Artigos

Aesthetic Plast Surg. 2026 Oct 19. doi: 10.1007/s00266-026-06405-x. Online ahead of print.ABSTRACTThis Letter to the Editor documents several verifiable internal inconsistencies in the article by Bruno and D’Antimi, including contradictory statements on study design, a level-of-evidence rating incompatible with the stated methods, contradictory informed-consent statements, and references to a procedure and outcome domain that do not correspond to the study performed. A correction or clarification is requested.Level of Evidence V 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:42897246 | DOI:10.1007/s00266-026-06405-x

Ugeskr Laeger. 2026 Sep 21;188(39):V01260052. doi: 10.61409/V01260052.ABSTRACTA previously healthy 35-year-old woman developed recurrent syncope and dyspnoea two days after extensive thigh liposuction for lipedema. CT pulmonary angiography revealed a large saddle embolus with peripheral emboli. Fat embolism was initially suspected; however, imaging findings and laboratory parameters supported a thromboembolic origin. Treatment with anticoagulation was complicated by postoperative bleeding. This case report highlights the importance of considering both fat embolism and thromboembolic pulmonary embolism after liposuction.PMID:42894944 | DOI:10.61409/V01260052

Phlebology. 2026 Oct 18:2683555261500186. doi: 10.1177/02683555261500186. Online ahead of print.ABSTRACTBackgroundLipedema is a chronic condition that predominantly affects women and is commonly associated with pain, edema, and functional impairment. Conservative physiotherapy interventions are frequently recommended; however, the scope and characteristics of the available evidence remain unclear.ObjectiveTo map the existing evidence on conservative physiotherapy interventions for lipedema, focusing on intervention types, outcomes assessed, and methodological characteristics.MethodsA scoping review was conducted according to the PRISMA-ScR guidelines. Eligibility was guided by the PCC framework. Electronic databases and gray literature were searched for primary studies and secondary sources addressing conservative physiotherapy interventions for lipedema. Data were synthesized descriptively.Results15 records were included, comprising randomized controlled trials, observational studies, and secondary sources such as reviews, guidelines, and consensus documents. The most frequently investigated interventions were complex decongestive therapy, therapeutic compression, structured exercise programs, and adjunct physical modalities. Outcomes mainly included edema, pain, functional capacity, and quality of life. Among primary studies, multimodal conservative physiotherapy approaches were the most frequently reported. Secondary sources consistently described conservative physiotherapy as a component of care, although they were not treated as independent confirmation of treatment effects.ConclusionThe available literature suggests that conservative physiotherapy is frequently described as a component of lipedema management. However, the evidence base is characterized by methodological heterogeneity, small sample sizes, and the absence of formal quality appraisal, and the findings should be interpreted as a mapping of the available evidence rather than as evidence of treatment efficacy.PMID:42893453 | DOI:10.1177/02683555261500186

Front Cell Dev Biol. 2026 Oct 1;14:1893552. doi: 10.3389/fcell.2026.1893552. eCollection 2026.ABSTRACTA progressive disease, lipedema is characterized by bilaterally symmetrical and disproportional accumulation of subcutaneous adipose tissue (SAT) in the extremities, leading to severe pain, inflammation, and mobility issues. Lipedema predominantly affects women in all stages of life and treatment options are currently limited as patients’ conditions can only be improved to a limited extent by diet or exercise. The pathogenesis of lipedema remains poorly understood and a reliable diagnostic marker is currently missing. Disease progression is marked by stage-dependent morphological adipose tissue changes, such as adipocyte hypertrophy and stage-dependent fibrosis, accompanied by an elevated proportion of anti-inflammatory macrophages. The molecular mechanisms regulating these compositional and structural changes in adipose tissue, and to what extent this altered response is cause or consequence of the disease, remain unclear. Therefore, the analysis of disease-related changes, with a focus on the cellular dynamics and tissue composition changes may help to distinguish lipedema more reliably from adiposity-related comorbidities.PMID:42889398 | PMC:PMC13670023 | DOI:10.3389/fcell.2026.1893552

