Surgery for lipoedema: health insurance covers the costs – under certain conditions

For years, affected women and associations have been fighting for health insurance companies to cover the costs of liposuction for lipoedema. Unfortunately, for a long time in vain – until now. This is because the preliminary results of the“LIPLEG” trial study commissioned by the Joint Investigation Committee (G-BA) have shown that liposuction of the diseased fat cells has a clear benefit in chronic fat distribution disorders. It alleviates the symptoms in the long term and enables affected women to lead a largely symptom-free life again.

The G-BA did not hesitate for long and on July 17, 2025 cleared the way for liposuction to be covered by statutory health insurance – much to the delight of the approximately 3.8 million women affected in Germany. According to the decision, liposuction will become a statutory health insurance benefit from January 1, 2026 – regardless of the stage. However, the Federal Joint Committee has attached strict conditions to the assumption of costs, which somewhat diminishes the initial euphoria.

Liposuction costs covered by statutory health insurance: Previously only possible for stage III patients

Before the G-BA’s decision, the costs of liposuction could only be covered for women with severe stage III lipoedema. This was only temporary due to a regulation from 2020. However, those affected in the earlier stages I and II were denied coverage of the costs for the liposuction they longed for. They only received lymphatic drainage, exercise and compression therapy as health insurance benefits. Although these can alleviate the symptoms and slow down the progression, they cannot reduce the diseased fatty tissue.

Liposuction at the expense of health insurance: these conditions must be met in future

After the G-BA decision was announced, many patients with lipoedema hoped that they would be able to undergo the redemptive procedure promptly and with cost certainty. Unfortunately, it is not quite that simple. The Federal Joint Committee (G-BA) has placed a number of hurdles in the way of those affected, much to the displeasure of patient representatives.

Lipedema diagnosis and surgical indication according to the “four-eyes principle”

The G-BA’s decision introduced the “four-eyes principle” for lipoedema diagnostics and the indication for liposuction. This means that the diagnosing specialist may not perform the lipoedema operation themselves. Instead, the correct procedure is as follows:

• A qualified doctor (with additional further training in phlebology, dermatology, internal medicine and angiology or physical and rehabilitative medicine) makes the diagnosis of lipoedema.
• Six months later, a second specialist must independently confirm the diagnosis and give the indication for liposuction.

If both specialists come to the same conclusion independently of each other, the costs may be covered by the statutory health insurance fund, provided the following criteria are also met.

Conservative lipedema therapy and stable weight development

In the six months between diagnosis and the indication for liposuction, women must undergo six months of conservative treatment according to the new guidelines. This includes:

• Regular wearing of special compression clothing,
• Regular manual lymphatic drainage,
• if necessary, an accompanying exercise therapy and
• a healthy lifestyle and no weight gain.

Unfortunately, this alone is not enough. Affected women must also be able to provide verifiable proof that they are consistently wearing their compression garments or that their weight is stable. Medical prescriptions or written confirmations from physiotherapists are sufficient for this. Proof must also be provided that the treatments have not sufficiently alleviated the symptoms and improved the quality of life.

BMI and Waist-to-Height Ratio (WHtR)

The Federal Joint Committee (G-BA) also sets strict guidelines for the Body Mass Index (BMI) and the Waist-to-Height Ratio (WHtR) of affected women:

• If the BMI is less than 32 kg/m², the statutory health insurance will cover the costs of liposuction for lipoedema without any further conditions.

• If the body mass index is between 32 and 35 kg/m², the health insurance company uses the waist-to-height ratio (ratio of abdominal circumference to height) for a better assessment. Depending on age, this should be below a certain limit and ensure that only the subcutaneous fatty tissue on the arms and legs is responsible for the excess weight.
• According to the G-BA, insured persons with a BMI of over 35 kg/m² must undergo obesity treatment before undergoing lipoedema surgery and wait until the limit values have not been exceeded for a period of six months.

Treatment by a specialist with health insurance approval

The G-BA’s new quality assurance guidelines(PDF) also limit the circle of doctors who are allowed to perform liposuction as a statutory health insurance benefit. According to these guidelines, only specialists in plastic, reconstructive and aesthetic surgery, surgery and dermatology who are also licensed to perform liposuction may do so in future.

The G-BA’s requirements for doctors’ experience with liposuction are less stringent: just 20 liposuction procedures performed within two years are sufficient. By comparison, an experienced specialist in plastic and aesthetic surgery performs a hundred or more procedures in the same period. The problem, however, is that these highly qualified specialists with experience in lipoedema treatment by liposuction work in their own private practices or clinics and have no way of billing their services to health insurance companies.

Alternative to lipoedema surgery financed by health insurance: liposuction by an experienced lipoedema specialist

The hurdles to having the costs of lipoedema surgery covered are high. Nevertheless, some patients will certainly benefit and quickly receive approval from the statutory health insurance provider for the desired treatment. For many, however, the G-BA’s requirements regarding BMI are likely to prove problematic and turn the application into a lengthy feat of strength. There may also be problems with other requirements, as the final framework conditions have not yet been determined.

Patients who do not want to wait months or even years for a non-guaranteed cost approval can take action themselves at any time. One option is to see a specialist in plastic and aesthetic surgery experienced in lipedema treatment, such as Dr. Nichlos in Frankfurt, on a self-pay basis. This not only eliminates long waiting times. The quality of the technically demanding lipoedema surgery and aftercare are also guaranteed.

The advantages of lipedema treatment with Dr. Nichlos at a glance:

• With us, you don’t have to put up with long waiting times. We will give you an appointment for a consultation at short notice, get an idea of your condition and its cause and plan the procedure promptly, provided there are no objections.
• Dr. Nichlos has many years of experience as a specialist in plastic and aesthetic surgery and has successfully performed countless liposuctions during his career. By choosing our practice, you can benefit from this experience.

• We do not limit our treatment to the arms and legs listed in the SHI benefits catalog, but plan individually according to your clinical picture. This means that we may also include your back, abdomen and buttocks in order to create a harmonious overall picture.
• Excess skin often remains after the operation (especially in stage III diseases). On request, we can combine liposuction with a skin tightening procedure to achieve an optimal functional and aesthetic result.

Arrange a no-obligation consultation at our practice in Frankfurt now. Dr. Nichlos will be happy to take the time to talk to you about the options for lipoedema treatment by liposuction and will explain both the procedure and the costs.