Study finds liposuction reduces lipedema pain more than conservative treatment

A study titled “Liposuction versus conservative therapy for patients with lipoedema: A randomized controlled multi-center clinical trial” published in The Lancet, provides the first large-scale, multicenter evidence base for the surgical treatment of lipedema.

The LIPLEG study (LIP – liposuction, LEG – leg) took place at 11 sites in Germany and included 410 patients with stage I to III lipedema. The results show that liposuction can be significantly superior to the established standard of care in key treatment outcomes.

Lipedema is a chronic, painful fat distribution disorder that almost exclusively affects women and is typically associated with fat deposits on the legs and sometimes arms, pain under pressure and an increased tendency toward hematomas.

The standard therapy consists of complex decongestive therapy with lymphatic drainage, compression and exercise. This can alleviate symptoms but requires long-term application and often results in only limited pain relief. Liposuction is a surgical procedure in which abnormally increased fatty tissue is locally removed.

How the trial shaped policy

In addition to the University of Cologne and University Hospital Cologne, the Clinical Trials Center Cologne (ZKS), the Institute for Medical Statistics and Bioinformatics at the University, and the Dermatology Clinic at Darmstadt Hospital were involved as study directors.

The Joint Federal Committee (Gemeinsamer Bundesausschuss), which initiated the LIPLEG study, decided in 2025 to include liposuction for lipedema in the catalog of services covered by statutory health insurance in Germany under defined conditions.

This was the first time that surgical treatment was established as a regular health insurance benefit. In 2019, the Joint Federal Committee commissioned ZKS Cologne, together with the Dermatology Clinic in Darmstadt, to scientifically evaluate the study on the effectiveness of surgical treatment and analyze the results.

Pain relief far outpaced standard care

In the study, all participants initially received several months of conservative pretreatment before being randomized to receive either further conservative therapy or liposuction.

After 12 months, there was a clear difference between the groups: 68.3% of patients who underwent surgery achieved clinically relevant pain reduction of at least two points on a 10-point scale. This was the case for only 7.6% of the conservatively treated group. As a result, significantly more patients achieved a reduction in pain with liposuction than with standard treatment. At the same time, there was a marked improvement in quality of life.

“Our data show for the first time that liposuction for lipedema can achieve a very significant and clinically relevant reduction in pain,” said Dr. Oliver A. Cornely, one of the key researchers and scientific director of ZKS Cologne. This proven pain reduction was the aspect that Dr. Maurizio Podda († 2025), head of the study and director of the Dermatology Clinic at Darmstadt Hospital, found most encouraging and impressive.

Benefits came with surgical risks

“At the same time, we must clearly state the surgical risks. It is not a trivial intervention, but an effective yet invasive treatment option that must be carefully weighed and monitored,” Cornely added.

The researchers found that adverse events occurred more frequently in the liposuction group than with conservative therapy, including serious complications observed only in the surgical arm of the study. They stress that, as with all surgical procedures, a careful individual risk-benefit assessment is necessary.

For many years, conservative therapy was seen as the standard. The new publication could now lead to a reassessment of treatment strategy and provides an important basis for decisions on cost coverage by statutory health insurance companies.

Long-term safety still under review

In addition to the 12-month evaluation, long-term observations over a total of 36 months are underway to assess the sustainability of the effects and possible late complications. The researchers emphasize that further studies are needed to better understand long-term safety, optimal surgical procedures and possible differences between liposuction techniques.

Who’s behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries.

Full profile →

Robert Egan

Bachelor’s in mathematical biology, Master’s in creative writing. Well-traveled with unique perspectives on science and language.

Full profile →