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OBJECTIVE: To compare central sensitization (CS), pressure pain threshold (PPT), and psychosocial factors between women with lipedema and healthy controls and to identify variables associated with CS in lipedema. METHODS: In this cross-sectional study, 30 women with clinically diagnosed lipedema and 30 age-matched healthy controls were assessed.CS was measured with the Central Sensitization Inventory (CSI), and PPT was recorded bilaterally at the deltoid, lateral thigh, and medial knee using an algometer, pain-related cognitions with the Pain Catastrophizing Scale (PCS), and mood with the Hospital Anxiety and Depression Scale (HADS). RESULTS: Compared with controls, the lipedema group had lower PPTs at all sites (all p ≤ 0.001) and higher CSI scores (p ≤ 0.001). CS prevalence (CSI ≥ 40) was 70.0% in lipedema versus 23.3% in controls (p≤ 0.001). HADS-Depression (p = 0.001), HADS-Anxiety (p = 0.017), and PCS helplessness, magnification, rumination, and total scores (all p ≤ 0.006) were higher in lipedema. In the total sample, CSI correlated negatively with all PPT values (all p ≤ 0.003) and positively with HADS-Depression/Anxiety and PCS scores (all p < 0.001). In multivariable analysis among patients with lipedema, higher CSI was associated with greater BMI (β = 1.117, p=0.018), hypertension (β = 15.918, p = 0.009), diabetes mellitus (β = 16.663, p = 0.002), higher VAS pain (β = 0.368, p = 0.002), lower right medial knee PPT (β = - 3.891, p = 0.011), and higher HADS-Depression (β = 1.307, p = 0.038). CONCLUSIONS: Lipedema is associated with lower pain thresholds and higher CS, alongside greater depressive and anxiety symptoms and pain catastrophizing. CS in lipedema appears linked to pain intensity, depressive symptoms, and cardiometabolic comorbidities. These findings suggest that management should complement peripheral approaches with strategies targeting central pain mechanisms and psychosocial factors. 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 .

Lipedema is a chronic, painful, estrogen-sensitive disorder of subcutaneous adipose tissue whose persistence is poorly explained by linear cause-effect models. Patients, clinicians and affected relatives frequently report that symptom flares track periods of sustained psychological stress, yet the 2026 international Delphi consensus records no formal role for stress, and a controlled study found normal stress scores with no stress-pain association, leaving the observation unexplained and exposed to a stigmatizing reading. We propose that lipedema chronicity is better understood as a self-sustaining attractor of a neuroimmune-stress feedback loop than as the product of any single root cause. In the proposed circuit, sustained hypothalamic-pituitary-adrenal and sympathetic activation promotes adipose mast-cell mediator release, neurogenic inflammation (CGRP, NGF), sensitization, pain and distress, which feed back onto the stress axis; genetic predisposition and estrogen act as the constraint landscape rather than as linear causes. We formalize the loop as a low-dimensional dynamical system with saturating feedback and a slow, near-irreversible tissue-remodeling variable. The model exhibits bistability above a critical loop gain and hysteresis, recasting the acute-to-chronic transition as a saddle-node bifurcation and chronicity as a high-burden basin maintained by a fibrotic ratchet. It yields falsifiable predictions-flare hysteresis, estrogen as a bifurcation parameter, a stage-dependent reversibility window, and super-additive combination therapy-and an explicit, non-stigmatizing map of which weak causal edges to measure. It reframes early, multimodal intervention as leverage on a loop rather than treatment of a symptom.

