To begin with, lipedema surgery is very particular and should ideally be done by a surgeon with extensive experience in lipedema for numerous reasons. These are complicated areas, there is a lot of fibrotic scar tissue that must be understood in terms of completely decongesting and releasing properly. The treatment of the calf and ankle area in particular needs to be done in a completely circumferential manner, covering every millimeter to not only get the best treatment off the disease itself but to truly optimize cosmetic results especially in Stage 1 patents where it has to be done perfectly cosmetically. For years I have emphasized the importance of trusting the surgeon rather than trusting a tool or modality. That is by far the most important thing. In regard to that, there are so many important considerations in how the area is designed, where axis points are strategically placed to not only create the smallest scar but to perfectly sculpt the area staying in what I call the “safe plane” and finally the ability to position the patient by ideally avoiding general anesthesia which is very important. Airsculpt is simply a tool that is another type of cannula. All those other things that I previously mentioned are what is truly important to getting the best result. Personally, I find a very systematic multistep approach the best in terms of insuring optimal cosmetic results. Even though I said that tools are of less importance, I do use a variety in my way of sculpting. Step 1, I properly prepare the tissue completely with tumescent anesthesia. Step 2, especially with lipedema, I remove the deeper layer of fat and mechanically release the fibrosis tissue. Step 3, I use Vaser to further emulsify fat and further release fibrosis to create a smooth skin undersurface. Step 4, is fine sculpting in certain areas. Step 5, I use a final skin tightening step of either Renuvion or bodytite radio frequency.
