Slowly but surely, more and more research is being done on lipedema, a condition that affects many hundreds of thousands of individuals, most often ladies. Lipedema is most commonly manifested by an exaggerated amount of excess fat in the lower extremities, from the upper thighs all the way to ankles (often referred to “cankles”). Less commonly, it can affect also the upper extremities, from the underarms down to wrist. The genetic is being currently studied most seriously in England and the rest of Europe.
That being said, my experience in Toronto does point towards a genetic factor, as many of my patients will mention their mother, sometimes also grand-mother, as having a similar, often more advanced condition. I have been treating Canadian patients with lipedema for many years now.
Patient with lipedema will experience not only issues with clothing (being larger lower body versus smaller-waisted) but also pain, accelerated osteoarthritis of knees and ankles, dilated veins and varicosities, and chronic swelling.
In Toronto, I treat my patients with lipedema with a gentle tumescence solution-assisted liposuction, using more tumescence solution to minimize injuries to veins and lymphatics, a concept favoured in Germany and Switzerland (where lipedema has been recognized for many years now) with their water-assisted liposuction.
Not only tumescence solution is generously used at VISAGE Clinic, I also favoured small cannulas in order to minimize injuries to tissues. This is particularly important around the knees, the calf and the ankles where “liposuction tracts” can easily be done inadvertently. Liposuction “tracts” are also minimized with the “equalization” techniques, an American concept called SAFEliposuction where a widen tip cannula is used without suction to break and equalize the soft tissues. I also often with gently and carefully turn (we call it “flipping”) my patients during general anesthesia (a 3-people manoeuver) so I can access safely and effectively the back of the legs.
Very rarely there will there be excess skin in the calf areas. That being said, it is common with the thighs to be left with excess skin if we are to perform a large volume (up to 5000 ml or 5 L) of tumescence liposuction. I explain to my patients it is like losing a serious amount of fat in one area over an afternoon; the skin cannot contract and usually need to be excised (as seen after weight loss and after pregnancy). The amount of skin laxity post liposuction depends on many factors, some of which are age, amount of liposuction done, quality of the skin, etc.
It is quite common to liposuction 5L in the thighs only (for patients with lipedema), and therefore, a thigh lift is often recommenced as most patients prefer a fine vertical scar and thinner tauter legs to thinner legs with excessive and loose skin.
There are various thigh lift techniques, the common ones being: 1. the crescentic inner vertical lift (not very powerful as a technique other than for the common mild excess and loose skin seen in aging patients in the upper inner part of the thighs), 2. the full inner thigh vertical thigh lift with or without an extension to below the knees (the common techniques after a large amount of liposuction to the thighs and after massive weight loss), and 3. The mid-thigh vertical lift, a technique somewhere between 1 and 2. I should add that all 3 techniques have a scar component in the groin (inguinal) area so the full inner thigh vertical thigh lift is really a “hockey stick”-like incision.
Lastly, one common request by my patients is to do – first – ver well the calf and ankle areas and to – then – complete the 5L maximum equally between the 2 thighs, which often means they will require another “session” of liposuction to the thigh areas in the future; doing so means less chance to require a thigh lift during the first procedure as less than 5 L will be removed from the thighs, postponing the thigh lift to the next procedure where more fat can be removed from the thighs and then the vertical thigh lift.
Dr. Marc DuPéré, aesthetic plastic surgeon