A major concern for many patients with lipedema is what will happen to their skin if they lose weight or undergo extensive liposuction. Patients’ worries are partly justified; however, in most cases, liposuction does not cause sagging, and we can often avoid procedures to correct sagging, which unfortunately are more burdensome in terms of recovery and leave noticeable scars that cannot be hidden.
At this point, it is helpful to understand how liposuction works and how sagging can be prevented.
Liposuction and Tissue Laxity
By definition, liposuction does not cause tissue laxity. In fact, based on numerous clinical studies, we know that liposuction can actually result in a 10–15% tightening of the treated area.
The reason liposuction has been associated with laxity is that in cases of severe laxity, liposuction cannot be performed properly because the tissue structure is too soft for uniform fat removal. In other cases, when fat is removed too superficially, the skin may wrinkle due to the loss of underlying natural support.
To avoid laxity, certain basic principles must be followed regarding the design and execution of liposuction for lipoedema treatment. Laxity can appear as either skin laxity, which manifests as a wrinkled surface, or subcutaneous tissue laxity, mainly of the connective tissue around the fat, giving the impression of sagging tissue.
In the first case—skin laxity—this can occur due to age, loss or damage of the superficial fat layer from improper liposuction, or significant weight loss.
True skin laxity is treated either with corrective procedures such as arm lift (brachioplasty) or thigh lift, or with minimally invasive methods such as radiofrequency, micro-LPG therapy, etc. Laxity of the underlying tissues, meaning fat and ligaments, is primarily addressed through proper liposuction, though in more severe cases, surgical tightening may also be required.
As you can see, preventing or treating laxity requires a detailed assessment of the areas, evaluating tissue quality, skin condition, and the extent of lipoedema. It is a multifactorial process that demands significant experience both in liposuction and in lipoedema treatment.
In many cases, additional tightening surgeries can be avoided, achieving excellent results with liposuction alone. It is crucial that the treating physician can accurately identify lipoedema, even in cases of significant laxity, as otherwise the results may be disappointing.
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Lipedema treatment focuses on body harmony—without pain, swelling, or unnecessary exhaustion.
Brachioplasty (Arm Lift)
Lipoedema can affect the upper limbs, particularly the arms, but may extend below the elbows or toward the armpits. From our experience, many patients with lipoedema undergo brachioplasty unnecessarily because the underlying condition—lipoedema—is not recognized. This can result in unnecessary surgery and improper treatment of the lipoedema, often leading to recurrence or disproportion and deformities of the arms.
When we see a problem with the arms, the first consideration should be treating the lipoedema, which is the primary condition. Lipoedema and excessive fatty tissue create heavy arms that appear lax. In these cases, proper liposuction can significantly reduce the weight burden on the tissues and effectively treat laxity without the need for brachioplasty.
In cases where skin laxity is more pronounced due to age or poor collagen quality, brachioplasty becomes necessary for an optimal surgical outcome. Skin tightening may also be needed if lipoedema is extensive or combined with severe obesity, reducing tissue elasticity.
The procedure is usually performed through a longitudinal incision from the armpit to the elbow. Mini-brachioplasty, with a small incision only at the armpit, is generally unsuitable for lipoedema cases. Strategically, brachioplasty can be performed simultaneously with or after liposuction.
We prefer a two-stage approach when laxity is borderline, as in some cases we may avoid brachioplasty, or in extensive lipoedema cases where large fat removal is required.
Brachioplasty with a longitudinal incision can vary—the scar may be zigzag, extend beyond the armpit or elbow. In lipoedema patients, brachioplasty without liposuction is not appropriate. The procedure lasts about 2 hours, performed as a day-case under general anesthesia.
Initial recovery takes about 10 days, and scars typically require 3–6 months to become less noticeable. Elastic garments with bolero-type sleeves are worn for 4–6 weeks.
