Lipedema consultation | Lipedema treatment - Frequently asked questions

The lipedema

A common but often unrecognized disease!

How do I know if I have lipedema?

One of the surest signs: Legs (and possibly arms) begin to thicken uncontrollably and no longer fit in with the rest of the body. The proliferation of fatty tissue on arms/legs typically cannot be influenced by diet and exercise, if at all. Other signs include an unpleasant pain when pressure is applied and touched, as well as a muscle-like pain when weight is applied (walking, climbing stairs). The disease progresses in episodes that usually occur during periods of hormonal change (puberty, pregnancy, menopause). A genetic component is suspected. Therefore, if there are other affected women in the family, the diagnosis is very likely.

Which doctor determines if you have lipedema?

It would be desirable if all physicians were aware of the disease! The diagnosis is made by physicians who are involved in the conservative or surgical treatment of lipedema. These are usually phlebologists (vein specialists), lymphologists, angiologists (vascular specialists), vascular surgeons, but also general practitioners, gynecologists, orthopedists should recognize the disease and refer to the appropriate discipline! In order to get clarity, I offer my own diagnostic consultation.

I have lipedema - do I have to stop taking the pill?

We lack clear scientific findings for this conclusion! A hormonal connection is assumed, but how this looks is still largely unknown. We know from experience that the discontinuation of a hormone, i.e. the discontinuation of a hormonal therapy, can also trigger relapses. Therefore, hormonal therapy should only be changed or stopped after the liposuctions.

What happens if you do not treat lipedema?

Not every lipedema patient will develop stage III if left untreated. This depends on the onset of the disease, the duration of the disease and the individual (genetic?) progression of the disease. It is clear that purely conservative therapy (compression, manual lymphatic drainage) has at best a symptom-relieving effect, but has no influence on the further development of the disease.

What is the conservative therapy for lipedema?

This consists of the consistent wearing of flat-knitted compression pants of class II made to measure in combination with manual lymphatic drainage. Important supplementary measures are sporting activity, ideally in water (swimming, aqua jogging, aqua cycling) and a healthy diet. Concomitant excess weight should be reduced as far as possible.

Do all patients benefit equally from conservative therapy?

No. In particular, patients with soft, non-congested tissue who present pure adipose tissue proliferation without an edema component will not benefit from manual lymphatic drainage ("I don't notice any difference after the treatment"). Unfortunately, health insurance companies usually require complete proof of six months of conservative therapy and confirmation of its unsuccessfulness in order to even consider covering the costs of liposuction! After surgery, manual lymphatic drainage at a frequency of twice a week is essential due to the swelling and fluid in the tissue!

What is the right time for liposuction?

When your suffering and your professional and private limitations become too great! The expert opinions are that liposuctions should be performed at a young age, at best before the first pregnancy.

Is lipedema surgery covered by health insurance?

Very rare! In Germany, in the presence of a stage III, provided that the BMI is below 35. In Austria, the decision is made irrespective of stage, so even patients with stage II have a chance of being covered. In these cases, however, the operation must be performed in a public hospital, where the waiting time can be up to two years. Since these operations are performed much less frequently in public hospitals, the quality of treatment may not be given!

What are the requirements for surgery

One requirement is to have a pair of custom-made, flat-knit Class II compression tights. Another, that one is physically and mentally capable of enduring the strenuous operations. A contraindication would be, for example, if the ability to undergo surgery is not given due to relevant secondary diseases. Furthermore, an accompanying person must be organized to take care of you during the first 1 - 3 days.

How long before surgery must the flat knit pants be worn?

This varies! In the rarest cases, young female patients have relevant congestion of the tissue. Then the pants must be worn consistently during the day for 6 - 8 weeks before the operation. If the tissue is soft and not thawed, it is recommended to "wear in" the pants at least 14 days before the surgery and get used to the feeling of wearing them. It should be washed several times to soften the fibers.

What does an optimal flat knit pant look like for the perioperative period?

This is always a one-piece pantyhose! Multi-part supplies make sense only in exceptional cases. The toe can be worked open or closed, the body part should be cut high up to under the breast (covering the flanks) and at best has a zipper at the front. Please also ask for advice regarding a gusset or functional zone in the knee area!

What happens during waterjet assisted liposuction?

The cannula is inserted into the subcutaneous fatty tissue through small incisions in the skin. A fan-shaped, pulsating water jet gently loosens the fat cells from the tissue, which are suctioned out in the same operation. As the fat cells separate from the rinsing fluid in the collection container, it is possible to read exactly what volume has been removed.

What are the advantages of waterjet-assisted liposuction?

In principle, it must be said that there is no "one" or even "best" method in liposuction! Rather than the technique used, the expertise of your surgeon is decisive! Compared to the TLA (tumescent local anesthesia technique), WAL does not require a longer application time, so the treatment time tends to be shorter. Due to the fact that less "water" is used overall, there is almost no secretion at home. Because the fat cells are not destroyed during WAL, it is possible to accurately balance the amount of fat removed.

