Your search

Validation and reliability of the Turkish version of the lipedema screening questionnaire - Turkish Journal of Physical Medicine and Rehabilitation

Background: Lipedema is a chronic disorder of subcutaneous adipose tissue characterized by symmetrical fat accumulation in the extremities, pain, and orthostatic edema. Objectives: This study aimed to assess whether high-resolution cutaneous ultrasound can detect measurable tissue-level changes in subcutaneous tissue over six months. Methods: A retrospective, single-center, real-world longitudinal observational cohort study was conducted in 60 women with lipedema followed at three timepoints (baseline, 3 months, 6 months). High-resolution ultrasound (18–20 MHz) measured subcutaneous and dermal thickness at standardized anatomical sites. Results: All primary ultrasound parameters decreased significantly over six months of conservative multicomponent management, which included individualized nutritional counseling and physical activity. Medial proximal thigh subcutaneous thickness declined by 18.7% (48.2 to 39.2 mm; p < 0.001). Edema prevalence fell from 100% to 55.0%. Echogenicity improved significantly between 3 and 6 months, suggesting a delayed structural remodelling effect distinct from early volumetric reduction. Ultrasound reductions were inversely correlated with weight loss, suggesting that ultrasound captures tissue-level information not fully reflected by anthropometric measures alone. Conclusions: Standardized cutaneous high-resolution ultrasound detected consistent tissue-level modifications over six months of routine clinical follow-up, capturing changes beyond anthropometric measures and representing a candidate monitoring tool warranting evaluation in controlled study designs.

BACKGROUND: Lipedema is a chronic adipose tissue disorder primarily affecting women, characterized by abnormal fat accumulation, pain, and reduced mobility. Its impact on sexual function remains underexplored. This study aimed to evaluate sexual function in women with lipedema and examine its associations with anxiety, depression, lower extremity function, and quality of life. METHODS: In this cross-sectional study, 100 sexually active women were recruited: 50 with lipedema and 50 age- and Body Mass Index-matched healthy controls. Sexual function was assessed with the Female Sexual Function Index (FSFI); anxiety and depression with the Hospital Anxiety and Depression Scale (HADS-A and HADS-D); quality of life with the EuroQOL 5-Dimensional 5-Level (EQ-5D-5L) instrument; lower extremity function with the Lower Extremity Functional Scale (LEFS); and pain intensity with the Visual Analog Scale (VAS). Multiple linear regression analysis was conducted to identify the factors associated with the total FSFI score. RESULTS: Women with lipedema had significantly lower total FSFI scores compared to controls (21.58 ± 3.99 vs. 25.86 ± 3.21, P < .001), with 76% having FSFI scores below the cut-off (≤ 26.55) compared to 36% of controls. All FSFI domain scores were significantly lower in the lipedema group (all P < .05). In the lipedema group, there was a significant correlation between total FSFI scores and age (P = .002), pain intensity (VAS; P = .022), depression (HADS-D; P = .010), quality of life (EQ-5D-5L index; P = .027), and lower extremity function (LEFS; P < .001). Multiple linear regression analysis identified depression (HADS-D; P = .047), perceived health status (EQ-5D-5L VAS; P = .033), and lower extremity function (LEFS; P = .011) as independent variables that had a significant relationship with the total FSFI score. DISCUSSION: Lower sexual function is common among women with lipedema and is associated with anxiety and depressive symptoms, lower extremity function, and pain intensity. These findings highlight the importance of incorporating sexual function assessment into the routine evaluation of patients with lipedema and support the need for comprehensive multidisciplinary treatment approaches addressing physical, psychological, and sexual health aspects of care.