Lipedema is a chronic and underrecognized adipose tissue disorder in women, often misdiagnosed as obesity or lymphedema. Diagnosis is challenging due to overlapping clinical features and the lack of standardized imaging criteria. We report a 50-year-old postmenopausal woman, known hypothyroid on thyroxine and currently euthyroid, presenting with a 6-year history of progressive, symmetrical bilateral lower-limb swelling, predominantly involving the thighs and legs with sparing the feet. Body mass index was 37.8 kg/m2 (Class II obesity). Lower-limb Doppler ultrasonography excluded arterial or venous obstruction, and filarial serology was negative. Crucially, lymphoscintigraphy, a cost-effective and readily available nuclear medicine tool, demonstrated normal lymphatic drainage, excluding lymphedema and prompting whole-body dual-energy X-ray absorptiometry (DEXA) for further assessment. Whole-body DEXA revealed obesity with disproportionately increased and symmetrical lower limb fat, elevated fat mass index (16.7 kg/m2), and near-equal trunk-to-leg fat distribution, suggestive of a possible lipedema phenotype (Stage II). Magnetic resonance imaging showed extensive symmetrical fat signal intensity in the subcutaneous layer, supporting the DEXA findings. This case emphasizes the sequential role of nuclear medicine techniques—lymphoscintigraphy for functional lymphatic assessment and DEXA for quantitative body composition analysis—in the accurate diagnosis of lipedema, in an obese postmenopausal woman.

ObjectiveLipedema, which mainly affects women, is a chronic and progressive disorder characterized by abnormal adipose tissue accumulation in the limbs. Despite its clinical importance, research on lipedema remains limited. Bibliometric analysis provides a quantitative way to evaluate the literature, identify trends, and assess research impact.Materials and methodsGlobal lipedema research was analyzed in the Web of Science database using the terms "lipedema", "lipoedema", and "lipolymphedema" for publications indexed through March 2025. Articles were classified by publication type, year, country of origin, journal quartile, and citation count. Citation analyses excluded publications from 2024 and 2025 because citation accumulation was incomplete. Only English original articles and reviews were included, while editorials, meeting abstracts, and non-indexed sources were excluded.ResultsOf 610 records identified, 382 met the inclusion criteria. The analysis identified the main contributing countries and highlighted knowledge gaps and opportunities for multidisciplinary collaboration in the evolving field of lipedema research.ConclusionsThis study provides a global overview of lipedema-related research and its scholarly development. It also highlights the need for further studies on the pathophysiology, diagnosis, and treatment of lipedema.

BACKGROUND/AIM: Although various distinctive morphological features such as hyperproliferation of adipocytes, fibrosis, and inflammation have been described in the progression of lipedema, the underlying mechanisms of these changes are not yet fully understood. In this study, we aimed to investigate the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and platelet distribution width (PDW) to demonstrate the role of inflammation in lipedema. METHODS: The retrospective study consisted of 60 lipedema patients (Group 1) and 40 healthy controls (Group 2). The age, height, weight, and body mass index (BMI) of all participants were recorded, along with the lipedema type and stage for Group 1. Laboratory results, including complete blood count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), were obtained for all participants. Hemoglobin, leukocyte, lymphocyte, neutrophil, and platelet counts, NLR, PLR, MPV, PDW, CRP, and ESR were evaluated. RESULTS: The mean age was 45.45 ± 10.17 years in Group 1 and 44.90 ± 10.69 years in Group 2; the BMI was 32.15 ± 5.05 in Group 1 and 30.94 ± 4.98 in Group 2, with no significant difference between the groups (p > 0.05). The most common type was Type 2 lipedema. Platelet counts, CRP, NLR, and PLR levels were significantly higher in Group 1 than in Group 2 (p < 0.05). There was no difference between groups in MPV and PDW values (p > 0.05). There was a positive correlation between BMI and both leukocyte count and CRP levels (p < 0.05). CONCLUSION: In our study investigating inflammation in lipedema-an etiology that is still not fully understood-NLR, PLR, platelet count, and CRP levels were found to be significantly higher in the patient group. The increase in BMI was correlated with leukocyte count and CRP levels. This finding is important for elucidating the etiopathogenesis of the disease, and we believe it may guide future research in this area.

