Liposuction for lipoedema in Thessaloniki and Athens, Greece

Liposuction for lipoedema (radical subcutaneous lipectomy) removes the diseased fat of the limbs through fine cannulas, after the tissue has been filled with a local anaesthetic solution (tumescent). It is the only treatment that removes lipoedema tissue. It does not cure the condition permanently, but it reduces the symptoms for many years.

It is a different operation from cosmetic liposuction. Much larger volumes are removed, often more than 5 litres (mega-liposuction), and the technique has to protect the lymphatic vessels, which in lipoedema are already under strain. For an overview of the condition itself, see the page on lipoedema.

It suits women with diagnosed lipoedema who have pain, heaviness or swelling in the limbs, or who see the condition progressing, despite compression stockings, lymphatic drainage massage and diet. You need a stable weight and a willingness to keep up conservative care afterwards. Whether it is right for you is always decided at the examination.

In stages 1 and 2 we usually start with conservative treatment: lymphatic drainage massage, compression stockings, exercise and a tailored diet. These ease the swelling but do not remove the tissue. Symptoms do not always match the stage, so I also operate on stage 1 lipoedema when symptoms persist. Conservative care continues after surgery, to a lesser degree.

At the consultation I confirm the diagnosis, examine each area and plan how much fat to remove, in how many operations and in what order. Before surgery you need blood tests with attention to haematocrit and iron, an anaesthetic assessment and, where needed, a venous ultrasound. You stop smoking 4 weeks before and after.

What happens at the consultation?

I confirm the diagnosis and distinguish it from obesity, lymphoedema and venous insufficiency, which often coexist. I examine each area separately, because the stage can differ from one area to another, and I assess your weight and skin quality. I estimate the volume of fat, whether one operation is enough and in which order the areas will be treated. We discuss a realistic result and the programme of compression and lymphatic drainage massage. You receive a written plan.

What tests and instructions apply before surgery?

You need pre-operative blood tests, with particular attention to haematocrit and iron, because the operation is followed by a drop in haematocrit; if you are iron deficient, we correct this first. You are assessed for general anaesthesia and, where needed, have a venous ultrasound scan by a vascular surgeon. Smoking increases the risk of complications: stop at least 4 weeks before and 4 weeks after surgery. If you take anticoagulants or antiplatelet medicines, tell me; they are only stopped in agreement with the doctor who prescribes them. The date is set once the tests are complete, at a time without pressing work or family commitments.

The operation is done under general anaesthesia, with a local anaesthetic solution injected into the fat. I prefer power-assisted liposuction (PAL), with gentle movements that protect the lymphatic vessels. I usually remove up to 7 litres per session; when there is more to remove, treatment is planned as two or more operations.

First I infiltrate a saline solution containing a local anaesthetic and an agent that limits bleeding (tumescent). I then remove the fat with fine cannulas through small incisions. The duration depends on the volume and the areas treated, usually 2 to 4 hours. You often need to lie face down; this is why I prefer general anaesthesia, which allows large volumes and safe control of breathing.

Why do I protect the lymphatic vessels during surgery?

In lipoedema the lymphatic system is already under strain; the more intact the lymphatic vessels remain, the faster the swelling settles. The tumescent solution expands the tissue and keeps the cannula away from the vessels, with less damage than the “dry” technique. The cannula moves parallel to the lymphatic vessels.

Power-assisted (PAL) or water-assisted (WAL) liposuction?

In my practice power-assisted liposuction (PAL) is the main technique. The vibration of the cannula reduces resistance and tissue trauma, and allows large volumes to be removed in less time, with precise contouring. Water-assisted liposuction (WAL) is also atraumatic and suitable, but it takes longer and introduces more fluid, with more marked swelling in the first hours; I use it in selected cases.

One operation or more?

In women weighing up to 70 kg, treatment is usually completed in one operation, and at 70 to 90 kg in two. I do not exceed 7 litres per operation: up to 5 litres recovery is smooth, up to 7 litres it is acceptable, and above 7 litres the likelihood of a blood transfusion rises. At higher body weights I recommend losing weight first. In the first operation I treat the back of the body and in the second the front, 3 to 6 months apart.