ObjectivesThe aim of this study was to compare metabolic status and biochemical indices associated with cardiovascular risk, including the triglyceride-glucose (TyG) index, triglyceride-glucose-body mass index (TyG-BMI), and atherogenic lipid indices, between obese individuals with and without lipedema, and to evaluate the potential effect of lipedema on these parameters.Materials and MethodsThis cross-sectional study included 70 obese patients diagnosed with lipedema and 70 obese control individuals without lipedema. Fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglyceride levels were recorded. Based on these parameters, the TyG index, TyG-BMI, atherogenic index of plasma (AIP), atherogenic coefficient (AC), and Castelli risk indices I (CRI-I) and II (CRI-II) were calculated.ResultsNo significant differences were observed between the lipedema and control groups in fasting glucose, total cholesterol, HDL-cholesterol, triglyceride levels, TyG, TyG-BMI, or atherogenic lipid indices (all p > .05). LDL-cholesterol levels were significantly lower in the lipedema group compared with the control group (p = .008). In the lipedema group, TyG-BMI showed a positive correlation with age and BMI, whereas no significant associations were found with symptom duration or pain severity.ConclusionAlthough LDL-cholesterol levels were lower in obese individuals with lipedema, this difference was not reflected in biochemical indices associated with metabolic status and cardiovascular risk. Importantly, metabolic parameters in patients with lipedema accompanied by obesity were comparable to those observed in individuals with obesity alone, suggesting that obesity rather than lipedema may be a more important determinant of metabolic risk in this population. Therefore, metabolic evaluation should not be overlooked in patients with lipedema, and the management of obesity should be considered in treatment planning.

INTRODUCTION: Recent research suggests that body contouring surgeries may reduce benzodiazepine (BNZ) use in patients with anxiety or depressive disorders. This study explores whether similar benefits occur in women with lipedema-a chronic adipose disorder causing pain, limited mobility, and psychological distress-who are often prescribed BNZ. MATERIALS AND METHODS: We conducted a retrospective observational study on 100 adult female patients with Stage I-III lipedema undergoing tumescent or water-assisted liposuction between 2019 and 2024. All participants were on stable BNZ therapy for at least six months before surgery. The primary outcome was BNZ usage at six months postoperatively. Secondary outcomes included anxiety (GAD-7), pain (VAS), sleep quality (PSQI), and body image (BODY-Q) and assessed pre- and post-surgery using validated instruments. DISCUSSION: At six months, 77% of patients reduced or discontinued BNZ (32% stopped entirely), with average daily dosage decreasing from 3.2 ± 1.1 to 1.4 ± 1.2 mg (p < 0.001). Statistically significant improvements were also observed in anxiety, pain, sleep quality, and body image (all p < 0.001). Reductions in BNZ use correlated with improvements in pain (r = 0.56), anxiety (r = 0.47), and body image (r = - 0.52). Only minor complications occurred (8%), and no major adverse events were reported. CONCLUSION: Liposuction for lipedema not only improves physical symptoms but also supports psychological recovery, reducing dependence on benzodiazepines. These findings highlight the potential of surgical treatment as part of an integrated approach to managing chronic conditions with both somatic and mental health components. Further research is needed to confirm long-term effects and underlying mechanisms. LEVEL OF EVIDENCE I: Level I, therapeutic study using a properly randomized controlled trial. 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 .

ObjectivesGenerative artificial intelligence (AI) models capable of producing photorealistic medical images are increasingly proposed for patient education, clinical illustration, and trainee instruction. However, their ability to accurately represent anatomically distinct disease subtypes remains unclear. This study evaluated the diagnostic accuracy of a widely used generative AI model in producing images corresponding to the five anatomical lipedema types defined by the Schmeller classification.MethodsIn this prospective audit, ChatGPT’s image-generation interface was prompted to create 60 images for each lipedema type (Types I–V),yielding 300 images. Prompts were standardized and limited to the subtype label without additional descriptors. Two clinicians independently classified each image into one of the five lipedema types or as indeterminate, blinded to the original prompt; disagreements were resolved by a third clinician. Diagnostic performance was assessed using a confusion matrix and per-type sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV),F1-score,and one-vs-rest receiver operating characteristic area under the curve (ROC AUC). Overall accuracy and Cohen’s κ statistics were also calculated.ResultsAll 300 images were evaluable. The model generated anatomically consistent images for Types I,II, and III (sensitivity = 1.00 for each). Specificity was 1.00 for Types I and II but 0.50 for Type III because all images requested as Types IV and V were classified as Type III. Consequently, the model failed to generate any images consistent with Type IV(arm-predominant) or Type V(calf-isolated) lipedema (sensitivity = 0.00 for both). Overall accuracy was 0.600. Unweighted and quadratic-weighted Cohen’s κ values were 0.500 and 0.667, respectively. Micro- and macro-averaged ROC AUC were both 0.750.ConclusionThe model reproduces severity gradients within lower-extremity lipedema but systematically collapses anatomically distinct subtypes into the dominant Type III phenotype, failing to depict arm-predominant and calf-isolated disease. Current generative AI systems may therefore encode lipedema as a single visual phenotype rather than a distributed anatomical entity, limiting their reliability for medical education and clinical communication.

