Lipedema treatment

Before treatment

Have you already seen a vascular surgeon, dermatologist or lymphologist? If so, please bring your medical records with you to your consultation with Dr Demir. A recent blood test (e.g. complete blood count and coagulation tests) is also very important for our planning.

Have you been diagnosed with varicose veins? These must be treated by us as a matter of urgency before any surgery. Studies have shown that chronic venous insufficiency in the legs contributes to the development and progression of lipoedema.

The existing phlebolymphoedema and the associated adipogenesis are eliminated. In cases of varicose veins, treatment should routinely be carried out at least 2–3 months prior to liposuction.

The treatment

All appointments for pre-operative consultations, surgery and post-operative care take place at our specialist clinic for plastic and aesthetic surgery run by Dr Demir in Cologne, Germany.

You should try, as far as possible, to reach your target weight and maintain it for several months. You should be aware that significant fluctuations in weight following liposuction can unfortunately lead to undesirable changes in your overall figure. This operation is not a suitable method for weight loss.

If you are taking blood-thinning medication or any other medication, we will discuss this with you, and you will need to switch to an alternative under medical supervision or, if possible, stop taking it.

The operation

Your procedure (WAL liposuction or a tummy tuck) will be carried out at our specialist clinic’s certified facilities under safe and gentle general anaesthesia (TIVA).

After the treatment

You will be fitted with your compression garment immediately after the operation, whilst still on the operating table, and will need to wear it for around six weeks. A small amount of fluid may occasionally seep out of the entry points during the first two days. This is not pure blood and is therefore usually completely harmless.

The special bandage over your compression garment should be left in place for 1–2 days. The compression garment aids lymphatic drainage and thus helps reduce swelling. It is also an important tool for body contouring and accelerating the healing process, helping to achieve the best possible result.

Aftercare

You’ll be back on your feet in just a few days. However, you should allow yourself about 1–2 weeks to rest. Depending on your job, you may also be able to return to work after 1–2 weeks.

We recommend starting lymphatic drainage after one week, with 2–3 sessions per week. Physical activity can be resumed after 5–6 weeks. With absorbable sutures, removal is usually not necessary.

Our promise

Your surgeon, Dr Demir, will arrange regular follow-up appointments with you and will be happy to act as your point of contact throughout your recovery and, of course, afterwards as well.

We are asked this question very frequently. Your safety is our top priority, so we will determine the amount of fat to be used with the utmost care during the procedure, ensuring that we do not take any unnecessary risks whilst still meeting your wishes.

With our WAL technique, we can remove significantly more fatty tissue than with other methods, whilst reducing the duration of the operation. Pures fat volumes of 6–8 litres can usually be removed very safely and gently using the water-jet method. However, this can only be determined following a thorough physical examination.

Of course, there are also clinical cases where we cannot exceed these volumes by any significant margin – we will advise you in detail on this matter.

Water-jet-assisted liposuction offers us a safe method of fat removal.

The lipoedema procedure is virtually pain-free for patients, and the risk of bruising is significantly reduced following the procedure. This results in a much shorter recovery time compared to other techniques.

The WAL method has been proven to be gentle on surrounding structures such as blood vessels, nerves and lymphatic vessels, making it a key tool in the treatment of lipoedema.

A highly accurate method

One of the greatest advantages is that the tissue structure remains clearly visible, as the tissue is not excessively swollen and the cannula removes the fatty tissue precisely at the desired surgical site by following the natural path of the water jet.

Using a specially designed suction cannula with an integrated injection line and nozzle (similar in design to a ballpoint pen), the fatty tissue is first flushed by injecting fluid at a pressure that can be adjusted as required.

The fat cells are gently separated from their surrounding tissue without causing significant trauma and are then immediately suctioned out along with the fluid.

This ingenious technology avoids the unnecessary and uncomfortable swelling of the fatty tissue that occurs with older techniques, which involve pre-infiltration of the areas to be suctioned.

The patient receives up to 70% less irrigation fluid containing medication and volume in the area to be aspirated.

Highly precise body contouring is possible

Thanks to the simultaneous technique, the plastic surgeon maintains a clear overview of the body contouring and the volumes of fluid already administered throughout the entire operation – allowing excess fatty tissue to be removed gently and precisely.

This method ensures a high level of patient safety and allows for aesthetic control over the outcome of the operation.

This direct method protects surrounding structures such as blood vessels, nerves and lymphatic vessels. The risk of bruising is therefore minimal. The tissue layers beneath the skin, which enable skin contraction and thus the desired body contouring, are spared.

The WAL method is therefore a very safe and modern technique for liposuction and body contouring.

After the operation, a small amount of drainage fluid will continue to seep from the small incisions for around 24 hours. Following the procedure, our patients report only mild discomfort, comparable to ‘sore muscles’. This can be easily managed with mild painkillers.

In certain areas of the body, patients also report a “tingling” sensation under the skin during the healing and contraction phase. The recovery time is significantly shorter than with other liposuction procedures.

The final result is already quite clear within a few weeks – however, we recommend waiting for up to 6–9 months before making a final assessment.

After this period, we can, for example, make joint decisions on whether further measures – such as disciplinary action – are necessary.

Studies have already shown that lipoedema fat cells do not exhibit the same metabolic activity as ‘healthy’ fat cells.

We aim to achieve visible results through our gentle surgical approach. This is achieved by removing unsightly, painful excess fat tissue from diseased lipoedema fat cells.

