The reason for this favorable response can be speculated based on mTOR inhibitor effect involved in fat synthesis and metabolism that causes dyslipidemia leading to lipedema.3Kim et al also said that mTOR inhibitor-induced lymphedema showed a higher subcutaneous fat ratio in lower extreme CT venography.2Furthermore, the aggravation after temporary improvement from the physiologic surgery may be partially explained by this mechanism as well. Here, MTOR is linked to metabolic syndrome.