Big news for women dealing with Lipedema as German surgeons announce the findings of a years-long study. Professor Dr Oliver A. Cornely, scientific director of the ZKS Cologne, revealed in a press release in September 2026, ‘Our data show for the first time that liposuction for lipedema can achieve a very significant and clinically relevant reduction in pain”.
Last year Germany’s Gemeinsamer Bundesausschuss approved liposuction for Lipedema for coverage by statutory health insurance, after reviewing the results of the LIPLEG clinical trial. Since the 2025 announcement, we’ve been waiting to learn more detail about the clinical benefits of liposuction for Lipedema. Now the team of doctors behind the trial have published their findings in the September 2026 edition of the Lancet.
In a randomized controlled clinical trial, doctors compared the outcomes of liposuction to a nonsurgical treatment for lipoedema to see whether, a year later, patients who underwent liposuction experienced less pain in their legs. The researchers quizzed over 250 Lipedema patients who got liposuction and 132 who tried a nonsurgical approach to test which treatment was more effective.
The results were clear. Only 8% of patients using complex decongestive therapy reported a reduction of two or more points on the German pain questionnaire. In contrast, 68% of Lipedema patients who tried liposuction experienced a reduction of two or more points on the pain scale.
Liposuction Benefited all Stages of Lipedema
Importantly, patients living with all stages of Lipedema found benefits with improvements of an average reduction of 3.7 pain scale points. The procedure worked as well for patients with stage I Lipedema (3.9 points lower) as with stage III Lipedema (3.7 points lower).
This isn’t all good news. The researchers also discovered that liposuction often came with complications. Nearly half of liposuction patients revealed that they suffered adverse events after surgery. While the researchers estimate that most of these were unrelated to the treatment, a few patients who tried liposuction experienced abscesses at the surgical site, erysipelas, serum, thrombosis, pulmonary embolism and postoperative pain. As Cornely explained, although he and his colleagues were ‘pleased and impressed’ by the results of the trial, ‘at the same time, we must clearly state the surgical risks. It is not a trivial intervention, but an effective and yet invasive treatment option that must be carefully weighed and monitored.’
Conservative Versus Surgical Treatments for Lipedema
Specialists have long suspected that liposuction would be an effective treatment for Lipedema. The problem was that, until now, case reports and clinical trials have included too much variability in experimental design and data collection to make a convincing argument for insurers to pay for it. In light of the lack of good quality research, the Gemeinsamer Bundesausschuss put together a consortium of German hospitals, doctors and insurers taking on the costly challenge of testing whether liposuction is a feasible and effective treatment.
The Evaluation Between Surgical Therapy of Lipedema Compared to Complex Physical Decongestive Therapy (CDT) Alone (LIPLEG) clinical trials ran between January 2021 and August 2024.
Researchers based at eleven hospitals across Germany recruited 410 patients living with stage I to III Lipedema. Doctors only included volunteers who had a confirmed diagnosis of Lipedema and did not have lymphoedema or any other additional medical condition that might cause swelling in the legs.
On your Marks
Before the trial started, every woman was asked to take part in a month-long course of complex decongestive therapy to get rid of as much oedema as they could. The participants continued the treatment for another six months to the same baseline levels of swelling, pain scores, quality of life scores, disability and proneness to bruising. All the volunteers were women, at an average age of 43 with a BMI of around 32. The average hip to waist ratio was 0.83, oedema score 0.5. Women started the trial with a mean pain score of 6.2, according to the German Pain Questionnaire, and were equally spread between stages I, II and III of Lipedema.
Next, they split the group at random into two. One consisted of 278 women who would get liposuction; the other 132 patients would try a conservative treatment. While the volunteers knew which treatments they were getting, the medical staff assessing the participants at follow-up sessions would not know, nor would the staff involved in statistical modelling until the final stages of the analysis.
Patients in the liposuction group got up to four sessions of wet-technique liposuction. Control participants continued with complex decongestion therapy performed by a physiotherapist for a further 12 months.
Liposuction for Lipedema Has Legs
The trial team planned assessments at six months post treatment (or randomization if they were in the control group) and again at 12 months, marking the end of the study. The researchers would interview participants and collect fresh ratings for each of the questionnaires to see whether patients were improving over time.
After the final follow-up, the investigators crunched the numbers to answer the question, ‘Does liposuction reduce a patient’s leg pain by two or more points a year after treatment?’ The conclusion was a clear ‘yes’.