ObjectivesThere is a deficiency in awareness and knowledge of lipedema disease among the general public and healthcare professionals. This situation may lead patients to waste time on getting the correct diagnosis and treatment. Currently, information regarding women's awareness and knowledge level of lipedema in Turkey is limited. This study aims to examine women's awareness, knowledge level, and desire for information concerning lipedema in Turkey.MethodsA total of 502 volunteer women participated in this online cross-sectional survey study. The survey, constructed by the authors of the study with the assistance of guidelines, systematic reviews, and current literature, consisted of sections aimed at determining demographic data, lipedema awareness, knowledge level, lipedema symptoms and suspicion, as well as individuals' health behavior and desire for information. The primary outcome of the study was lipedema awareness, which was defined by having previously heard the term lipedema.ResultsDespite 76.1% of participants reporting awareness of lipedema, the average knowledge score about the condition was a low-to-moderate level of knowledge. The vast majority of participants (71.3%) indicated that they were willing to learn more about lipedema, and their preferred source of information was healthcare professionals (80.3%). Yet, only 19 participants (3.8%) think that lipedema is sufficiently regarded within the healthcare system.ConclusionThis study reveals that, despite relatively high awareness of lipedema among women in Turkey, the level of knowledge remains limited. The strong willingness to receive further knowledge and the preference for healthcare professionals as the principal source of information garner attention. However, the low confidence in the recognition of lipedema within the healthcare system may suggest that healthcare professionals have insufficient knowledge or do not prioritize this issue. Improving awareness and knowledge of lipedema among the public and healthcare professionals might facilitate early identification and minimize treatment delays.

BACKGROUND: Lipedema is a prevalent chronic condition in women, characterized by a painful and symmetrical accumulation of adipose tissue primarily in the lower limbs. Its diagnosis is based on specific clinical characteristics; however, these characteristics lack robust scientific validation. Furthermore, lipedema is frequently misdiagnosed as obesity. This study aims to compare quality of life and physical and psychological characteristics between patients with obesity with and without lipedema. METHODS: This cross-sectional study included 30 patients with obesity and lipedema (Lip-Obes group) and 29 patients with only obesity (nonLip-Obes group). Quality of life, body composition (BMI, fat free mass, fat mass, waist-to-hip ratio, waist-to-height ratio, leg volume), pain (pain pattern, pressure pain thresholds, pain interference, pain distribution, symptoms of neuropathic pain), physical functioning (hand grip strength, quadriceps strength, functional exercise capacity, functional mobility and physical activity level), and psychosocial functioning (pain catastrophizing, depression, anxiety, and stress, body image dissatisfaction, self-efficacy, and eating difficulties) were assessed using clinical measurements and self-reported outcomes. Statistical analyses were performed using independent t-tests or Mann-Whitney U tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables. A two-sided p-value of < 0.05 was considered statistically significant. RESULTS: Compared to the nonLip-Obes group, the Lip-Obes group showed greater impairments in quality of life (p < 0.05). Despite similar body composition variables, the Lip-Obes group had lower waist-to-hip, waist-to-height, upper leg-to-waist, and lower leg-to-waist ratios, as well as higher total limb volume than the nonLip-Obes group. Additionally, the Lip-Obes group reported higher pain intensity, lower pressure pain thresholds in the arms and legs, and greater pain interference than the nonLip-Obes group (p < 0.05). Although hand-grip strength and physical activity levels were comparable, the Lip-Obes group exhibited lower quadriceps strength, functional exercise capacity, and functional mobility (p < 0.05). Additionally, the Lip-Obes group reported higher pain catastrophizing, greater body image dissatisfaction, and more severe eating difficulties than the nonLip-Obes group (p < 0.05). No significant differences were found in depression, anxiety, stress, or self-efficacy between groups (p > 0.05). CONCLUSION: This cross-sectional study highlights the complex nature of lipedema, providing preliminary evidence of differences in quality of life and distinct body composition and physical and physiological characteristics between patients with obesity with and without lipedema. These results emphasize the need for further research to identify diagnostic biomarkers for lipedema through in-depth investigations. Future studies should also focus on developing and optimizing a multidisciplinary treatment approach tailored to the unique characteristics of patients with lipedema.

