To date, liposuction remains the most appropriate and widely accepted treatment for lipedema at any stage or severity within the medical community. Lipedema should be viewed as an aggressive, space-occupying condition, in which pathological tissue grows uncontrollably at the expense of the healthy tissues of the limbs. Treatment focuses on relieving and freeing the limbs from its spread.
From this perspective, liposuction is the most direct, effective, and minimally traumatic method for removing lipedema tissue. It is important to note that liposuction does not replace a healthy diet and regular exercise. As with any surgical procedure, a discussion with your doctor is essential before making any decisions regarding liposuction.
Liposuction for Lipedema: Safe and Effective Fat Removal
The main feature of liposuction in lipedema patients is, first of all, the increased volume of fat removed. Typically, quantities exceed 5 liters of fat, which is why we use the term megaliposuction.
To make this possible, more specialized liposuction equipment and technical expertise are usually required to perform these procedures safely. In the author’s opinion, the available technical tools—i.e., the liposuction devices—are merely instruments that allow the surgeon to perform the procedure faster or more efficiently, and they are not as crucial as the surgeon’s technical skills.
Anesthesia in Liposuction
Regardless of the liposuction technique, anesthesia is almost exclusively general, mainly for safety and practicality.
General anesthesia offers significantly higher safety levels compared to local anesthesia or sedation, for the following reasons: local anesthesia involves injecting an anesthetic, such as xylocaine or lidocaine, into the fat, which requires a specific concentration, quantity, and time to act.
However, these drugs can have cardiotoxic effects and other side effects above certain doses, limiting the amount that can be administered to each patient. Additionally, local anesthesia requires 20–40 minutes to take full effect, which adds to the total operation time.
For small liposuctions, local anesthesia is acceptable, but in lipedema, it is impossible and extremely risky to remove large volumes of fat with local anesthesia. Likewise, combining local anesthesia with sedation is also unsuitable, because in most cases the procedure requires a prone position, which increases risk under sedation due to limited access to the mouth and nose for proper ventilation if needed.
For these reasons, general anesthesia combined with low-dose local anesthesia is the safest, fastest, and most effective method for performing liposuction in lipedema.
Enhance your silhouette as it deserves.
Lipedema treatment focuses on body harmony—without pain, swelling, or unnecessary exhaustion.
Techniques for Lipedema Treatment with Liposuction
Often, the surgical technique of liposuction is mistakenly equated with the liposuction device. However, the surgeon’s technique is decisive, not the device, since all offered liposuction technologies can provide excellent results in skilled hands.
The main difference lies in the speed, precision, and efficiency that newer assisted-liposuction technologies offer, which can make one technique preferable over another.
From the author’s personal experience and general medical consensus, the two most suitable assisted-liposuction technologies are Microaire PAL (Power-Assisted Liposuction) and Water-Assisted Liposuction (WAL), e.g., Bodyjet.
Power-Assisted Liposuction with Microaire PAL for Lipedema
PAL has the advantage of being faster than WAL, allowing larger volumes to be removed in a shorter time and providing precision in shaping, i.e., liposculpture.
The method works as follows: first, a solution of saline containing local anesthetic and hemostatic agents is injected into the areas to be treated using a pump.
After allowing time for the hemostatic agents to take effect, removal begins with the vibrating cannula. The vibration mobilizes surrounding tissues more effectively while reducing resistance during liposuction, minimizing trauma to adjacent tissues.
The PAL mechanism works like an electric toothbrush: the vibration reduces the required back-and-forth movements, protecting the tissues. The suction of lipedema tissue and fat is performed via a vacuum pump connected to the PAL cannula handle.
Water-Assisted Liposuction (WAL) for Lipedema
Similarly, WAL (Bodyjet) works by preparing the tissues with a local anesthetic solution, as in PAL. The main difference lies in how the fat is released.
A pulsed water jet is ejected from the cannula tip, breaking up fat and pathological tissue, which is then removed through the cannula.
