A woman comes into Southwest Plastic Surgery with legs that have not changed in twenty years of dieting. She has lost weight more than once. It came off her waist and her face and left her thighs exactly where they were.
Dr. Frank Agullo sees that pattern often, and he names it on the first visit. Lipedema. Two days ago he wrote about the citrus supplement a Daily Mail reader swears by. This post is the full path, from the first compression garment to the operating room.
How He Knows It Is Lipedema
“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.”
“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.”
Step One Is Not Surgery
The first plan written at Southwest Plastic Surgery is conservative: compression garments worn daily, more movement, holding or lowering body weight, lymphatic massage and an anti-inflammatory diet. Our lymphatic drainage massage providers do that work in house. When a patient has given that plan a real try and still has pain, bruising and limited mobility, Dr. Agullo talks about liposuction. Any stage can be treated, and the conservative plan continues afterward.
What the Surgery Is
“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.”
Why It Happens in Stages
“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.”
Between sessions the patient is back in compression and back on the massage table. That is not downtime. It is part of the treatment.
Insurance, Answered Before You Ask
“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. Because lipedema can be very voluminous, sometimes the surgery can be prolonged, and this is taken into consideration for OR time and anesthesia, which can increase the costs listed on the web page. Some patients will opt to have the procedure with us and then submit their claim to their insurance separately. 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.”
What Patients Report a Year Later
“Overall, the results will be maintained over time, as long as the patient also continues maintenance therapy like lymphatic massages, weight maintenance or weight reduction, and compression garments. The final result really depends on the stage of presentation, or how the patient shows up before surgery. The higher grades of lipedema have stretched and overhanging skin, which does not retract as much as we would want with liposuction. Nevertheless, the areas are debulked, they are smaller, and there is increased mobility. Most patients report improved mobility, less pain, and less bruising.”
When loose skin is left behind, a lift is the next conversation, at the same time for mild cases and about six months later for the more advanced ones. The full surgical post, with the comparison table and the candidate criteria, is on Agullo Plastic Surgery. His shorter read on why the diet advice fails is on drworldwide.com.
Why Southwest Plastic Surgery
Dr. Agullo is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at Mayo Clinic, and is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for 13 consecutive years. Compression fitting, lymphatic massage and the surgery itself happen under one roof in El Paso.
Book Your Consultation
Bring your old photos. One visit tells you whether this is lipedema. (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.