ObjectivesLipedema is a chronic disorder characterized by pain and disproportionate fat distribution, and its diagnosis is frequently overlooked. The aim of this study was to evaluate and compare the responses generated by contemporary artificial intelligence models-ChatGPT-5o, Gemini-3, and Perplexity AI-to structured clinical questions developed in accordance with the 2024 S2k Lipedema Guideline. The models were analyzed in terms of clinical accuracy, readability, and reference reliability to assess their performance in delivering guideline-based medical information.MethodsThis cross-sectional and comparative study was conducted by submitting 30 structured clinical questions, prepared on the basis of the relevant guideline, to three large language models. Responses collected on 10 February 2026, were evaluated using a seven-point Likert scale (reliability) and a five-point scale (accuracy). Text readability was assessed using six established indices, including the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), and Gunning Fog Index (GFOG). Reference reliability was examined by analyzing hallucination tendencies as defined in the literature.ResultsA statistically significant difference in reliability was observed among the models (p = .041); Perplexity (4.95 ± 1.20) achieved significantly higher scores than ChatGPT-5o (4.38 ± 1.05) (p = .038). In readability analyses, Perplexity (12.80 ± 2.10) required a significantly higher educational level according to FKGL scores compared to both ChatGPT-5o (p = .041) and Gemini-3 (p = .036). Regarding reference reliability, ChatGPT-5o outperformed Perplexity in source verifiability (p = .031), bibliographic precision (p = .044), and total RHS scores (p = .027), emerging as the most robust model in this domain. No statistically significant differences were found among the models in terms of clinical accuracy and usefulness (p > .05). Inter-rater agreement was excellent (Kappa: 0.92-0.97).ConclusionIn this study, ChatGPT-5o distinguished itself in reference quality, whereas Perplexity demonstrated superior reliability. However, the complex linguistic structures accompanying efforts to maintain high medical accuracy may constitute a significant barrier for individuals with limited e-health literacy. Although these systems show strong potential as medical information resources, they cannot yet replace expert physician oversight in terms of patient safety. A balanced approach between technical reliability and patient-centered simplification remains necessary.

Background:Lipedema is a chronic connective tissue disorder characterized by painful subcutaneous adipose accumulation, mainly in the lower extremities. Pain is a hallmark feature, yet its mechanisms remain poorly defined. Neuropathic components may contribute, but direct comparisons with lymphedema are scarce.Methods:In this exploratory cross-sectional study, 118 female patients with lipedema (n = 62) or bilateral lower extremity lymphedema (n = 56) were assessed. Pain intensity was measured with the Visual Analogue Scale (VAS). Neuropathic pain was evaluated with painDETECT and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS). Psychological status was measured using the Hospital Anxiety and Depression Scale (HADS), cognitive–emotional aspects with the Pain Catastrophizing Scale (PCS), and health-related quality of life with the WHOQOL-BREF.Results:Lipedema patients reported higher pain severity (VAS 6.2 ± 1.4 vs. 5.5 ± 1.5, p = 0.02) and greater neuropathic pain prevalence (42% vs. 21%, p < 0.01) than lymphedema. painDETECT and LANSS scores were significantly higher in lipedema (p < 0.001). HADS-Anxiety (10.2 ± 3.8 vs. 7.8 ± 3.5, p = 0.005) and PCS scores (29.5 ± 7.2 vs. 25.4 ± 6.5, p = 0.03) were also elevated, while HADS-Depression was slightly higher in lymphedema without significance. WHOQOL-BREF scores were similarly reduced in both groups compared to population norms. Correlation analyses showed strong associations between pain intensity, neuropathic features, catastrophizing, and anxiety, particularly in lipedema.Conclusions:A substantial proportion of lipedema patients exhibit neuropathic pain features and higher pain severity compared with lymphedema, while anxiety and pain catastrophizing appear to amplify symptom burden; however, quality-of-life impairment is substantial in both conditions, and the findings should be interpreted as hypothesis-generating with implications for more individualized management approaches.

