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

Lipedema is a chronic condition characterized by abnormal fat buildup, primarily in the legs, arms, hips, buttocks, and stomach. It primarily affects women and usually begins around puberty. Lipedema is genetically inherited and is distinguished by its symmetrical distribution, in which both sides of the body are affected equally. In contrast to obesity, lipedema fat deposits are typically unaffected by weight loss measures. Common symptoms include pain and discomfort, swelling, and sensitivity to touch, which can sometimes progress to impede mobility. To relieve their symptoms, some patients consider compression therapy, elevation, or lymphatic drainage massages. However, most patients find that surgery is the most effective treatment for lipedema. Dr. Solomon Azouz, a board-certified plastic surgeon in Dallas, Texas, treats many cases of lipedema to help ease symptoms and improve the quality of life.

woman legs

Lipedema Center of Excellence

Dr. Solomon Azouz founded the Lipedema Center of Excellence with a strong desire to improve the lives of those suffering from lipedema. This program is a model of comprehensive care, providing professional and compassionate care to patients suffering from this chronic fat disorder. The program, led by Dr. Azouz, offers cutting-edge diagnostic procedures as well as a thorough understanding of the many phases and forms of lipedema. The approach incorporates tailored treatment programs that may involve both conservative methods such as compression therapy and specific workouts as well as advanced surgical techniques such as liposuction. Dr. Azouz’s mission for the Lipedema Center of Excellence goes beyond medical competence to provide a welcoming atmosphere that addresses both the physical and emotional elements of living with lipedema.

Am I a candidate for Lipedema surgery?

Patients with an abnormal accumulation of fat in specific areas of the body, such as the calves, legs, thighs, hips, abdomen, and arms, might suffer from lipedema. The signs and symptoms of lipedema include:
orange peel skin | cellulite treatment

  • Symmetric enlargement of both legs between the hips and ankles
  • A disproportion of legs in comparison to the knees; the disproportion of hips, stomach, or buttocks
  • lipedema symptoms

  • Easy bruising
  • Pain in the ankles, legs, buttocks, thighs, arms, or stomach
  • Sensitivity to touch in any of the lipedema-affected areas
  • Spider veins
  • Orange-peel texture to skin
  • 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 for post-bariatric surgery patients who have had a sleeve, gastric bypass, or lap band.

Lipedema diagnosis

Plastic surgeon Dr. Solomon Azouz diagnoses lipedema through history and a 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 are present.

What are the different types of lipedema?

Stages of Lipedema
lipedema fat distributions
Stage 1
lipedema fat distributions
Stage 2
lipedema fat distributions
Stage 3
lipedema fat distributions
Stage 4

Lipedema presents itself in a variety of forms, each with its own set of characteristics and affected areas. Dr. Solomon Azouz in Dallas is well-versed in recognizing and treating different types of lipedema. Dr. Azouz takes a thorough approach to addressing the specific problems involved with each stage of lipedema. Lipedema treatment may comprise a combination of techniques, such as compression therapy, and surgical interventions, such as liposuction, to ease symptoms and improve general well-being. Lipedema appears in stages that are distinguished by the progression of the condition and the location of excess fat.

Stage 1 Stage 2 Stage 3 Stage 4

Stage I lipedema causes a disproportionate distribution of fat due to a modest buildup of fat, starting in the calves with painful nodules in the hips, thighs, and buttocks. There isn’t much skin change at this stage; however, there is swelling and pain. This condition is genetic, so it would be maternally inherited. Lipedema is progressive and evolves throughout the body over time.  Easy bruising is common.

Stage II lipedema is characterized by a rise in fat buildup and nodules in the calves, hips, thighs, and buttocks. The skin becomes more uneven or dimpled as the swelling worsens, and nodules are painful and swell. Bruising is even more common than in stage one.

Stage III lipedema involves significant fat buildup in the lower legs, buttocks, hips, and thighs. This stage is distinguished by prominent swelling, larger nodules, and significant skin changes such as sponginess and increased sensitivity to bruising.

Stage IV lipedema is characterized by significant fat accumulation across the lower body. The fat distribution pattern includes the hips, thighs, buttocks, and lower legs. At this stage, the illness can appear as significant swelling, huge nodules, and noticeable skin changes.

Lymphedema vs. Lipodystrophy vs. Lipedema

the difference between lipedema and lymphedemaLymphedema

Lymphedema is a disorder of the lymphatic system that causes an abnormal accumulation of lymphatic fluid. Novel techniques in microsurgery and liposuction have helped patients have definitive treatment for 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 pitting edema, whereas lipedema has non-pitting edema. Pitting edema is swelling similar to pressing into a cushion. When pressing your skin, you will notice a visible “dent” in the skin. Non-pitting edema is swelling similar to that of an inflated balloon. Your skin may feel firm, but it will not make an impression on the skin. 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. This is a form of stubborn fat that does not improve with diet and exercise. Lipodystrophy causes fat to accumulate more in certain areas of the body than it would usually. Lipodystrophy causes fat to be stubborn and difficult to lose, despite diet and exercise. Lipodystrophy is often asymmetric and does not involve pain, swelling, or nodules. Lipodystrophy is often located in one or more areas but does not evolve over time. Lipodystrophy can be associated with weight changes.

