"Effect of Endermologie-Assisted Physiotherapy on Edema, Pain, and Functional Recovery After Liposuction for Lower-Limb Lipedema"

This study will evaluate the effect of adding Endermologie to a standard postoperative physiotherapy program for patients recovering from liposuction for lower-limb lipedema.

Lipedema is a chronic disorder of abnormal fat distribution that commonly affects the lower limbs and may be associated with pain, heaviness, tenderness, swelling tendency, bruising, and reduced mobility. Although liposuction may reduce pathological adipose tissue, postoperative recovery often requires structured rehabilitation to manage swelling, pain, tissue stiffness, and functional limitations.

Participants will be assigned to one of two treatment groups. The control group will receive standard postoperative physiotherapy, which may include compression guidance, manual lymphatic drainage, gentle therapeutic exercises, walking progression, lower-limb elevation advice, skin care education, and activity modification. The intervention group will receive the same standard physiotherapy program with the addition of Endermologie sessions.

Endermologie is a non-invasive mechanical soft-tissue mobilization technique using controlled suction and rolling movements. In this study, it will be applied as an adjunctive modality after surgical clearance and according to patient tolerance. Treatment intensity and duration will be adjusted based on healing status, pain level, and tissue response. Areas with open wounds, infection, hematoma, seroma, or excessive tenderness will be avoided.

The study will assess changes in postoperative edema, pain, and functional recovery over the intervention period. Edema may be evaluated using standardized lower-limb circumference or volume measurements. Pain may be assessed using a validated pain rating scale. Functional recovery may be evaluated using mobility or lower-limb function measures. Additional observations may include tissue stiffness, tenderness, heaviness, bruising, patient satisfaction, and quality of life.

The purpose of this study is to determine whether Endermologie-assisted physiotherapy provides additional benefits compared with standard physiotherapy alone in improving postoperative recovery after liposuction for lower-limb lipedema.

Inclusion criteria

Participants will be eligible for inclusion if they meet all of the following criteria:

Female participants diagnosed with lower-limb lipedema. Age between 25 and 45 years old.

• Clinical diagnosis of lipedema confirmed by the treating physician or specialist physiotherapist.
• Lipedema stage II or stage III based on clinical presentation, including disproportionate fat deposition, pain/tenderness, easy bruising, tissue nodularity, or lobular tissue changes.
• Scheduled for or recently underwent lower-limb liposuction for lipedema management.
• Body mass index (BMI) between 25 and 35 kg/m².
• Medically stable and cleared by the treating surgeon to start postoperative physiotherapy.
• Ability to understand instructions and comply with treatment visits and assessment procedures.
• Willingness to wear prescribed compression garments according to the postoperative protocol.

3.2 Exclusion Criteria

• Primary or secondary lymphedema unrelated to lipedema, unless clearly differentiated and documented.
• Lipedema stage IV with advanced lipo-lymphedema requiring complex decongestive therapy beyond the study protocol.
• BMI greater than 35 kg/m² or less than 25 kg/m².
• Uncontrolled diabetes mellitus, uncontrolled hypertension, severe cardiovascular disease, renal disease, hepatic disease, or active systemic inflammatory disease.
• Deep vein thrombosis, active thrombophlebitis, severe peripheral arterial disease, or untreated varicose complications.
• Active infection, open wounds, skin ulceration, cellulitis, or significant postoperative complications preventing mechanical therapy.
• Known coagulopathy, current anticoagulation therapy not cleared by the surgeon, or high bleeding risk.
• Pregnancy or lactation.
• Previous lower-limb liposuction within the preceding 12 months.
• Use of other structured edema-reduction interventions during the study period outside the assigned protocol.
• Inability to attend scheduled follow-up assessments.