Liposuction – Please tread lightly

By Tatjana van der Krabben

Every time people inquire which surgeon I saw or compliment me on the visible progress I made since my liposuction, while sharing their own plans, hopes and dreams in that direction, I tell them to tread lightly. My answer often surprises them, considering the obvious progress I made, but there are several reasons to urge for caution. It’s not all rainbows and song. Here are a few misconceptions that I wish to address.

“Liposuction is a cure for lipedema.”
This claim doesn’t come from the medical field per se, but patients sometimes say this. Liposuction is not a cure. It couldn’t be a cure. You don’t need to be a doctor to come to that conclusion: fat is extracted. No more, no less. Current insights have revealed it’s at least in part genetic, in part responding to hormones and in part to lifestyle. That’s what’s known at this point. With your full genetic package intact post-op and the same old hormones, you’ll be anything but cured…

“The fat that was removed, will not return.”
Technically true and misleading. The very fat that was extracted was disposed of post-op, obviously, in those canisters. So that fat will not come back to haunt you. However, your remaining fat cells can continue to swell. There’s also speculation new fat cells can be formed. Not that farfetched, considering your adipose tissue also contains stem cells that can theoretically become any type of cell. When regaining it will likely start in arms, belly and/or back, but eventually adipose mass can also increase on your legs. I met people who experienced that…

“Only this or that doctor can perform liposuction safely.”
There are absolutely dozens of skilled doctors out there who can do this safely with lipedema patients. I hear of - for me - new names on a regular basis. And those doctors in turn train other doctors, who…. Etc. It’s getting a less exclusive area of expertise, although the geographic spread is very uneven, with Germany as the absolute hotspot. Most doctors work for private clinics and have very good use for this claim. Presenting yourself as the absolute top of the bill is good advertising. It’s also fuelled by patients, providing raving reviews of their surgeon, leaving the impression that that particular surgeon is the (only) person to go see.

There are exceptions: many doctors refuse to perform liposuction in case of advanced lipedema and/or combined health issues. For these people it can seriously be slim pickings when searching for a surgeon.

“It’s safe.”
As safe as any sur-ge-ry. Don’t ever forget it’s a surgical procedure. The fact you’ll most likely be treated as an outpatient, doesn’t mean it’s not a surgery. They worked on the procedure to minimize risks, yes, but any surgery has its risks. This one too.

Also, since your primary won’t be involved, most likely you’ll have to look around for a surgeon yourself. It’s costly. I see people looking at expenses before track record. Do they check your medical history? Do they explain what it entails, what you can expect? Or are they smooth talking you into doing this? And what if there are complications post-op? Will your primary help you or refer you back to your surgeon, even if that’s in another country or across the country? Ask questions. Come prepared.

“The surgery will provide cosmetic improvement.”
Yes – no – maybe. It takes skill to work on a large lady. A lot of skill. I’ve seen uneven results. Also, only so much fat can be extracted. Sometimes choices are made to bring as much relief as possible to one particular area. Think proportions: smaller legs will make your behind, hips, belly possibly look larger. Or the surgery will finally get the proportions right for you - that could also happen. It’s all very individual. Finally, you could be left with loose or even sagging skin. Some doctors will focus more so on providing relief, others take more interest in the cosmetic side. So even the approach varies.

Super cosmetic results are usually only achieved in stage 1 lipedema or early stage 2 with good skin elasticity. Meaning: I don’t have a superb cosmetic result either. I’m happy, but my expectations were realistic. So while someone recently said I should look into a tummy tuck, I accept the somewhat loose skin. Especially since it seems a bit crazy to have a special liposuction procedure to spare the lymphatic system and next risk lymph damage through skin surgery. No, thank you.

“I will never have to wear compression again.”
That remains to be seen. If you needed compression pre-op you could still be needing compression after the healing period. It’s a wait and see kind of thing. Maybe you could do with lighter compression or could afford some cheating. Maybe you’re so lucky you can give up compression completely, but don’t assume that’s ‘normal’.

“After liposuction you will need to wear compression 24/7 for the rest of your life, or else your legs will start ‘growing’ again.”
Thankfully that’s not true! The first few weeks post-op (exact recommended duration varies per clinic) you will have to do so. By then you’ll be very, very happy to toss them aside for the night. Seriously! After that it will be limited to the daytime and after your healing period it’s a question mark what you’ll need. That’s very personal.

Your legs could ‘grow’ again. True. That has to do with how stable your lipedema is. More likely causes would be hormones and lifestyle. Not pointing the finger here! If your doctor doesn’t know (much) about lipedema, you could be getting poor medical advice on your lifestyle. You could be under the impression you’re doing everything right, while another approach would be far better in your case. It’s a common problem, I’m afraid… There are many misconceptions on that as well and contradicting recommendations, even among doctors and therapists specialized in lipedema.

“How much weight can I expect to lose?”
Don’t expect the scales to show a plummeting number. One liter of fat weighs about a pound and only so much will be extracted. Substantial weight loss is sometimes reported. Post-op improved mobility can sometimes do that for you.

What can you realistically expect?
Literature on the benefits of liposuction is widely available nowadays. That means already many have been successfully operated on. Improved looks and/or contours and improved mobility are mostly reported, although not necessarily in that order. The average patient generally reports progress, or great progress, even. Perception does play a part here, of course. The other factor is your specific health status. Are you a stage 1, 2 or 3? How active are you? How stable is your weight currently? What’s your plan to maintain the surgically obtained result?

Liposuction can be a shortcut to potentially great improvement. All else is a matter of perseverance, trial and error. That doesn’t make the alternative or traditional route less valid or less important, or mean that we should all look at liposuction. Not everybody can afford liposuction, is willing to try a surgical solution or is a suitable candidate. Plus, if you want to hang on to your results, you better come up with a lifestyle plan you will be able to stick with, if you haven’t already. There’s your perseverance, trial and error again.

In short: you could get a lot out of it, but you’re not out of the woods post-op. So tread lightly, please. I did! My surgically obtained result is still intact. That’s 3 years since the first surgery and 1 year since the last. That’s all effort, not dumb luck or an incorporated effect from the surgery. Sorry…

PS. Please don’t shoot the messenger…