Lipedema is a painful, symmetrical fat distribution disease of the extremities, characterized by a disproportion to the trunk. The increased circumference of extremities results from hyperplasia and hypertrophy of subcutaneous adipose tissue, with characteristic symptoms including pain triggered by inadequate stimuli and increased tendency for bruising in affected areas. The condition predominantly affects women, with an estimated prevalence of up to 10%. Initial manifestation of this currently considered chronically progressive disease is often triggered by hormonal changes such as puberty, pregnancy, or menopause. The pathogenesis of lipedema is not fully understood. Due to familial clustering, a genetic predisposition is presumed. Complete physical decongestive therapy (CDT), although not always necessary with all its elements, is an important and effective treatment to alleviate symptoms and delay progression. If patients do not experience sufficient relief from symptoms through conservative measures, surgical resection of pathologic lipedema adipose tissue (lymph-sparing liposuction) should be considered as a treatment option.