABSTRACTAim Lipedema is a chronic, progressive disease that predominantly affects women and is strongly influenced by estrogen. Its onset or worsening is associated with hormonal periods such as puberty, pregnancy, pregnancy induction, and menopause. It is characterized by abnormal, bilateral fat deposition in the buttocks and legs, which may be accompanied by edema, pain, and tenderness to touch. It is still frequently confused with more common conditions such as obesity and lymphedema. Pycnogenol® is a combination of anthocyanins and phenolic acids belonging to the large polyphenol family, with potent antioxidant activity and a proven effect in controlling chronic venous insufficiency. It has been used by several professionals for the symptomatic management of lipedema. 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.PMID:41393612 | PMC:PMC12697813 | DOI:10.7759/cureus.96589

Aesthetic Plast Surg. 2025 Dec 14. doi: 10.1007/s00266-025-05507-2. Online ahead of print.ABSTRACTINTRODUCTION: Lipedema is a chronic inflammatory disease characterized by symmetrical deposition of adipose tissue in the upper and lower limbs, disproportionate to the trunk. It primarily affects women. The objective of this study was to evaluate the effects of surgical treatment in patients with lipedema who are refractory to conservative management.METHODS: We conducted a systematic review and single-arm meta-analysis in accordance with PRISMA guidelines. Retrospective studies involving patients who underwent surgical treatment after failing clinical management were included. Means and proportions were pooled using the inverse variance method and logit transformations, and heterogeneity was assessed using the I2 statistic.RESULTS: We included 6 studies comprising 429 patients, with follow-up ranging from 6 months to 44 months. In this meta-analysis, surgical treatment with tumescent liposuction resulted in significant clinical improvements for patients with lipedema. The pooled mean preoperative pain score was 5.64 (95% CI: 3.67-8.69), which decreased to 1.19 (95% CI: 0.91-4.22) postoperatively. Sensitivity to touch or pressure was reduced from a preoperative mean of 5.77 (95% CI: 4.10-8.10) to 1.96 (95% CI: 1.17-3.29) after surgery. Swelling scores improved from 5.47 (95% CI: 3.73-8.02) preoperatively to 2.14 (95% CI: 1.31-3.48) postoperatively, while restriction of movement scores decreased from 3.76 (95% CI: 2.48-5.72) to 0.77 (95% CI: 0.36-1.64).CONCLUSION: The results of this single-arm meta-analysis, which included six studies and 429 patients with lipedema refractory to clinical treatment and undergoing surgical intervention, demonstrate that tumescent liposuction is associated with reductions in postoperative pain and edema, as well as improvements in cosmetic outcomes, quality of life, and mobility. The duration of follow-up was adequate to capture relevant clinical outcomes and adverse events. However, lipedema remains a condition that requires further high-quality studies to define the optimal therapeutic approach.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 .”PMID:41392052 | DOI:10.1007/s00266-025-05507-2

J Postgrad Med. 2025 Dec 10. doi: 10.4103/jpgm.jpgm_273_25. Online ahead of print.ABSTRACTLipedema is a chronic adipose tissue disorder primarily affecting women, marked by abnormal, symmetrical, and disproportionate accumulation of subcutaneous fat in the lower limbs and sometimes in the arms, with hands and feet typically spared. Frequently misdiagnosed as lymphedema or obesity, lipedema presents with pain, easy bruising, bilateral nonpitting edema, and swelling that worsens throughout the day. We present two cases: Two middle-aged women reported longstanding bilateral lower limb swelling, pain, and varicose veins, without significant comorbidities. Clinical examination revealed characteristic disproportionate fat distribution and negative Stemmer’s sign. Laboratory investigations and lymphoscintigraphy excluded other causes of edema. Imaging confirmed subcutaneous thickening, fat stranding, and varicosities. Both patients were advised to have conservative management including compression therapy, limb elevation, physiotherapy and dietary counseling; one exhibited significant limb volume reduction. Our report underscores the importance of recognizing lipedema for early diagnosis and effective management to prevent progression and complications.PMID:41370187 | DOI:10.4103/jpgm.jpgm_273_25