BACKGROUND: Recent studies have consistently shown that patients with lipedema are at a higher risk for depression and anxiety. The aim of this study is to identify the psychological factors associated with lipedema syndrome (LS) and their link to the patient's psychological symptomatology. METHODS: A mixed-methods approach was employed, combining quantitative and qualitative components. The quantitative component involved anonymous online questionnaires, including a Health and Demographic Questionnaire, the body satisfaction and global self-perception questionnaire (BSGSPQ), the lymphedema quality of life questionnaire (LYMQOL), and the Hospital Anxiety and Depression Scale (HADS). The qualitative component consisted of oral interviews to explore the complexity of the phenomenon. Participants included those with "easy bruising," a waist-to-hip ratio ≤0.7 (W/H), and pain levels ≥4/10 on the visual analogue scale (VAS). RESULTS: Our findings indicate that the level of depression is positively correlated with spontaneous pain (p = 0.002; r = 0.331) and the lack of medical understanding (p = 0.011; r = 0.229). Anxiety scores are inversely correlated with body satisfaction (r = -0.317) and global self-perception (r = -0.393); similarly, depression scores show similar correlations with body satisfaction (r = -0.445) and global self-perception (r = -0.608), all with p value of <0.0001. DISCUSSION AND CONCLUSION: This study highlights significant connections between the physical symptoms and mental health in patients with LS. The more affected the self-perception, the greater the depression and anxiety levels. These multiple contributing factors may explain the decline in quality of life (QOL) and deterioration of mental health. It is therefore crucial to proactively integrate mental health management into the care of LS patients. Future research should focus on identifying concrete, actionable methods to support women experiencing LS.

Lipedema is a chronic adipose tissue disorder characterized by disproportionate and often painful enlargement of the extremities, occurring predominantly in women. Despite increasing clinical recognition, the underlying pathophysiology remains incompletely understood and is likely multifactorial. Existing evidence suggests contributions from vascular alterations, adipose tissue remodeling, inflammatory activation, hormonal influences, and lymphatic dysfunction. This review proposes a hypothesis-generating integrative framework in which lipedema may reflect a regenerative imbalance of subcutaneous adipose tissue. Within this model, genetically and hormonally modulated endothelial permeability could promote activation of perivascular adipose-derived stromal/stem-cell niches and stromal vascular fraction signaling pathways, thereby facilitating coupled angiogenesis and adipogenesis. Progressive adipocyte hyperplasia and hypertrophy may subsequently contribute to inflammatory remodeling, pain generation, and secondary impairment of dermal and subdermal lymphatic drainage. The proposed framework attempts to integrate clinical, histological, imaging, molecular, and endocrine observations into a biologically coherent conceptual model. At the same time, the review emphasizes the current limitations of the available evidence, the heterogeneity of lipedema phenotypes, and the ongoing controversies regarding disease progression, obesity overlap, and the relative role of lymphatic dysfunction. Finally, the potential mechanistic rationale of lymphatic-sparing liposuction is discussed in the context of tissue decompression, restoration of lymphatic transport, and interruption of persistent adipose remodeling. The model presented here should be interpreted as a hypothesis-generating conceptual scaffold requiring prospective validation. Importantly, the present framework should be interpreted as a biologically plausible and hypothesis-generating conceptual model rather than a definitive mechanistic doctrine. Several proposed interactions remain associative and require prospective biological validation.

Lipedema is a chronic adipose tissue condition that primarily affects women. Despite increasing recognition of lipedema, the condition remains poorly understood and lacks standardized diagnostic criteria or confirmatory tests. Variability in definitions and measurement across clinical and research settings impedes comparability across studies, constraining the evidence base needed to support future advances in clinical practice and patient care. To address challenges associated with inconsistent definitions and data collection, the Lipedema Foundation (LF) partnered with clinicians, researchers, and biostatisticians to develop a Lipedema Common Case Report Form (CCRF). The CCRF was designed to be a research data harmonization tool and is not intended to define diagnostic standards or guide clinical treatment decisions. Its development involved review of published lipedema clinical guidelines and collaborative work to define data elements and attributes for inclusion. When they existed, validated or standardized measures were incorporated directly. When no suitable standardized measures were available, an iterative and collaborative process was used to develop lipedema-specific Common Data Elements (CDEs). The initial version of the CCRF was piloted in participants with and without lipedema, and updates based on participant and clinician feedback were incorporated into the CCRF. A biostatistical review evaluated data completeness, quality, and structure, leading to additional refinements. The final Version 1 instrument consists of 682 CDEs organized into four classifications: (1) Core, (2) Supplemental Highly Recommended, (3) Supplemental, and (4) Exploratory. The current version is prepared for dissemination in the field. By disseminating the CCRF broadly and encouraging adoption in all lipedema research beginning in 2026, including all newly initiated LF-funded projects, LF intends to evaluate its use with grantees and iterate systematically to achieve consistent and comparable data collection. The CCRF provides a structured framework for harmonized data collection that may facilitate comparability across studies and support future development of standardized diagnostic and research methodologies.

