FDRS's Stance on Liposuction

About Liposuction

Types of Procedures

Variations in Procedures

List of known Liposuction Surgeons on Lipedema

Questions to Ask Liposuction Surgeons

 

FDRS's Stance on Liposuction

Everyone should attempt to manage their lipedema through conservative therapies to the best of their abilities first, including: dry brushing, MLD, compression, eating nutritiously (low processed carbohydrates, low refined sugars combined with overall healthy eating), exercise, CDT, supplements, medications, kinesiotaping, and/or other inflammation management, as warranted by their situation and approved with their physicians.

However, in some cases, liposuction is necessary and prudent. The need for liposuction is clear (medically necessary) when there is significant pain, altered mobility and/or gait, or strain on joints such as the knee, secondary to the lipedema fat. The risks of liposuction are similar to other surgeries and include pain, bleeding, and infection, and, similar to bariatric/metabolic procedures may result in sagging skin and altered body contours.

About Liposuction

Many people with lipedema and Dercum’s disease find relief of pain from liposuction surgery. Liposuction for lipedema is not a cosmetic procedure but a medically necessary procedure to relieve pain and intervene on the progression of the disease. In fact, due to potential skin retraction problems, the cosmetic results may not be great.

LIPOSUCTION MUST BE DONE IN A WAY THAT CAUSES AS LITTLE DAMAGE TO THE LYMPHATIC SYSTEM AS POSSIBLE, including the tiny lymphatic vessels that go all the way to skin. It can take several years for damage to the lymphatic system to develop, so finding a knowledgeable, experienced surgeon is critical. It is imperative to follow pre- and post-op instructions and to make lifestyle-related modifications. Liposuction alone will not cure lipedema.

The mechanism of how liposuction relieves pain is not fully understood. Depending on the patient, the total body mass removed during liposuction may be a very small percentage. Yet this procedure is enough to relieve the patient of a significant amount of pain [cite]. According to some experts, there is also a change in the metabolic processing and weight loss typically occurs naturally for the first 18 months after surgery [cite].

Liposuction is a surgery. All surgeries come with risk. The patient should consult their primary care physician before surgery.
There are currently different procedures used for lipedema patients. Not all surgeries are suitable for all patients at all times. The patient should also consult with multiple liposuction doctors to gain insight into the different doctors’ techniques.

Types of Procedures

There are three overall types of liposuction that have been used: the ‘dry technique’, tumescent, and WAL. 

The dry technique was first used for treating lymphedema, where there are systemic problems with the lymphatic system. It involves putting a tourniquet the limb, draining the fluid, performing liposuction to remove all tissue around the subcutaneous fat layer. Because this technique removes everything, lifelong compression is required after the procedure. Likewise, full anesthesia is necessary and a hospital stay may be advised.

The tumescent technique is often done under local anesthesia and may or may not require long-term compression. The tissue is ‘tumesced’, meaning it is saturated with fluid and anesthesia, and the fat is removed. 

WAL, or water-assisted liposuction, is a specific type of tumescent liposuction. Less tumescent fluid is used initially, and the cannula that suctions the fat tissue out has a water jet attached to it that facilitates removing the fat cells without causing as much damage to the other components around the fat cells. This is also done under local anesthesia.

Variations of Procedures

There are many, many variations beyond these overarching types, in the: pre-op procedures; anesthesia ingredients; liposuction machine equipment; post-op procedures like compression and supplements/medications; and surgeon.

List of known Liposuction Surgeons on Lipedema

THIS TABLE IS NOT UPDATED FREQUENTLY AS WE RELY ON INFORMATION PROVIDED TO US. PLEASE CALL THE RESPECTIVE OFFICES FOR CURRENT INFORMATION.

Name

Approx #

lipedema

surgeries

performed

Status

Insurance

FDRS

2014 / 2016

conference?

Office website

Amron, David

>1200

Actively performing surgery (averages 7-8 per week)

post-surgical billing assistance

Spkr / Spkr advancedlipedematreatment.com

 

amronmd.com

Buck, Donald

>50

Actively performing surgery (averages 6 per week)

~45%

success 

No / Spkr
prsinstitute.wustl.edu

Byrd, Marcia

>700

Actively performing surgery (averages 6 per week)  ~40%

success 

Panel / Spkr lipedemaliposuctioncenter.com

Emer, Jason

127

Actively performing surgery Not accepted Spkr / No

jasonemermd.com

Spalding

Granzow, Jay

call office  call office call office No / No

https://lymphedemasurgeon.com/

Greuner, David

>600

Actively performing surgery

Also treats Dercum's, Madelung's and lymphedema
Yes >90% success No / No
nycsurgical.net

Gutowski, Karol A.

~ 250

Actively performing surgery (Avg 1-2 per month)

No

No / No

https://drgutowski.com/

Hanke, C. William

>500

Actively performing surgery

No

No / No

www.thelassi.com

Hollingsworth, Christopher

>50

Actively performing surgery

Also treats Dercum's, Madelung's and lymphedema

Yes >90% success

No / No

nycsurgical.net

Landis, George

 

 

 

No / No

drlandis.com

Nguyen, Dung >50 Actively performing surgery Yes No / No

Stanford University

No website available

Rotgans, Arno >150 Actively performing surgery

Also treats Dercum's, Madelung's and lymphedema
Yes >90% success No / Yes nycsurgical.net

Shapira, Nadiv

20 Actively performing surgery

75%

success prior to WAL

Attendee / Yes

 

 www.1ststatelipedema.com

Smith, Mark

call office

call office

call office

No / No

marksmithmd.com

Wright, Thomas

>100 surgeries

1000s treated with

conservative therapies

Actively performing surgery

Performs WAL Liposuction

~33% success

No / Spkr

https://www.laserlipoandveins.com/

http://lipedema.net/

 

FDRS List of Known Liposuction Surgeons on Lipedema - International

Name Clinic Country  #

FDRS

2014 / 2016

Conference?

