Lipoedema Plastic Surgery from A to Z

A

Aesthetic liposuction is about achieving the most aesthetically pleasing body shape possible – although beauty is always in the eye of the beholder.
The goal of lipoedema surgery is to remove the pathologically changed fatty tissue as completely as possible with lasting effect.
However, lipoedema and healthy fat cells are mixed in the tissue layer and even today it is impossible to distinguish between them.
Therefore, lipoedema cells always remain in the fat layer, because a complete removal of all fat cells should not be carried out under any circumstances.
However, if the lipoedema cells are removed systematically, i.e. sufficiently, the remaining cells usually no longer become symptomatic in the course of the disorder, even if they increase in size.
As lipoedema surgery is very different from aesthetic liposuction, it should only be performed by a specialist experienced in this field, because only then you can expect a lasting result.

An individual treatment plan is made for each patient, taking into account body weight and surface area of the body and the amount of fat to be removed. Under no circumstances can the entire body surface be operated on professionally in a single operation, because this would end in a life-threatening situation.
In addition, the amount of fat to be removed per operation must also be limited. Depending on your individual state of health, more than 6-8% fat in litres in relation to body weight should not be removed.
Liposuction creates large wound areas under the skin, into which the body loses fluid due to swelling.
In addition, haematomas develop, depriving the body of red blood cells as oxygen carriers.
The loss of fluid into the tissues and the loss of red blood cells can lead to a drop in blood pressure, circulatory weakness and even collapse ; the resulting anaemia may even necessitate a blood transfusion. Therefore, careful surgical planning in advance is very important for us. Your health is always our top priority.
We perform the operation under general anaesthesia. Our experienced anaesthetists will be with you throughout the operation and will supervise you.

C

The systematic wearing of straight, flat-mesh compression stockings is decisive for the long-term success of lipoedema treatment. It is important that these tights are properly fitted by a specialist, because you have to wear them 12 hours a day.
After the operation you will wear the compression tights day and night for six weeks and during the day for another two weeks. That is why it is important that the tights fit properly.
In addition, wearing the compression tights will will directly influence the shaping brought about by the operation. An incorrect fit could result in pressure points or wrinkles. Please wear your compression stockings during your consultation, so that we can check that they fit properly.
Please note that round knitted compression stockings are inadequate. They are used for venous diseases and do not sufficiently support lymph drainage for cases of lipoedema.
The conservative treatment of lipoedema includes flat-knit compression tights and, if necessary, lymphatic drainage, exercice and a balanced diet. This therapy cannot cure lipoedema, but it can significantly alleviate the symptoms.

Corrections may also be necessary even after a successful and proper liposuction, either because there are still complaints in certain areas or because there are irregularities after healing. If corrections are necessary, a follow-up examination is possible one year after the last operation. We will discuss surgical result, the course of the disorder and your current condition. Together we will clarify the resulting options. It is important that you are open with us – together we will always find a solution!

After the consultation, you will receive a medical report and a detailed cost breakdown.
All the costs are listed individually, including anaesthesia, accomodation, food, thrombosis injections an so on, so that you know exactly what costs you will incur.
At present, the treatment costs for lipoedema stages I and II are generally not covered by the health insurance.
In some cases, the costs for lipoedema stage III are covered by the health insurance, but in these cases an operation with us is not covered.
We follow the recommendations of the Association of German Surgeons and Anaesthetists (DGCH/BDC and DGAI/BDA for scheduling elective surgical procedures after Covid-19 infection and vaccination (https://www.bdc.de/empfehlungen-der-dgch-zur-terminierung-elektiver-operativer-eingriffe-nach-covid-19-infektion-und-impfung/).
The interval between surgery and infection should be at least 7 weeks.
Elective surgery should therefore be performed, if possible, at earliest 7 weeks after the onset of Covid-19-related symptoms and in the absence of persisting symptoms.
The interval between vaccination and surgery should be at least 2 weeks.
An interval of at least 2 weeks should therefore be observed between vaccination and surgery, among other things in order to be able to correctly assign any symptoms that may occur, such as fever or chills, to the vaccination rather than a complication from the surgery. In addition, the corresponding expected immune response should have occurred after the vaccination. Against this background, an interval of at least 2 weeks after complete immunisation should be aimed for.

D

Lipoedema presents a complex and very individual clinical picture with a variety of symptoms that can occur to varying degrees.

Lipoedema is diagnosed by a specialist in phlebology, vascular surgery, skin diseases or the family doctor. Other causes of the symptoms, such as venous diseases, can also be ruled out there.