JCEM Case Rep. 2025 Dec 3;4(1):luaf278. doi: 10.1210/jcemcr/luaf278. eCollection 2026 Jan.NO ABSTRACTPMID:41347113 | PMC:PMC12673377 | DOI:10.1210/jcemcr/luaf278

JCEM Case Rep. 2025 Dec 3;4(1):luaf278. doi: 10.1210/jcemcr/luaf278. eCollection 2026 Jan.NO ABSTRACTPMID:41347113 | PMC:PMC12673377 | DOI:10.1210/jcemcr/luaf278

Int J Womens Health. 2025 Nov 27;17:4949-4960. doi: 10.2147/IJWH.S563416. eCollection 2025.ABSTRACTBACKGROUND: Lipedema is a relatively unknown condition, often leading to misdiagnosis and a lack of proper treatment.PURPOSE: To explore the experiences of seeking healthcare support and treatment among women with a physician-verified diagnosis of lipedema.METHODS: Twelve women with lipedema, verified by medical examination, were interviewed using semi-structured interviews. The transcribed data was analyzed using qualitative content analysis with an inductive approach and abstracted to visualize manifest and latent meanings.RESULTS: The theme “Pushing the barricaded doors to treatment and care while fighting to illuminate the shadows of lipedema” describes the experiences of women being denied subsidized treatment and disregarded by healthcare professionals. The theme is based on three categories “Experiencing societal injustice and gatekeeping in healthcare services”, “Combating prejudice and stigmatization with increased awareness”, and “Having a solid desire for improved and affordable treatment options”. Women with lipedema described feelings of being abandoned by decision-makers and healthcare. When in need of symptom relief, women with lipedema searched and attempted different therapies, and when treatment were available, the women would have to pay for it themselves.CONCLUSION: Lipedema remains an unknown disease with few available treatments in subsidized healthcare. Lack of experience regarding lipedema among healthcare professionals and their failure to assess the condition risks damaging the confidence of affected women. Therefore, increased awareness and education of healthcare personnel to increase the clinical recognition of lipedema are necessary first steps to reducing misdiagnosis, improve patient satisfaction, and the availability of care among patients with lipedema.PMID:41333043 | PMC:PMC12667720 | DOI:10.2147/IJWH.S563416

Physiother Theory Pract. 2025 Nov 28:1-8. doi: 10.1080/09593985.2025.2592718. Online ahead of print.ABSTRACTBACKGROUND: 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.PMID:41312907 | DOI:10.1080/09593985.2025.2592718

Int J Mol Sci. 2025 Nov 18;26(22):11130. doi: 10.3390/ijms262211130.ABSTRACTObesity is increasingly recognized not only as a metabolic disorder, but also as a state of chronic low-grade inflammation that predisposes to systemic complications. Within this context, Dercum’s disease (DD), or adiposis dolorosa, emerges as a rare yet debilitating disorder characterized by painful subcutaneous lipomas, most commonly affecting middle-aged women. Despite its clinical impact, DD remains underdiagnosed and is often misclassified as lipedema, fibromyalgia, or lipomatosis, complicating prevalence estimates and hindering the development of targeted interventions. Current evidence suggests that DD represents a distinctive model of inflammatory obesity, where adipose tissue actively contributes to pain generation rather than serving as a passive fat reservoir. Histological and molecular findings point to adipose tissue dysfunction, immune cell infiltration, and elevated secretion of pro-inflammatory adipokines, signals which appear to fuel systemic low-grade inflammation, perineural immune interactions, and nociceptor sensitization. Peripheral mechanisms further shape the clinical phenotype. While familial clustering suggests possible genetic contributions, no definitive markers have been identified, and the role of obesity-induced epigenetic modifications remains unexplored. Therapeutic strategies remain largely symptomatic, including analgesics, antidepressants, physical rehabilitation, and surgical excision of lipomas, whereas molecularly targeted and diet-based interventions are still experimental. This article discusses the pathophysiology of DD, current treatments, and future perspectives, emphasizing that advancing patient registries, omics-based analyses, and interdisciplinary clinical trials will be crucial to elucidate disease mechanisms and guide novel therapies. Improved understanding of DD may not only enhance patient care, but also provide broader insights into the interplay between obesity, inflammation, and chronic pain.PMID:41303617 | PMC:PMC12652810 | DOI:10.3390/ijms262211130