J Vasc Bras. 2026 Sep 7;25:e20260056. doi: 10.1590/1677-5449.202600562. eCollection 2026.ABSTRACTBACKGROUND: The Questionário de avaliação sintomática do lipedema (QuASiL – Lipedema Symptom Assessment Questionnaire) assesses 13 distinct inflammatory symptoms of lipedema, but whether these symptoms resolve and recur simultaneously or follow a consistent order remains unknown.OBJECTIVES: To characterize the persistence hierarchy of the 13 QuASiL inflammatory symptoms in a retrospective lipedema cohort under heterogeneous conservative treatment, using 6 complementary rank-order analyses and testing the null hypothesis that symptoms resolve with equal magnitude.METHODS: This retrospective longitudinal study included 1,300 patients who were clinically diagnosed with lipedema by a vascular surgeon and who completed the QuASiL on at least 2 occasions (minimum 14-day interval; median follow-up 181 days, IQR 92-380, maximum 1,787 days). A consensus ranking was computed across all analyses. A sensitivity analysis was conducted using the conventional T 0 = first visit, T 1 = last visit convention, and a Kaplan-Meier survival analysis estimated the time (in absolute days) to ≥ 50% reduction from baseline per symptom.RESULTS: The symptoms did not resolve simultaneously (Friedman χ2 (12) = 168.08, p < 0.001). All 13 symptoms improved during follow-up, showing a consistent order across the 6 analyses. A slower-resolving core was identified: bruising (consensus rank 1.7), swelling (2.0), touch sensitivity (4.3), leg heaviness (4.7), and fatigue (4.7). A rapidly-responding group comprised skin irritation (66.4% proportional reduction), itching (62.0%), and walking difficulty (62.6%). Even the most resistant symptom (bruising) achieved a mean 39.1% proportional reduction, with half of patients reaching ≥ 50% improvement. During worsening, swelling and pressure/tension re-emerged first. The sensitivity analysis (T0 = first, T1 = last) produced an essentially identical ranking (Spearman ρ = 0.945, p < 10-5). The Kaplan-Meier analysis estimated a median of 546 days for bruising vs 207 days for itching to reach ≥ 50% reduction from baseline (log-rank χ2 = 44.6, p < 10-10); the fastest-resolving symptom was heat/burning at 203 days.CONCLUSIONS: In this retrospective cohort of patients under heterogeneous conservative treatment, the 13 QuASiL inflammatory symptoms improved following a consistent order across 6 independent analyses, with bruising and swelling as the most persistent symptoms.PMID:42890093 | PMC:PMC13671008 | DOI:10.1590/1677-5449.202600562

J Vasc Bras. 2026 Oct 9;25:e20250210. doi: 10.1590/1677-5449.202502102. eCollection 2026.ABSTRACTLipedema is a chronic adipose tissue disorder that predominantly affects women, although some rare cases do occur in men. We report the case of a 32-year-old man with symmetrical, lower-limb fat accumulation, foot sparing, pain, easy bruising, and a positive family history of lipedema. His first-degree female cousin exhibited the classic phenotype. Dual-energy X-ray absorptiometry demonstrated greater fat accumulation in the gynoid than in the android and visceral regions, reinforcing a predominantly gluteofemoral adiposity pattern. The patient underwent a 7-month personalized nutritional intervention consisting of a moderately hypocaloric, high-protein, low-glycemic diet with vitamin D supplementation and regular physical activity. This intervention was associated with reductions in anthropometric measurements and decreased pain scores on a Visual Analogue Scale. Laboratory tests revealed a preserved hypothalamic-pituitary-gonadal axis, except for mild idiopathic hyperprolactinemia that normalized during follow-up. This case highlights lipedema in men and the potential benefits of early lifestyle-based interventions.PMID:42890151 | PMC:PMC13671010 | DOI:10.1590/1677-5449.202502102

J Clin Med. 2026 Oct 4;15(19):7678. doi: 10.3390/jcm15197678.ABSTRACTBackground/Objectives: Lipedema is an adipose tissue disorder associated with body-related burden. This study compared orthorexic eating tendencies between women with and without lipedema and examined associations with body-shape concern and psychological symptoms. Methods: This controlled cross-sectional study included 44 women with lipedema and 44 women without lipedema. Participants completed the Düsseldorf Orthorexia Scale (DOS), Body Shape Questionnaire (BSQ), and Hospital Anxiety and Depression Scale (HADS). Associated variables were examined using multiple linear regression. Results: Women with lipedema had higher DOS scores than women without lipedema (25.07 ± 6.55 vs. 20.48 ± 5.05; Cohen’s d = 0.79; p < 0.001). BSQ, HADS-Anxiety, and HADS-Depression scores were also higher in the lipedema group (all p ≤ 0.001). DOS and BSQ scores were positively correlated in both groups. In the multivariable model, which included group status, age, BMI, BSQ, HADS-A, and HADS-D scores, BSQ score was independently associated with DOS score (B = 0.067; 95% CI 0.025-0.108; p = 0.002), whereas group status and the other covariates were not. The model’s adjusted R2 was 0.234. Conclusions: Women with lipedema exhibited greater orthorexic eating tendencies, body-shape concern, and psychological symptoms than controls. Body-shape concern was independently associated with orthorexic eating tendencies. The group difference in DOS scores is largely explained by the higher BSQ scores accompanying lipedema; this should not be interpreted as indicating that lipedema is unrelated to orthorexic tendencies. These findings support consideration of body image when addressing eating behavior in lipedema care.PMID:42882140 | PMC:PMC13665791 | DOI:10.3390/jcm15197678