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Thigh Lift
The purpose of a thigh lift is to improve sagging, mainly on the inner thighs or generally around the perimeter of the thighs. There are two types of procedures, depending on the extent of the incision. In the first case, which for distinction is called a mini thigh lift, a horizontal incision is made at the base of the thigh, starting from the lower gluteal fold and extending to the groin area. This procedure primarily aims to improve the inner thighs up to approximately the mid-thigh.
In the second case, an additional vertical incision is made from the root of the thigh down to the knee, on the inner side of the thigh. The goal of a thigh lift is to correct sagging around the entire thigh. Both procedures are mainly intended for individuals with obesity who have experienced significant weight loss and less so for patients with lipedema. However, in some cases, they are appropriate for achieving an optimal aesthetic result. A prerequisite is that lipedema has been properly addressed.
Thigh lifting in patients with lipedema is usually performed in a second stage, after we have completed correction with liposuction. The reasons are as follows:
- Reduce thigh weight before lifting
- Minimize complications
- Optimize recovery
Regarding the reduction of thigh weight, since in patients with lipedema we very often encounter fat enlargement in the inner thighs, which weighs down the tissues and causes sagging, we can often achieve tissue relief and address sagging through liposuction alone.
In other cases, we first perform liposuction to treat the lipedema and lighten the area so that thigh lift techniques do not have to support a large amount of weight, which could lead to healing problems or shifting and widening of scars.
Another important reason is to reduce complications. Extensive liposuctions performed for lipedema cause significant fluid leakage into the extracellular space. If these procedures are combined with lifting surgeries, which involve some degree of tissue undermining, the risk of seroma—i.e., fluid collection in a cavity—increases considerably.
For the same reason, the risk of hematoma and infection also rises, which can lead to impaired healing, infections, prolonged recovery time, and reduced quality of the aesthetic result.
Finally, regarding recovery, our opinion is that liposuction for lipedema is already a procedure that requires significant patience during the early postoperative stage. Combining it with a lift procedure complicates and greatly prolongs the recovery process.
Lipedema requires special treatment that cannot feasibly be combined with other moderate or major procedures, such as a thigh lift.
Regardless of whether we choose a mini thigh lift or the classic lift with a vertical incision, the procedure is performed under general anesthesia as a day surgery and lasts 2–2.5 hours. Postoperatively, a special compression garment is worn for 4–6 weeks. Difficulty with movement and walking usually lasts 10–15 days.
In the case of a mini thigh lift, the scars are relatively well hidden on the inner thighs and are not very noticeable. When performing a lift with a vertical incision, scar improvement with laser or other treatments can usually begin after approximately 3–4 months.
Corrective Procedures
Patients often come to us after previous surgeries—liposuction or skin tightening like brachioplasty or thigh lift—with functional or aesthetic problems. In many cases, lipoedema was not diagnosed, so the symptom was treated, not the underlying problem.
Common scenario: brachioplasty in the presence of lipoedema. Arms remain disproportionately large, scars wide, and healing complications are reported. In some, dermolipectomy was done but an hourglass deformity remains toward the elbow and armpit.
Some patients had partial correction of the inner arm, but lipoedema persists externally. Most of these are treated with liposuction; in some cases, brachioplasty or scar revision may be needed.
Another scenario: prior thigh lift. Again, lipoedema was undiagnosed and treated as obesity or laxity. Correction involves addressing imperfections with liposuction or repeating the procedure.
The most common issue in our clinic is after previous liposuction. Either lipoedema was undiagnosed, liposuction was inadequate, or skin irregularities like dimpling were created.
Some problems are addressed with additional liposuction; others require fat grafting or skin tightening techniques.
Finally, early self-diagnosis of lipoedema is critical before any surgical intervention—liposuction or skin tightening.
Considering lipoedema as the underlying condition, Plastic Surgeon Dr. Prodromos Papaioannou selects the most appropriate strategy to ensure optimal treatment while avoiding repeat or corrective surgeries.
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.