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Slim woman's legs after leg fat removal for lipedema treatment. Slim woman's legs after leg fat removal for lipedema treatment.

Lipedema is very common occurring in millions of women. As many as twenty million people in the US are affected by lipedema. Lipedema is a disorder of fat distribution that is genetically inherited and most often affects women. Unlike lipodystrophy, which is stubborn fat that is abnormally deposited, lipedema is also associated with pain and swelling. Lipedema is often misdiagnosed as obesity. Many patients will have a normal weight but will have stubborn, painful fat that would be much more likely to be seen in a much heavier person.

woman legs

Am I candidate for Lipedema surgery?

Patients with an abnormal accumulation of fat in specific areas of the body option such as calves, legs, thighs, hips, trunk, and arms might suffer from Lipedema. The sign and symptoms of lipedema include:

  • Symmetric enlargement of both legs bilaterally between the hips and ankles
  • A disproportion of legs in comparison to the knees, the disproportion of hips, stomach, or buttocks
  • Legs and thighs with easy bruising
  • Pain in the ankles, legs, buttocks, or thighs
  • The fat that accumulates and pushes over the knees
  • The fat accumulates over the legs and thighs even when there has been extreme weight loss in the upper body. This is especially true in post-bariatric surgery patients who have had a sleeve, gastric bypass, or lap-band.

Lipedema diagnosis

Plastic surgeon Dr. Azouz diagnosis lipedema through history and physical exam. Lipedema often presents during puberty, pregnancy, or menopause. Lipedema can be caused by hormone imbalances. Providing Dr. Azouz with a history of the occurrence of lipedema in puberty, pregnancy, peri-menopause, menopause, and following gynecologic surgery can be helpful. Dr. Azouz will examine the fat distribution and palpate the areas of lipedema to determine if fluid, nodules or scarring is present.

Lymphedema vs. Lipodystrophy vs. Lipedema

woman legs

Lymphedema is a disorder of lymphatics which causes an abnormal accumulation of lymphatic fluid. Novel techniques in microsurgery and liposuction have helped patients to have definitive treatment of their lymphedema. Lymphedema typically only affects one limb, whereas lipedema is usually bilateral, affecting both limbs. Lymphedema often occurs after a trauma or surgery, whereas lipedema occurs after hormones act on tissues (during menopause or puberty). Lymphedema usually has to pit edema, whereas lipedema has non-pitting edema. Lipedema is generally more painful than lymphedema. Lymphedema is generally associated with skin infections, unlike lipedema, where skin infections are not common.
Lipodystrophy is a disorder of fat accumulation. Lipodystrophy causes fat to accumulate more so in certain areas of the body than those where it would usually. Lipodystrophy causes fat to be stubborn and difficult to lose despite diet and exercise.
Lipedema is very similar to lipodystrophy but it is also associated with pain, discomfort, and swelling. Lipedema patients tend to get worse over time. Enlarging fat cells can compress the surrounding lymphatics and cause worsening of swelling and even progress to lymphedema which is referred to as lipo-lymphedema. Furthermore, fat cells can compress blood vessels and cause problems in circulation. Fat cells can scar and form lipomas within the lipedema tissue.

Both lipodystrophy and lipedema can be treated with liposuction. Lipedema is sometimes treated with direct surgical excision. It is imperative to perform a history and physical exam to determine if a patient has lipedema, lipodystrophy, or lipedema

Surgical vs non-surgical treatments for lipedema

Nonsurgical Treatments for Lipedema
Unfortunately, there is no medical treatment that typically results in the complete resolution of lipedema. Compression and elevation can be helpful but do not address the underlying fatty tissue. Similarly, non-surgical fat reduction (liposuction alternatives) such as laser fat removal, creams, and fat freezing has not been proven to remove deep lipedema and lipodystrophy. Though weight loss can remove fat, in general, it does not remove lipedema. Compression garments for lipedema can be painful, hot, cause sweating, and can be poorly tolerated.
Surgical Treatment of Lipedema: Liposuction and Lipectomy

Surgical options for lipedema include liposuction and lipectomy (direct removal of fat). Many major medical organizations have listed liposuction as the only effective treatment for lipedema. Liposuction and surgical excision actually remove fat cells in the calve, leg, thigh, abdomen, and arms. Once fat cells are removed there is less stress placed on lymphatics and blood vessels. Dr. Azouz utilizes a variety of liposuction techniques to remove stubborn and scarred fatty tissue.

Lipedema surgery benefits

Lipedema surgery can be life-changing for many patients. Some of the benefits include improved in aesthetic appearance, improved mobility in some cases, and increased self-confidence. Some patients report that they have decreased pain in the lower extremities after lipedema surgery.

