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INTRODUCTION: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat deposition, pain, and progressive functional impairment. Although diagnosis remains primarily clinical, ultrasound has emerged as a valuable adjunctive tool for diagnosis, surgical planning, intraoperative guidance, and postoperative monitoring. The aim of this review was to provide a comprehensive overview of the current and potential applications of ultrasound throughout the entire surgical management pathway of patients with lipedema. MATERIALS AND METHODS: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, and Google Scholar databases. Articles published up to January 2026 were screened using the keywords "lipedema," "lipoedema," "ultrasound," "ultrasonography," "lipedema diagnosis," "lipedema imaging," "lipedema surgery," and "liposuction." Studies addressing ultrasound-based diagnosis, differential diagnosis, surgical planning, intraoperative guidance, and postoperative monitoring in lipedema patients were included. Both original investigations and review articles published in English were considered. RESULTS: Ultrasound demonstrated significant utility across all phases of lipedema management. In the preoperative setting, it improved diagnostic accuracy by identifying characteristic sonographic features, quantifying tissue thickness, differentiating lipedema from obesity and lymphedema, and enabling vascular mapping for surgical safety. Advanced techniques, including three-dimensional ultrasound, provided additional information regarding fascial alterations, fibrosis, and fluid accumulation. Intraoperatively, ultrasound off ered real-time visualization of anatomical structures, facilitated identification of fibrotic tissue, and supported more precise liposuction by improving cannula guidance andassessment of tissue homogeneity. Postoperatively, ultrasound enabled early detection of complications such asseromas and hematomas, assessment of fi brosis and tissue remodeling, and long-term monitoring of disease recurrence or progression. DISCUSSION: The available evidence suggests that ultrasound represents a versatile, accessible, and reproducible imaging modality capable of enhancing both diagnostic and surgical aspects of lipedema care. By integrating ultrasound intopreoperative evaluation, intraoperative decision-making, and postoperative follow-up, clinicians may improve surgical precision, patient safety, and treatment outcomes. Nevertheless, the current literature remains limited by heterogeneity, operator dependency, and the absence of standardized imaging protocols. Larger multicenter studiesare needed to validate diagnostic criteria and establish evidence-based guidelines for ultrasound utilization in lipedema management. CONCLUSION: Ultrasound has the potential to become an integral component of modern lipedema management. Its applications extend beyond diagnosis to encompass surgical planning, intraoperative guidance, and postoperative surveillance. The increasing availability of portable, high-resolution ultrasound devices may further facilitate its routine incorporation into clinical practice, ultimately contributing to safer procedures, more personalized treatment strategies, and improved long-term outcomes for patients with 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 .
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