Lipedema is a lose connective tissue disorder associated with pain in the legs and lower half of the body. Traditionally Lipedema had been associated only with painful fat. Many doctors do not fully understand complexity of Lipedema and, unfortunately, ignore it. Patient is usually referred to a weight-loss specialist, for bariatric surgery and sometimes to psychiatrist. Truth be told, the fact that is deposited in the legs and the lower extremity in the Lipedema patients is resistant to diet and exercise.
Liposuction have been one of the most common treatment methods of Lipedema. However, it’s difficult commonly to differentiate between different types of liposuction. This video is designed to provide some clarity. One of the most commonly used terms is tumescent liposuction. Unfortunately, tumescent liposuction is not the liposuction at all. Tumescent is a technique of preparation of the tissue for liposuction. Going back in 1970 when the liposuction became popular, liposuction was performed without any preparation. It resulted in a lot of bleeding. Many people at that point felt that this was not a productive technique. At some point Dr. Klein, California-based Dermatologist and Pharmacist came up with a solution that was designed to shrink the blood vessels to decrease blood loss and to numb up the area. He use the combination of the normal saline solution with lidocaine and Epinephrine injected under the skin. The solution now is known as tumescent solution. Saline usually blows up the tissues, epinephrine shrinks the blood vessels and decreases blood loss and lidocaine numbs up the tissues requiring less anesthesia. When people refer to tumescent liposuction, all they mean is that the tissues are injected with numbing solution. One of the most common ways to perform liposuction is standard tumescent liposuction. What it means is that after tumescent Fluid was injected into the subcutaneous fat, A hollow cannula attached to a suction machine, is placed under the skin and moved back-and-forth. Unfortunately, it is a very demanding process on a surgeon. Therefore, our assistant liposuction came as an alternative to a traditional way. With power assisted liposuction the canyola vibrates about quarter of an inch back-and-forth. As the vibrating cannula passes through the tissues, it creates shaking affect on the tissues and is more gentle. The cannula size is also decreased creating less damage. The tip of the cannula is rounded to prevent cutting the tissues. I would say that 90% of surgeons today use power assisted liposuction devices for Lipedema liposuction. Another popular technique is water assistant liposuction. Water assisted liposuction uses a large cannula with a special jet located inside of the kennel itself. As a cannula is moved back-and-forth and the jet sprays saline solution, it is supposed to provide more gentle way of removing fat. I do not think that water assisted liposuction is necessarily more gentle. The tip of the cannula is sharp like a tip of the boat and the size of the cannula is larger. Cannula does not vibrate so it requires significantly more force to move it back-and-forth through the tissues. I believe it is helpful and patient requiring smaller amount of fat to be removed but in patients with what significant fat deposits, it is not practical. Another popular technique is ultrasonic assistant liposuction. It is also known as vaser. Vaser is not liposuction. Vaser probe is a solid metal tube with ultrasonic rings on it’s very tip. After tumescent fluid is injected into the tissues, the ultrasonic probe is moved back-and-forth. Ultrasonic energy is specifically tuned to the frequency designed to disrupt the connection between connective tissues and fat cells. It is similar to shaking the apple tree and letting the apples fall down on the ground. As a result, the fat cells drop on the bottom and turn into the buttermilk like fluid. Then the liposuction machine is brought in and using power assist and liposuction this fluid is removed on a low setting. In most cosmetic patients ultrasonic assisted liposuction is believed to add additional skin shrinking. I don’t think there are studies to support that the same affect happens in Lipedema patients. Finally, I have to mention laser assisted liposuction. I do not think that it should be ever used for Lipedema patience. Laser assisted liposuction uses laser energy passed through a fiber optic wire under the skin. Then the fiber optic wire is passed back-and-forth. In essence, it acts as a hot poker. It burns everything on its way including blood vessels, fibers connections, and lymphatic’s. Even though surgeons use the same Equipment for cosmetic Patients and Lipedema patience, the technique of liposuction in Lipedema patients is different. Surgeon must be aware of location of lymphatics and be extremely careful. Smaller cannulas are used and the cannulas cannot be used in certain directions. This is lymph sparing technique