Cells. 2026 Oct 7;15(19):1820. doi: 10.3390/cells15191820.ABSTRACTLipedema is a chronic, predominantly female disorder characterized by disproportionate regional expansion of subcutaneous adipose tissue, pain, tenderness, and easy bruising. Reported abnormalities involve adipocytes, stromal/progenitor cells, microvascular and immune compartments, extracellular matrix (ECM), and, variably, lymphatic function, but their causal and temporal relationships remain unresolved. Here, we propose the adipovascular unit (AVU) as a systems-level framework that links these compartments within a spatially organized regenerative niche. The conceptual advance is not the identification of a new anatomical structure, but the prediction that regional disease expression depends on reciprocal interactions among adipose stem and progenitor cells (ASPCs), endothelial and mural cells, immune populations, ECM, and mature adipocytes, rather than on a universal defect in any single cell type. We hypothesize that physiological female reproductive signals may expose a regionally susceptible AVU in which regenerative responses are inadequately constrained in space, magnitude, or duration. This framework also distinguishes lipedema from obesity-associated adipose dysfunction: lipedema is regionally patterned and may coexist with relatively preserved systemic metabolic function, whereas obesity-related adipose dysfunction is more closely linked to whole-body energy excess, ectopic fat, insulin resistance and cardiometabolic risk. Evidence demonstrated directly in lipedema is separated throughout from general adipose-tissue biology used to establish plausibility and from mechanisms that remain hypothetical. We derive falsifiable predictions involving depot-specific molecular states, endocrine context, multicellular cross-talk, extracellular-vesicle cargo and transfer, spatial biological boundaries, and persistence after stimulus withdrawal. Testing these predictions in paired-depot, spatially resolved and multicellular systems will determine whether AVU dysregulation is a causal organizing principle of lipedema or a descriptive consequence of established disease.PMID:42882518 | PMC:PMC13664079 | DOI:10.3390/cells15191820

Phlebology. 2026 Oct 16:2683555261499797. doi: 10.1177/02683555261499797. Online ahead of print.ABSTRACTObjectivesTo investigate the clinical and ultrasonographic changes associated with radial extracorporeal shock wave therapy (rESWT) in women with lipedema.MethodsThis prospective, single-arm study included 40 women with lipedema who completed six sessions of rESWT administered twice weekly to the index lower limb. Treatment consisted of 3000-6000 impulses at 15 Hz and 3-4 bar. Participants were evaluated at baseline (T0), immediately after treatment (T1), and at 4-week follow-up (T2). Outcomes included visual analog scale (VAS) pain scores, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, pressure pain threshold (PPT), limb circumference, subcutaneous fat thickness (SCFT), and tissue echogenicity. Patient Global Impression of Change (PGIC) was assessed at T1 and T2.ResultsVAS scores decreased from 8.45 at T0 to 5.45 at T1 and 4.17 at T2, while PROMIS scores decreased from 25.3 to 16.2 and 14.3, respectively (both p < .001). PPT increased significantly at all four evaluated sites (p < .001). Calf and thigh circumferences decreased significantly over time (both p < .001). Medial calf SCFT decreased from 16.5 to 15.2 and 15.1 mm, and medial thigh SCFT from 21.0 to 18.2 and 18.1 mm (both p < .001). Median tissue echogenicity decreased from 3 at baseline to 2 at both post-treatment assessments (p < .001). PGIC scores also improved between T1 and T2 (p < .001).ConclusionsSix sessions of rESWT were associated with improvements in pain, quality of life, mechanical pain sensitivity, limb circumference, and ultrasonographic tissue characteristics in women with lipedema, with most improvements maintained at 4-week follow-up. These findings support further evaluation of rESWT as an adjunctive conservative treatment for lipedema in controlled studies with longer follow-up.Trial registrationClinicalTrials.gov, NCT07683559.PMID:42886234 | DOI:10.1177/02683555261499797

Phlebology. 2026 Oct 16:2683555261499769. doi: 10.1177/02683555261499769. Online ahead of print.ABSTRACTObjectivesLipedema is a chronic adipose tissue disorder characterized by disproportionate fat accumulation, lower extremity pain, functional impairment, and reduced quality of life. Although pain is a cardinal symptom, its underlying mechanisms remain incompletely understood. This study aimed to characterize sensitization-related pain phenotypes in women with lipedema by examining central sensitization (CS) and neuropathic -like pain features and their associations with lower extremity function, sleep quality, and health-related quality of life (HRQoL).MethodsIn this cross-sectional case-control study, 54 women with clinically diagnosed lipedema and 48 age-matched control participants were enrolled between March and October 2025. Pain phenotypes were assessed using the Central Sensitization Inventory (CSI) and Pain-DETECT questionnaire. Lower extremity function, sleep quality, and HRQoL were evaluated using Lower Extremity Functional Scale (LEFS), Jenkins Sleep Scale (JSS), and EuroQol-5D-3L (EQ-5D-3L), respectively.ResultsWomen with lipedema had significantly higher Pain-DETECT and CSI scores than controls, indicating greater neuropathic-like pain features and CS-related symptom burden (both p < .01). They also demonstrated poorer lower extremity function, greater sleep disturbance, and lower HRQoL. Pain-DETECT scores were positively correlated with CSI, anxiety, depression, and sleep disturbance scores. In multivariable analyses, LEFS independently predicted Pain-DETECT scores (B = -0.171, p = .015), whereas anxiety independently predicted CSI scores (B = 1.980, p = .002).ConclusionsWomen with lipedema exhibit prominent sensitization-related pain phenotypes associated with functional impairment, sleep disturbances, and reduced quality of life. Identification of these pain characteristics may improve clinical assessment, patient stratification, and multidisciplinary management of lower extremity symptoms in lipedema.PMID:42886501 | DOI:10.1177/02683555261499769