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 .

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.

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.

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.

BACKGROUND: Lipedema is a chronic adipose tissue disorder characterized by abnormal and disproportionate fat accumulation in the extremities, leading to pain, edema, and functional impairment. Liposuction has become a central component of surgical management. However, postoperative complications, particularly seroma formation, remain a concern. OBJECTIVES: To evaluate the incidence of postoperative seroma and associated risk factors in patients undergoing liposuction for lipedema treatment, based on procedures performed by a single surgical team in a single institution. METHODS: This retrospective observational study included 93 female patients who underwent liposuction for lipedema between April 2019 and January 2024. Data collected included demographic variables, body mass index (BMI), anesthesia type, volume of aspirated fat, percentage of body weight removed, use of adjunct technologies (ultrasound or laser), association with other surgeries such as varicose vein surgery, and prior conservative treatment. The primary outcome was the development of postoperative seroma. Statistical analysis included Chi-square and Student's t-tests and multivariable logistic regression, with significance set at p ≤ 0.05. RESULTS: Among 93 cases, 17 patients (18.3%) developed postoperative seroma. Higher volumes of aspirated fat (% body weight) were significantly associated with seroma formation (7.27% vs. 5.84%, p = 0.005). Concomitant minor procedures were also linked to increased seroma incidence (p = 0.035). No seromas occurred in patients treated using ultrasound-assisted liposuction. Minor complications included one infection and one hematoma (1.07%). CONCLUSIONS: Liposuction for lipedema is a safe and effective surgical option with a low rate of major complications, but seroma remains a relatively frequent postoperative finding. Higher aspirated fat volumes relative to body weight and the presence of concomitant procedures increase the risk of seroma. No seromas were observed in the ultrasound-assisted group; however, this difference did not reach statistical significance and should be considered only as hypothesis-generating. Further studies are needed to validate these findings and guide surgical decision-making. 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 .

