FAQs
Which areas do we do you treat first?
Usually the first areas that we treat are the areas of greatest concern to the patient.
How many surgeries do I need?
This is not easy question to answer. Depending on the amount of excessive Lipedema tissue, the number of __cpLocations, age, overall health and many other factors, the number of surgeries may vary from 1 to 5 or more.
How often can I have my surgeries done?
That depends on how fast you were able to recover, how fast the swelling goes away, how old you are, what is your Health status, number off health related conditions that might hinder your recovery, etc. However, on average we space the procedures every three months.
Should I have weight loss surgery or Lipedema surgery first?
The expected answer would be weight loss surgery first. However, the answer is not that simple.The decision is based not on amount of overall fat or BMI but on the amount of visceral fat.
The expected answer would be weight loss surgery first. However, the answer is not that simple.The decision is based not on amount of overall fat or BMI but on the amount of visceral fat. Usually it is determined by one of our metabolic specialists.
If the patient has significant amount of excessive weight which is located outside of the areas affected by lipedema, we recommend weight loss surgery and then will perform Lipedema surgery after the weight is stable. It is about six months or a year after the surgery.However, many patients come in with high BMI but they do not have significant amount of visceral fat or they already had bariatric surgery. In this case were able to perform Lipedema surgery.
Is BMI a factor in Lipedema surgery?
Traditionally high BMI is associated with higher risk of complications. On average Patients with BMI over 40 have 100% risks of complication. In most cases we see minor complications, such as fluid collection, seroma, separation of the wound, need for revision, Etc.
We also understand that reaching normal BMI is impossible in most of our Lipedema patients. We educate them on proper preparation for surgery, management of the risks and possible complications and we design the surgery to minimize risk factors and complications.
How long does Lipedema Liposuction Surgery take?
The length of lipedema liposuction surgery depends on number of areas treated, the volume of fat removed and on use of ultrasonic device. It may take between two and four hours to perform the surgery.
Is there a difference between cosmetic Liposuction and Lipedema Liposuction?
Yes, there is. In both Cosmetic and lipedema patients I use ultrasonic liposuction and Power Assisted liposuction techniques. The direction of Liposuction, level of liposuction, size of the cannulas and other details of the surgery are quite different. Lipedema liposuction takes significantly longer and that is why it is usually more expensive.
Where do you do lipedema liposuction?
Lipedema Liposuction is usually done either in an Accredited Surgery Center with overnight observation or in a hospital outpatient setting. How much fat can you remove in one session with Lipedema Liposuction? There are several guidelines on safe liposuction protocols. Traditionally, it is believed that 5 L of fat can be removed safely from cosmetic healthy patient in the outpatient setting and the patient can be sent home after that. New York and New Jersey guidelines mirror those recommendation. I rarely remove 5 L of fat or less on my patients. I have removed over 20 L on some of the lipedema patients in a single session. However most patients fall into 6 to 10 L category. Because I remove so much fat, I have to follow a different set of rules. First of all, all of my patients receive proper DVT prophylaxis. Second, all of my patients with Lipedema stay at least one night in the observation or hospital facility. We do not send patients to hotels the first night! It has been demonstrated that close to 60% of patients with Lipedema have components of Ehler Danos syndrome, connective tissue disorder, which is associated with abnormal response to anesthetic within the first 24 hours. There is a national protocol for anesthesia safety related to the patient with this condition and that’s what we usually follow as a guideline. Third, these patients require sophisticated compression garments. Traditional garments rarely fit them and they need to be adjusted.
Is there a lot of pain associated with Lipedema Liposuction?
Just like any other Liposuction, there is moderate amount of pain associated with lipedema liposuction surgery. Especially when the large amounts of fat are removed. Compression garments help to relieve the pain significantly. The difference between Lipedema patients and cosmetic patients is that lipedema patients have abnormal function of lymphatic system making them more prone to increased and prolonged swelling especially in the lower extremities. In my experience, the most painful area after liposuction is the medial knee.
How long do I have to wear a compressive garment?
Most lipedema patients have abnormal function of lymphatics. Therefore, the answer is forever. And it is not related to the surgery but rather to the original condition. After the surgery the patient will slowly notice significant reduction in pain and in size of the extremities and trunk and the size of the compression garment will have to be changed and adjusted.
Do you recommend using LymphaPress or other the mechanical compression devices after surgery?
Absolutely! Depending on where liposuction was performed, I recommend using mechanical lymphatic compression and possibly manual lymphatic drainage First week after the surgery.
When can I have my next lipedema Liposuction surgery after the first one?
Usually we space lipedema liposuction surgery or excision procedures three months apart.
How long will it take me to see the results from Lipedema Liposuction?
It is not uncommon for the Lipedema patients to have legs bigger than prior to surgery for the first week After the surgery especially if there’s not enough compression. Eventually the swelling comes down but it does take several weeks or months depending on the size and amount of fat removed.
Do you remove little painful fat bumps or perform manual extraction of Lipedema nodules?
Yes I do. But I do not perform it on every patient. I only perform it on the patients who require it.
If I’m traveling from far away, how long do I have to stay in the area after Lipedema Surgery?
I recommend staying for about a week to make sure that majority of possible complications do not happen or can be managed quickly.
Can I fly out the next day?
I understand that traveling for medical procedures can be challenging timewise and financially. However, I do not recommend flying the next day. I would strongly suggest staying in the area for about a week. If you do not have enough family support or you cannot have a family member or friend accompany you here, we can always arrange outpatient observation facility stay with nursing supervision through your insurance.