Liposuction for Lipedema

Dr. Azouz uses a combination of liposuction techniques in removing lipodystrophy, lipedema, and scarred fat in lymphedema patients. These liposuction techniques include:

Traditional liposuction
Traditional liposuction cannulas have varying tips, sizes, lengths, and widths to target different types of fatty tissue. Dr. Azouz combines traditional liposuction techniques with other modalities to offer patients a safe, comfortable, and effective contouring of various body locations. Liposuction allows for the removal of fat through small minimally invasive incisions that are hidden, concealed, and camouflaged by Dr. Azouz.
Tumescent Liposuction
Tumescent liposuction adds fluid and epinephrine to traditional liposuction techniques effectively minimizing bleeding while also permitting a less painful procedure. Liposuction can be performed under local anesthetic and sedation rather than general anesthesia with tumescent liposuction techniques. Tumescent liposuction also can help to avoid bruising and soreness.
Safe Liposuction
SAFE liposuction stands for liposuction with Separation, Aspiration, and Fat Equalization and has been extensively studied in Aesthetic and Plastic, and Reconstructive surgery journals. Safe liposuction breaks up adhesions and scar tissue between the dermis, fascia, and fatty tissue to create a uniform subcutaneous fat layer. Safe liposuction helps to avoid contour deformity and inadequately treated areas. Dr. Azouz uses SAFE liposuction techniques in patients undergoing their first operation and patients who have had liposuction elsewhere that require a revision liposuction procedure.
Power-Assisted Liposuction (PAL Liposuction)
Power-assisted liposuction uses a vibrating cannula to break up fatty tissue. Studies have shown that power-assisted liposuction permits increased precision with less bruising and efficient fat removal. Power-assisted liposuction can also remove up to 30 percent more fat than traditional liposuction methods.
Liposuction with a power source (Ultrasonic/Vaser/Laser Liposuction)
Liposuction with a power source can help dissolve fat and permit liposuction to be easier and more efficient. Some energy sources are also thought to contribute to skin tightening.

smiling woman

Anesthesia used during lipedema surgery

Dr. Azouz uses local and sedation anesthesia when performing lipedema surgery. Dr. Azouz has found that his patients recover more quickly and have less nausea with the use of local and sedation anesthesia versus the use of general anesthesia.

Lipedema recovery

After undergoing lipedema surgery with Dr. Azouz, it is advised to give yourself a few days to completely rest, recover, and elevate your legs as much as possible. Within the first few weeks following lipedema surgery many patients can return to desk work as long as they continue to elevate their legs. During your follow-up appointments, Dr. Azouz will help guide you on when you can add in prolonged standing time and more vigorous activities.

Combination of Lipedema with other plastic surgeries

Dr. Azouz usually does not recommend combining other plastic surgery procedures with lipedema surgery. However, each patient is different. If you are interested in undergoing a combination surgery with your lipedema, book a consultation with Dr. Azouz. During your consultation, Dr. Azouz will discuss your surgical options and determine if you are a candidate to combine another procedure with your lipedema procedure.

Lipedema surgery cost

The cost of lipedema surgery is highly variable and depends on the sites which need liposuction or lipectomy (cutting out fatty tissue). The price is also dependent on the type of fatty tissue, scar tissue, the severity of lipedema, medical comorbidities, history of previous surgery, and patients’ weight. Following the history and physical examination, Dr. Azouz will assess the individual patient to determine the Lipedema surgery price and explain financing options available for his patients.

Lipedema Before and After

Lipedema surgery results

Results of Lipedema surgery are unique to each patient. Cosmetic improvements can be seen after several weeks; however, most patients will see final results after 6-12 months after Lipedema surgery.

Schedule a consultation with Dr. Azouz

If you are a patient suffering from Lipedema, lipodystrophy, or lymphedema call us at (972) 702-8888 or contact us online, arrange a consultation with Dallas Lipedema plastic surgeon Dr. Azouz today, and take the first step to enhance your figure.

Frequently Asked Questions

Lipedema Surgery patient review for Dr. Azouz

“I highly recommend Dr. David Azouz and Dr. Soloman Azouz to anyone suffering with lipedema. I knew for many years that something was wrong with how large my legs were, but I did not know what was wrong. I did my own research and when I suspected I had lipedema, I visited Dr. Azouz and he confirmed that I did have it. I was very nervous to discuss the surgery, but went prepared with a list of 15 questions. The doctors took their time to answer everything in detail and reassured me of any worries I may have had. Dr. Azouz removed 10.5 liters of fat from my legs. As of today (5 weeks later), I am down 19 pounds. Both doctors are very personable, informative, professional and attentive. They both called me every day for the first week to check on me. If I had a concern, I called the phone number given and would receive a call almost immediately after. I felt very safe and very well taken care of. This surgery is a big surgery and Dr. Azouz prepared me for what to expect after.”

Read more patient reviews for Dr. Azouz

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