After a year 190 out of 278 participants in the liposuction groups reported their leg pain as at least 2 points lower ion the German Pain Questionnaire. In contrast only 10 of the 132 strong control group who got complex decongestive therapy for a year reported a two-point improvement. Not only did liposuction improve pain scores by a clinically significant two points, the average change was a 3.74 point reduction, taking the average pain scored from 6.2 to 2.6. The average pain score did not change to a significant degree in the control group, increasing from 6.2 to 6.6.
More than Just Pain Relief
The next question was, would the stage at which a patient tried liposuction affect the outcome? It doesn’t seem so, with patients at stage III reporting similar improvements to stage I participants. Women with stage 1 Lipedema reported a reduction in pain of 3.87, while those with stage III showed a 3.67 reduction in pain scores.
The team also revisited scores for quality of life, bruising, mental health, restricted movements, etc. Participants who had had liposuction reported better outcomes than patients in the control group. In particular, patients with stage II or III Lipedema found that liposuction gave them nine times better odds of losing weight.
The researchers used a pragmatic approach to the study, including participants who dropped out of the study in the analysis. This step is important because if a treatment is so horrible that people don’t complete it, the results of a clinical trial should reflect that. They also accepted that the liposuction techniques would not be identical across sites and individual surgeons. While this might introduce more variability in the results, it reflects what will happen to patients in real life. Despite the added complication of so many potential differences, the procedure still yielded clinically significant improvements.
We don’t know, however, how long the effects will last, since the study concluded in 2024 and they only followed subjects for a year. The researchers plan to track the participants for another 36 months to see if the benefits last and whether there are any long-term adverse effects.
Why Liposuction and Not Diet and Exercise?
The roots of Lipedema lie in a connective tissue disorder. While the amount of swelling correlates to the volume of fat stored in the legs, obesity doesn’t cause Lipedema. If you have Lipedema your legs swell because the connective tissue that surrounds the fat cells in your leg is prone to trapping fluid. This leads to painful swelling and bruising that give the legs a disproportionately thick appearance. The extent of the swelling increases over time, and doctors often categorize people into stages of Lipedema depending on how severe their symptoms are. The more fat you accumulate on your legs, the more connective tissue there is to trap oedema.
The causes of lipedma are still a mystery, but in recent years scientists have found that there might be a genetic element as Lipedema can run in families, and it seems to be influenced by hormones.
Dieting and exercise don’t help patients reduce the swelling in their legs, even if they manage to lose weight from other parts of their body. This is because the problem lies in the connective tissue, not the fat itself. So why would liposuction work?
The most common treatments for Lipedema involve trying to massage away the excess fluid, wearing compression garments, exercises and lymphatic drainage; however, these treatments only focus on relieving the symptoms, not fixing the underlying pathology.
The reasoning behind using liposuction is that when you remove the fat cells sitting under the skin, you take the extracellular matrix that traps fluid with them. What’s more, when you remove fat cells via liposuction, they are gone for good, so, in theory, you are less likely to accumulate large fat stores in that area again, reducing the likelihood of the swelling coming back.
References
Podda M, Schmidt J, Cornely ME, et al. Liposuction versus conservative therapy for patients with lipoedema in Germany: a multicentre, randomised controlled clinical trial. The Lancet. 2026;408(10558):910-923. doi:10.1016/S0140-6736(26)00910-4
Surgical treatment of fat distribution disorder is particularly effective. EurekAlert! Accessed September 22, 2026. https://www.eurekalert.org/news-releases/1142737
Hautklinik Darmstadt. Multicentre, Controlled, Randomized, Investigator-Blinded Clinical Trial on Efficacy and Safety of Surgical Therapy of Lipedema Compared to Complex Physical Decongestive Therapy Alone (LIPLEG). clinicaltrials.gov; 2025. Accessed September 22, 2026. https://clinicaltrials.gov/study/NCT04272827
van la Parra RFD, Deconinck C, Pirson G, Servaes M, Fosseprez P. Lipedema: What we don’t know. J Plast Reconstr Aesthet Surg. 2023;84:302-312. doi:10.1016/j.bjps.2023.05.056
Mortada H, Alhithlool AW, AlBattal NZ, et al. Lipedema: Clinical Features, Diagnosis, and Management. Arch Plast Surg. 2025;52(3):185-196. doi:10.1055/a-2530-5875
Wold LE, Hines EA, Allen EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Ann Intern Med. 1951;34(5):1243-1250. doi:10.7326/0003-4819-34-5-1243
