SURGICAL AND NON-SURGICAL APPROACHES IN THE MANAGEMENT OF LIPEDEMA: A SYSTEMATIC REVIEW

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.