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Lipedema Treatment

Welcome to Lipedema Safety page.

Below you will find most common Safety concerns, questions and answers related to Lipedema and Lipedema Surgeons.

To read about procedure and view the additional pictures, click HERE.

To view infiltration process prior to Liposuction of Lipedema, click on the image below

     

The patient below has very significant Lipedema and had about 20L aspirate removed in one session. This is immediate post-operative view.  She was observed overnight at rehab hospital for safety. 

picture lipedema below knees before liposuction Volshteyn Plastic Surgeon New york new jersey   picture lipedema below knees after liposuction Volshteyn Plastic Surgeon New york new jersey

Who is qualified to perform Lipedema treatment?

Multiple specialties claim expertise in treating lipedema patients. Plastic Surgeons, Bariatric Surgeons, Thoracic Surgeons, Gynecologists, Cosmetic Surgeons, Dermatologists, even Pediatricians and Radiologists. All claim expertise and experience. As a patient you might be confused by advertising of who to see. Here is what you need to remember.  Lipedema surgery is not just liposuction surgery.  Lipedema treatment includes skin excisions, arm and thigh lifts, tummy tucks etc.  In patients with lipedema the surgery is usually more complicated and more risky.  The only specialty properly trained in all of these procedures are plastic surgeons.  Doctors who perform liposuction only will not be able to address the full spectrum of the disease and you most likely will have to see someone else to complete the process.

Safety concerns about Lipedema Surgery.

As a lot of cosmetic surgeons claim interest in Lipedema, you have to consider safety of the procedure and associated risks. It is commonly recognized that the limit of outpatient liposuction is about 5L per session, when the patient can go home after the procedure.  It may work for most cosmetic patients but 5L is nothing for Lipedema patients.  In order to make a dent in the volume, many of severe cases require 10L or more per session.  In order to do the surgery and have a margin of safety, patient usually is admitted overnight to the hospital or rehab facility for observation. The nurses will provide dressing changes and monitor patient for fluid overload, pulmonary embolism, DVT and other rare but possible complications.

The American Society of Plastic Surgery recommends and New Jersey Law requires that regardless of the type of anesthesia, large volume liposuction patients (over 5  liters of total aspirate) should be performed in Licensed or Accredited Facility and observed for 24 hours in an acute-care or rehab hospital facility. Postoperative vital signs, oxygen saturation, blood pressure, heart rate, temperature and urinary output should be closely monitored  by qualified staff who are familiar with perioperative care of the liposuction patient.

To make matters more complicated, many women with lipedema have components of Ehlers Danlos Syndrome (EDS). EDS has specific recommendations for Anesthesia and Post-Operative Monitoring.  It is recommended that all EDS - Lipedema patients should be monitored for at least 24 hours following surgery. This is because EDS can cause issues related to anesthesia (over or under sedated), blood pressure and bleeding. 

Can my surgery be performed in the office setting?

Some physicians perform Liposuction surgery in their office under local anesthesia.  Others perform in the office under sedation and either administer it themselves or bring anesthesiologist or anesthetist to do that. It may be OK for low volume liposuction cosmetic patients.

In my book it is very risky and not OK for lipedema patients and if amount to be removed is over 5L.  It is just a matter of time before a patient has a life threatening issue.  

What qualifications my Surgeon needs to have?

Make sure surgeon has hospital privileges.  The surgeon has to be able to perform the surgery in the hospital setting or licensed ambulatory surgery center.  If the surgeon is able to do it in the hospital, most likely, surgeon went through the hospital credentialing process and is qualified to perform procedure and malpractice insurance provides coverage for it.  For example, as a plastic surgeon, I can perform all lipedema procedures in one of my affiliated hospitals.  Cosmetic Surgeon with training in Gynecology or Dermatology, for example, will not be allowed to do that because of training, experience and malpractice coverage.  That is why one of the first questions you should ask is: CAN YOU DO THE SURGERY IN THE HOSPITAL?

Ambulatory surgery centers may not have as strict guidelines as hospitals.  If your surgeon performs the surgery in Ambulatory Surgery Center, you need to know if it is Licensed or Certified.  Different States have different requirements to ASCs.  If the center is Medicare, AAASF. AAAAHC or JCACO Accredited, they must have required monitoring equipment and emergency equipment available on site. Also they have ACLS trained staff to handle emergencies.

To summarize, I would not feel safe doing lipedema surgery in the office if I am removing over 5L.  Also I feel that every Lipedema patient needs to be treated at properly licensed Ambulatory Surgery Center or hospital and observed for 24 hours either at regular hospital or rehab facility.  No exceptions.  I realize that some doctors perform surgery in the office and tell the patients that it is OK, but I strongly disagree.

Do I need anesthesiologist?

Yes. Some office-based physicians or surgeons use local or twilight anesthesia that they administer themselves.  To me it is very risky.  It is done either to save money of because they try to bend safety regulations.  Regardless if your insurance is paying for surgery, do you want your surgeon doing 2 jobs instead of one?  Surgeons should be focused on surgery and anesthesiologist on keeping patient safe.  If you have any doubts, you should ask to see where surgery is going to be done and ask about proper monitoring and emergency capabilities. If the surgeon is going to be using an anesthesiologist or nurse anesthesiologist, you need to ask to speak with them before your procedure and see if they are experienced in treating Lipedema EDS patients and discuss possible complications you have had in the past as well as any health issues.  This needs to be done before surgery.  Risk of anesthesia complications is low but it is there.  Even if risk is 1 in 1,000 or 100,000, you need to do everything you can to make sure that you are safe and do not become a statistic.



dr volshteyn

Dr. Volshteyn is a board certified Plastic Surgeon, who is specialized in reconstructive and plastic surgery.

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Dr. Daniels is the Medical Director of Daniels Vein Center, and is a highly skilled vascular specialist.

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Janet P Parler MD is one of the most respected and experienced board certified plastic and reconstructive surgeons in New Jersey.

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Dr. Boris Volshteyn is a plastic surgeon dedicated to excellence in plastic & reconstructive surgery such as breast augmentation, liposuction, and facelifts. Boris Volshteyn MD plastic surgery offices are located in New York and New Jersey. This website is a plastic surgery resource for viewing before and after photos, and learning about various procedures.

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