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In the guidelines for lipedema treatment, in addition to decongestive therapy, surgical therapy (liposuction) is advised as a standard treatment. However, in most cases the German social health insurance system refuses to pay for the costs of treatment. While primarily medical arguments are cited, it is clear that this refusal is chiefly due to the socioeconomic restrictions in the German social health insurance system. At present objective criteria in the form of prioritization are being tested for evaluation and to create a ranking list for the validity of treatment. For liposuction it is not yet clear whether in addition to an improvement in the quality of life, a reduction in lifetime treatment costs can be achieved.