Lipoedema is a syndrome in which the accumulation of fatty tissue occurs without a known cause in the extremities, especially affecting women. It can affect both the lower extremities with accumulation of fatty tissue from the hips to the feet, and the upper extremities accumulating fatty tissue from the shoulders to the hands.
These disproportionate deposits of fatty tissue generate not only an aesthetic alteration in the patient, but also generate a significant decrease in the quality of life of the patient, as it is accompanied by pain and hypersensitivity in the affected areas (unlike being overweight or obesity that does not hurt or affect the sensitivity of the skin), bruises occur more frequently due to the fragility of the blood vessels, a feeling of heaviness and progressive appearance of lymphedema (alteration of lymphatic drainage).
Lipoedema is not associated with being overweight, nor does it improve with diet and sports, as they are fatty deposits that are more due to genetics. In fact, it is common for a relative of the patient to present some degree of lipoedema.
The areas affected by lipoedema present an alteration of the skin, being it is nodular and somewhat firmer than in the other areas of the body. It is also characteristic that when gently pinching said area, pain is felt, but it is not in the rest of the non-lipedematous skin.
The pattern of fat deposits is characteristic and does not affect the hands or feet, unlike lymphedema, which produces a general increase in the size of extremities due to poor lymphatic drainage. The two diseases are often widely confused, which can lead to delays in diagnosis and poor treatment. Lipoedema is bilateral and symmetrical, whereas lymphedema usually affects only one side.
A certain degree of association has been observed between lipoedema and other diseases such as migraines and depression. Possibly there is an emotional cause between them, as much improvement has been seen in both areas, after lipoedema surgery.
On the other hand, after the treatment of lipoedema, symptoms such as pain, the appearance of bruises and hypersensitivity are also reduced, and it also reduces the need to use other therapies such as pressotherapy and lymphatic drainage. The improvement in the quality of life of patients with lipoedema after surgery is striking, not only from the point of view of their self-esteem, but also in a practical sense.
In order for a patient with lipoedema to be considered suitable for surgery, they must meet the following requirements:
- The diagnosis must be confirmed by physical examination, medical history, and an imaging test.
- The presence of lymphedema must be ruled out.
- Lymphatic drainage massage must have been performedfor more than 6 months without improvement.
- Strong compression stockings must have been used for more than 6 months without improvement.
- Stable medical condition.
The fatty tissue is extracted through the suction that originates from a device which produces a negative pressure that sucks the fat from the patient’s body. To do this, fine cannulas are introduced through tiny holes in the skin, which are very hidden, that will be the instrument with which the surgeon models and extracts the fat in the desired quantity and depth.
In lipoedema in particular, two types of liposuction are recommended:
- Power Assisted Liposuction (PAL): A motorised liposuction cannula is used, which facilitates the extraction of fatty tissue due to vibration, as it separates the fat in a less traumatic way, producing less pain and inflammation of the tissues.
- Water-Assisted Liposuction (WAL): The liposuction cannula infiltrates water under pressure into the tissues while sucking, this separates the fatty tissue in a less traumatic way, facilitating its extraction, while reducing the bleeding.
Currently there is no study that demonstrates the superiority of one liposuction technique over the other, so it is valid to use either of the two.
Once the liposuction is finished, these holes are closed, leaving a scarcely noticeable mark, so that you will hardly be able to notice any marks from the surgery in the future. Pressotherapy garments are put on to reduce bleeding and improve the re-adaptation of the skin.
Carrying out this type of intervention must be performed by a plastic surgeon with experience in liposuction surgery, as it will be performed in complex areas.
This type of intervention must be carried out in a hospital that meets all health requirements, in addition to having an intensive care unit. Plastic surgery is a very regulated surgery with few complications, but in the unlikely case these cases occur, it is essential to have the support of a good hospital. Hence, low-cost surgeries save on this and are performed in small clinics where these safety conditions are not covered.
Dr. Ospina is fully aware of this and that is why he performs all his surgeries in the operating rooms of Hospitales San Roque, as he provides that extra security that he wants for his patients.
After the intervention, it is completely normal for the patient to feel a sensation of stiffness and discomfort in all the intervened areas, this usually normalizes after about 3 days. On the other hand, it is common for inflammatory fluid to leak through the small holes used to extract the fat, this can last several days and is completely normal and nothing to worry about.
The patient must simply keep the small wounds clean and take the prescribed medication at the time of hospital discharge.
It is essential to use compression garments from the beginning, this compression will help reduce postoperative bleeding and inflammation, as well as help to better retract the skin.
It only takes about 7 days to return to normal, however, compression garments should continue to be used throughout the first few months as appropriate. On the other hand, after the surgery the patient must begin a protocol of therapies that will be explained and delivered to the patient before the intervention. It also requires the readjustment of their nutritional and sports habits, which will be gradually reintroduced from the first few weeks.
What is mainly sought is to reduce hypersensitivity and pain in the lipedematous area, as well as to improve the contour of the patient. Although the difference is noticeable after the surgery in the patient’s body, the first days an inflammatory process of the skin and tissues occurs that causes the accumulation of fluid within the intervened area. For this reason, during the first two months, there is a progressive process of elimination of inflammation, which causes the result to be seen little by little. After two months, a big difference can be seen, but it will continue to evolve until after 6 months. The painful sensation on the skin improves over the first few weeks.
Depending on the degree of lipoedema that the patient presents and the amount of fatty tissue, several liposuction sessions may be necessary.
Liposuction is not a surgery in which there are large defects or scars, so your recovery is faster than other cosmetic surgeries. However, despite having the reputation of being a “less aggressive” surgery, it can involve risks that can be serious without proper training and experience. In order to avoid these risks, the surgeon must be highly qualified, operate in approved centres and use appropriate and properly sterilised material and instruments.
Another type of complication, small but more common, is usually asymmetries or irregularities in the skin, caused by the poor application of the technique, which has been carried out in a very superficial way, in a very traumatic way or in an inappropriate way. This causes the skin to be flaccid and with ripples, which are often very difficult to correct. It does not reverse seriousness in the patient’s health, but it does affect the aesthetic result of the surgery in a very negative way.