Int J Obes (Lond). 2025 Nov 27. doi: 10.1038/s41366-025-01960-w. Online ahead of print.ABSTRACTBACKGROUND/OBJECTIVES: 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.SUBJECTS/METHODS: A cross-sectional study was conducted on 60 female participants with stage 2-3 lipedema and BMI between 30-40 kg/m². Using three-day dietary records, DII was calculated. MDS was measured by Mediterranean Diet Adherence Screening Tool. Pain and quality of life were evaluated using the Visual Analog Scale (VAS) and the Short Form-12 (SF-12), respectively. Body composition was measured via bioelectrical impedance analysis, and serum TNF-α and IL-6 levels were measured using ELISA.RESULTS: DII score was positively associated with elevated TNF-α and IL-6 concentration (p < 0.001). DII was moderately and positively correlated with both inflammatory markers, while MDS showed moderate negative correlations. Multiple linear regression models identified DII, MDS, and body mass index (BMI) as significant predictors of TNF-α and IL-6 concentration. No significant associations were observed between DII or MDS and pain (VAS) or quality of life (SF-12) scores, although mental component scores were slightly higher in participants with moderate DII levels compared to those with higher DII levels. Higher DII and BMI were linked to increased inflammation, while higher MDS was associated with lower biomarker levels. Age and disease duration were not significant in any model.CONCLUSIONS: A pro-inflammatory diet, as reflected by higher DII, is associated with increased systemic inflammation in lipedema. These findings highlight the potential role of anti-inflammatory dietary patterns, particularly the Mediterranean diet, as part of non-pharmacological strategies for managing inflammation in lipedema. These findings suggest that while dietary inflammatory potential influences systemic inflammation, its relationship with pain and quality of life remains unclear and warrants further interventional studies.PMID:41310256 | DOI:10.1038/s41366-025-01960-w

J Pers Med. 2025 Nov 1;15(11):525. doi: 10.3390/jpm15110525.ABSTRACTBackground/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.PMID:41295226 | PMC:PMC12653540 | DOI:10.3390/jpm15110525

Cureus. 2025 Oct 24;17(10):e95299. doi: 10.7759/cureus.95299. eCollection 2025 Oct.ABSTRACTKnee pain in women with lipedema is frequently misattributed and undertreated. We outline a biomechanical and inflammatory cascade linking systemic adipose dysfunction, anabolic resistance, and thigh-predominant sarcopenia to dynamic knee valgus, plantar arch collapse, altered gait, patellofemoral malalignment, and ultimately chondromalacia patellae. We integrate synovial-adipose crosstalk and the high prevalence of generalized joint hypermobility as amplifiers of joint loading. This framework supports a practical, staged approach that couples symptom control with progressive, targeted strengthening and gait retraining. Rather than treating the knee in isolation, addressing the cascade may reduce pain and improve function.PMID:41287673 | PMC:PMC12640552 | DOI:10.7759/cureus.95299

Nutr Rev. 2025 Nov 25:nuaf203. doi: 10.1093/nutrit/nuaf203. Online ahead of print.ABSTRACTLipedema, a chronic condition primarily affecting women, is characterized by abnormal subcutaneous fat accumulation and swelling in the extremities (while sparing the hands, feet, and trunk). This disease is associated with genetic predisposition, hormonal imbalances, impaired lymphatic function, and vascular dysfunction. Lipedema does not directly cause weight gain, but excess weight can worsen symptoms and accelerate disease progression. Bariatric surgery is considered a treatment option for body weight management and reduction of subcutaneous fat; however, reported studies have indicated that this treatment cannot reduce localized fat accumulation or fat cell hypertrophy or alleviate pain symptoms. Although no proven dietary treatment currently exists, nutrition plays a key role in managing lipedema. Certain dietary approaches such as ketogenic, low-carbohydrate, and modified Mediterranean diets have been explored for weight management and inflammation reduction in lipedema, with studies showing positive effects on body composition and pain. However, according to the current literature no evidence-based nutritional treatments or nutritional supplements are effective in this patient group. Nutritional therapy in lipedema is complicated by frequent comorbidities; therefore, precision nutritional therapy should be planned by evaluating the causes and consequences of the disease. In this review, we evaluated reported studies of current evidence-based clinical nutritional approaches to lipedema treatment.PMID:41288228 | DOI:10.1093/nutrit/nuaf203

