In the case of persistent complaints with functional limitations due to the pain symptoms, we recommend a presentation to plastic surgery in order to work out a treatment concept. If conservative measures have not led to a significant improvement in symptoms, liposuction may be the right alternative for you.
course of treatment
Each treatment is as individual as each lipoedema is. However, we would like to give you a brief general overview.
The areas to be treated are drawn on the skin and photo-documented immediately before the procedure. According to the markings, small puncture incisions (cuts) are made and the subcutaneous (subcutaneous) fatty tissue is infiltrated with a water jet through an infiltration cannula with a special solution and loosened up.
The solution also causes the smaller vessels to contract, reducing blood loss as much as possible. Due to the balanced salt composition, your body is not deprived of any liquid by the solution. For the most part, the applied solution is gently suctioned off after the appropriate exposure time, together with the loosened fat cells, and thus puts as little strain on your circulation as possible. The suction takes place with liposuction cannulas of different calibers. The selection is made individually according to the findings. We pay meticulous attention to protecting the neighboring anatomical structures, especially the blood and lymphatic vessels.
It is important to have an axially correct (parallel to the blood and lymphatic system), lymph-sparing liposuction in order to prevent or prevent the development of secondary lymphedema. A residual layer of subcutaneous fat corresponding to the anatomical contours of the body is left to maintain a necessary lubricating layer between the skin and muscles.
After the operation, the small wounds are closed with sterile adhesive plasters. Additional protective plasters are attached over this. The compression garment is put on in the operating room so that the initial swelling is limited.
There are basically two anesthetic procedures available for liposuction. On the one hand, the operation can be performed under general anesthesia. This is the procedure we use in most cases. In addition, the tissue is infiltrated with a so-called tumescent solution. This contains a local anesthetic to relieve pain, adrenaline, which constricts the smallest vessels in the tissue so that there is less bleeding, and another substance (bicarbonate) which causes the fat cells to swell so that they can be suctioned out more easily.
On the other hand, the operation can also be performed alone under tumescent anesthesia. Large amounts of liquid are infiltrated into the areas to be treated. In addition, the patient is then given a drug to sedate (calm down). We consider general anesthesia with additional tumescence infiltration to be a very safe and comfortable procedure for the often large and time-consuming operations, since there can be no sudden and unexpected pain reactions during the operation.
In our experience, patients who have already experienced both procedures are more likely to opt for general anesthesia, since the entire procedure is then more relaxed for them. Worldwide there is a clear trend towards surgery under general anesthesia. Both procedures have an extremely low complication rate and are considered to be similarly safe. A very experienced anesthesia team is available to you and will discuss all the details of the anesthesia with you in advance.
As part of our care, we primarily address your individual complaints and problems. In addition to the diagnosis of lipoedema, other aspects that are important to you can also be treated. Common problems are a slack complexion, broom tears, scars, etc.
After liposuction, we recommend wearing compression clothing day and night for a total of 6 weeks. This can of course be taken off for showering or washing.
After the fat cells have been removed by liposuction, there is sometimes pronounced swelling. In order to reduce this as quickly as possible and to achieve an even skin surface, wearing a compression garment is essential. Your tissue needs rest, stability and strength after the operation. This can best be achieved in the weeks after the operation with a compression garment. This should be worn for at least 4-6 weeks.
If you have the feeling that the bodice will still do you good after this time, there is nothing wrong with wearing the underwear longer. If you have a suitable flat-knit compression garment (e.g. compression class 2) from the previous conservative therapy, this supply would be a very good option for the first few weeks after the operation.
In particular, before and after the operation, you should ensure a balanced diet rich in vitamins in order to be optimally prepared for the operation. If you are planning a diet, it should be finished a few weeks before the operation so that your body can return to normal metabolism and you are in a situation of building up and not breaking down.
After the operation, you can support the healing process with various homeopathic remedies, for example to promote the reduction of bruises (haematomas) or the reduction of swelling. There is no lipoedema-specific diet, but it is recommended to take sufficient breaks between meals and to avoid blood sugar and insulin spikes (isoglycaemic nutrition). Because high insulin levels promote lipogenesis, i.e. the increase in fatty tissue. In addition, weight loss should not be at the expense of muscle mass, but fat mass.
After the operation, you should avoid sports and strenuous activities for 4-6 weeks so that your body can regenerate optimally. You can then slowly and in a coordinated manner start your sports program again.
You will achieve the almost definitive result of liposuction approx. 2-3 months after the operation. This is also our recommendation as a time interval between further liposuction sessions, if your therapy concept requires it. The follow-up checks take place in our clinic. If necessary, we are also available to you by telephone via our secretariat.
Priv. Doz. Dr. med. Klaus J Walgenbach
Plastic and Aesthetic Surgery at the University Clinics Bonn | dermatology