Office Website / Comments
Munnoch, Alex Ninewells Hospital Scotland   No / No ??? / Accepts NHS patients only
Liew, Se Hwang

Spire Liverpool Hospital &

Fairfield Independent Hospital

England   No / No http://www.mycosmeticsurgeon.co.uk/
Karri, Vasu       No / No www.karrilymphoedemaclinic.co.uk/mr-vasu-karri-bschons-mbbs-msc-frcsplast
Gupta, Puneet The Private Clinic England   No / No http://www.theprivateclinic.co.uk/
Wolf, Dennis The Private Clinic England   No / No http://www.theprivateclinic.co.uk/
Dancey, Anne   England   No / No  
Ross, David   England   No / No https://www.thelondonclinic.co.uk/consultants/mr-david-anthony-ross
Stutz, Josef   Germany   Yes / Yes http://www.stutz-dr.com/
Stattler, Gerhard   Germany >10,000 No / No www.rosenparkklinik.de/en/clinic-team/physicians/dr-gerhard-sattler/
Rapprich, Stefan   Germany   No / Yes http://www.hautmedizin-badsoden.de/
Schmeller, Wilfried   Germany   No / No http://www.hanse-klinik.de/
Lexer, Erich   Germany   No / No http://www.lexerklinik.de/
Schift, Reggy   Germany   No / No http://reggyschift.com/
Diedrichson, Jens   Germany   No / No http://www.plastische-chirurgie-medienhafen.de/home.html
Heck, Falk-Christian   Germany   No / No http://www.falk-heck.de/
Boonen, Robert   Netherlands   No / No www.drsboonen.nl/over-dokter-boonen
Habbema, Louis   Netherlands   No / No Lymphedema only?
Brorson, Hakan   Sweden   No / No www.plasticsurg.nu / Lymphedema only?

 

CLICK HERE for printable PDF of 2017 LIPOEDEMA DOCTORS IN EUROPE prepared by Maria Kokkinou

Questions to ask potential liposuction doctors:

Q: How many patients who have been officially diagnosed with lipedema (or Dercum’s) have they operated on?

Notes: Look for surgeons who are experienced with lipedema patients.

Q: What type of liposuction do they perform? WAL, TMA, etc?

Q: What type of anesthesia do they use?

Notes: There are two main types, general (meaning the person is ‘put under’) and local (meaning the region that is to be operated upon is numbed). By its nature, general anesthesia is risky then local. Several papers suggest using local anesthesia only. The liquid solutions used during the procedures often contain medications. Please ensure you are not allergic to the ingredients in the solution.

Q: What number of procedures do you recommend in my case?

Notes: Most doctors will recommend multiple smaller procedures. This helps with skin retraction, easing the strain of surgery, and improving recovery.

Q: What pre-operation recommendations do they have? What tests are done before the surgery?

Notes: Most surgeons will want to have certain blood tests done, an ECG, and a look into the lymphatic system ahead of time. The purpose is for the surgeon to be aware of any lymphatic issues before surgery. Some doctors will not operate on patients with a compromised lymphatic system, or on areas of the body where lymphatics are not fully functioning. If there is a large physical distance between the patient and doctor, the doctor may request a video conference or photos taken in advance.

Q: What post-operative recommendations do they have?

Notes: Some doctors may have recommendations regarding wearing light compression garments (to help skin retraction), an exercise regimen possibly including long walks, nutrition or diet guidelines. Hopefully the doctor also requires post-op follow-up to track the long-term success of the surgery.

Q: Will the doctor put you in touch with other lipedema patients they have operated on?

Q: What kind of long-term tracking do they do of the outcomes?

Q: Will they share before, immediately after, and long-run after pictures of surgeries they have performed?

Q: How do they define and measure a ‘successful’ procedure?

Notes: Pain? Cosmetic results? Slowing the disease progression?

Q: Do they recommend losing weight before the surgery? After?

Q: When and how is follow-up done?

Q: Do they test the function of your lymphatic function before surgery? How?

Notes: Different doctors may recommend different tests such as: MRI, ECG, Doppler, lymphangiogram, SPY 2, …lymphoscintigraphy

Q: What specialties do they have in plastic surgery?

Notes: Look for a doctor who specializes in lipedema patients

Q: Do they do research? What kind of research?

Q: What degrees do they have? Are the degrees in plastic surgery or a different field? From what institutions? How good are those institutions?

Q: Are they affiliated with any professional organizations? Which?

Q: How is lipedema fat different from regular fat?

Q: How is liposuction on the lipedema fat different from liposuction with regular fat?

Notes: WHAT TO WATCH FOR – THEY MUST MENTION THAT IS IMPERATIVE TO NOT CAUSE ANY DAMAGE TO THE LYMPHATIC SYSTEM. IF THERE IS ANY DAMAGE TO THE LYMPHATIC SYSTEM, THEN THE PATIENT MAY DEVELOP LIPO-LYMPHEDEMA, WHICH IS WORSE THAN JUST LIPEDEMA!

Q: How much pain does the typical patient experience during surgery?

Notes: Some patients report pain with some surgeons, and other patients report no pain with other surgeons.

Q: Am I a good candidate?

Q: What risks should I be aware of?

Q: What will recovery be like? How long might it take?

Q: How much will my procedures cost? Do you take insurance?

Q: How far apart will my procedures be?