Aesthetic Plast Surg. 2025 Nov 25. doi: 10.1007/s00266-025-05456-w. Online ahead of print.ABSTRACTINTRODUCTION: Liposuction is effective for body contouring but may cause transient cutaneous sensory changes. In lipedema, therapeutic liposuction involves higher aspirate volumes, fibrotic tissue, and exposure of distal-leg zones at risk. We hypothesized that postoperative sensory alterations are more frequent and persistent after lipedema surgery than after aesthetic lower-leg liposuction, with disease severity-rather than technique-driving outcomes.MATERIALS AND METHODS: In this prospective, single-center cohort (January 2023-March 2024), 90 women underwent lower-leg liposuction (knee-to-ankle) by one surgeon: Control (aesthetic; n = 30), lipedema Stage I (n = 20), Stage II (n = 20), Stage III (n = 20). All procedures used VASER-assisted emulsification and MicroAire PAL aspiration under standardized tumescent infiltration. Sensory testing (Semmes-Weinstein monofilaments, thermal discrimination, pinprick, 10-point VAS) was performed at baseline and 1, 3, 6, and 12 months. Persistent alteration was defined as > 6 months. Satisfaction was assessed at 6 and 12 months with the BODY-Q Lower Leg module and a functional questionnaire. Logistic regression identified predictors of 12-month hypoesthesia.DISCUSSION: Aspirated volume increased with disease stage (Control 2400 mL; Stage I 2600 mL; Stage II 3500 mL; Stage III 4600 mL; p < 0.01) and correlated with persistent hypoesthesia/paresthesia (p < 0.01). Twelve-month hypoesthesia was seen in 3.3% (Control), 5% (Stage I), 15% (Stage II), and 25% (Stage III). Despite this, satisfaction was high across groups (BODY-Q: Control 90, Stage I 91, Stage II 88, Stage III 86). Lipedema patients also reported substantial improvements in pain (85-95%), mobility (80-92%), heaviness (88-96%), and bruising (78-91%). These findings indicate that advanced disease, not surgical method, accounts for prolonged sensory alterations.CONCLUSION: Lower-leg liposuction in lipedema provides significant symptomatic and functional relief, with consistently high satisfaction despite persistent sensory changes in Stage II-III disease. Disease severity and aspirated volume, not technique, are the main determinants of postoperative hypoesthesia. Counseling should balance sensory risk with the strong likelihood of life-changing benefits.LEVEL OF EVIDENCE II: 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 .PMID:41291075 | DOI:10.1007/s00266-025-05456-w

Front Cell Dev Biol. 2025 Nov 6;13:1691161. doi: 10.3389/fcell.2025.1691161. eCollection 2025.ABSTRACTLipedema 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.PMID:41278213 | PMC:PMC12631410 | DOI:10.3389/fcell.2025.1691161

Vasa. 2025 Nov 17. doi: 10.1024/0301-1526/a001250. Online ahead of print.ABSTRACT 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 pain, leading to impairments in daily activities and reduced quality of life. Conservative treatment mainly focuses on lifestyle modifications, along with compression therapy and manual lymphatic drainage. Exercise training could also play a pivotal role in the management of lipedema. The aim of this systematic review was to explore the effectiveness of exercise training in women with lipedema. A comprehensive literature search was conducted in Embase, MEDLINE, Cochrane CENTRAL, Web of Science, CINAHL on June 23, 2025. The main outcomes were pain, fatigue and other symptoms, quality of life, anthropometric characteristics, lower limb volumes and/or circumference, and functional performance. The search strategy identified 523 studies, of which six were included in this review. Studies included 115 women with lipedema. Exercise training seems to improve pain and other symptoms, quality of life, limb volumes and/or circumference, and functional performance. The effects seem to be greater when combined with ongoing compression therapy. However, the effects of exercise training on the different outcomes varied among the studies, probably related to the high heterogeneity, different training approaches, and small sample sizes. Exercise training might be a promising therapeutic care option in women with lipedema, and the effects seem to be greater when combined with ongoing compression therapy. Appropriately designed and adequately powered studies are needed to further explore the benefits of exercise in these patients. (PROSPERO Registration No.: CRD42024604164).PMID:41243294 | DOI:10.1024/0301-1526/a001250

