BMI would be higher in someone with lipedema. Why is that not taken into consideration, or is it?

Each plastic surgeon will have their own level of comfort in regards to operating on patients regarding BMI.

For me I don’t use BMI as a strict criteria but rather total body weight since Liposuction is limited by total fat amount that can be removed and stay within safety limit parameters set by state regulators in some states and recommendations by the American Society of plastic surgeons.

In most states this is a limit of 5 L of that removal per procedure.

That turns out to be about 8 pounds of fat sometimes a little bit more.

8 pounds of fat is sufficient for most people who weigh under 170 pounds. Went through obesity sets in and patients way over 200 pounds 8 pounds of fat removal is insufficient to make a significant impact and these patients need multiple rounds of surgery in order to stay within the 5 L safety limits.

220 pounds is typically my maximum absolute cut off at which point I will not consider surgery because even three rounds of liposuction becomes insufficient. Obviously it matters what part of the body is being treated.

The specific gravity of fat is very close to water. It is 0.93. Even if there’s more water in the fat of patients with lipedema the differential is 7% at the most.

Lymphedema is completely unrelated to lipedema. It is a completely different condition and the two have really nothing to do with each other. People with lipedema do not have lymphedema and people with lymphedema should not be treated the way people with Lipedema are. Generally speaking patients who have lymphedema should avoid all surgical procedures because scar tissue can worsen the condition.

The most common cause for lymphedema is due to previous surgical intervention typically cancer treatments were lymph channels are damaged and blocked off with scar tissue. skin reduction is not a typical treatment for lymphedema.

It isn’t really clear what you’re asking for in your post.

If you have lipedema and you found a surgeon you like then follow his or her recommendations.

Don’t confuse having lipedema with lymphedema.

The truth is very little is known about lipedema. There is virtually no information in plastic surgery textbooks on the condition.

Any doctors who have expertise in this condition will be from first-hand experience doing liposuction and or skin resection on these patients.

It is not something that is learned from board certification, specialty residency or fellowship training etc. etc.

We still do not know what causes lipedema, what it is or even how to properly diagnosed nor treated other than Liposuction.

It is for sure a frustrating condition to have.

Best,

Mats Hagstrom MD

I will try to clear up a little of your confusion. I cannot, however, make too many comments about you, since you did not really tell me anything about yourself other than implying you have an elevated BMI. First, fat is fat. The more fat, the higher your BMI. The only time where a high BMI does not mean that is if you have a significantly increased muscle mass. Even then, this does not markedly increase the BMI. Secondly, there really is no such thing as lipedema. It is simply a term people use for localized fat deposition. Liposuction is used to remove localized fat. It is not used to reduce generalized fat or your BMI. If you are overweight, and the doctors you saw refused to do liposuction, good for them. Before doing liposuction you need to get down to a very reasonable BMI and then determine whether the remaining localized fatty areas can be removed by liposuction leaving a reasonable contour or if you need to remove the skin that would be loose after the liposuction. You also need to know that not all "board certification" is equal. You need to make certain that whomever is doing your liposuction is board certified in plastic surgery. Many board certified family practitioners, GYN doctors, anesthesiologist, etc. are doing liposuction because they think it is easy and profitable. However it is not easy, particularly if you want to get a good result, and it is also not a surgery to take lightly. It actually has 1 of the highest mortality rates of any surgery, mainly because it is done by untrained people on overweight people removing too much fat and causing too much fluid shift within the body. If done by an expert, however, it is a very safe procedure. The other thing you need to know is that, just because the doctors have a "great reviews" does not necessarily mean that they are great surgeons.