Medicina (B Aires). 2026;86(5):1284-1293.ABSTRACTLipedema is a chronic adipose tissue disorder that primarily affects women, characterized by symmetrical and disproportionate fat accumulation in the lower and/ or upper extremities, sparing hands and feet. This review aims to update knowledge on diagnosis, staging classification, and available therapeutic options. Diagnosis is fundamentally clinical, based on characteristic adipose tissue distribution, presence of pain, easy bruising, after excluding other similar entities. Treatment includes conservative measures (complete decongestive therapy, exercise, compression) and surgical procedures (tumescent liposuction or, in severe cases, resective surgery). Early recognition of lipedema allows implementation of therapeutic strategies that significantly improve patients’ quality of life, preventing progression to advanced stages and associated complications such as secondary lymphedema.PMID:42886966

Phlebology. 2026 Oct 15:2683555261499777. doi: 10.1177/02683555261499777. Online ahead of print.ABSTRACTObjectivesTo determine the prevalence of chronic venous insufficiency (CVI) in patients with lipedema, characterize venous reflux patterns and CEAP clinical classes, and evaluate associations with demographic and lipedema-related characteristics.MethodsThis retrospective, single-center observational study included adults with lipedema evaluated between January 2023 and December 2025. Of 120 patients screened, 50 were excluded because of incomplete venous Doppler ultrasonography, clinical, or demographic data, leaving 70 patients for analysis. Demographic and clinical characteristics and lower-extremity venous duplex ultrasonography findings were reviewed. Superficial, deep, and perforator reflux; segment-specific reflux; great saphenous vein (GSV) and small saphenous vein (SSV) diameters; laterality; and CEAP clinical class were recorded. Pathological reflux was defined as reversed flow lasting >0.5 s in superficial truncal veins and >1.0 s in the common femoral, femoral, and popliteal veins. Univariable and multivariable logistic regression analyses examined factors associated with CVI.ResultsCVI was identified in 38 of 70 patients (54.3%; 95% confidence interval, 41.9%-66.3%). Venous reflux predominantly involved the superficial system, with GSV reflux as the most frequent segment-specific finding, whereas deep venous reflux was uncommon. Patients with CVI had greater GSV and SSV diameters than those without CVI (both p < 0.001), while age, body mass index (BMI), and disease duration did not differ between groups. CVI frequency increased across BMI categories, although the overall categorical association was not significant. Lipedema stage was not associated with CVI or individual reflux patterns; however, increasing lipedema stage showed a weak positive association with higher CEAP clinical class. Age, BMI, and lipedema stage were not independently associated with CVI in multivariable analysis.ConclusionsVenous insufficiency was frequently observed in patients with lipedema and predominantly involved the superficial venous system. Greater saphenous vein diameters provided an objective ultrasonographic correlate of venous involvement. Because an appropriately matched local control population was not available, the present study cannot establish whether venous reflux is more frequent in patients with lipedema than in the general population. The observed relationship between lipedema stage and CEAP clinical class should therefore be considered hypothesis-generating and warrants confirmation in prospective controlled studies.PMID:42880401 | DOI:10.1177/02683555261499777

Phlebology. 2026 Oct 15:2683555261499144. doi: 10.1177/02683555261499144. Online ahead of print.ABSTRACTObjectiveThis study aimed to comparatively evaluate sleep quality in individuals with lipedema and healthy controls. In addition, the relationships between sleep quality and depression, anxiety, fatigue, and clinical parameters were investigated.MethodsThis cross-sectional study included 30 women with lipedema and 30 healthy female controls aged 18-75 years. Pain severity in individuals with lipedema was assessed using the Visual Analog Scale (VAS). Lipedema stage, comorbidities, and symptom duration were also recorded. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), depressive and anxiety-related symptoms were assessed using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and fatigue severity was evaluated using the Fatigue Severity Scale (FSS).ResultsIndividuals with lipedema had significantly higher BDI, BAI, and FSS scores than controls (all p < 0.001 except BDI, p = 0.001). Sleep quality was significantly poorer in the lipedema group (p < 0.001). Among PSQI subcomponents, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, and daytime dysfunction were significantly worse in individuals with lipedema, while sleep medication use was similar between groups (p > 0.05). In the lipedema group, PSQI scores were positively correlated with depressive (r = 0.489, p = 0.006) and anxiety symptoms (r = 0.386, p = 0.035). No significant associations were found between sleep quality and age, anthropometric measurements, education duration, pain severity, lipedema stage, symptom duration, or fatigue severity.ConclusionsThis study demonstrated poorer sleep quality in individuals with lipedema compared to healthy controls. Sleep quality was also associated with depressive and anxiety-related symptoms, highlighting an association between psychological symptoms and sleep problems in individuals with lipedema.PMID:42880360 | DOI:10.1177/02683555261499144