Int J Mol Sci. 2025 Nov 5;26(21):10741. doi: 10.3390/ijms262110741.ABSTRACTLipedema is a chronic, progressive adipose tissue disorder that affects up to 10% of women and is characterized by disproportionate lower-limb fat accumulation, pain, edema, and resistance to conventional weight-loss approaches. Its pathophysiology involves a complex interplay of adipocyte hypertrophy, chronic inflammation, extracellular matrix fibrosis, mitochondrial dysfunction, and sex steroid imbalance, highlighting the need for disease-modifying therapies. This narrative review synthesizes mechanistic, translational, and clinical evidence linking metabolic, inflammatory, and fibrotic pathways to lipedema and tirzepatide’s potential therapeutic relevance. Tirzepatide, a dual GLP-1 (Glucagon-Like Peptide-1)/GIP (Glucose-Dependent Insulinotropic Polypeptide) receptor agonist, has demonstrated unprecedented efficacy in obesity and diabetes, alongside pleiotropic actions on inflammation, fibrosis, and adipose remodeling. Mechanistic studies reveal favorable effects on macrophage polarization, cytokine signaling, extracellular matrix turnover, and thermogenesis, suggesting potential relevance to lipedema biology. Translational evidence from related fibro-inflammatory conditions such as steatohepatitis and heart failure further supports its antifibrotic and immunomodulatory plausibility. Although direct clinical evidence in lipedema is lacking, the convergence of mechanistic pathways provides a strong rationale to investigate tirzepatide as a disease-modifying candidate. If future clinical studies confirm these mechanisms, tirzepatide could represent a novel metabolic-hormonal therapy capable of modifying the natural course of lipedema.PMID:41226777 | PMC:PMC12608556 | DOI:10.3390/ijms262110741

Aesthet Surg J Open Forum. 2025 Sep 26;7:ojaf120. doi: 10.1093/asjof/ojaf120. eCollection 2025.ABSTRACTBACKGROUND: Liposuction in lipedema is a safe and effective treatment, but there currently are no studies analyzing the individual complications of water-jet-assisted liposuction in lipedema or the impact of the cannula’s design.OBJECTIVES: The aim of the authors of this study is to answer the question which WAL cannula is the safest in lipedema patients and provide practitioners with the data they need to make an informed decision about the cannula they choose.METHODS: The authors retrospectively analyzed complications and their underlying risk factors in 117 patients across 243 cases. Groups were formed by diameter (Ø) and number of ports of the used cannulas. Unpaired t-tests, Fisher’s exact tests, and χ2 tests were used to analyze the patients’ characteristics for the complication rates across the cannulas.RESULTS: Cannulas with 8 ports showed statistically significantly higher hemoglobin loss (P = .011), shorter incision-to-suture time (P = .023), and higher volume of aspirated fat (P < .001). The same results occurred when comparing the Ø3.8 mm cannulas that differ in the number of ports (4 vs 8 ports). The Ø4.8 mm group showed a significantly increased rate of wound-healing disorders compared with the Ø3.8 mm group (P = .041) and a statistically significantly higher aspirated fat volume (P = .014).CONCLUSIONS: No specific cannula showed superior safety in terms of complication rates. However, 8-port cannulas facilitated a faster aspiration of large volumes and reduced the incision-to-suture time compared with 4-port cannulas. This benefit was accompanied by a greater loss of hemoglobin. In contrast, cannula diameter played a less significant role in aspiration speed and did not increase the hemoglobin loss.PMID:41211203 | PMC:PMC12596102 | DOI:10.1093/asjof/ojaf120