This method has advantages in terms of being minimally traumatic, but its drawbacks include longer procedure times and large fluid volumes required.
These fluids cause more extensive swelling and discomfort during the initial hours post-surgery. However, Bodyjet is preferred in certain specialized cases.
Liposuction for Lipedema in Our Clinic
In our practice, the Microaire PAL technique is predominantly used, with Bodyjet applied only in specific cases. It should be emphasized that the technique does not ultimately determine the outcome; it is a tool for the surgeon.
Reducing operative time and tissue trauma makes liposuction even safer and allows safe large-volume liposuctions. Other techniques, such as Vaser liposuction, have been tested with good results but increase operative time and cost without significant advantage over PAL, while some methods are entirely unsuitable because they cannot remove large volumes. Other techniques, such as Vaser liposuction, have also been tried with good results. However, they tend to increase the duration and cost of the procedure without offering any significant advantage compared to power-assisted liposuction (PAL). In addition, some techniques are entirely unsuitable, as they do not allow for the removal of large fat volumes.
Liposuction: Strategies in Lipedema
When evaluating a patient with lipedema, key questions include: how much lipedema can be removed, how large volumes need removal, whether one or multiple procedures are needed to achieve the desired result, and whether aesthetic and functional improvements are achievable.
Conservative treatment considerations also include total body weight, the patient’s ability to lose weight before or after surgery, age, and the degree, extent, and location of lipedema.
The goal of surgery is to remove as much lipedema tissue as possible, along with some healthy fat if feasible. In each procedure, the maximum fat removal ranges from 5 liters to 9–10 liters. However, larger volumes increase recovery difficulty, blood loss, hematocrit drop, and the likelihood of requiring transfusions. In each procedure, the maximum amount of fat that can be removed ranges from 5 liters up to 9–10 liters. However, the larger the amount removed in a single procedure, the more difficult the recovery becomes, the greater the blood loss and the drop in hematocrit, and the higher the likelihood that blood transfusions will be needed.
In practice, removal of up to 5 liters is accompanied by a relatively smooth recovery, up to 7 liters allows for an acceptable recovery, and above 7 liters makes liposuction considerably more taxing and the recovery more difficult. For this reason, we generally prefer not to exceed 7 liters per procedure
Therefore, in cases where lipedema affects larger volumes, it is preferable to perform more than one procedure.
The way we select the areas for each session depends on the distribution of lipedema. Usually, if there are two procedures, we start the first session on the posterior side of the body, meaning the back of the thighs, calves, ankles, and possibly the arms, with possible extension to the inner thighs.
In the second session, we complete the anterior part of the lower limbs, the calves, thighs, and knees, and possibly improve other areas as deemed necessary. Cases requiring more than two procedures are in grade 3 and higher lipedema, combined with obesity, where it may be necessary to treat the arms separately from the lower limbs.
Therapeutic strategy according to the grade of lipedema:
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Grade 1 Lipedema
- Grade 2 Lipedema
- Grade 3 Lipedema
- Grade 4 Lipedema
In stage 1 lipedema, where symptoms are not yet present and the disease’s spread is still limited, the approach is primarily aesthetic. The focus is on creating better calf curves, highlighting the ankles, reducing the appearance of cellulite on the thighs, or minimizing “saddlebags.”
The amounts removed are usually smaller, averaging 3–5 liters, and recovery after liposuction is relatively simpler. The goal is to significantly improve the appearance of the upper and lower limbs, while also preventing the lipedema from spreading and becoming more severe.
In stage 2 lipedema, symptoms begin to appear, so our approach becomes both aesthetic and functional. It is important to remove as much lipedema as possible, and the quantities needed from the upper and lower limbs are clearly larger, usually 4–6 liters.
In stage 3 lipedema, we treat lipedema even more aggressively, with the main goal of preventing further spread in the coming years and alleviating symptoms, mainly pain and functional problems around the knees.
