In his insightful presentation, Dr. Wright dove into his meticulous approach to treating lipedema using Tumescent Local Anesthesia (TLA). He elucidated his preoperative ultrasound mapping technique, utilizing high-frequency ultrasound to map saphenous compartments and identify lymph-collecting ducts. This precision minimizes the risk of duct injury during lipedema liposuction. Dr. Wright presented on using Power Assisted Liposuction (PAL) for treating lipedema, usually performed as a large-volume liposuction. He demonstrated his manual extraction technique for hard, fibrous nodules, which had not been adequately reduced after liposuction. Moreover, Dr. Wright employed the Renuvion Helium plasma device to achieve tissue contraction and skin tightening, enhancing the overall results of his procedures.
In this video, Dr. Wright will take you through his meticulous approach to treating lipedema using Tumescent Local Anesthesia (TLA). He’ll explain his preoperative ultrasound mapping technique, which uses high-frequency ultrasound to map saphenous compartments and identify lymph-collecting ducts, thereby minimizing the risk of duct injury during liposuction. Dr. Wright will also discuss using Power Assisted Liposuction (PAL) for treating lipedema, often performed as a large-volume liposuction. He will demonstrate his manual extraction technique for hard, fibrous nodules that may not have been adequately reduced after liposuction. Additionally, he utilizes the Renuvion Helium plasma device to achieve tissue contraction and skin tightening, enhancing the overall results of his procedures.
To comprehensively understand Dr. Wright’s technique, including preoperative preparations and postoperative care, he will be available on-site to respond to your inquiries. Before surgery, Dr. Wright employs high-frequency ultrasound to locate and map the great and small saphenous fascia sheaths, sometimes identifying principal lymphatic collecting ducts. He then infiltrates dilute Lidocaine tumescent anesthesia, waits for it to take effect, and utilizes the Micro Air PAL Liposculptor with multi-hole cannulas to remove adipose and fibrous tissue while avoiding major lymphatic collecting ducts. Dr. Wright’s technique includes gentle massage or incisions for fibrous nodules that may still remain after liposuction. Watch Dr. Jamie Schwartz’s manual extraction technique for the full procedure by following the provided link to Total Lipedema Care. Post-surgery, Dr. Wright advises using Renuvion Helium plasma for tissue contraction and skin tightening on the arms. Patients are instructed to wear compression pantyhose with a strength of 20 to 30 mm Hg, 24/7 for the first month, and then during the day for an additional month.
Dr. Wright uses small (3mm) blunt cannulas to remove as much lipedema-affected adipose tissue as possible. This process works to debulk the area using longitudinal techniques.
The cannula is directed in longitudinal strokes, especially in the areas marked with lymphatic collectors, so it allows transecting of the lymphatic vessels. This requires frequent position changes, sometimes 8-12 different patient re-positions, to ensure he can remove the tissue using longitudinal cannula strokes.
After removing lipedema-affected tissue as possible with the suction cannula, he feels and massages the affected areas to check for any remaining fibrous lipedema nodules. If lipedema nodules are still present, then we manually loosen the nodules. If necessary, we manually extract them with an additional puncture of incision.
The patient is then placed in medical-grade compression to be worn for 24 hours a day for the first month.
Early-stage Lipedema (Stage 1) has small nodules the size of small seeds or peas, which often appear pearl-size. Middle-stage Lipedema (Stage 2) has larger nodules that feel the size of walnuts or gumballs. The presence of lobules characterizes the later stage, Lipedema (Stage 3). The nodules in Stage may be the same size as those in Stage 2 or larger up to the size of a plum.
In the earlier stages of Lipedema (Stage 1 and most patients in Stage 2), the subcutaneous nodules are removed with lipedema reduction surgery, which involves modification of cosmetic liposuction using tools and techniques that minimize harm to the lymphatics. The nodules have to be manually extracted in lipedema patients with larger or more adherent nodules.
In these cases, a small incision is made over the nodules that resist removal with a suction cannula and are gently milked out of the skin. Surgeons don’t want to cause any more trauma than is absolutely necessary. However, there are instances where this method is the only way to get larger, more adherent nodules removed. Dr. Wright has several videos of the extraction process you can view here.
Physicians and surgeons worldwide attending the Congress asked many questions about the technique and the surgery results. These results have just been accepted for publication in the PRS Open Global and will be shared widely and with open access to the world. Dr. Wright expects publication in late 2023. The audience was interested and intrigued by the procedure and the resulting positive impact on patient well-being, mobility, and quality of life. Representatives from patient organizations worldwide were encouraged by the improvements offered by Dr. Wright’s surgical techniques and the potential for increased patient well-being.
