Two words. Lose weight. She has heard them from her mother, her trainer, two doctors and a stranger at the pool.
So she loses it. Face, arms, waist. The legs do not move. Same thighs, same knees, same bruises from a bump she does not remember.
That is lipedema, and it is one of the most under-named conditions I see. Two days ago I wrote about a citrus supplement the Daily Mail asked me about. Today, the surgery.
Spotting It
“Lipedema is usually symmetric, which is different from lymphedema, which usually only happens on one side of the body. Lipedema usually affects the thighs and the legs. It can be associated with tenderness to palpation, easy bruising, and decreased mobility. It does not affect the hands or the feet. It almost always happens in women, and it starts around puberty.”
Symmetric. Tender. Bruises. Hands and feet untouched. If that is you, the diet was never going to work, and here is why:
“Lipedema usually doesn’t respond to diet and exercise. The patient can lose weight and they’ll lose it around the waistline, but the areas affected by lipedema do not respond. The usual patient has dealt with this problem for many years and has always been told to lose weight, but that in essence does not help.”
Not Your Cousin’s Lipo
Cosmetic liposuction sculpts. Lipedema liposuction protects. The whole operation is built around the lymph channels, because damaging them trades one disease for another.
“I usually perform lipedema surgery through liposuction with a power-assisted device, as it has become much of the gold standard. I prefer to keep cannulas under four millimeters. The main objective is to spare the lymphatics, so as not to create lymphedema or worsen the problem. It is performed under general anesthesia, and the strokes are made longitudinally in order to preserve the lymphatic drainage.”
Thin cannula. Strokes along the leg, never across it. Those two choices are the entire difference.
Why Nobody Should Do It All at Once
“Preferably, the lipedema surgery is staged. Outer thighs and hips first, then inner thighs and knees, then the calves, and the arms last, typically four to eight weeks apart. The staging order is a general guideline, but some patients have an area that bothers them more than others, so these areas can be prioritized during the treatment.”
“For an outpatient procedure, we limit the lipoaspirate to five liters per case, and that is one of the reasons why we stage these procedures. Volumes greater than five liters can create big fluid shifts in the body and require a hospital overnight stay, which usually doesn’t outweigh the benefits. Therefore, repeated smaller sessions can be less costly.”
A surgeon who offers to clear all of it in one marathon session is offering you a hospital bed and a fluid problem. Walk out.
The Insurance Answer, Plainly
“It’s important to note that neither Dr. Agullo nor Southwest Plastic Surgery works with insurance. Lipedema surgery is charged just like liposuction, and the fees can be checked on our fees page as of this writing. The cost is by areas treated. Overall, it is a difficult procedure to have covered under insurance. If you wish to have a physician that takes your insurance, we would be more than happy to refer you to a board-certified plastic surgeon. Nonetheless, many times these procedures will not be approved.”
I would rather say that on the first visit than on the fourth.
A Year Later
“Most patients report improved mobility, less pain, and less bruising. The liposuction will remove the diseased fat or reduce the amount of it. The loose or overhanging skin may need an actual surgical procedure, an excision and lift, for a more cosmetic contour.”
“For mild to moderate skin excess, the procedure could be performed at the same time. For more severe presentations and skin laxity, it’s usually staged and can be performed as soon as three months later, but ideally six months later.”
Moving. Less pain. Fewer bruises. The mirror comes after. The full surgical post, with the candidate criteria, the comparison table and the cost section, is on Agullo Plastic Surgery. The compression-and-massage side, the part that starts before surgery and never stops, is on Southwest Plastic Surgery. Skin after big weight changes, which comes up in the same visit, is here.
Why Choose Dr. Agullo
Double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, Mayo Clinic plastic surgery fellowship, Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center, and a Castle Connolly Top Doctor for 13 consecutive years. Body contouring is the center of my practice.
Ready to Talk?
Stop apologizing for your legs. Get them looked at. (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com/appointments. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
