Smart lipo ok for lipedema?

Question

I have lipedema in my hips outer thighs and inner. I went to consult and the doctor said that he will do the procedure but only with smart lipo. Is that the correct procedure?

David Amron, MD · Answer

Dear Lora,Smart Lipo is a tool that we use in liposuction and I use it myself in a specific way. Rather than paying so much attention to the tools that are being used, more importantly is the evaluation of the patient with lipedema. My experience with lipedema is almost always a circumferential pattern of distribution that goes all the way around. My feelings are just to focus on the hips, outer and inner thighs is not going to correct lipedema, number one from a disease treatment standpoint, secondly from a cosmetic standpoint. Lipedema really encircles the entire thigh, at least then goes down to the lateral thigh, anterior thigh and posterior thighs. 
I do a lot of revision surgery for lipedema, where it was targeted in certain areas such as inner or outer thighs, but it’s not the right approach because all of this lipedema fat is left behind and disproportion is created from a cosmetic standpoint. My preference is to approach it circumferentially. Is the doctor approaching it in a circumferential fashion? Secondly, lipedema is a complex disease, the surgeon needs to understand the pre and post care and also done in a lymphatic sparing way. Lymph sparing liposuction means to not damage the lymphatics. I strongly prefer to avoid general anesthesia, because the advantages including safety, recovery and more importantly, the results. General anesthesia can be done, it is not my preference for a number of reasons. General versus local does not guarantee that it is lymphatic sparing or not, it is where the surgeon stays in terms of the safe plane in the subcutaneous layer of fat. 
In terms of devices, there is a lot of discussion of this. We all know that the WAL (Water-assisted liposuction) has become very common with lipedema patients and has lymphatic sparing attached to it. I use the WAL as the first step in surgery, to put the fluid in, to hydro dissect and to numb the area. I then use an emulsification step, which is either VASER or a Laser (Smart Lipo) or sometimes both. I’ve used it for years in hundreds of patients and believe it’s safe to use in the right hands. Finally, I use PAL (power-assisted liposuction) as my primary sculpting tool, which mechanically further helps to release things. So, yes Smart Lipo can be used, but it is not what to focus on as the most important factor in the best result in a lipedema patient. I wish you the best of luck with your care. If you have any questions, I encourage you to contact my practice.

Lawrence Broder, MD (license disciplinary actions) · Answer

Liposuctions is the preferred procedure for lipedema areas.  Aggressive liposuction under local anesthesia would be ideal.  Use of the Smartlipo laser would only be warranted if loose skin was also an issue.

Smart lipo ok for lipedema?

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Smart lipo ok for lipedema?

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