Lipedema remains an enigmatic loose-connective-tissue disease despite a presumed prevalence of 10–20 % among women. This critical review maps the landscape of what is known—and, crucially, still unknown—about its pathogenesis, diagnosis, and treatment. Current evidence supports two non-mutually exclusive hypotheses: primary adipocyte dysfunction that drives disproportionate limb hypertrophy, and micro-lymphatic failure that secondarily fosters adipogenesis and pain. Clinical differentiation from lymphedema, phlebo-lymphatic disease, and obesity is confounded by frequent overlap and the absence of validated biomarkers. Imaging tools (lymphoscintigraphy, ultrasound, MRI) show promise but lack standardized thresholds, leaving diagnosis largely clinical. Therapeutically, tumescent liposuction emerges as the only intervention consistently reducing limb volume, pain, and disability, yet long-term lymphatic safety and the role of simultaneous skin-resection surgery remain unclear. The authors highlight priority research questions: quantifying lymphatic changes after contour surgery, establishing objective imaging criteria, and delineating molecular pathways that couple interstitial-fluid overload to adipocyte expansion. Addressing these gaps is essential for evidence-based, multidisciplinary care. (pubmed.ncbi.nlm.nih.gov)
R F D van la Parra – Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
C Deconinck – Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
G Pirson – Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
M Servaes – Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
Ph Fosseprez – Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
Tags: Adipose tissue; Diagnostic imaging; Lipedema; Liposuction; Lymphatic drainage
