Using the membrane-bending elasticity theory and a simple effective model of adhesion, we study the morphology of lipid vesicle doublets. In the weak adhesion regime, we find flat-contact axisymmetric doublets, whereas at large adhesion strengths, the vesicle aggregates are nonaxisymmetric and characterized by a sigmoidally curved, S-shaped contact zone with a single invagination and a complementary evagination on each vesicle. The sigmoid-contact doublets agree very well with the experimentally observed shapes of erythrocyte aggregates. Our results show that in identical vesicles with large to moderate surface-to-volume ratio, the sigmoid-contact shape is the only bound morphology. We also discuss the role of sigmoid contacts in the formation of multicellular aggregates such as erythrocyte rouleaux.lipid vesicle ͉ vesicle doublet ͉ sigmoid-contact doublet ͉ rouleau E lastic theory of shapes of phospholipid vesicles (1) is a very successful model. Its phase diagram, now explored in considerable detail, comprises a broad spectrum of shapes such as stomatocytes, discocytes, dumbbells, pears, torocytes, starfish, rackets, etc. (2-5). A large majority of the predicted shapes has been observed experimentally (6), and some of them correspond very closely to the different normal and abnormal forms of a mammalian erythrocyte, a simple anucleate eukaryotic cell. If the theory is extended to include the shear elasticity of the membrane skeleton, the agreement between the calculated and the actual shapes is truly striking, even in very deformed erythrocytes such as echinocytes (7).These results give hope that the approach can be extended to describe not only single vesicles but also their aggregates. With some exceptions, theoretical studies of aggregates rely on the simplest model of the intermembrane attraction where the adhesion energy is proportional to the contact area (8-10). In the first analyses of erythrocyte doublets and rouleaux, the contact zone was assumed to be flat (10-12), but at large adhesion strengths, this hypothesis was found to disagree with experiments (10); so far no explanation of the observed shapes has been available.Here we fill this gap by studying vesicle-vesicle adhesion within a fully numerical model free of all symmetry constraints, and we focus on vesicle doublets as the most elementary aggregates. Our central result is a doublet morphology with a sigmoid shape of the contact zone, which closely reproduces the large-scale features of erythrocyte doublets (10-16). In vesicles of volume and area of a human erythrocyte, this doublet is the stable shape at large enough adhesion strengths, whereas immediately beyond the aggregation threshold, a flat-contact doublet is found. We show that with increasing surface-to-volume ratio, the range of adhesion strengths corresponding to the flat-contact doublet should diminish and eventually vanish, leaving the sigmoid-contact doublet as the only stable bound morphology. These findings also provide an insight into the mechanics of aggregates of more than ...