Conservative treatments can be thought of as lifestyle changes (better nutrition and more moderate exercise), mechanical (MLD, compression garments and compression pumps), and supplements/medications. Treatments that are cheap and easy to start include deep breathing, dry brushing and walking.

Therapy

A proof-of-principle study published in 2022 by Donahue et. al found that patients with early stage Lipedema could benefit from physical therapy to manage leg pain and improve quality of life. Nine 60-minute therapy sessions spanned a total of 6 weeks and included manual therapy, tailored exercise guidance for a home program, education and compression needs. Post-therapy, pain and function had clinically significant improvements and sodium levels in the skin and SAT regions had reduced, indicating lower inflammation in the treated areas. See more from that study here.Seeing a therapist familiar with treating Lipedema, typically a Certified Lymphedema Therapist (CLT), can be helpful. These professionals usually consist of physical therapists, occupational therapists, and licensed massage therapists, and have typically received Lipedema-specific training.

Nutrition

Research surrounding nutrition for Lipedema is still evolving, and there is not much data to support one particular diet. Some diets that have been utilized in the field include: paleo, keto, LCHF (low carb high fat), RAD (rare adipose disorder diet), and anti-inflammatory. As Lipedema tissue is typically resistant to caloric restriction; it is generally suggested to utilize diet to lower overall inflammation and alleviate symptoms.

For many who are trying new diets to support their health, it can be helpful to take note of which foods may aggravate or relieve symptoms.

The Lymphedema and Lipedema Nutrition Guide book is a resource that helps people identify practicable changes to eat healthier foods that can support people with Lipedema and Lymphedema.

Exercise

Exercise recommendations are usually: walking, aquatic exercise of any kind, Pilates, cycling, and yoga. The goals are to get the lymphatic system moving, take care of your joints if you are hypermobile, and build strength to help combat extra weight.

CLTs and other Lipedema-aware therapists can help develop a tailored exercise program designed to support patients with Lipedema.

Supplements

Certain vitamin and/or mineral deficiencies may present with Lipedema, and these deficiencies may warrant the use of supplements. Current research does not give a definitive answer on this subject. Patients should consult with a physician that can perform appropriate testing to assess the need for use of supplements and monitor use as needed.Keep in mind that supplements are not tested by the FDA so there limited data on safety and side effects. Most diuretics do not help alleviate the swelling of Lipedema.

Compression

Several recent studies have upheld compression as an effective non-surgical treatment modality. Both compression garments and pneumatic compression devices (pumps) can deliver benefits for quality of life and potential changes to body composition. 

Compression garments should be tailored to the patient. There are many types, sizes, and strengths of compression garments and all of these factors will likely have an impact on how effective the garment is at reducing inflammation, pain, and swelling. For the best chance of finding appropriate compression garments, patients can work with an experienced therapist or compression fitter to ensure accurate fit.

To learn more about insurance coverage for Compression garments, refer to The Lymphedema Education & Awareness Project website for useful handouts tailored to Patients, Providers, and Suppliers.

Lipedema patients often seek surgery in order to alleviate pain, increase mobility, decrease joint stress, and improve their quality of life.

The procedures most often considered for Lipedema patients include: Liposuction, vein surgery, knee and/or hip replacements, excisions of fat nodules, bariatric surgery to treat abdominal obesity*, and debulking/lifts/resections.

Whenever surgery is considered for Lipedema patients, the pre-op routine, surgical technique and post-op care should be very carefully tailored to the patient and the protocols can vary greatly by surgeon. Some surgeons advise their patients to develop healthy routines before surgery, especially incorporating healthy eating and exercise habits. Many surgeons and clinicians advise that surgeons should go to great lengths to avoid damaging shallow and deep lymphatics and vasculature in this patient group.

Venous procedures have not been found to effectively treat Lipedema symptoms. Be sure to ask your clinician for clarification if these procedures are being recommended, as well as information on non-invasive, conservative treatments.

Many insurance plans require a trial of conservative treatments prior to covering surgical procedures. Individual insurance plans vary, so it is important to contact your insurance provider to gather more information.

Notes on Liposuction

Not all doctors who perform liposuction know about working with Lipedema patients, and seeking out a doctor with demonstrated knowledge of Lipedema and Lipedema patients is important.

Realistic expectations should be set with patients receiving liposuction as to aesthetic outcomes, which may vary. Many surgeons place a focus on alleviating pain, preventing worsening progression, and improving gait and mobility.

Although a very small number of surgeons claim to be able to remove all Lipedema fat, thereby “curing” the patient, there is no way to know if that is truly the case because there is no way to definitively say all Lipedema fat is gone, or if the underlying problem was fixed.

New Findings

The LIPLEG trial (Podda et al., 2026), published in The Lancet, represents the first large, multi-center, randomized controlled trial directly comparing liposuction (often combined with conservative therapy) to conservative therapy alone. Key findings from the 12-month follow-up include:

• 68% of participants receiving liposuction achieved a meaningful reduction in leg pain compared to 8% in the conservative therapy group.

• Pain reduction benefits were observed across Lipedema Stages I, II, and III.

• The surgical group reported improvements in physical functioning and tendency to bruise. 

• The surgical group reported improvements in quality of life, although these improvements were not consistent across all Lipedema stages.

Safety Considerations

While the LIPLEG study demonstrates that liposuction can be beneficial, the trial highlights other considerations that may impact the decision to have surgery:

• Surgery is invasive and carries significant risks. Adverse events occurred in 47% of the liposuction group compared to 21% in the conservative therapy group, with serious adverse events occurring in 7.5% vs. 3.4% of cases. Reported events included surgical site infections, fluid buildup under the skin, and drops in blood counts.

• Participants in the LIPLEG trial were operated on by highly experienced Lipedema surgeons under strict safety limits only after completing months of conservative therapy.

• The study was conducted entirely in Germany and excluded individuals over 120 kg and those with significant arm involvement, meaning these findings may not apply equally to every patient. These factors may limit how broadly the findings apply to patients in other healthcare settings or to patient populations that were not represented in the trial.

• The published data reflect 12-month outcomes. Long-term follow-up (36 months) is currently ongoing to assess whether improvements in pain are sustained and whether symptoms recur over time.

Read more about LF’s review of the LIPLEG Study on our blog.

Other Surgical Considerations

Post-op care often includes compression, manual lymphatic drainage (MLD) and light exercise like walking to stimulate lymphatic vessel pumping.

Surgery can sometimes have a significant mental health impact on patients. It is important to have realistic expectations about recovery and surgical goals.

Adherence to pre-op and post-op protocols is important, and setting healthy routines before surgery should be advised (eating well, MLD, compression).

The lymphatic system and lymphatic dysfunction can impact anesthesia.

It is important to do careful research prior to electing for surgery. Although some claim a procedure can remove all Lipedema fat and "cure" the patient, there is currently no medical test to confirm that all Lipedema tissue has been removed or that the underlying disease mechanism has been resolved. Social media can be a useful tool to connect with other Lipedema patients who have shared their surgical experiences.

*While bariatric surgery has very limited (if any) effect on lipedematous tissue directly, non-lipedema fat and obesity can be reduced. Patients should be aware of this when they are considering which treatments to pursue.

For more information about insurance coverage for compression garments and supplies, visit the Lymphedema Education & Awareness Project website.

Specifically, view the Patient, Provider, and Supplier Handouts for useful information tailored to each audience. All three address the most commonly asked questions and provide the information most necessary for each group.