INTRODUCTION: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat deposition, primarily in the lower extremities, leading to pain, functional impairment, and reduced quality of life. While Power-Assisted Liposuction (PAL) is the standard surgical approach, the integration of Ultrasound-Assisted Liposuction (UAL) with PAL has been proposed to enhance fat removal and improve patient outcomes. OBJECTIVE: To compare the clinical efficacy, postoperative outcomes, and complication rates of PAL alone versus UAL + PAL in patients with Stage II and III lipedema. METHODS: A retrospective cohort study was conducted on 60 female patients diagnosed with lipedema (Stage II and III). 30 patients underwent PAL alone, while 30 received UAL followed by PAL. Primary outcomes included the volume of fat aspirated, circumferential reduction, and postoperative pain, measured at multiple time points over a 12-month follow-up. Secondary outcomes assessed patient satisfaction, time to return to daily activities, and complication rates. RESULTS: The UAL + PAL group demonstrated a significantly higher mean fat extraction volume (5,500 ± 450 mL) compared to the PAL group (4,100 ± 380 mL; p < 0.01). Circumferential reduction was greater in the UAL + PAL group, with an average reduction of 12.5 cm versus 8.2 cm in the PAL group (p < 0.01). Postoperative pain, assessed using a Visual Analog Scale (VAS), was significantly lower in the UAL + PAL group (VAS 4.5 ± 0.7) compared to the PAL group (VAS 6.2 ± 0.8 at 24 hours post-surgery; p < 0.01). Additionally, patients treated with UAL + PAL reported a faster return to daily activities (9.3 ± 1.8 days vs. 12.8 ± 2.1 days; p < 0.01) and higher satisfaction scores (4.8 ± 0.5 vs. 4.2 ± 0.6 on a 5-point Likert scale; p < 0.05). Complication rates were comparable between the two groups, with no major adverse events reported. CONCLUSION: UAL + PAL offers significant advantages over PAL alone in the surgical management of lipedema, providing superior fat removal, reduced postoperative pain, faster recovery, and improved patient satisfaction. These findings support the integration of UAL into standard liposuction protocols for advanced-stage lipedema, emphasizing its efficacy in overcoming the challenges posed by fibrotic adipose tissue. 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 .

Background/Objectives: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat accumulation, pain, microvascular dysfunction, and low-grade inflammation. Although low-carbohydrate, high-fat (LCHF) dietary approaches are increasingly used in clinical practice, their longer-term associations with vascular, lymphatic, and immunometabolic pathways in lipedema remain insufficiently understood. This preliminary exploratory study evaluated clinical outcomes and circulating mediators during a 7-month LCHF dietary intervention. Methods: Twenty-four women with lipedema (median age: 39 years) underwent a 7-month individualized, calorie-restricted LCHF diet under medical supervision. Outcomes included body mass index (BMI), leg volume, and adipose tissue pain assessed using a visual analogue scale (VAS). Fasting serum samples collected at baseline and follow-up were analyzed for angiogenic, inflammatory, endothelial, and lipid mediators using Luminex assays and liquid chromatography-tandem mass spectrometry (LC-MS/MS). Results: The intervention was associated with significant reductions in BMI, leg volume, and adipose tissue pain (p < 0.001). These changes were accompanied by increased vascular endothelial growth factor A (VEGF-A), vascular endothelial growth factor D (VEGF-D), and angiopoietin-2 (Ang-2), together with decreased pro-inflammatory cytokines and endothelial adhesion molecules. Several endocannabinoid-related lipid mediators, including oleoyl ethanolamide (OEA), arachidonoyl ethanolamide (AEA), and palmitoyl ethanolamide (PEA), also decreased. Baseline OEA and AEA concentrations, as well as reductions in OEA over time, were associated with greater BMI reduction. Change in interleukin-8 (IL-8) showed a nominal association with leg volume reduction, while pain improvement was associated with decreases in P-selectin and VEGF-A and increases in interleukin-13 (IL-13). Conclusions: A 7-month calorie-restricted LCHF dietary intervention in women with lipedema was associated with clinical improvement and changes in circulating vascular, inflammatory, and lipid mediators. These findings reflect systemic changes accompanying the intervention; however, causal relationships and specific mechanisms cannot be established.

