Liposuction in the Treatment of Lipedema: A Longitudinal Study

Background Lipedema is a condition consisting of painful bilateral increases in subcutaneous fat and interstitial fluid in the limbs with secondary lymphedema and fibrosis during later stages. Combined decongestive therapy (CDT) is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical treatment option. The aim of this study was to determine the outcome of liposuction used as treatment for lipedema.

Methods Twenty-five patients who received 72 liposuction procedures for the treatment of lipedema completed a standardized questionnaire. Lipedema-associated complaints and the need for CDT were assessed for the preoperative period and during 2 separate postoperative follow-ups using a visual analog scale and a composite CDT score. The mean follow-up times for the first postoperative follow-up and the second postoperative follow-up were 16 months and 37 months, respectively.

Results Patients showed significant reductions in spontaneous pain, sensitivity to pressure, feeling of tension, bruising, cosmetic impairment, and general impairment to quality of life from the preoperative period to the first postoperative follow-up, and these results remained consistent until the second postoperative follow-up. A comparison of the preoperative period to the last postoperative follow-up, after 4 patients without full preoperative CDT were excluded from the analysis, indicated that the need for CDT was reduced significantly. An analysis of the different stages of the disease also indicated that better and more sustainable results could be achieved if patients were treated in earlier stages.

Conclusions Liposuction is effective in the treatment of lipedema and leads to an improvement in quality of life and a decrease in the need for conservative therapy.

Keywords - Lipedema - Lipoedema - Lipectomy

This article was presented the annual meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) that was held from October 1, 2015 to October 3, 2015 in Berlin, Germany.

Publication History

Received: 24 January 2017

Accepted: 10 May 2017

Article published online:
20 April 2022

• REFERENCES

• 1 Allen EV, Hines EA. Lipedema of the legs: a syndrome characterized by fat legs and orthostatic edema. Proc Staff Meet Mayo Clin 1940; 15: 184-7
• 2 Chen SG, Hsu SD, Chen TM. et al. Painful fat syndrome in a male patient. Br J Plast Surg 2004; 57: 282-6
• 3 Child AH, Gordon KD, Sharpe P. et al. Lipedema: an inherited condition. Am J Med Genet A 2010; 152: 970-6
• 4 van Geest AJ, Esten SC, Cambier JP. et al. Lymphatic disturbances in lipoedema. Phlebologie 2003; 32: 138-42
• 5 Dimakakos PB, Stefanopoulos T, Antoniades P. et al. MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. Int Surg 1997; 82: 411-6
• 6 Vaughan BF. CT of swollen legs. Clin Radiol 1990; 41: 24-30
• 7 Herpertz U. Lipedema. Z Lymphol 1995; 19: 1-11
• 8 Curri SB, Merlen JF. Microvascular disorders of adipose tissue. J Mal Vasc 1986; 11: 303-9
• 9 Amann-Vesti BR, Franzeck UK, Bollinger A. Microlymphatic aneurysms in patients with lipedema. Lymphology 2001; 34: 170-5
• 10 Tiedjen KU, Schultz-Ehrenburg U. Isotopenlymphographische befunde beim lipodem. In: Holzmann H. Dermatologie und nuklearmedizin. Berlin: Springer-Verlag; 1985: 432-8
• 11 Lohrmann C, Foeldi E, Langer M. MR imaging of the lymphatic system in patients with lipedema and lipo-lymphedema. Microvasc Res 2009; 77: 335-9
• 12 Ryan TJ. Lymphatics and adipose tissue. Clin Dermatol 1995; 13: 493-8
• 13 Meier-Vollrath I, Schmeller W. Lipoedema: current status, new perspectives. J Dtsch Dermatol Ges 2004; 2: 181-6
• 14 Hoffmann JN, Fertmann JP, Baumeister RG. et al. Tumescent and dry liposuction of lower extremities: differences in lymph vessel injury. Plast Reconstr Surg 2004; 113: 718-24
• 15 Rudkin GH, Miller TA. Lipedema: a clinical entity distinct from lymphedema. Plast Reconstr Surg 1994; 94: 841-7
• 16 Sattler G. Liposuction in lipoedema. Ann Dermatol Venerol 2002; 129: 1S103
• 17 Rapprich S, Loehnert M, Hagedorn M. Therapy of lipoedema syndrome by liposuction under tumescent local anaesthesia. Ann Dermatol Venerol 2002; 129: 1S71
• 18 Klein JA. The tumescent technique for liposuction surgery. Am J Cosmetic Surg 1987; 4: 1124-32
• 19 Stutz JJ, Krahl D. Water jet-assisted liposuction for patients with lipoedema: histologic and immunohistologic analysis of the aspirates of 30 lipoedema patients. Aesthetic Plast Surg 2009; 33: 153-62
• 20 Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol 2012; 166: 161-8
• 21 Rapprich S, Dingler A, Podda M. Liposuction is an effective treatment for lipedema-results of a study with 25 patients. J Dtsch Dermatol Ges 2011; 9: 33-40
• 22 Baumgartner A, Hueppe M, Schmeller W. Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years. Br J Dermatol 2016; 174: 1061-7
• 23 Iverson RE, Lynch DJ. American Society of Plastic Surgeons Committee on Patient S. Practice advisory on liposuction. Plast Reconstr Surg 2004; 113: 1478-90
• 24 Hoefflin SM, Bornstein JB, Gordon M. General anesthesia in an office-based plastic surgical facility: a report on more than 23,000 consecutive office-based procedures under general anesthesia with no significant anesthetic complications. Plast Reconstr Surg 2001; 107: 243-51
• 25 Habbema L. Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases. Dermatol Surg 2009; 35: 1728-35