Cureus. 2026 Sep 12;18(9):e116127. doi: 10.7759/cureus.116127. eCollection 2026 Sep.ABSTRACTThe aesthetic-functional planning of the lower limbs is frequently conducted empirically, using idiosyncratic markings and limited standardization among specialists who work in this field. The absence of a common topographic language restricts clinical communication, technical reproducibility, documentation of results, and the integration between the aesthetic approach and the vascular/lymphatic assessment of the segment. This is a descriptive study of methodological development. Based on a review of the anatomic and surgical literature and prospective clinical application during body-contour consultations, six topographic zones of the lower limbs were defined: gluteal, trochanteric (saddlebag), thigh (anterior, medial, and posterior subunits), knee, crural (calf), and talocrural (ankle), each delimited by reproducible surface bony and muscular landmarks. Onto this map, the cartography of the zones of adherence, superficial and deep adipose planes separated by the superficial fascia, saphenous venous axes, and main lymphatic collector pathways was overlaid. A four-stage marking protocol was defined (orthostatism, marking of bony landmarks, zone delimitation, and coding of plane and intensity), with standardized photographic documentation. For each zone, the following are presented: anatomic boundaries, muscular and adipose content, vascular and lymphatic correlates, zones of adherence to be preserved, recommended working plane (deep, intermediate, or superficial), specific risks, and expected aesthetic outcomes. The map provides a common nomenclature among surgeons and enables technology to be prescribed by anatomic zone rather than by generic “region”. This anatomofunctional zone-based marking provides a simple, low-cost, and reproducible instrument to structure the therapeutic planning of the lower limbs, aligning the aesthetic objective with the anatomic, vascular, and lymphatic constraints of the segment. Interobserver reliability studies and comparative clinical outcome studies are the necessary next step toward validation.PMID:42866530 | PMC:PMC13656836 | DOI:10.7759/cureus.116127

Cureus. 2026 Sep 12;18(9):e116127. doi: 10.7759/cureus.116127. eCollection 2026 Sep.ABSTRACTThe aesthetic-functional planning of the lower limbs is frequently conducted empirically, using idiosyncratic markings and limited standardization among specialists who work in this field. The absence of a common topographic language restricts clinical communication, technical reproducibility, documentation of results, and the integration between the aesthetic approach and the vascular/lymphatic assessment of the segment. This is a descriptive study of methodological development. Based on a review of the anatomic and surgical literature and prospective clinical application during body-contour consultations, six topographic zones of the lower limbs were defined: gluteal, trochanteric (saddlebag), thigh (anterior, medial, and posterior subunits), knee, crural (calf), and talocrural (ankle), each delimited by reproducible surface bony and muscular landmarks. Onto this map, the cartography of the zones of adherence, superficial and deep adipose planes separated by the superficial fascia, saphenous venous axes, and main lymphatic collector pathways was overlaid. A four-stage marking protocol was defined (orthostatism, marking of bony landmarks, zone delimitation, and coding of plane and intensity), with standardized photographic documentation. For each zone, the following are presented: anatomic boundaries, muscular and adipose content, vascular and lymphatic correlates, zones of adherence to be preserved, recommended working plane (deep, intermediate, or superficial), specific risks, and expected aesthetic outcomes. The map provides a common nomenclature among surgeons and enables technology to be prescribed by anatomic zone rather than by generic “region”. This anatomofunctional zone-based marking provides a simple, low-cost, and reproducible instrument to structure the therapeutic planning of the lower limbs, aligning the aesthetic objective with the anatomic, vascular, and lymphatic constraints of the segment. Interobserver reliability studies and comparative clinical outcome studies are the necessary next step toward validation.PMID:42866530 | PMC:PMC13656836 | DOI:10.7759/cureus.116127

Aesthetic Plast Surg. 2026 Oct 12. doi: 10.1007/s00266-026-06371-4. Online ahead of print.ABSTRACTBACKGROUND: Lipedema is a chronic disorder of adipose tissue marked by disproportionate fat accumulation in the extremities and persistent pain, which significantly impairs quality of life. Although liposuction has been adopted as a therapeutic intervention beyond aesthetic purposes, the extent and long-term persistence of pain reduction after surgery have not been fully quantified.METHODS: This systematic review and meta-analysis followed PRISMA guidelines. Multiple electronic databases were searched from inception to September 2025. Eligible studies included adult patients with lipedema who underwent lower limb liposuction and reported both preoperative and postoperative pain outcomes. Pain scores, measured by the Visual Analog Scale or Numeric Rating Scale, were pooled using random-effects and reported as standardized mean differences (SMDs). Analyses were stratified by short-term (≤ 6 months) and long-term (> 6 months) follow-up. Subgroup analyses examined outcomes by liposuction technique.RESULTS: Ten studies comprising 901 patients were included. Liposuction was associated with a significant reduction in pain at ≤ 6 months postoperatively (SMD – 1.72, 95% CI – 2.18 to – 1.27). Pain reduction persisted at long-term follow-up (> 6 months; SMD – 1.96, 95% CI – 3.05 to – 0.88). Subgroup analyses demonstrated pain reduction across all evaluated techniques; however, the current evidence is insufficient to determine the superiority of any specific technique. Overall, 87.7% of patients reported improvement in postoperative pain.CONCLUSIONS: Liposuction for lower limb lipedema is associated with substantial and sustained pain reduction across various surgical techniques. Despite heterogeneity and the predominance of observational data, these findings support liposuction as an effective therapeutic intervention for pain related to lipedema.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:42864541 | DOI:10.1007/s00266-026-06371-4

