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BACKGROUND: Lipedema is a chronic, progressive and underdiagnosed condition characterized by bilateral, disproportionate and painful subcutaneous fat accumulation in extremities. Key symptoms include pain, heaviness and easy bruising. Surgical treatment, particularly liposuction, has shown excellent outcomes in symptom reduction and quality of life improvement. This study evaluates clinical outcomes in symptoms and aesthetic self-perception improvements in patients treated with selective combined liposuction (SCL). PATIENTS AND METHODS: A retrospective review of 126 female patients who underwent surgical treatment over a four-year period was performed. Selective tumescent liposuction combining power-assisted liposuction (PAL) with VASER (ultrasound-assisted liposuction) for proximal areas, especially the thighs. Demographic and clinical data, including BMI, medical history and comorbidities were analyzed. Symptoms such as pain, heaviness and edema, and body image perception were assessed preoperatively and six months postoperatively with a structured questionnaire. RESULTS: The mean patient age was 39 years, with a mean BMI of 27.2. The mean aspirated volume was 3270 mL per procedure. In 25.4% of the cases (n=32), a second procedure was required, with an average total aspirated volume of 5150 mL. Significant symptom improvement was observed: 89% reported reduced pain, 92% reduced heaviness, 82% reduced edema. Mobility limitations improved in 91% of patients, while 60% reported enhanced aesthetic perception of their extremities. Additionally, 68% of patients expanded their wardrobe postoperatively. CONCLUSIONS: Selective combined liposuction is a safe and highly effective technique for lipedema treatment, providing substantial symptom relief, improved body aesthetic self-perception, which leads to an improvement in the quality of life.