How much fat may be removed during surgery?

This depends on various factors such as the age of the patient, the preoperative hemoglobin value, the presence of secondary diagnoses and the initial findings. As a rule, 6 - 8% of the patient's own body weight in pure fat is aspirated per procedure, in exceptional cases even 10%.

Is 1 liter of fat removed equivalent to 1 kilo of body weight less?

Unfortunately no! Converted, this is only about 300 g less body weight on the scales. However, patients often lose weight much more easily after liposuction because they can move better and more painlessly, their basal metabolic rate increases and dietary measures are more effective.

Can the complete legs be treated in one operation?

Only in exceptional cases, such as correction after previous operations. In addition to the volume removed, the size of the internal wound areas plays a role. A wound area from the ankles to the waist would be associated with large-area (normal) bleeding in and out and might even require the administration of foreign blood! Therefore, the legs must be treated in two sessions even in very slim stage I patients.

How long does liposuction for lipedema take?

Depending on the findings and the effort required (corrections can sometimes take significantly longer due to scarring), between 60 and 150 minutes.

Can lymphedema be caused by the operations?

If liposuction is performed in the correct layer, strictly axial (i.e. parallel to the longitudinal lymphatics) and carefully: no! If liposuction is not performed properly and essential basic principles are disregarded, this danger does exist! It is therefore all the more important to choose a surgeon with the appropriate expertise!

Can surgery be performed even if lipo lymphedema is diagnosed?

This should be decided on a case-by-case basis! An already existing lymphedema should not worsen, but will not improve by the liposuctions, so that compression must continue to be worn if necessary. In principle, however, lymphedema is not a contraindication!

Are the operations performed under general anesthesia?

Without exception yes! General anesthesia is the absolutely safest procedure for you, since you are 100% supplied with oxygen at all times through mechanical ventilation and you can be given good painkillers already during the operation, which will support you during the first postoperative hours! That analgesia ("twilight sleep") would be more harmless or better tolerated is not true!

Are the operations performed on an outpatient basis?

After high-volume liposuction, you will always stay with us for one night and be cared for and supported by our magical staff! Circulatory reactions may still occur at home, which is why a companion should be with you for the first 1 to 3 days.

How safe is waterjet-assisted liposuction in terms of complications?

Performed by an experienced surgeon, waterjet-assisted liposuction, like other suction procedures (PAL, TLA), can be described as very safe! Since the cannula is moved in a very superficial layer, the subcutaneous fat tissue, injuries to important deeper structures (deep veins, arteries, nerves) are practically impossible. To minimize the risk of postoperative infection, a one-time antibiotic is administered intravenously at the beginning of surgery. If you would like to be on the safe side, please contact us on the subject of follow-up cost insurance.

Do I have to come to Salzburg for a check-up after an operation?

As a rule, no. It is important that a family doctor supports you, gives you prescriptions for painkillers and lymphatic drainage in advance and removes the stitches after 8 - 10 days. I myself am always available for my patients by phone/ via WhatsApp if there are special questions postoperatively! The close follow-up care is particularly close to my heart!

Is there a ban on sports after the operations?

Definitely no! Start immediately with short walks and move the knees through specifically when climbing stairs or on a bicycle. The knees and ankle are where swelling and hematoma-related restrictions are most noticeable. Listen to how your body feels and expand the workload! Strength training, horseback riding, walking or jogging are also allowed as soon as you feel confident!

How long do I have to take a break from work?

It depends! For an office job with the possibility of a home office, you should expect to be unable to work for 10 - 14 days after leg surgery and approx. 1 week after arm surgery. For physically demanding jobs, such as nursing, you should calculate 3 to perhaps even 4 weeks after leg surgery and approx. 2 - 3 weeks after arm surgery. We issue a private certificate of incapacity for 14 days, which may have to be extended by the family doctor.

Will I need to continue wearing compression permanently after liposuctions?

One goal of liposuction is to eliminate the need for compression! In young patients, we usually achieve this 100%. However, depending on the age of the patient, the findings and the duration of the disease (possibly already fibrosis of the tissue, accompanying lymphedema), flat-knitted compression is still useful or even necessary.

Can lipedema come back?

Honest answer? Unfortunately yes! I scientifically assume that there are several subtypes of female patients, which may even be genetically determined. There are women who show stable findings for years and decades after successful surgery. In others, although rare, painful nodules may reappear in the operated area in the course of time despite radical liposuction. This must be distinguished from the so-called "fat redistribution" on the abdomen and back, which cannot yet be clearly explained scientifically. If necessary, these areas must also be treated by liposuction!

When can I get pregnant after an operation? Do I have to wait for the healing year?

No, you don't have to! Once you feel it is the right time and nature allows it, it is good. However, I think you should give yourself and your body some time. And your head also deserves the time to arrive in the new body and to be able to leave the exhausting lipedema journey behind before starting "a new project".

Frequently asked questions

The lipedema

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