Aesthetic Plast Surg. 2026 Oct 12. doi: 10.1007/s00266-026-06371-4. Online ahead of print.ABSTRACTBACKGROUND: Lipedema is a chronic disorder of adipose tissue marked by disproportionate fat accumulation in the extremities and persistent pain, which significantly impairs quality of life. Although liposuction has been adopted as a therapeutic intervention beyond aesthetic purposes, the extent and long-term persistence of pain reduction after surgery have not been fully quantified.METHODS: This systematic review and meta-analysis followed PRISMA guidelines. Multiple electronic databases were searched from inception to September 2025. Eligible studies included adult patients with lipedema who underwent lower limb liposuction and reported both preoperative and postoperative pain outcomes. Pain scores, measured by the Visual Analog Scale or Numeric Rating Scale, were pooled using random-effects and reported as standardized mean differences (SMDs). Analyses were stratified by short-term (≤ 6 months) and long-term (> 6 months) follow-up. Subgroup analyses examined outcomes by liposuction technique.RESULTS: Ten studies comprising 901 patients were included. Liposuction was associated with a significant reduction in pain at ≤ 6 months postoperatively (SMD – 1.72, 95% CI – 2.18 to – 1.27). Pain reduction persisted at long-term follow-up (> 6 months; SMD – 1.96, 95% CI – 3.05 to – 0.88). Subgroup analyses demonstrated pain reduction across all evaluated techniques; however, the current evidence is insufficient to determine the superiority of any specific technique. Overall, 87.7% of patients reported improvement in postoperative pain.CONCLUSIONS: Liposuction for lower limb lipedema is associated with substantial and sustained pain reduction across various surgical techniques. Despite heterogeneity and the predominance of observational data, these findings support liposuction as an effective therapeutic intervention for pain related to lipedema.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:42864541 | DOI:10.1007/s00266-026-06371-4

Rev Cardiovasc Med. 2026 Sep 3;27(9):50869. doi: 10.31083/RCM50869. eCollection 2026 Sep.ABSTRACTLipedema is a chronic, progressive, and often underdiagnosed disease characterized by the pathological, bilateral, and symmetrical accumulation of adipose tissue. This distribution results in disproportionate and painful swelling of the limbs. Typically extending distally from the hips, this predominantly female condition is frequently misidentified as lifestyle-induced obesity or bilateral lymphedema. This review aims to provide a comprehensive overview of the current understanding of structural and functional abnormalities in myocardial dimensions, mechanics, valves, and major arteries in patients with lipedema. According to the existing literature, left atrial enlargement, left ventricular rotational abnormalities, mitral annular dilation, and increased aortic stiffness have been identified in patients with lipedema. These findings suggest latent but significant alterations in left heart physiology. Although current data remain limited and are primarily focused on the left heart and the aorta, the rapid evolution of cardiac imaging technologies suggests that both clinical knowledge and the body of research in this field are poised for significant expansion.PMID:42859491 | PMC:PMC13653151 | DOI:10.31083/RCM50869