The amounts that need to be removed often exceed 7 liters, and the procedures need to be done in stages, over two or more sessions. In our overall strategy, we also aim for patients to lose weight, so that the procedures are more effective and simultaneously help reverse the worsening condition caused by lipedema.
In stage 4 lipedema, i.e., lipolymphedema, our focus is on decompressing the limbs from the lipedema tissue, and we usually select a specific area such as the knees or a limited region to address functional problems as much as possible.
In these cases, a more conservative removal is required because the skin has been affected by lymphedema and lacks the necessary elasticity and blood supply to respond properly after liposuction.
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Liposuction for Lipedema and the Areas Where It Is Applied
As we have mentioned, lipedema can appear in both the lower and upper limbs, and consequently, the areas where liposuction can be applied are multiple. We will examine in detail the areas where we perform liposuction for lipedema and the particularities of each region.
The areas listed below are used to classify and group liposuction zones and are very helpful in planning the strategy we will follow. Very rarely do we perform liposuction in isolated areas, as the goal of any therapeutic approach is to remove the maximum amount of lipedema from the body and reduce its impact and recurrence.
The usual practice is therefore to perform liposuction in multiple areas consecutively, as both the upper and lower limbs must be treated as a single anatomical unit.
Liposuction for Lipedema Treatment in the Knees
Liposuction of the knees is perhaps the most frequently affected area by lipedema, and by definition, we consider that a patient seeking liposuction around the knees certainly has lipedema.
When we refer to the knees, we mean the inner side, the area above and around the patella, as well as the posterior and outer surfaces. Knee liposuction can be performed either alone or in combination with other areas, which is the most common approach.
The result of liposuction in this area is extremely impressive because, beyond the functional problems, the aesthetic and psychological impact is significant. Many women cover their knees with long skirts or pants. Liposuction radically changes the appearance of the knees, producing highly impressive results.
Liposuction for Lipedema Treatment in the Calves
As with the knees, the indication for liposuction in the calves is always the presence of lipedema. Normally, the amount of subcutaneous fat in the calves is minimal, even in obese individuals, and excessive fat in this area always indicates lipedema.
Calf liposuction is almost always performed in combination with other areas, such as the knees and ankles. The goal of the procedure is to reduce the severity of the lipedema while creating anatomically correct curves, avoiding the blocky appearance typical of lipedema.
It should be noted that liposuction in the calves is technically more demanding than in other areas and requires significant surgical experience to avoid irregularities and deformities. With proper surgical technique and liposculpture, the results are extremely satisfying.
Liposuction for Lipedema Treatment in the Ankles
The area around the ankles continues from the calves, and liposuction is performed simultaneously. This is also a very delicate area, as it represents the lower limit of lipedema; below this point, lipedema is not present.
For this reason, removal must be done in a way that “blends” smoothly toward the foot, while also enhancing the curves of the ankles and defining the Achilles tendon.
Liposuction for Lipedema Treatment in the Thighs
Lipedema in the thighs may appear as cellulite, extensive fat deposits, or disruption of the smooth contour of the skin. The goal of thigh liposuction is to reduce the lipedema, highlight muscle contours such as the quadriceps, and smooth the skin.
In many cases, this can be achieved solely with liposuction; however, in other cases, a complementary tightening procedure, such as a thigh lift, may be required. Patients often worry that liposuction may cause sagging, especially on the inner thighs. This is not the case; properly performed liposuction does not cause sagging.
Areas with significant laxity may not show sufficient improvement from liposuction alone, and a more conservative approach may be needed.
Liposuction for Lipedema Treatment in the Hips (“Saddlebags”)
The trochanteric area, often referred to as the “saddlebags,” is a very common location for lipedema in Mediterranean-type women. In the past, liposuction was performed in this area without recognizing the presence of lipedema, but today we can correct it much more effectively, knowing it is lipedema.
