Surgeons

Fat nodules extracted by Dr Anne Dancey (UK)

Fat nodules extracted by Dr Anne Dancey

(UK)

Lipedema fat removed via liposuction by Dr Jason Emer (CA, USA)

Lipedema fat removed via liposuction by Dr Jason Emer

(CA, USA)

about lipedema

Lipedema patients seek surgery in order to alleviate pain, increase mobility, decrease joint stress, and improve their quality of life. Extensive co-morbidities may be present due to the chronic nature of lipedema.

Some health care professionals identify lipedema by the texture of the subcutaneous fat. Depending on the stage, lipedema fat can feel like it has grains of sand or rice in it. More advanced stages can feel like frozen peas in a bag or even larger nodules. Lipomas may be even larger, reportedly up to the size of grapefruit.

The procedures most often considered for lipedema patients include: WLS (Weight Loss Surgery), liposuction, knee and/or hip replacements, excisions, debulking or lifts, and stem cell treatments. WLS has very limited (if any) effect on lipedematous tissue directly although normal fat and edema can be reduced, and this information must be made known to the patient when they are considering which treatments to pursue.

It is important to note that anesthesia can be cleared through the lymphatic system and this patient group may have lymphatic dysfunction.

Whenever surgery is considered for lipedema patients, the pre-op routine, surgical technique and post-op care must be very carefully tailored to the patient.

Some surgeons advise their patients to develop good routines before surgery.

Several clinicians advise surgeons that surgeons should go to great lengths to avoid damaging shallow lymphatics and vasculature in this patient group.

Liposuction:

Early liposuction techniques removed a lot of tissue without discriminating what gets removed; newer techniques focus on leaving the vasculature and lymphatic systems intact as much as possible.

Realistic expectations should be set with liposuction patients as to the aesthetic outcome, which may not be as good as they want. The surgeries necessarily must focus on alleviating pain, prevent worsening progression, improving gait and improving mobility. 

Although a very small number of surgeons claim to be able to remove all lipedema fat thereby 'curing' the patient, there is no way to know if that is truly the case because there is no way to definitively say all lipedema fat is gone, or if the underlying problem was fixed.


surgical considerations

Post-op care often includes compression, MLD and light exercise like walking to stimulate the lymphatic pumps.

Gait correction must be a target.

Be aware of potential mental health issues and be sure to set realistic expectations with this group.

Patient pre-op and post-op compliance are a must and setting healthy routines before surgery should be advised (eating well, MLD, compression).

Some patients may not respond in typical ways to anesthesia.


resources

Lipedema is discussed at length during the FDRS conferences. Those conferences provide good networking opportunities. Liposuction is always a hot topic and FDRS publishes the videos on their YouTube channel.

There are several German surgeons who have treated lipedema with liposuction and published their long-term follow-up data.

See our Resources page and these too:

Primer video

CME

Dutch Guidelines

Should I Get Surgery? video

FDRS's write-up on Liposuction