Phlebology. 2026 Oct 8:2683555261490379. doi: 10.1177/02683555261490379. Online ahead of print.ABSTRACTObjectivesThis study aimed to determine the frequency of probable lipedema among women with lower extremity pain (LEP) using a validated screening questionnaire and to examine its associations with neuropathic pain (NP) characteristics, functional status, psychological symptoms, and health-related quality of life (HRQoL).MethodsThis prospective questionnaire-based case-control study included 133 women, comprising 68 women with LEP and 65 age-matched healthy controls. Participants were evaluated using the Lipedema Screening Questionnaire (LSQ), Lower Extremity Functional Scale (LEFS), Hospital Anxiety and Depression Scale (HADS), PainDETECT questionnaire, and 12-Item Short Form Health Survey (SF-12). An LSQ score of ≥8 was classified as probable lipedema, whereas a score of ≥12 was classified as high-probability lipedema. These categories indicate screening probability rather than a confirmed clinical diagnosis of lipedema. Group comparisons, correlation analyses, and multivariable regression analyses were performed to examine factors associated with LSQ and LEFS scores.ResultsWomen with LEP had significantly higher LSQ scores and a greater proportion of probable lipedema (36.8% vs 12.3%, p = .001) and high-probability lipedema (19.1% vs 3.1%, p = .003) than controls. Compared with controls, women with LEP had poorer lower extremity function, greater anxiety symptoms, more prominent NP characteristics, and lower physical and mental HRQoL scores (all p < .05). Higher LSQ scores were positively correlated with PainDETECT scores (r = 0.446, p < .001), whereas pain intensity was not significantly correlated with the evaluated clinical outcomes. In multivariable linear regression, PainDETECT score was independently associated with LSQ score (β = 0.382, p = .004). For functional status, both the SF-12 physical (β = 0.352, p = .001) and mental component scores (β = 0.362, p = .002) were independently associated with LEFS scores.ConclusionsProbable lipedema was more frequently identified by LSQ among women with LEP than among healthy controls. NP characteristics were independently associated with greater lipedema-related symptom burden, whereas lower extremity function was independently associated with both physical and mental HRQoL. These findings support the use of lipedema and NP screening as complementary components of the clinical assessment of women with LEP. However, LSQ findings should not be interpreted as a clinical diagnosis of lipedema and require confirmation through appropriate clinical assessment.PMID:42847205 | DOI:10.1177/02683555261490379

Int J Dermatol. 2026 Oct 7. doi: 10.1111/ijd.70720. Online ahead of print.NO ABSTRACTPMID:42839854 | DOI:10.1111/ijd.70720

J Rehabil Med. 2026 Oct 2;58:jrm46824. doi: 10.2340/jrm.v58.46824.NO ABSTRACTPMID:42823795 | PMC:PMC13636027 | DOI:10.2340/jrm.v58.46824

Cureus. 2026 Sep 1;18(9):e115591. doi: 10.7759/cureus.115591. eCollection 2026 Sep.ABSTRACTBACKGROUND: Lipedema is a common, female-predominant disorder characterized by disproportionate, painful lower-limb adipose tissue, and it still lacks an objective biomarker, a disease-modifying therapy, or consensus on whether its core lesion is inflammatory. Its molecular literature is openly contradictory, reporting both immune enrichment and immune down-regulation in the same gluteofemoral depot. Because the dominant morbidity is pain rather than adipose mass, this ambiguity carries direct clinical cost. We therefore asked the following three questions: whether the reported molecular hallmarks survive control for cell-type composition, whether pain and adipose volume behave as separable endpoints, and what the germline architecture implies about the primary lesion.MATERIALS AND METHODS: From a theory-neutral standpoint, we reprocessed the largest publicly deposited adipose bulk RNA-seq dataset of lipedema (14 women with lipedema versus seven controls, paired by depot) with Salmon (College Park, MD: University of Maryland) and DESeq2 (Seattle, WA: Bioconductor Project), estimated cell-type composition by single-sample gene-set enrichment (ssGSEA), and refitted differential expression with leukocyte and erythroid composition covariates to test identifiability. We also synthesized published treatment cohorts (pain versus volume) and reviewed the architecture of germline genome-wide association studies (GWAS).RESULTS: There is no transcriptional lipolytic brake (ADRA2A +0.001; lipases unchanged or mildly up). The apparent immune down-regulation is not identifiable from blood content; adjusting for tissue composition reduces genome-wide-significant genes from 1,501 to four, with blood content correlated with disease at r approximately -0.7, so bulk data can neither establish nor exclude immune involvement, including the NLRP3 inflammasome. Pain and adipose volume are dissociable across treatments, so body weight is a confounded endpoint. The germline architecture reported to date (GRB14-COBLL1, VEGFA, RSPO3, ADAMTS9) is adipo-vascular and extracellular-matrix-based rather than immune, although the largest contributing study defined cases by a bioimpedance proxy rather than by clinical diagnosis.CONCLUSIONS: Lipedema’s inflammatory status is currently undecidable from composition-confounded bulk tissue rather than settled, which explains the field’s contradictory literature; the germline evidence, limited by its case definitions, supports as a hypothesis an adipo-vascular and connective program rather than a primary immune lesion; and pain, not weight, should anchor trials. We specify, but do not perform, the single decisive experiment – paired thigh-versus-abdomen single-nucleus RNA-seq with explicit composition control.PMID:42824866 | PMC:PMC13629613 | DOI:10.7759/cureus.115591

Front Cell Dev Biol. 2026 Sep 15;14:1893868. doi: 10.3389/fcell.2026.1893868. eCollection 2026.ABSTRACTINTRODUCTION: Low-carbohydrate diets (LCDs) have been suggested as a potential treatment option for females with lipedema, due to their superiority in reducing pain, possibly through improvements in insulin dynamics.OBJECTIVES: The objective of this secondary analysis was to compare changes in markers of glucose and insulin dynamics after a low-carbohydrate versus low-fat low-energy diets in females with lipedema and obesity. A secondary objective was to investigate potential associations between changes in glucose and insulin dynamics and changes in pain.METHODS: Females with obesity and lipedema were randomized to either an LCD or a low-fat low-energy diets (1200 kcal/day for both; 75 vs. 180 g carbohydrates/day) for 8 weeks. Basal and postprandial (total and incremental area under the curve (tAUC and iAUC)) concentrations of glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), and C-peptide were measured before and after the intervention, and HOMA-IR, Matsuda index and insulin clearance calculated.RESULTS: A total of 70 females (35 in each group, age 47 ± 11 years, BMI 37 ± 5 kg/m2) were included in the analysis. Both groups lost body weight, but with a significantly greater weight loss in the LCD group. Both groups showed ed a reduction in basal glucose, C-peptide, and insulin concentrations, with a greater reduction in glucose on the LCD. A significant increase in glucose iAUC, C-peptide iAUC, insulin clearance, and Matsuda index was observed in the LCD group only. Both groups experienced an increase in GIP tAUC, as well as a reduction in HOMA-IR, with no significant differences between groups. No associations were seen between changes in glucose and insulin measures and changes in pain.CONCLUSION: Both diets improved insulin dynamics in females with lipedema and obesity, despite additional benefits in the LCD group. However, changes in the measured indices of insulin dynamics were not associated with pain reduction, suggesting that the effects of the LCD on pain and systemic metabolic regulation may involve other pathways.PMID:42812451 | PMC:PMC13619572 | DOI:10.3389/fcell.2026.1893868

Aesthetic Plast Surg. 2026 Sep 28. doi: 10.1007/s00266-026-06279-z. Online ahead of print.ABSTRACTOBJECTIVE: The aim of this study was to compare serum adiponectin, leptin, resistin, irisin, and galectin-3 levels between patients with lipedema and healthy controls, and to examine their relationship with subcutaneous adipose tissue thickness.METHODS: In this cross sectional case control study, 40 female patients with lipedema and 36 age and body mass index matched healthy controls were included. Serum levels of adiponectin, leptin, resistin, irisin, and galectin-3 were measured using enzyme-linked immunosorbent assay. Subcutaneous adipose tissue thickness was assessed by ultrasonography at predefined anatomical sites. Pain intensity, functional status, and quality of life were evaluated. Correlation analyses were performed to investigate associations between biomarkers and ultrasonographic findings.RESULTS: Serum adiponectin, leptin, resistin, irisin, galectin-3, and routine biochemical parameters did not differ significantly between groups (all p > 0.05). Subcutaneous adipose tissue thickness was significantly higher in all measured regions in the lipedema group (p < 0.001). Biomarker levels did not differ according to lipedema stage (all p > 0.05). Among the evaluated biomarkers, only serum leptin showed a weak positive correlation with anterior thigh subcutaneous adipose tissue thickness (rho = 0.399, p = 0.014). In secondary comparisons, patients with lipedema reported higher pain scores and lower functional capacity and quality of life (all p < 0.05).CONCLUSION: Serum adiponectin, leptin, resistin, irisin, and galectin-3 levels were similar between patients with lipedema and healthy controls despite significantly increased subcutaneous adipose tissue thickness. Only leptin showed a weak positive correlation with anterior thigh subcutaneous adipose tissue thickness. These findings suggest that circulating biomarkers may not adequately reflect local adipose tissue alterations in lipedema. Further studies are needed to clarify their role in the pathophysiology of lipedema.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 .PMID:42806128 | DOI:10.1007/s00266-026-06279-z

Life (Basel). 2026 Sep 2;16(9):1471. doi: 10.3390/life16091471.ABSTRACTBACKGROUND: Lipedema is a chronic progressive condition affecting approximately 10% of women, characterized by disproportionate subcutaneous adipose tissue accumulation and pain in the lower extremities. Standardized assessment methods for pain evaluation in lipedema remain limited. The Progressive Pain Check (PPC) method represents a potentially valuable tool for standardized pain assessment in lipedema patients.OBJECTIVE: To evaluate the inter-rater reliability of the PPC method for clinical assessment of evoked pain in lipedema patients.METHODS: Two independent assessors performed PPC evaluations. Inter-rater reliability was assessed using the Intraclass Correlation Coefficient [ICC(2,1), two-way random-effects, absolute agreement, single-measurement] with 95% confidence intervals (CI).RESULTS: This study included 429 women diagnosed with lipedema (mean age 41.2 ± 11.5 years, mean disease duration 27.2 ± 12.6 years). Patient characteristics revealed mean BMI of 29.5 ± 6.9 kg/m2, predominantly Type III lipedema presentation, and disease onset during adolescence (mean age 14 ± 9.3 years). The PPC method demonstrated excellent inter-rater reliability between two independent assessors across all examined anatomical districts.CONCLUSIONS: The PPC method shows promise as a simple, repeatable, and standardized clinical tool for evoked pain assessment in lipedema patients. The demonstrated inter-rater reliability supports its potential utility in clinical practice. Further research is warranted to evaluate its intra-rater reliability, concurrent validity, and responsiveness in monitoring treatment effects.PMID:42795335 | PMC:PMC13608010 | DOI:10.3390/life16091471