The areas treated by liposuction undergo permanent changes; in other words, the fatty tissue in these areas will be gone for good. This means that, for example, no new fat cells will form in the areas treated by liposuction even if you gain weight.

In other parts of your body, however, the metabolically active ‘healthy’ fat cells grow larger or smaller in response to changes in weight – just as they did before. 

You should therefore prepare yourself for this and adjust your diet and exercise routine accordingly. However, it is important to note that the treated areas of the body are finally free of lipoedema problem areas.

Yes, we receive a great many enquiries about this at our clinic in Cologne. We are always available to provide a second opinion or to continue surgical treatment that has already begun elsewhere.

There are many reasons why people experience symptoms following surgery. These range from incomplete or ineffective liposuction to differences in the techniques used (e.g. laser or radiofrequency techniques), and the progression of the condition to areas that were previously symptom-free, such as the upper arms or lower legs.

With water-jet-assisted liposuction, our private clinic has a safe method of liposuction at its disposal. The results are therefore significantly better than with conventional liposuction methods.

In addition to preserving the lymphatic vessels and blood vessels, the treated area of skin shows excellent contraction following liposuction.

The lipoedema procedure is virtually pain-free for the patient, and the risk of bruising following the procedure is significantly reduced. This results in a much shorter recovery time compared to other techniques.

Since January 2020, the costs of surgical treatment have been covered by statutory health insurance funds depending on the stage of the disease, for example in stages III and IV. However, the procedure must be carried out as an inpatient in a contracted hospital or on an outpatient basis by a doctor registered with the statutory health insurance scheme.

Liposuction for lipoedema has been included in the list of services covered by statutory health insurance schemes for trialling as a potential alternative treatment to existing conservative measures.

In some cases, health insurance funds will also cover the costs of surgical treatment at stage II following a claim. A five-year study is currently investigating the benefits and risks of surgical treatment compared with conservative treatment.

Once the study is completed in 2024/2025, new decisions regarding health insurance coverage at earlier stages of the disease are expected.

We will, of course, keep you informed about the current legal situation both on our website and during your consultations with Dr Demir.

Depending on the stage of the condition and the type of fat distribution disorder, the period of incapacity for work is usually 2–3 weeks. We would advise you to allow yourself sufficient time to rest and recover.

The sick note is issued by colleagues providing conservative treatment, such as GPs, lymphologists or referring vascular surgeons.

We will analyse the distribution pattern and the stage of the condition together and work with you to draw up a surgical treatment plan.

For medical reasons, it is very important in specialised lipoedema therapy to develop a multi-stage treatment plan.

For example, there are limits to the amount of fat that can be safely removed in a single surgical session using the water-jet-assisted method. Similarly, it is not medically advisable to perform liposuction on both the front and back of a limb in a single operation.

The risks of circulatory problems, skin tissue necrosis and the development of compartment syndrome would be too great if the safe limit for fat removal were exceeded, and the recovery time would be prolonged. Your safety is always our top priority.

Advanced stages of the condition (stages III and IV) require skin tightening procedures in addition to WAL liposuction. This usually affects the upper arms, thighs and, in some cases, the abdominal area.

Following water-assisted liposuction, we monitor the progress of skin retraction and then decide together on the best time to perform a body lift.

Provided the diagnosis is correct and treatment is carried out by a plastic surgeon with extensive experience in lipoedema therapy, surgical treatment of this chronic fat tissue disorder is usually very feasible.

The surgical treatment we recommend, in the form of liposuction, is listed in the lipoedema guidelines of the German Society of Phlebology.

Nowadays, even colleagues with a primarily conservative approach tend to recommend surgical treatment. It must be made clear, however, that liposuction does not completely eliminate lipoedema.

With lipoedema, a lifelong increase in fatty tissue is to be expected, and surgery should ideally be sought at an early stage, as soon as the first typical symptoms appear.

If the removal of diseased fat cells is carried out at a certain stage of the condition, it is conceivable that measures such as lymphatic drainage or the wearing of compression stockings may not be necessary.

Improving quality of life

An improvement in quality of life, a reduction in the compression class of the compression stockings and a reduction in the need for manual lymphatic drainage can be expected.

Basic therapy in the form of KPE usually needs to be continued – albeit at a significantly reduced frequency and intensity. In some cases (stages I and II), patients may be able to temporarily stop KPE or wearing compression stockings altogether;
often, at least one stocking of a lower compression class can be worn.

Surgical intervention is therefore the only sustainable option for the successful treatment of lipoedema, as it involves the removal of the pathological fatty tissue.

Pain and a lack of physical activity should be alleviated or eliminated through conservative supportive therapies, as these factors perpetuate the cycle of symptoms and promote the progression of lipoedema.

Although accompanying physical activities may help reduce any excess weight, they cannot cure the disproportionate, pathological accumulation of fat associated with lipoedema in the legs and arms. Nevertheless, weight gain should generally be avoided.

Even though the fat associated with lipoedema is, so to speak, resistant to diets, weight management and a healthy diet are key components of your treatment. Patients who are obese and have lipoedema experience significantly greater problems with pain and mobility.

A healthy diet can reduce the risk of other conditions such as diabetes and cardiovascular disease.

Stay active and mobile – swimming, yoga, Pilates, stretching and trampoline training all help to stimulate lymphatic drainage and keep your joints flexible.