BACKGROUND: Lipedema is a chronic adipose tissue disorder predominantly affecting women, often misdiagnosed as obesity or lymphedema. Emerging evidence points to microvascular dysfunction and chronic inflammation in its pathophysiology. This study aimed to compare complete blood count (CBC) parameters and derived inflammatory indices between women with lipedema and age-matched healthy controls, focusing on the potential diagnostic value of platelet indices such as PDW and MPV. METHODS: We conducted a retrospective observational study including 45 women with clinically confirmed lipedema and 40 age matched healthy controls. CBC parameters and derived inflammatory indices were compared between groups without adjustment for body mass index (BMI). RESULTS: The study included 45 women with lipedema and 40 healthy controls with similar age distributions. No statistically significant between group differences were observed in complete blood count parameters after correction for multiple comparisons, although PDW and MPV were numerically higher in the lipedema group. CONCLUSION: In this exploratory study, PDW and MPV were numerically higher in women with lipedema than in controls, but these differences lost statistical significance after correction for multiple comparisons. These findings argue against PDW or MPV as standalone diagnostic markers of lipedema and indicate that future research should prioritize larger, BMI-matched cohorts and multimodal approaches that integrate platelet indices with tissue-level or imaging markers.

Objectives: To examine the associations of ultra-processed food (UPF) consumption, dietary inflammatory index (DII), and Mediterranean diet adherence with pain severity, physical quality of life, body composition, and inflammatory markers in women with lipedema. Methods: This cross-sectional study included women diagnosed with lipedema across different disease stages. Dietary intake was assessed using a validated food frequency questionnaire, and foods were classified according to the NOVA system to determine UPF consumption. The dietary inflammatory index was calculated to assess the inflammatory potential of the diet, and Mediterranean diet adherence was evaluated using a standardized scoring system. Anthropometric measurements, body composition parameters, inflammatory markers, pain intensity (VAS), and physical quality of life (SF-12 PCS) were assessed. Multivariable regression analyses were performed to investigate the associations between dietary variables and clinical outcomes. Results: A total of 86 women with lipedema (stage 1: n=36, stage 2: n=33, stage 3: n=17) were included. UPF consumption increased from 28.1% to 41.3% of total energy and DII scores from +1.46 to +3.02 across stages, while Mediterranean diet adherence decreased from 28.2 to 21.3. In parallel, BMI increased from 27.1 to 31.1 kg/m² and body fat percentage from 36.7% to 41.1%. Inflammatory markers also rose across stages (hs-CRP: 3.9 to 6.1 mg/L; IL-6: 3.1 to 4.6 pg/mL). In multivariable models, higher DII scores were associated with increased pain severity (β=0.29, p=0.007) and higher hs-CRP levels (β=0.41, p<0.001), whereas Mediterranean diet adherence was positively associated with physical quality of life (β=0.34, p=0.002). Conclusion: Higher ultra-processed food consumption and dietary inflammatory potential were associated with increased inflammation, pain, and adiposity, whereas greater Mediterranean diet adherence was associated with better physical quality of life in women with lipedema.

Lipedema affects an estimated 11–12% of women worldwide and is characterized by bilateral, symmetric adipose deposition in the lower extremities, disproportionate pressure pain, spontaneous bruising, and resistance to conventional dietary interventions. Despite its prevalence, lipedema lacks a unifying mechanistic framework. Current descriptions treat it as a fat storage disorder with secondary vascular and inflammatory features, leaving critical observations mechanistically unexplained: a highly characteristic quantitative sensory testing (QST) pattern with no published alternative mechanistic explanation, a paradoxical immunological profile, a 35–40% comorbidity with fibromyalgia, a 1.42 relative risk for ADHD, estrogen-dependent onset, and asymmetric expression in the presence of local vascular triggers. We propose the gfWAT-IIT2 framework, which posits that lipedema is fundamentally a syndrome of polarization of the gluteofemoral white adipose tissue (gfWAT) microenvironment toward innate type 2 immunity (IIT2), amplified by estrogen via mast cell estrogen receptors, and generating neuropathic pain through selective histaminergic sensitization of Aδ/C fibers (H1/H4 receptors, PPT↓) and inhibition of Aβ fibers (H3 receptor, VDT↑), with thermal thresholds remaining normal: a triad that is mechanistically explained by histaminergic peripheral sensitization. The gfWAT-IIT2 framework integrates reported clinical, sensory, immunological, and depot-specific observations into a testable mechanistic cascade, generates fourteen falsifiable predictions, and repositions the therapeutic target from adipocyte to mast cell. The framework further proposes that asymmetric lipedema (where one limb expresses the disease more severely due to an identifiable local trigger) constitutes a natural controlled experiment suggesting that local trigger removal may be disease-modifying in selected patients with documented triggers.

