Sequential Management of Stage 3/Type III Lipedema With a Ketogenic Dietary Phase Followed by Adjunctive Photothermal Biomodulated Autologous Platelet-Rich Plasma: A Descriptive Case Report

Stage 3/Type III lipedema Symptoms: Adipose tissue accumulation involving the hips, buttocks, thighs, and peri-knee region • lobular adipose prominences and folds over the thighs and around the knees • pain elicited by palpation • skin dimpling • symmetrical disproportionate enlargement of the lower body Clinical Procedure: -Specialty: Dermatology Background:Lipedema is a chronic adipose tissue disorder associated with pain, tissue fibrosis, and functional impairment.Evidence supporting nutritional strategies and adjunctive local treatments remains limited. Case Report:A 47-year-old woman with stage 3/type III lipedema and obesity underwent an individualized ketogenic, carbohydrate-restricted, normoprotein dietary phase for 7 months.This was followed by a 4-month local intervention phase including 4 monthly sessions of multipuncture administration of autologous platelet-rich plasma after ex vivo photothermal biomodulation with blue light (467 nm, 2 J/cm 2 , 37 °C, 10 min).Body composition was assessed by bioelectrical impedance analysis, fat thickness by ultrasonography, pain by visual analog scale, and patient-reported global aesthetic improvement at the final visit.Over 11 months, body weight decreased from 103.4 to 72.0 kg, body mass index from 37.1 to 25.8 kg/m 2 , fat mass from 47.2 to 23.2 kg, and visceral fat level from 12 to 6. Subcutaneous, preperitoneal, and omental fat thickness also decreased.Pain decreased from 9/10 at baseline to 5/10 at final assessment; patient-reported global aesthetic improvement was 5/5, and no adverse events were documented. Conclusions:Most objective changes occurred during the dietary phase.During the local intervention phase, the diet continued to be modified, and body weight decreased further, confounding attribution of second-phase outcomes specifically to photothermal biomodulated platelet-rich plasma.Pain was not assessed at the end of the dietary phase.Therefore, the independent contribution of photothermal biomodulated platelet-rich plasma to second-phase outcomes cannot be determined.This case should be interpreted as a descriptive report rather than as evidence of efficacy, mechanism, or additive benefit.