This state-of-the-art review collates the emerging evidence that distinguishes lipedema from both primary lymphedema and lifestyle-driven obesity. Drawing on genetic association studies, histopathology, and imaging advances, the authors outline a pathophysiologic model in which hormonally sensitive adipose expansion combines with microangiopathy and low-grade inflammation to produce the characteristic symmetrical limb enlargement. They propose a tiered diagnostic algorithm that pairs clinical “red flags” (painful nodular fat, negative Stemmer sign, easy bruising) with ultrasound and indocyanine-green lymphography to avoid missed or delayed diagnosis. Therapeutically, the paper synthesizes data on complex decongestive physiotherapy, tumescent liposuction, laser-assisted lipolysis, and emerging biophysical modalities, emphasising that surgical debulking must respect intact lymphatics to prevent iatrogenic lymphedema. By framing lipedema as a genetically primed, immunometabolic disease and cataloguing evidence-based interventions, the review sets an agenda for randomized trials that will refine staging, outcome metrics, and long-term surveillance.:contentReference[oaicite:0]{index=0}
Authors & affiliations
Hatan Mortada Division of Plastic Surgery, King Saud University Medical City, Riyadh, Saudi Arabia; Abdulmalek W Alhithlool College of Medicine, King Faisal University, Alhasa, Saudi Arabia; Nouf Z AlBattal College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Rashika K Shetty University of Minnesota Medical School, Minneapolis, USA; Ghaleb A Al-Mekhlafi Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia; Joon Pio Hong Asan Medical Center, Seoul, Republic of Korea; Feras Alshomer Division of Plastic Surgery, King Saud bin Abdulaziz University for Health and Sciences, Riyadh, Saudi Arabia
Tags: lipedema; liposuction; lymphedema.
