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Lipedema treatment: lymph-sparing liposuction (WAL)


How can lipedema be operated on?

In our practice clinic we use one of the most established methods of liposuction with state-of-the-art technology. Our liposuctions are performed with a water jet. The procedure is also called Water-Assisted Liposuction. With this, the fat cells can be gently released from their network by means of a special solution mixture. At the same time, the fat cells can be carefully removed by a slight negative pressure. To illustrate the procedure, please feel free to use the following animation.

Behandlungsvideo ansehen

Which technique do we use in our clinic in Oldenburg?

In our clinic we use the Bodyjet system by Humanmed. This is one of the most modern devices on the market and enables a tissue‑sparing method via water‑jet‑assisted liposuction (WAL). The goal is to spare lymphatic vessels and prevent soft‑tissue edema—hence lymph‑sparing liposculpture. We work with blunt cannulas to be atraumatic and achieve even results after fat removal. Based on current scientific evidence, this is the most established method for reducing fat cells in lipedema.

Why have lipedema surgery performed by a plastic surgeon?

As part of the specialist training to become a plastic surgeon, liposuctions are an elementary component, so that you can expect qualified suctioning with regard to function and aesthetics. No other specialist category, apart from the plastic and aesthetic surgeon, comes into relevant contact with liposuctions during specialist training.

Lymphatic-sparing surgery — what does that mean?

The goal is the reduction of the lipedema fat cells. We want to suction these out as gently as possible in order to relieve the lymphatic system. It is important here to suction as much as possible in the longitudinal direction of the extremities so as not to damage the lymphatic vessels, which also run longitudinally. After surgery, the lymphatic vessels should ultimately function better than before.

How much fat is removed in lipedema?

We specialize in large‑volume liposuctions as part of lipedema surgery. We have developed techniques that allow us, in selected cases, to remove more than 10 liters of pure fat per procedure (excluding fluids) without increasing patient risk. Lipedema surgery should be effective so that as few operations as possible are needed, minimizing internal scarring and downtime. We have not had a major complication (thrombosis, extensive infection or sepsis) in our clinic to date. In each of our >50 procedures per year in this field we work with utmost care to ensure good results and low risk.

Surgery for lipedema under general anesthesia or twilight sedation?

We perform both procedures, but since most lipedema operations are so-called large-volume liposuctions (around 5 l of pure fat), we see more safety in performing them under general anesthesia. A tumescent anesthesia, that is, a local anesthesia, is additionally carried out in our practice for less postoperative pain. The anesthesia costs are included in our prices, so that you have more planning security.

How many operations are necessary for lipedema?

The number of operations depends on the volume to be suctioned. We frequently remove around 5 l of pure fat per operation. With added tumescent solution, this can sometimes be considerably more. We are of course endeavoring to keep the number of operations low. During the initial consultation, we can already tell you fairly precisely the number of operations to be expected.

What does lipedema treatment in our clinic involve?

During the preparatory consultation—including detailed counseling, informed consent, and examination—the diagnosis is established and surgery is planned. Our goal is to address your wishes and needs as best as possible before the operation and to mark and document the areas to be treated.
On the day of surgery, which we perform on our own premises, we schedule you so that long waiting times are avoided. I will then review everything with you once again and repeat the markings. Our nursing and anesthesia teams will take care of you. We perform large‑volume liposuction, which can occasionally cause circulatory complaints; therefore, we will accommodate you overnight in one of our patient rooms. A nurse will look after you throughout the night. I will be nearby and personally attend to your wellbeing. After the final visit the next day, you can usually leave our clinic.
Manual lymphatic drainage should be resumed soon after surgery. If your physiotherapist is hesitant because of the small wounds, we can temporarily connect you with our in‑house physiotherapist.

Advantages/disadvantages/risks of liposuction for lymphedema—what alternatives exist?

The treated regions become considerably slimmer after the procedure. Per session, a maximum of 5 liters of pure fat can be removed without exposing you to an excessive risk of circulatory collapse. This means that several sessions may be necessary. Treatment planning is individualized. In addition to surgery, exercise, nutrition, compression therapy and manual lymphatic drainage are essential. Because lipedema is a progressive disease, I currently see no alternative to liposuction.

What should be considered after liposuction?

The flat‑knit compression garment should continue to be worn. Sutures do not need to be removed. Social and work activities are usually possible after 7–14 days. Sports can be cautiously resumed after 4 weeks, and showering is possible from day 5 after the operation.

Dimples and grooves after liposuction?

It is of course the case that a leg which does not require any suctioning is always smoother than a leg which has to be suctioned over a large area. Most lipedema areas already exhibit considerable dimples before the operation. In the course of a liposuction, as a plastic surgeon I am interested — alongside good function and relief of symptoms — in as smooth a result as possible, so that you may also like to show your legs afterward. Occasionally, despite all care, it can happen that small dimples are visible. For a good result, I allow myself sufficient time in the operating room.

Sagging skin after lipedema surgery — what to do?

Depending on the severity of a lipedema, the circumferences of the respectively affected areas can take on large dimensions. If, depending on the skin condition, the restoring force is not sufficient after reduction of the internal volume, we offer tightening operations using modern methods. In selected cases, an internal tightening is possible; in this, argon gas is selectively ignited through tiny access points, as in liposuction, and collagen synthesis is stimulated in order to make the skin shrink. I have a special technique to ensure a retraction stimulus of the skin, that is, a shrinking of the skin, already during the actual liposuction. We are happy to provide more information during our consultation.

Minimally invasive tightening with almost no scar

With our Argon Plasma technology, we can combine tightening with liposuction without creating additional scars. Already during the informational consultation, I can tell you whether this additional service makes sense for you and how we will incorporate it into your individual surgical plan. Through minimally invasive tightening, we can achieve even smoother results after large-volume liposuctions. We would be happy to advise you about the possibilities and the low risks during our consultation.

Please use the following video to illustrate the tightening process:

Behandlungsvideo ansehen


The following info flyer is intended to clarify the procedure even further:

Further information on Argo Plasma can be found here

Follow-up cost insurance for lipedema surgery?

No matter which operations are performed that are medically indicated but not always covered by the health insurer, they should be secured by follow-up cost insurance. After all, one does not buy a new car without insuring it accordingly either. In relation to the cost of the procedure, the amount is small; basic protection is usually sufficient. Medassure is one of our partners and would be happy to advise you.

Is liposuction useful in early lipedema stages?

Current evidence indicates that early removal of diseased fat cells has a positive effect on disease progression, as the development of the capillary leak described above is reduced.

Everything about lipedema at a glance

Treatment facts

  • Duration?
  • Procedure duration approx. 3 hours
  • Technique?
  • Water-jet assisted liposuction (WAL)
  • Anesthesia?
  • General anesthesia
  • Hospital stay?
  • Inpatient
  • Follow-up?
  • After 2 and 6 weeks
  • Suture removal?
  • Not necessary
  • Aftercare?
  • Compression garments for 6 weeks. Showering from the 2nd day after surgery. Socially presentable after 5-7 days. Sports after 4 weeks.

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Ihr Dr. Phil Million

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