Lipedema Liposuction
Lipedema Liposuction Surgery in New York, New Jersey and Tri-State Area
Lipedema liposuction is one of the most common techniques used for treatment of lipedema patients.
It is important to understand that lipedema liposuction is not a cure. It does not address the underlying problem, which is loose connective tissue disorder. The only thing liposuction can do is to remove diseased or affected fat cells from the lower extremities, torso and arms to relieve or improve pain and functionality.
The abnormality of vascular system, lymphatic system, joints, and other body organs and systems will not be affected.
CLICK ON THE PICTURE OR HERE TO VIEW LIPOSUCTION VIDEO FROM DR VOLSHTEYN
There are several types of liposuction. Sometimes they get very confusing. There’s a lot of misinformation on the Internet.
Tumescent liposuction. The term tumescent means that the subcutaneous tissues are infiltrated with solution containing normal saline, Lidocaine and Epinephrine. Lidocaine is designed to provide local pain control. Epinephrine provides tightening of the blood vessels under the skin to decrease bleeding. Normal saline increases the size of fat cells and makes the process of liposuction slightly easier and less traumatic. However, tumescent is not liposuction. Tumescent is a technique of preparation of the tissues for liposuction. Most common techniques of Lipedema liposuction are standard, power assisted, ultrasonic assisted, water assisted, and laser assisted.
Standard liposuction or traditional liposuction is when a solid liposuction cannula is inserted under the skin and connected to a liposuction device. The cannula is a hollow tube with one or more openings at the tip. The tip is usually a rounded or blunt. As the cannula is moved through the tissues, fat cells get aspirated into the cannula and removed.
It is a good solid technique. However, it is very tiring and physically demanding on the surgeon. As a matter of fact, one of the most common reasons for Plastic Surgeon's disability is shoulder injury from of liposuction.
Power assisted liposuction or PAL is a more advanced technique of standard liposuction. Hollow cannula is inserted under the skin in the same fashion as standard liposuction. However, the cannula vibrates back-and-forth. As the PAL cannula approaches subcutaneous fibers, it is able to navigate in between them easier. Therefore Power Assisted Liposuction is less demanding on the surgeon. In addition to that, larger volume of fat can be removed with smaller cannulas, using smaller suction, creating less damage to the blood vessels, nerves and other connective tissue fibers. There’s less pain, less bruising, less swelling and lower risk of complications. Majority of plastic surgeons who treat patients with Lipedema use this technique.
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Water assisted liposuction or WAL is a liposuction technique popularized in Europe, especially in Germany, but it did not become very popular in the United States for various reasons.
The concept is that the cannula has a small jet inside of it. In essence, it is a tube inside of the tube. The smaller tube sprays saline solution and hypothetically it knocks the fat cells out of their existing compartments. As those cells become loose from the jets of water, they get aspirated into the larger tube.
The proponents of this technique feel that it is less traumatic to the tissues. Several well-known surgeons use this technique but it is not the most popular method in the United States. I have tried Water assisted liposuction several times. In my hands I get better result with other methods.
I have several concerns about water assisted Liposuction.
First, the size of the cannula is much larger compared to power assisted liposuction. The tip of the cannula is sharp and so are the edges. It looks like a bow of the boat. It does require a bit of force to move the cannula through the tissues. I am concerned that sharp edges of the cannula and large size create more damage to the tissues including lymphatics, than anticipated, especially in Lipedema patients.
When the fat is removed at the same time as saline solution injected into the tissues, it becomes difficult to determine how much fat is left.
It also makes it impossible to perform excision surgery at the same time. I cannot perform arm lift, thigh lift, or panniculectomy surgery together with water assisted liposuction.
Also, I find it challenging to remove large volumes of fat with water assisted liposuction. Again, I respect opinions of other surgeons and if I need to, occasionally I use it. But this is not my favorite equipment.
Ultrasound assisted liposuction or UAL is actually not liposuction at all.
I started using ultrasound assisted liposuction about 20 years ago. It uses a solid metal probe with one or more ultrasound generating rings on its very tip. The tip is blunt. Through a small incision that is usually created for liposuction cannula, this ultrasound probe is inserted under the skin and moved back-and-forth in multiple directions.
The frequency of the ultrasound is specifically designed to disrupt connections between fat cells and between the fat cells and surrounding connective tissues.
Let me explain it in a different fashion. Imagine a small apple or orange tree. Start shaking the tree. If you’re shaking the tree very lightly, the tree and the fruits will move back-and-forth but no fruit will fall down. If you shake it too much, you might break the tree branches or the tree itself. However, you can find a frequency of shaking where most of the apples or oranges will fall down but the tree will not be hurt. This is how the frequency of the ultrasound have been developed over 20 years ago.
Ultrasound assisted liposuction has shown to promote skin tightening in patients undergoing cosmetic liposuction and improved smoothness of results. There are no studies to show that skin tightening occurs in patients with lipedema. However, I do feel that I can get a better contour and more smooth appearance by using ultrasonic liposuction.
After the ultrasound had been used to treat the fat, PAL or Power Assisted liposuction removes displaced fat cells in a more gentle fashion. The disadvantage of this technique is that it takes more time and potentially higher risk of seromas.
Several well-known Lipedema surgeons treating lipedema use ultrasound assisted liposuction together with power assisted liposuction and in my hands this is my favorite method of getting results.
Laser assisted liposuction. Just like the previous method, laser assisted liposuction is not Liposuction at all. It is performed before or after liposuction. The very small cannula is inserted under the skin with a laser fiberoptic wire inside of it. The laser energy is delivered under the skin heating up the tissues. It was promoted as a method of tightening skin in cosmetic patients. However, laser does not differentiate between blood vessels, nerves, skin or lymphatic vessels. It burns everything. I love the name laser liposuction but I believe it is contraindicated in patients with Lipedema because of higher risk of injury to the skin and lymphatics.
Lymph sparing liposuction is not a separate equipment but rather a method of utilizing the knowledge of anatomy and flexibility of the available equipment to minimize damage to lymphatic vessels.
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.