Strategy by stage

• Stage 1: the approach is mainly aesthetic, with better curves at the calves, ankles and thighs. On average 3 to 5 litres are removed, and the aim is also to stop the condition from progressing.
• Stage 2: symptoms are now present, so surgery is also functional. Usually 4 to 6 litres are removed.
• Stage 3: removal is more extensive, often more than 7 litres, in 2 or more sessions, with the aim of less pain and better knee function. At the same time we work towards weight loss.
• Stage 4 (lipo-lymphoedema): removal is more conservative and focuses on limited areas, such as the knees, because the skin has lost elasticity and blood supply.

Treatment areas

I rarely treat one area in isolation; the limb is treated as a single unit. The knees are the most common area: the inner side, around the kneecap and the back. On the calves and ankles, removal has to taper smoothly towards the foot and bring out the Achilles tendon; this is a technically more demanding area. On the thighs and saddlebags I smooth the contour without over-emptying the area that supports the buttocks. On the upper arms the fat weighs down the lower part of the arm; often this is not skin laxity, and liposuction is enough without an arm lift. Where needed, I extend treatment to the elbows and forearms.

Incisions and stitches

The incisions are a few millimetres long and placed where they are hidden. If skin stitches are used, they are removed at 5 to 7 days.

The operation is usually done on its own, on several areas at once. If loose skin remains on the thighs or upper arms, a thigh lift or an arm lift may be needed later.

Hospital stay

After a moderate removal you go home the same day; after an extensive removal you stay 1 night. In moderate or severe cases you need someone with you for the first 10 days. If you come from another city, you stay near us for 2–5 days for up to 5 litres, 7–10 days for 5–7 litres and more than 10 days above 7 litres. For the journey home: a flight of up to 3 hours, or car travel with a 10-minute stop every 1–2 hours.

The first 10 to 15 days are the most tiring, with weakness, swelling and bruising, and recovery is more demanding than after cosmetic liposuction. You can return to desk work in 10 to 15 days. Areas above the knee settle in 3 to 6 months, and the calves and ankles in 6 to 12 months.

When	How you feel	What you can do
Days 1–5	Weakness and tiring easily because of the drop in haematocrit; mild to moderate pain after the first 24 hours; swelling and bruising increase	Up and about from day one; compression garment day and night; simple painkillers; plenty of fluids and iron-rich foods; on your feet only when necessary
Days 6–15	A low-grade temperature of up to 37.5–38 °C is common; swelling stays stable until day 10 and then starts to go down	From day 10 the garment can come off at night; desk work at 10–15 days, with a footrest
Weeks 2–4	Swelling, tenderness and numbness	Lymphatic drainage massage from week 2–3; standing for up to 30–60 minutes, with 5–10 minutes legs up every half hour; walking for up to 30 minutes at a time
Month 1	70–80% of the swelling above the knees has gone, but only 40–50% at the ankles	Exercise again, gradually; work that involves long hours standing
Week 6	The thighs and arms feel more comfortable	Compression above the knee no longer needed
Months 3–6	Areas above the knee and the arms take their final shape	Compression below the knee stops at 3 months (longer after extensive surgery); lymphatic drainage massage for up to 3–4 months
Months 6–12	The calves and ankles settle; numbness fades along with the swelling	Normal activity; lymphatic drainage massage as you wish

Compression garments

Special lipoedema compression garments or compression stockings are essential. For the first 10 days you wear them continuously, day and night; after that you can take them off to sleep. For areas above the knee daily wear lasts 6 weeks, and for areas below the knee 3 months; after extensive surgery it may need to be longer. As the swelling goes down, the original garment loosens and you need a smaller size. In advanced lipoedema or lipo-lymphoedema, compression may be needed permanently, usually at a lower strength than before.

Lymphatic drainage massage

Lymphatic drainage massage speeds up the resolution of swelling. I prefer it to start after week 2 to 3, when the skin is less sensitive and the massage is tolerable, 2 to 3 times a week for 3 to 4 months, always by a certified physiotherapist. Later you can have it whenever you need it, to relieve your limbs.