Removal should smooth the contour of the thighs without over-emptying the area, as it supports the fat of the buttocks. Overly aggressive removal can negatively affect the buttock shape. Liposuction in the trochanteric area, besides improving the contour, also helps reduce the appearance of cellulite, which, as mentioned, is a symptom of lipedema.
Liposuction for Lipedema Treatment in the Buttocks
Lipedema rarely affects the buttocks, so liposuction in this area is usually not indicated. Indications exist when lipedema extends above the trochanters, contributing to an excessively wide hip circumference.
The aim is to reduce the overall width of the pelvis and improve the buttock shape. If significant cellulite is present, specialized cannulas can be used to break up fibrous tissue without removing fat, resulting in a smoother skin appearance.
Liposuction for Lipedema Treatment in the Abdomen
Lipedema does not occur in the abdomen; any fat accumulation in this area is due to excess weight. The only exception is a small area in the lower abdomen at the outer edges of the pelvis, roughly the size of a palm, creating a characteristic “pillow” caused by lipedema.
Liposuction for Lipedema Treatment in the Arms
More than half of women with lipedema in the legs also have it in the arms. Fat distribution is very characteristic, mainly affecting the lower part of the arm, giving a “hanging” appearance.
This is due to the increased weight caused by lipedema, not sagging. Therefore, liposuction can achieve excellent results without the need for an arm lift. Unfortunately, many women undergo unnecessary arm lifts because lipedema was not diagnosed.
Besides the lower arms, lipedema may affect the outer surface under the shoulder. Treating this area with liposuction reduces the upper torso’s circumference.
Liposuction for Lipedema Treatment in the Elbows
In many cases, lipedema extends beyond the elbows to the forearms, even reaching the wrists. Liposuction in these areas is generally rare but may be necessary in some cases to achieve a more balanced and natural appearance of the upper limbs.
Complementary Procedures for Lipedema Treatment
In some cases, liposuction alone is not enough to address all the aesthetic problems of lipedema. Additional procedures may be required, similar to those performed in patients with significant weight loss.
These complementary procedures may include removal of skin and other tissues, shaping and lifting of tissues, and other surgical techniques that help achieve the desired aesthetic results.
The specialized clinic for lipedema, DrPapaioannou, provides all the information you need about lipedema and its treatments. Plastic surgeon Dr. Prodromos Papaioannou is available to assist you with anything you need. Do not hesitate to contact the clinic.
Self-Diagnosis of Lipedema
Self-diagnosis of lipedema can prove to be particularly useful.
Lipedema and Nutrition
The role of nutrition in lipedema is very important, as certain foods significantly affect both the progression and treatment of the condition.
Lipedema and Genetics
Statistical data shows a correlation between lipedema and heredity.
Lipedema and Hormonal Changes
A woman’s hormonal profile and hormonal changes throughout her life play a major role in the onset of lipedema.
Lipedema and Obesity
Body weight plays a significant role in the manifestation of lipedema, but in turn, lipedema often leads to difficulty in maintaining a healthy body weight.
Lipedema Treatment with Liposuction
To this day, liposuction remains the most recommended and widely accepted treatment for lipedema at any stage or extent.
Conservative Management
Conservative treatment usually focuses on lifestyle and dietary changes, aiming to improve lipid balance in the female body.
After Liposuction for Lipedema
Recovery after liposuction is a critical phase for the successful outcome of the procedure.
Surgical Correction of Skin Laxity
A common concern among lipedema patients is what will happen to the skin after weight loss or extensive liposuction.
Dr. Prodromos Papaioannou
He completed his specialty in Plastic Surgery in Germany, at Pirmasens Hospital, Asklepios Wandsbek Hospitals in Hamburg, the University Hospital of Magdeburg, and the Braunschweig Clinic. He worked as a specialist–deputy director at the Braunschweig Clinic (specializing in breast reconstruction after cancer and aesthetic surgery). He also participated in scientific research and completed his doctoral thesis (Dr. Med.) at the University Hospital of Magdeburg.