The publication “Liposuction versus conservative therapy for patients with lipoedema: A randomised controlled multi-centre clinical trial” in The Lancet provides the first large-scale, multi-centre evidence base for the surgical treatment of lipoedema. The LIPLEG study (LIP - liposuction, LEG - leg) took place at 11 locations in Germany with a total of 410 patients suffering from stage I to III lipoedema. The results show that liposuction can be significantly superior to the established standard of care in terms of key treatment outcomes.
Lipoedema 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 towards haematoma. The standard therapy consists of complex decongestive therapy with lymphatic drainage, compression, and exercise. This can alleviate symptoms, but calls for long-term application and often only leads to limited pain relief. Liposuction is a surgical procedure in which abnormally increased fatty tissue is locally removed.
In addition to the University of Cologne and University Hospital Cologne, in particular the Clinical Trials Center Cologne (ZKS) and the Institute for Medical Statistics and Bioinformatics at the University, the Dermatology Clinic at Darmstadt Hospital was involved as sponsor and study director. The Joint Federal Committee (Gemeinsamer Bundesausschuss), which initiated and financed the LIPLEG study with funding from the statutory health insurance, decided in 2025 to include liposuction for lipoedema in the catalogue of services covered by statutory health insurance in Germany under defined conditions. This was the first time that the surgical treatment has been established as a regular health insurance benefit. In 2019, the Joint Federal Committee commissioned the ZKS Cologne, together with the Dermatology Clinic in Darmstadt, to scientifically monitor the study on the effectiveness of surgical treatment and to analyse the results.
In the study, all participants initially received several months of conservative pre-treatment before being randomized to receive either further conservative therapy or liposuction. After 12 months, there was a clear difference between the groups: 68.3 percent of patients who underwent surgery achieved clinically relevant pain reduction of at least two points on a ten-point scale. This was only the case in 7.6 percent of the conservatively treated group. As a result, significantly more patients achieved a reduction in pain with liposuction than with the 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 lipoedema can achieve a very significant and clinically relevant reduction in pain,” explains Professor Dr Oliver A. Cornely, one of the key researchers and scientific director of the ZKS Cologne. This proven pain reduction was the aspect that Professor Dr Maurizio Podda († 2025), head of the study and director of the Dermatology Clinic at Darmstadt Hospital, was most pleased and impressed with. “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,” Cornely added.
The researchers found that adverse events occurred more frequently in the liposuction group than in the case of conservative therapy, including serious complications that were only observed in the surgical arm of the study. They stress that, as in 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 the treatment strategy and at the same time provides an important basis for decisions on cost coverage by statutory health insurance companies. In addition to the 12-month evaluation, long-term observations over a total of 36 months are currently 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.
The Lancet
Randomized controlled/clinical trial
People
Liposuction versus conservative therapy for patients with lipoedema: A randomised controlled multi-centre clinical trial
3-Sep-2026