BackgroundLipedema is a chronic and progressive disorder of subcutaneous adipose tissue that predominantly affects women and is frequently misdiagnosed as obesity, lymphedema, or venous disease. Increasing evidence indicates that lipedema represents a systemic vascular-lymphatic-inflammatory disorder rather than a cosmetic or metabolic condition. Delayed diagnosis often results in progressive fibrosis, lymphatic dysfunction, chronic pain, and functional impairment.ObjectiveThis review aims to present a structured, clinically applicable framework for the diagnosis and multimodal management of lipedema within phlebology practice, with an emphasis on stage-specific assessment and integrated therapeutic strategies.MethodsA narrative clinical review of peer-reviewed literature in phlebology, vascular medicine, lymphatic disorders, and adipose tissue pathology was conducted. Diagnostic criteria, clinical staging, and differential diagnostic features were synthesized into a practical, stage-based framework. A multilayer therapeutic approach targeting inflammation, lymphatic function, adipose tissue pathology, extracellular matrix remodeling, and post-treatment rehabilitation is proposed.ResultsAccurate diagnosis of lipedema relies primarily on clinical evaluation, including pain assessment, tissue palpation, characteristic fat distribution, and exclusion of lymphedema and simple obesity. Early-stage identification enables effective intervention focused on inflammation control and lymphatic unloading, potentially preventing irreversible fibrosis. Advanced stages require targeted adipose tissue interventions, fibrosis management, and structured rehabilitation to preserve mobility and quality of life.ConclusionLipedema should be recognized as a systemic vascular-lymphatic-inflammatory disorder within phlebology practice. Early diagnosis and implementation of a structured, stage-specific multimodal treatment framework may significantly alter disease progression and reduce the risk of long-term disability.

BACKGROUND: Lipedema is a chronic and progressive adipose tissue disorder that is often misdiagnosed and notoriously resistant to weight loss. Liposuction remains the most effective surgical treatment, but it requires precise technique to preserve the fragile lymphatic system. This study investigates the utility of pre-, intra- and postoperative ultrasound (US) to objectively assess fat reduction and the selective removal of pathological adipose tissue in patients undergoing liposuction for lipedema. METHODS: A retrospective, single-center study of 24 female patients with lipedema who underwent liposuction of the lower extremities. Perioperative US was used to measure the thickness of the superficial subcutaneous fat (D1) and the deep fat layer (D2) at a standardized anatomical site. Intraoperative US was employed to verify that fat aspiration was performed in the correct superficial plane. A paired t-test was conducted to assess the statistical significance of the change in D1 thickness. RESULTS: The mean patient age was 38 years, with a mean BMI of 25.3 kg/m2. The mean volume of liposuction aspirate was 4.5 L. Statistical analysis showed a significant reduction in mean D1 thickness from 9.9 mm preoperatively to 6.3 mm immediately postoperatively (p < 0,05). This reduction was sustained at the 3-month follow-up, with a mean D1 thickness of 5.8 mm. CONCLUSION: Our pilot study suggests that the perioperative use of ultrasound is a valuable tool for objectively documenting the selective fat reduction achieved with liposuction in lipedema patients. Intraoperative US not only enhances surgical precision, but also reduces the risk of complications by confirming correct cannula positioning in the superficial plane. This technique enhances surgical precision by allowing for the quantifiable removal of pathological superficial fat, confirming its potential to improve outcomes with a low complication rate. 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 .