Background Lipoedema is a condition of abnormal accumulation of painful adipose tissue, usually in the lower body of women. The disproportionate subcutaneous adipose tissue may negatively impact health-related quality of life (HRQoL). There are currently no patient reported outcome measures (PROM) specifically designed to assess the HRQoL in individuals with lipoedema. The aim of this study was to compare scores on validated lower limb lymphoedema PROMs between females with lipoedema and lymphoedema. Methods In a private lymphoedema clinic in Australia between 1 October 2021 and 22 August 2023, individuals assigned female at birth, aged 18 years and older who consented to the entry of de-identified data into a research databank and completed the Lymphoedema Quality of Life tool (LYMQOL-leg) and/or Lymphoedema Symptoms Intensity and Distress Survey (LSIDS-L) for the legs were included in this study. Between group analysis was conducted on 151 participants who were either diagnosed with lipoedema (N = 90) or bilateral leg lymphoedema (N = 61). Participants with both conditions were excluded. Results Participants with lipoedema reported significantly higher burden scores for symptoms (p = 0.003), appearance (p = 0.003) and mood (p = 0.011) in the LYMQOL-leg survey when compared to participants with bilateral leg lymphoedema. Participants with lipoedema also reported significantly worse LSIDS-L scores for neurological sensation (p = 0.003), biobehavioral (p = 0.016) and resource (p = 0.008) questions compared to participants with lymphoedema. Conclusions This study highlights that although females with lipoedema and lymphoedema experience similar symptoms, their experiences differ in specific outcomes that influence their HRQoL. These findings warrant further investigation into the HRQoL concerns of individuals with lipoedema.

Introduction: Lipedema, a painful disease that almost exclusively affects women, leads to an excessive accumulation of subcutaneous adipose tissue, primarily in the extremities. Morphologically, it is characterized by hyperplasia and hypertrophy of adipocytes as well as by inflammation-associated cells and fibrosis. Limited knowledge exists regarding the background of adipocyte pathology. In the present study, we aimed to identify morphological alterations of lipedema adipocytes, which could cause functional implications in lipedema adipose tissue. Methods: Approximately 3000 adipocytes from nine lipedema and five control adipose tissue samples, originating from non-obese donors, were analyzed. The ratio of atypical nuclei (Lochkerne) in relation to the total amount of nuclei was assessed and compared between lipedema and non-lipedema samples. Results: Lipedema adipose tissue exhibits a significantly higher proportion of Lochkerne compared to controls (p=0.001). While 24% of adipocyte nuclei presented as Lochkerne in lipedema samples, only 3% were identifiable in controls. We further show that the process of Lochkern-formation involves the nuclear indentation by small lipid droplets and their subsequent transmigration through the nucleus towards the central lipid content. Conclusion: The significantly increased occurrence of lipoma-associated Lochkerne in lipedema adipose tissue compared to controls reveals that, from a morphological point of view, lipedema is a form of lipomatosis.

ObjectiveTo analyse and compare the prevalence of comorbidities associated with lipedema in Spanish women with that in the general population.MethodsA cross-sectional study was conducted using an anonymous online questionnaire distributed among lipedema patient associations in Spain. Sociodemographic variables, clinical aspects, and comorbidities were collected. These were then compared with data from the 2023 National Health Survey, which represents the general Spanish population. The prevalence of each pathology was compared using odds ratios (OR) with 95% confidence intervals. Age-group contributions were assessed using standardised residuals from expected/observed contingency tables, considering absolute values >1.96 (95% confidence) to be significant.ResultsA total of 1001 responses were obtained, with a mean age of 44.2 years. The most prevalent comorbidities were vitamin D deficiency (63.4%), lower limb venous insufficiency (47.2%), and migraine (43.1%). Compared to the general female population in Spain, patients with lipedema were more likely to suffer from venous insufficiency (OR= 5.05; 95% CI: 4.3-5.8), urinary incontinence (OR= 4.93; 95% CI: 4.1-5.8), migraine (OR= 3.9; 95% CI: 3.4-4.5), thyroid disease (OR= 2.21; 95% CI: 1.8-2.6), and asthma (OR= 2.09; 95% CI: 1.7-2.5). However, the probability of hypertension (OR= 0.38; 95% CI: 0.2-0.4) and diabetes (OR= 0.36; 95% CI: 0.2-0.6) was significantly lower.ConclusionsSpanish women with lipedema have a higher prevalence of certain pathologies that should be considered in their medical care. Understanding these relationships is crucial to improving the detection and treatment of patients.