Lipedema stage 3. Recommendations? (Photo)

Question

Been told i have early stage 3 Lipedema in legs. Looking at pics of ppl that had Lipedema Lipo and they don’t look very successful which I was considering doing. My BMI is a 41 though and I afraid I’m never going to get it down unless I do something. It’s almost a catch 22. I did have WLS and have lost 70 lbs but have been stagnant for roughly 8 months now. Recommendations?

Jason Emer, MD · Answer

When you have lipdemedma you will need procedures to improve the medical portion of your condition but if you want cosmetic improvement, you will need staged procedures with liposuction and skin removal.You need a formal evaluation by an expert in body shaping and contouring to determine what is best.  Traditional liposuction awake and smart liposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radiofrequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well . trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a brazilian butt lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting.  Dr. Emer.

Thomas Wright, MD · Answer

Thank you for sharing your pictures. From your pictures, it looks like you have Stage 2 lipedema. At least from the pictures you shared. I do not see the lobules on the legs that are characteristically seen in stage 3 lipedema. It also appears you have some secondary obesity. 
I would encourage you to treat your lipedema comprehensively with compression and an anti-inflammatory diet and consider lipedema reduction surgery. Lipedema Reduction Surgery with lymphatic sparing surgical techniques is associated with improved quality of life and decreased risk of disability.  Treatment of your lipedema in my experience and from my publications can help with your leg symptoms, improve mobility, and even help control your overall weight. I just published a paper on this in the November 30th PRS Global Open Medical Journal. I would encourage you to treat your lipedema comprehensively with compression and an anti-inflammatory diet and consider lipedema reduction surgery. Keep up the good work. Wishing you the best of health.

Raffy Karamanoukian, MD, FACS · Answer

Lipedema affects nearly 25 million women in the US. As a board certified plastic surgeon and a board certified lymphedema expert, I manage complex lip edema cases with a combination of liposuction and skin tightening procedures. 
Most cases of lipedema improve with liposuction and fat lipolysis with laser and Coolsculpting. A combination approach is ideal. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jaime S. Schwartz, MD, FACS · Answer

Lipedema is a very underdiagnosed condition in the US and the world. This is mainly from a lack of understanding. There are a lot of symptoms and differences from just weight gain. However, I would need to understand a lot more about your particular case. As an FYI, there is a small group of us that is working very closely with the lipedema community to educate as well as develop Standard of Care Guidelines for the US. My treatment algorithm includes a Lymphatic Sparing Thigh Lift. I presented this at the lipedema conference in 2017. 
For more information please visit our lipedema educational website.

Hope this helps!
Jaime S. Schwartz, MD, FACS

Diplomate, American Board of Plastic Surgery 
Fellow, American College of Surgeons
Associate Clinical Professor of Surgery
USC Keck School of Medicine
Division of Plastic and Reconstructive Surgery
#RealSelf100Surgeon

#RealSelfCORESurgeon

Resat Aktas, MD · Answer

Dear Madam, I hope you are doing well. Yes your BMI is over the liposuction criteria. In your case first it would be fine if you would try to lose weight on your own. If you can not, you would consider liposuction and skin removal options. According to my experience the best option is removal of excess fat from your legs and arms, later skin removal surgery should be done. It is a long journey around 1-2 years however if you would be patient, I believe that you see its result.

Boris Volshteyn, MD, MS · Answer

Lipedema rarely starts in the arms. Remember, lipedema is not heavy arms or fat accumulation. Lipedema is increased pain, increased bruising, and hypersensitivity. Women with arm involvement usually complain of being unable to even check blood pressure because of pain and discomfort. That is not what I get from your post. I congratulate you on losing 70 pounds with weight loss surgery. If indeed you have a lipedema, the treatment is usually a combination of liposuction and skin excision. Some other skin tightening procedures can be performed using energy devices, but the results may only be partially predictable in lipedema patients.

Lipedema stage 3. Recommendations? (Photo)

Answers (6)

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