Symptoms that may indicate lipoedema are :

  • Onset of changes on legs and arms in puberty with an increase in fatty tissue.
  • Symmetrical increase in fatty tissue on the hips and thighs
  • Hands and feet are not affected
  • Pain and sensitivity to pressure and touch
  • Skin feels knotty and coarse
  • Hormonal changes, such as pregnancy or changing the contraceptive pill, increase the volume of fatty tissue, often episodically.
  • Tendency to haematoma (bruising) without corresponding injury
  • Exercice and diet do not have a significant effect on the arms and legs
  • Other female family members are affected by the disorder
The duration of the operation depends on the initial diagnosis, the areas to be operated on and the condition of the tissue and is about 1 – 2 hours.

F

As the costs of these operations are usually not covered by the health insurance, financing their cost is a very important issue for all patients. Should you wish to consider requesting financing assistance, please do not hesitate to contact us.
Your health is very important to me. Even with all the care and years of surgical experience, surgical complications can never be 100% excluded. Health insurance providers have the right to require you to participate in the costs resulting from complications. A supplementary insurance can cover this risk completely. I have already subscribed to a supplementary insurance for general patients resident in Germany. This insurance ist also valid for patients from other European countries. This covers all medical complications up to an amount of 300,000 euros. There is a free choice of doctor. It is a German provider with a German insurance product.

G

The pathological increase of fatty tissue is arrested by liposuction, thus preventing the progression of the disease.
The pain is reduced or eliminated by virtue of the reduction in pressure resulting from the decreased volume of tissue.
Lymphatic drainage is also improved, which reduces swelling. Permanent compression is usually no longer necessary.
The body gains more harmonious appearance, you feel good in your body again.
Mobility is significantly improved, making exercice and good nutrition fun again, and secondary damage to the joints is avoided.

H

Lipoedema surgery is a demanding and strenuous procedure for which you should be fully prepared.
You will need support for the first few days at home. You should eat a balanced diet rich in vitamins and iron, drink plenty of fluids and move around as much as you can. You should take repeated rest breaks and put your legs up.
It is recommended not to sit or stand for too long, as this impedes lymphatic flow and can increase swelling.
Wound fluid may continue to leak out during the first few days, so get protective materials such as bed sheets in advance.
Lipoedema is a chronic condition and cannot be cured, so treatment with a professional and experienced lipoedema surgeon is important in order to achieve the best possible outcome for you.

I

In each case, the lower incisions of the surgical area remain open to allow drainage of the wound fluid. These incisions heal on their own within a few days, the other incisions are closed with fine suture material. This should be removed 7 to 10 days after the operation. After some time, the small scars will have healed almost invisibly.
During our individual consultation, we will get to know each other, discuss your wishes and expectations, but also your medical history, previous medical treatments, particular medical risk factors, allergies, etc.
We will explain the conservative and surgical therapy options to you in detail.
We will discuss your personal treatment plan with you and explain in detail the proposed course of treatments tailored to your needs.
You can have someone accompany you during your consultation. This will help you take in all the information and to ensure all questions are answered fully.
Please wear your compression tights during your consultation, if available.
We will perform a thorough physical examination, including an examination of the tissue.
You will be photographed from all sides and your entire body will be measured.
We then draw up a detailed medical report that you can present to your health insurance company or the tax office, for example.

L

More and more patients make an appointment with me to ask about possible lipoedema in the abdomen. Already during or after the initial operations there is sometimes a significant increase in fatty tissue on the chin, neck, abdomen, back or pubic area. The body weight usually remains constant. We are happy to discuss treatment options.

In the case of congested tissue, lymphatic drainage may be necessary and useful in addition to conservative therapy.
But not all patients really need lymphatic drainage. We will discuss this with you during your consultation, once we have examined you.
After the operation, however, you will always need lymphatic drainage, at least twice a week, preferably more often.

O

After induction of anaesthesia, several small incisions of only 2-3mm are made, then the tissue is first loosened with injection of a tumescent solution. This is followed by the actual suction, during which it is important not to damage nerves, blood vessels or lymphatic vessels This is made possible by the water-jet assisted method (WAL method), which I have been using for many years in the treatment of lipedema.

The pathological fatty tissue must be removed permanently, thoroughly and completely.
It is important to follow a standardised procedure for all operations in order to achieve a consistent and optimal result for each patient.

P

The level of pain associated with lipoedema varies greatly from person to person and does not depend on the stage of the disorder. A significant reduction or even elimination of the pain can be achieved throuph surgery, usually immediately after the operation.
Even after the operation, my team and I are always there and available for you. For an optimal result after the operation, it is important that we work together and in a spirit of trust.
After the operations I carry out follow-up examinations regularly in order to monitor the success of the treatment.
I use state-of-the-art medical office software that keeps you in close contact with us, even if you live far away.
Our software enables the exchange of messages and images, and video conferencing is also possible. My team and I make sure that you feel you are in good hands after the operation and are always there for you if you have any questions.

