Page 112 - Read Online

Page 8 of 10 Wiedner et al. Plast Aesthet Res 2020;7:10 I http://dx.doi.org/10.20517/2347-9264.2019.51

Figure 8. Lipedema Stage 3 patient before and after five sessions of liposuction in the lower legs

complications as well as persistent postoperative edema due to damage to the lymphatic vessels. As a
result, conventional dry liposuction under general anesthesia was therefore contraindicated in lipedema
[34]
patients .
Nowadays, the “wet”, “super-wet”, and “tumescent” techniques are used, which are less likely to damage
the lymphatic system compared to the conventional “dry” technique. The use of microcannulas as well as
new liposuction techniques such as power-assisted liposuction with vibrating cannulas or waterjet-assisted
liposuction have been shown to further minimize tissue trauma and complication rates.

When performing liposuction in lipedema patients, the crisscross technique, which is commonly used in
aesthetic surgery, is contraindicated because of the higher risk of harming lymph vessels with consecutive
development of lymphedema. Therefore, it is of great importance to take the lymph vessel anatomy into
account and move the cannula parallel to the lymph vessels in order to save them. This is why more
incisions are usually needed to remove the fat from the affected area.

Since 2005, guidelines of the German Society of Phlebology recommend liposuction as an integrated
[35]
part of therapy . Tumescent liposuction has been demonstrated to reduce disproportions and pain
[36]
permanently , stop progression of the disease [35,36] , and improve quality of life [37-40] . In addition, surgical
therapy may reduce the amount of necessary conservative therapy [38,40] . Weight management is an important
requirement for maintaining the benefits of liposuction. There are reports that fat can re-accumulate in
those who put on weight after liposuction.

Most patients undergoing liposuction for lipedema require several treatments over several months.
According to the guidelines, more than 4-6 liters of fat per session should not be removed because the risk
of cardiopulmonary complications increases with increasing blood and fluid loss. Electrolyte imbalances
are particularly dangerous. Usually, a minimal interval of at least three months between the sessions is
recommended. Figure 8 shows a 36-year-old patient after five sessions of liposuction.

In conclusion, Lipedema is a frequently unrecognized and misdiagnosed disorder. Clinicians should be
aware of clinical signs and clearly distinguish the condition from other entities. Accurate diagnosis and
treatment are essential because they determine the patient’s prognosis. A targeted therapy for lipedema is
not known because the exact etiology of the disorder is not clarified yet. Decongestive physical therapy
is the basic conservative treatment, which is usually necessary lifelong. However, liposuction has led