Lipedema is often genetically inherited among all women in the family. Lipedema is very similar to lipodystrophy, but it is also associated with pain, discomfort, and swelling. Lipedema patients tend to get worse over time. Lipedema is symmetric. spider veins with lipedema | stubborn fat spider veins Enlarging fat cells can compress the surrounding lymphatics, cause worsening swelling, and even progress to some forms of lymphedema, which is referred to as lipo-lymphedema. Most patients feel “knots,” or clusters of fat cells, in their arms, legs, stomach, hips, or back. Furthermore, fat cells can compress blood vessels and cause problems in circulation. Many patients develop spider veins, or telangiectasias, which are dilated blood vessels and appear as small, thin red or purple lines. Some patients may develop venous insufficiency; however, they find that vein procedures usually do not affect their lipedema symptoms. 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 a direct surgical excision. It is imperative to perform a history and physical exam to determine if a patient has lipedema, lipodystrophy, or lipedema.

Lymphedema Lipodystrophy Lipedema
“water or fluid build up” “stubborn fat” “painful knots of fat cells”
Asymmetric Asymmetric Symmetric
Swelling (pitting) No swelling Swelling (non-pitting)
Painful Not painful Painful
Affected by lymphatic drainage Affected by weight changes Constant and progressive, even with weight changes

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 they do not address the underlying fatty tissue. Similarly, non-surgical fat reduction (liposuction alternatives) such as laser fat removal, creams, and fat freezing have 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 calves, legs, thighs, abdomen, and arms. Once fat cells are removed, less stress is placed on lymphatics and blood vessels. Dr. Solomon Azouz utilizes a variety of liposuction techniques to remove stubborn and scarred fatty tissue.

Dr. Azouz may need to perform multiple procedures to address all areas of lipedema. It’s important to note that some surgeries may need to be spaced apart to allow for adequate healing between each procedure.

Facelift: Also known as a rhytidectomy, a facelift addresses sagging jowls and facial tissues that may be brought on by aging or weight changes linked to lipedema. To lift and realign the facial tissues, Dr. Azouz performs facelift surgery by making camouflaged incisions, typically around the hairline and ears. Facelift surgery addresses the effects of aging or changes associated with lipedema, resulting in a more youthful and rejuvenated facial contour.

Breast Lift: To treat drooping or sagging breasts that may arise from weight changes associated with lipedema, a mastopexy, often known as a breast lift, is performed. Dallas plastic surgeon Dr. Azouz performs breast lift surgery, which involves contouring and raising the breasts to a more youthful position. Patients experiencing lipedema can achieve a more perky breast contour with breast lift surgery.

Brachioplasty: Brachioplasty is a procedure that removes extra fat and sagging skin from the arms. Board-certified plastic surgeon Dr. Azouz performs a brachioplasty by carefully placing incisions on the inner arms and removing excess fat and skin. This improves arm contour and reduces flabbiness, resulting in a more aesthetically pleasing appearance.

Abdominoplasty (Tummy Tuck): Abdominoplasty removes extra fat and skin from the abdomen. A drainless tummy tuck is frequently combined with muscle tightening to improve abdominal tone. Dr. Azouz’s method produces a smoother and firmer abdomen contour, addressing the specific needs of lipedema patients.

Body Lift: Often performed after substantial weight loss or for lipedema treatment, a body lift is a comprehensive operation that addresses extra skin and fat in numerous regions. Board-certified plastic surgeon Dr. Azouz removes extra skin and fat by strategically placing small camouflaged incisions, usually around the torso. This helps to remove excess fat and saggy skin from the back. By addressing the effects of lipedema in multiple places, body lift surgery produces a more toned and proportionate body form.

Thigh lift: A thigh lift is a procedure that reshapes the thighs by removing extra skin and fat. Thigh lift operations are designed for lipedema patients and involve strategically placed incisions to remove excess tissue. This can lead to improved thigh contour, which contributes to an overall improved aesthetic appeal by treating excess fat accumulation in the upper legs.

Lipedema surgery benefits

Lipedema surgery can be life-changing for many patients. Some of the benefits include improved 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.

woman legs

Liposuction for Lipedema

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

Custom Traditional liposuction

Traditional liposuction cannulas have varying tips, sizes, lengths, and widths to target different types of fatty tissue. Dr. Solomon Azouz combines traditional liposuction techniques with other modalities to offer patients 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. Dr. Azouz has customized and created novel cannulas specifically for lipedema surgery that are unique to his lipedema program.

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 can also 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 also 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.  These devices are often associated with burns and are therefore no longer used by many plastic surgeons in favor of SAFE liposuction.

smiling woman

Anesthesia used during lipedema surgery

Dr. Solomon Azouz most commonly 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. Solomon Azouz, it is important 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. Solomon 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 that need liposuction or lipectomy (cutting out fatty tissue). The price also depends on the type of fatty tissue, scar tissue, the severity of lipedema, medical comorbidities, the history of previous surgery, and the patient’s weight. Following the history and physical examination, Dr. Azouz will assess the individual patient to determine the Lipedema surgery price and explain the financing options available for his patients.

Lipedema Before and After

Lipedema surgery results

Lipedema surgery can have a life-changing impact on anyone suffering from this stubborn lipedema. Dallas plastic surgeon Dr. Solomon Azouz uses liposuction to remove excess fat accumulation, particularly in the arms, legs, stomach, and even the back. Patients often report a significant reduction in discomfort and pain, better mobility, and improved body contour following surgery. Dr. Azouz’s expertise offers a tailored approach that addresses the specific needs of each patient. Many patients report a significant improvement in their general well-being and a more comfortable and active lifestyle. The 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. Board-certified plastic surgeon Dr. Solomon Azouz also offers virtual consultations for patients who live far from Dallas. During your virtual consultation, Dr. Azouz will discuss options for traveling to Dallas for lipedema surgery

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