Standing, work and diet

Standing for long periods keeps fluid in the legs and slows recovery. For the first 10 to 15 days, stand only when necessary. In jobs with long hours on your feet (hairdressing, pharmacy, hospital work), returning before one month is possible, but swelling and numbness take longer to go; the final result does not seem to be affected. In the first month a diet rich in protein and iron helps, with an iron supplement if you are anaemic. After that, the aim is to maintain or lose weight, with strength training and aerobic exercise. Above all, you need patience: recovery moves slowly, over months.

How long you stay depends mainly on the volume removed. After a moderate removal you leave the hospital the same day; after an extensive one you stay 1 night. If skin stitches are used, they are removed at 5 to 7 days, before you travel. You then stay near us for a period that depends on the volume removed.

As a guide from my practice, the stay near us is 2 to 5 days for up to 5 litres, 7 to 10 days for 5 to 7 litres and more than 10 days above 7 litres. For the journey home I recommend a flight of no more than 3 hours, or travel by car with a 10-minute stop every 1 to 2 hours to keep your legs moving.

Follow-up after you return home is by video call at 10 days, 1 month, 6 months and 1 year. Before you travel, arrange three things at home:

• someone to stay with you for the first 10 days, if your case is moderate or severe;
• a certified physiotherapist for lymphatic drainage massage, 2 to 3 sessions a week from week 2 to 3, for 3 to 4 months;
• spare compression garments in a smaller size, as the swelling goes down.

If you have a second operation, you plan a second trip 3 to 6 months later.

Pain, heaviness and bruising usually improve within the first months, and knee mobility increases. Studies with follow-up of up to 12 years show that the improvement lasts. Lipoedema is not cured permanently, so keeping your weight stable and continuing conservative care remain important.

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Liposuction for lipedema

Woman, 25–30 · Liposuction for lipedema · 11 months after · Surgeon: Dr Prodromos Papaioannou

Results vary from patient to patient.

By removing most of the diseased tissue, the limb becomes lighter and fat distribution more even: the kneecap is visible again, the ankles regain their contour, and your clothing size matches top and bottom. The cellulite-like appearance is reduced, and with the right technique, leaving an even layer of fat under the skin, liposuction does not cause skin laxity. The scales usually change after the first month, and weight loss can exceed 10 kg. The right goal is not that lipoedema never reappears, but that it does not reach the stage it would have reached without surgery. In the longest studies, patients needed less conservative treatment than before, and results were more durable when surgery was done at an early stage.

Liposuction for lipoedema is a bigger operation than cosmetic liposuction, because large volumes are removed. The most common difficulties are a drop in haematocrit, prolonged swelling and numbness, all of which settle gradually. Serious complications are rare. I explain the risks for your own case at the consultation.

Complication	How common	Prevention and management
Drop in haematocrit, weakness, dizziness	Common, temporary	Up to 7 litres per operation; iron deficiency corrected beforehand; fluids and iron afterwards
Need for a blood transfusion	Rare, more likely above 7 litres	Spreading treatment over more operations
Prolonged swelling, especially at the calves and ankles	Common, temporary	Lymph-sparing technique, compression garment, lymphatic drainage massage, limited standing
Numbness and tenderness	Common, temporary	Settle along with the swelling, even after months
Contour irregularities	Uncommon	An even layer of fat under the skin, extra care at the calves; corrected with a minor procedure
Loose skin	Not rare with large volumes or at an advanced stage	Correct technique; if needed, a thigh lift or arm lift later
Venous thrombosis	Rare	Walking from day one, compression garment, anticoagulant prophylaxis when indicated
Infection	Rare	Sterile technique and wound care; antibiotics if needed
Worsening of lymphatic function	Rare, with the tumescent technique	Gentle, lymph-sparing movements; conservative removal in lipo-lymphoedema

Smoking. Stop 4 weeks before and 4 weeks after surgery; smoking increases the risk of thrombosis and slows healing.

Blood thinners. Tell me if you take anticoagulants or antiplatelet medicines. They are always stopped in agreement with the doctor who prescribes them.

We do not publish prices. The cost depends on the extent of your lipoedema, the areas treated and the number of operations. You receive a quote after the consultation and examination, once we have agreed on the plan. Compression garments and lymphatic drainage massage afterwards are not usually included.

• The areas (legs, arms), the volume removed and the operating time.
• The hospital stay and anaesthetic care.
• Compression garments and lymphatic drainage massage afterwards, which are not usually included.

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