BackgroundLipedema is an adipose disorder associated with multiple impairments. Conservative treatments remain the mainstay of management, yet evidence regarding the effects of physical therapies on clinical, imaging, and body composition outcomes is limited. Radial extracorporeal shock wave therapy (rESWT) has been proposed as a non-invasive therapeutic option, although its impact is not fully established.MethodsThis was a prospective, longitudinal, within-patient study conducted in women with clinically diagnosed lipedema. One lower limb was treated with radial extracorporeal shock wave therapy (rESWT), whereas the contralateral limb served as an internal control. A total of 16 patients were initially assessed, of whom 12 completed the full follow-up and were included in the final analysis. rESWT was applied over six sessions (two sessions per week) using standardized parameters. Clinical outcomes (LEFS, EQ-5D, SF-36 Physical Function, and IPAQ) were assessed at baseline, 6 weeks, and 3 months. Ultrasound and elastography were used to evaluate subcutaneous tissue thickness and stiffness at predefined leg and thigh sites, while segmental bioimpedance analysis assessed body composition and fluid distribution. Longitudinal changes were analyzed using mixed-effects models.ResultsSignificant improvements were observed in functional capacity, quality of life, and physical activity levels at both 6 weeks and 3 months compared with baseline (p < .05). In contrast, no statistically significant changes were detected in ultrasound-derived tissue thickness, elastography measurements, or bioimpedance parameters over time, and no significant differences were detected between treated and control limbs within the constraints of the available sample size.ConclusionsrESWT was associated with meaningful clinical and functional improvements in patients with lipedema, despite the absence of detectable changes in tissue thickness, stiffness, or body composition. These findings suggest that the benefits of rESWT may be mediated through symptom modulation and functional adaptation rather than structural tissue modification, supporting its role as part of conservative, symptom-oriented treatment strategies in lipedema.

Lipedema has long been misclassified as a cosmetic concern or a subtype of obesity, leading to delayed diagnosis and suboptimal surgical outcomes. Growing molecular, histopathologic, and imaging evidence supports lipedema as a systemic disorder involving adipose tissue, connective matrix, vascular–lymphatic integrity, and neuroimmune regulation. To integrate these findings into a clinically actionable model, we introduce the concept of Adipoconnective Fragility Syndrome (AFS), framing lipedema as a multisystem condition with direct implications for surgical planning and perioperative management.

BackgroundLipedema is a chronic, progressive adipose tissue disorder affecting mainly women, characterized by bilateral, disproportionate fat accumulation in the lower extremities. The condition is often associated with pain, heaviness, and functional limitations. While the adipose tissue changes in lipedema are well-described, its impact on muscle mass, strength, and functional performance remains underexplored. This study aimed to evaluate the prevalence of sarcopenia and its relationship with lipedema severity.Materials and methodsA cross-sectional observational study was conducted on 48 women with clinically diagnosed lower-extremity lipedema. Diagnosis followed the International Lipoedema Association and German S2k guidelines. Sarcopenia was assessed using a multidimensional approach, including ultrasonographic rectus femoris thickness, handgrip strength, the Five Times Sit-to-Stand Test, and four-m walking speed. The lipedema stage was determined using morphological criteria. Statistical analyses evaluated the relationships between sarcopenia, functional parameters, and lipedema stage.ResultsParticipants had a mean age of 47.2 ± 8.4 years and a BMI of 33.0 ± 4.3 kg/m2. Sarcopenia was identified in 33.3% of participants, with 14.6% classified as severe. Those with sarcopenia exhibited lower rectus femoris thickness and slower walking speed (p < .05). Advancing lipedema stage correlated with reduced muscle thickness, weaker handgrip strength, slower gait, and prolonged Five Times Sit-to-Stand Test duration (p < .05). Stage 3 patients demonstrated the highest prevalence of sarcopenia, indicating progressive impairment in muscle mass and functional performance with disease severity (p < .05). No significant associations were found between age or BMI and muscle parameters (p > .05).ConclusionsSarcopenia is prevalent in women with lower-extremity lipedema and increases with disease stage. Comprehensive musculoskeletal assessment should be integrated into lipedema management to address functional impairment and optimize patient care.