Would liposuction help my lipedema or should I get a tummy tuck first? (photos)

Be47125 thank you for sharing your photos. Your decision about a Tummy Tuck or Abdominoplasty should be just for cosmetic considerations. It should have no effect on lipedema. Lipedema is an subcutaneous adipose tissue disorder that should be treated comprehensively and can be managed but not cured. Medical grade compression and an antinflammatory diet should be part of any treatment of lipedema. For women with lipedema who need additional help with symptoms lipedema reduction surgery using modified liposuction techniques can decrease pain, swelling and increase mobility.
In theory, insurance covers surgery for some women, who the insurers, not you or your doctors deem are significantly hindered in their ability to perform instrumental activities of daily living. In practice medical insurers impose arbitrary denials for surgery, for example by looking a patient's photo and claiming they do not have lipedema.
Yes, I would recommend choosing a surgeon who has a good deal of experience treating lipedema and has consistently good to excellent results for his or her lipedema patients.

With a diagnosis of lipedema, it is advisable to first address the lower extremity lipedema with liposuction prior to considering a body lift procedure. I recommend making an in-person or virtual consultation appointment with a lipedema specialist for a thorough history and review of photos/physical examination to determine if liposuction is right for you.

I am so happy to hear that other physicians are becoming aware of lipedema and correctly diagnosing patients. Your vascular surgeon correctly diagnosed you with lipedema as I can appreciate simply based on the characteristic shape and distribution of fat and swelling of your legs, both upper and lower. Your legs are forming more of a column like shape with distribution of fat and swelling. Your torso which was previously done with liposuction created a lot of the irregularities in my opinion and should not have been done first. Not only because it is creating irregularities but because it is not properly treating balance and proportion in your body and is creating more disproportion. Your legs should have been considered as part of the overall approach to creating balance and proportion with liposuction surgery. I strongly feel that it is important to have the lipedema in your legs properly treated by an experience lipedema surgeon. As time goes on, this will only continue to get worse and can begin to affect your lymphatic circulation potentially leading to lipolymphedema. In addition to that, the skin elasticity will also begin to decrease, becoming more difficult for well-done liposuction to achieve uniform and even skin retraction. It does look as though from the photographs that what might be necessary to improve the irregularities in your abdomen is a well done abdominoplasty procedure but personally I would not make this a priority right now but rather focus on your legs. It could be possible under further evaluation that I would maybe consider revision liposuction surgery to your abdomen involving a multistep approach with emulsification, release of fibrosis and scarring from the previous liposuction surgery and using a modality such as Renuvion J-plasma to get skin tightening but I would have to make that determination when seeing you in person.

Seek out an expert for a formal evaluation. When we perform liposuction to the lower legs, microcannulas are used to remove fat very superficially without damaging the tissue or causing any scars or irregularities. Multiple energy devices are used to melt fat and tighten skin, which is especially needed in this small, sensitive area. Precision and skill is vital to get the best outcomes.

Coolsculpting and Kybella are non-surgical options that can also be used for fat reduction in the knees.

I recommend getting a formal evaluation with an expert to determine the best course of treatment for you. Best, Dr. Emer

Thank you for your question. You can have both procedures done at the same time, but your doctor might refer you to a rheumatologist that will provide the clearance and to make sure is under control.

Respectfully,
Dr. Emmanuel Mallol Cotes.-