Q

Liposuction significantly improves quality of life. Pain is reduced, movement is easier and the body image is harmonised. You can look forward to your life without lipoedema !

R

During your consultation, I will discuss the expected results with you openly and honestly, including all possible complications. The result after lipoedema surgery is never completely perfect and depends on your initial situation.
But you can be sure that I will devote all my knowledge and experience to achieve the best possible result for you personally.
Before any lipoedema operation, intensive conservative therapy should be carried out with compression therapy, lymphatic drainage, if necessary, accompanied by exercise and diet.
If this does not alleviate the symptoms, a lipoedema operation may be the right solution for you.
Howeyer, before you decide on an operation, you should carefully weigh up the pros and cons and inform yourself fully. Our entire team is at your disposal for this.

S

I use all my knowledge, skills and years of experience to achieve the best possible result for you. However, skin irregularities can never be ruled out. These also depend on the condition of your skin, its elasticity and regenerative capacity and, of course, on the quantity of liposuctioned fat tissue.
After liposuction, the skin tightens very well. For some patients, however, excess skin may remain. If this is bothersome, it can be surgically removed by a skin lift. As a specialist in plastic and aesthetic surgery, I have had over 20 years of experience in this field, including skin lifts.
Sport is an important corner stone for conservative lipoedema treatment and is also important in the post-operative phase. There are no recommendations for the „right“ sports activity – the important thing is that you have fun and that the joints are not strained if you are overweight.
Similarly, diet is also an individual matter. Many patients benefit from an anti-inflammatory or even low-carbohydrate diet – but listen to your own body and find out works for you.

On the day of the operation, please come to the clinic at the appointed time, with an empty stomach.
First, we conduct the formalities and verifiy all the required documents.
During the consultations with the anaesthetist any questions can be clarified. He or she will also insert an intravenous catheter for the intravenous administration of medication during the operation.
Your surgeon will talk over the operation again in detail. Afterwards, your arms or legs will be examined again, the surgery area will be marked, and photographs will be taken once again.
Once the operating room has been prepared, a nurse will take you there, the operating area will be disinfected and covered, and the anaesthetic will be induced intravenously. Then you sleep in a relaxed state while we work…

After the operation, you will first rest a little in your bed, then you should move around as much as possible and above all drink a lot. Our medical team will take devoted care of you.
Of course, we provide food and drink for your sustenance.
That evening you will receive your first anti-thrombosis injection.
Following hopefully a quiet night and after a tasty breakfast, we will visit you in the morning during a ward round, after which your escort can come and pick you up.

Good preparation is very important for the operation and the time afterwards.
Wear your flat-knit compression tights systematically for several weeks before the operation, because only decongested and soft tissue can absorb well and thus allow the most aesthetically pleasing and even result possible.
Maintain a balanced diet rich in vitamins and iron; if necessary, take an iron supplement.
In the days before the operation, you should drink enough in order to provide additional support for your circulation.

When treating lipoedema, it is important to consider the surgical region as an anatomical whole and to treat it as such. If only limited painful areas are suctioned, this can lead to an increase in the remaining fatty tissue due to the hormonal changes that occur afterwards, so that irregularities and an even more disproportionate appearance result. Thus, my view ist, either operate completely and correctly, or not at all!
Lipoedema is a complex clinical picture and lipoedema surgery is also a specialised and complex procedure that requires many years of experience in this surgical field in order to achieve a good result.
I have specialised in this procedure and you can rely on my many years of surgical experience.
The hydrostatic pressure of the water relieves congestion in the tissues without straining the joints. Many women achieve a significant improvement in their symptoms by swimming or doing water sports such as aqua gymnastics or aqua aerobics.
Especially after the operation, water sports are particularly beneficial. You can begin sports activities when the wounds have completely healed, usually 2-3 days after the removal of the suture material.

W

Basically, there are different and successful methods of performing lipoedema surgery.
In my opinion, the water-jet is the most suitable to achieve the best possible result. The water-jet helps to protect the tissue, including the lymphatic system and blood vessels.
The water-jet makes it possible to dissolve out the fat cells and suck them out of the tissue at the same time.
Since the tissue is not swollen beforehand, the result can be assessed at any time during the operation. The operation time can be kept relatively short.
After the operation, you will be unable to work for 2 to 4 weeks. The exact time will depend on the physical exertion required of your work.
Your will receive a certificate of work incapacity for 14 days from your clinic. This can be extended by your family doctor if necessary.

Do you have any questions about our practice or our services ?
Please call us or contact us by e-mail, we will be happy to help you.

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