Liposuction surgery is the only available technique to correct the abnormal adipose tissue of lipedema. Liposuction is a surgical treatment that involves the application of local (tumescent and water assisted) anesthesia, and subsequent removal of adipose tissue through a straw-like device called a cannula.4 One end of the cannula is connected to a vacuum device, and the other end is inserted through a small incision of the skin and removes fat via aspiration.
There are two techniques of liposuction which can be safely used to treat lipedema provided the surgeon has experience in techniques to avoid injury to the lymphatics. Please note that lipedema patients often have impaired lymphatic function a great care must be taken to not cause further damage the lymphatic function. The two liposuction techniques are safest and most effectively used by surgeons with a great deal experienced with the treatment lipedema are tumescent liposuction and water assisted liposuction.
- Tumescent liposuction involves the introduction of large volumes of tumescent solution into the fat below the skin[subcutaneous] space to tumesce (swell) the area. The solution contains lidocaine anesthetic, which causes local numbness; epinephrine, which causes constriction of blood vessels to reduce the risk of bleeding; and saline, which causes swelling of the adipose tissue and protects the vascular structures from trauma. The solution is allowed to infiltrate the tissue, and its salinity causes the adipose tissue and cells to swell and separate from the connective tissue, at which point the cannula is used to aspirate the fat.1, 2, 3, 4
- Water-assisted liposuction does not involve over-swelling [tumescence] of the adipose tissue. Instead, small amounts of tumescent solution and water are introduced into the adipose tissue. Once sufficient numbing occurs, a modified cannula with an attached fan-shaped water jet is inserted into the subcutaneous space and applied to separate the adipose cells from the tissue, while simultaneously aspirating the solution and detached cells.5
When Should Liposuction Be Done for Lipedema?
All the experts on lipedema agree that the timing of liposuction needs careful consideration. It is crucial for patients to be evaluated by a doctor who can fully diagnose and assess patient before any consideration of surgery. The type and stage of lipedema needs to be diagnosed and a careful exam to detect swelling or secondary lymphedema should be done. Most patients with lipedema have secondary swelling or lymphedema, which should be addressed with conservative measures before surgery should be considered. Be careful of surgeons who claim this not necessary. Most patients will benefit from compression, lymphedema therapy and other conservative measure before surgery. For the relatively few patients with early lipedema no secondary swelling or lymphedema, liposuction can be done without a lengthy conservative therapy. However, it is critical that proper physical assessment of swelling be done before surgery is considered.
Team Work Before Liposuction for Lipedema
All the lipedema experts and guidelines recommend a multidisciplinary approach to the treatment of lipedema which includes lymphedema therapist, nutritional counseling, compression instruction and fitting be undertaken before surgery and continued after liposuction surgery. Among the experts on the treatment of lipedema there is some disagreement of how long the conservative treatment of lipedema should be done and what the end points of the conservative treatment should be before surgery is scheduled. Some experts recommend optimization of lymphatic flow with compression and therapy. However, the Dutch lipedema guidelines go further and state that “[liposuction] is only the treatment of choice for patients with a suitable health profile and/or inadequate response to conservative therapy. Before using [liposuction], associated deteriorating components such as edema, obesity, unhealthy lifestyle, lack of physical activity, lack of knowledge about the disease, and psychosocial distress should be addressed. Moreover, even after liposuction, women generally require conservative therapy, and weight normalization should remain a goal.”
The asymmetric accumulation of of bulk fat on the thighs from lipedema can cause the knees to knock inward (valgus deformity) or droop to the side of the leg (ptosis) and, in serious cases, lead to the inability to walk, thereby dramatically impacting the patient’s life. Liposuction can correct the valgus or knock knee deformity and improve mobility and gait.
1. Rapprich, S., Dingler, A. & Podda, M. Liposuction is an effective treatment for lipedema-results of a study with 25 patients. J. Dtsch. Dermatol. Ges. J. Ger. Soc. Dermatol. JDDG 9, 33–40 (2011). https://www.ncbi.nlm.nih.gov/pubmed/21166777
2. Buck, D. W. & Herbst, K. L. Lipedema: a relatively common disease with extremely common misconceptions. Plast. Reconstr. Surg. Glob. Open 4, e1043 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055019/
3. Schmeller, W., Hueppe, M. & Meier-Vollrath, I. Tumescent liposuction in lipoedema yields good longterm results. Br. J. Dermatol. 166, 161–168 (2012). Link https://www.ncbi.nlm.nih.gov/pubmed/21824127 and https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2133.2011.10566.x
4. Wollina, U., Goldman, A. & Heinig, B. Microcannular tumescent liposuction in advanced lipedema and Dercum’s disease. G. Ital. Dermatol. E Venereol. Organo Uff. Soc. Ital. Dermatol. E Sifilogr. 145, 151–159 (2010). links https://www.ncbi.nlm.nih.gov/pubmed/20467389 and https://www.dovepress.com/treatment-of-elderly-patients-with-advanced-lipedema-a-combination-of–peer-reviewed-fulltext-article-CCID
5. Stutz, J. J. & Krahl, D. Water jet-assisted liposuction for patients with lipoedema: histologic and immunohistologic analysis of the aspirates of 30 lipoedema patients. Aesthetic Plast. Surg. 33, 153–162 (2009). Link: https://www.dovepress.com/lipedema-diagnostic-and-management-challenges-peer-reviewed-fulltext-article-IJWH
6. Damstra, RJ. First Dutch guidelines on lipedema using the international classification of functioning, disability and health. Phlebology. 2017 Apr;32(3):152-159.
Dutch Standard of Care for Lipedema Guidelines: links https://journals.sagepub.com/doi/abs/10.1177/0268355516639421 and https://www.ncbi.nlm.nih.gov/pubmed/27075680
For more information, read this lipedema guide: