Most important questions regarding the operation
Do I need additional insurance?
In most cases, liposuction is unfortunately not covered by your health insurance. To be on the safe side, we therefore recommend to take out a so-called follow-up cost insurance. This usually doesn't cost much. However, these are only offered by a few specific insurance companies and your surgeon usually must be listed with them.
Can I eat something after the operation?
Immediately after the operation, you will be served a light soup of your choice in your room. Also make sure to drink enough. You will find a selection of drinks in the minibar in your room.
Can I exercise after surgery?
We recommend taking short walks on the first day after the operation. These can then be increased over the next few days. A healthy diet, drinking a lot, slowly increased exercise and lymphatic drainage contribute to a faster healing process. Most patients also feel safer if another person is present when changing the dressing. So, it is important to organize this beforehand.
Can I eat before surgery?
Yes. You should eat breakfast before the operation. You will need the energy.
In what order are the areas treated?
There is no fixed order. Each surgeon will decide this individually based on his experience and surgical technique.
Is lymphedema an exclusion criterion?
Lymphedema that accompanies lipoedema does not necessarily represent an exclusion criterion. It is also often referred to as lipo-lymphedema or as secondary lymphedema in lipedema. However, if the medical finding is severe, i.e., if the tissue is already fibrotic, liposuction can no longer be performed. However, this will be decided during the physical examination of the consultation.
General anesthesia or twilight sedation?
At Hanse-Klinik, liposuction is never conducted under general anesthesia. This will certainly irritate some patients, but believe us, there are advantages to not having this done under general anesthesia. We treat lipoedema with vascular and tissue-friendly vibration liposuction under tumescent local anesthesia, which leaves your lymphatic system in particular intact. This means that before liposuction we infiltrate a solution into the subcutaneous fatty tissue that contains a local anesthetic. The tissue is anesthetized and loosened so that it can then be sucked out very easily. Of course, it is possible to have anxiolytics (sedatives) administered at any time. However, we deliberately avoid general anesthesia in order to maintain mobility on the operating table. This means you can stand up immediately after the operation and the results of the operation can be assessed immediately and reworked if necessary. After the nurse in the operating room has applied the bandage, you can then go to your room independently, accompanied by a nurse.
When can I shower again?
You can shower the next morning after the operation.
When should I start MLD after surgery?
We recommend that our patients start MLD approximately 3-5 days after the operation. Approximately 12 sessions, 45-60 minutes each, twice a week are ideal. There are also patients who start MLD much earlier. This is possible, but it depends on how you tolerate it or whether it might still be too painful immediately postoperatively.
What are the requirements for an operation?
You must be healthy and the procedure must not put you at risk. In a consultation before the operation, you will discuss any pre-existing medical conditions and medications you may need to take. We weigh your individual health risks against the risks of the operation. To do this, we need your blood values approximately 2 weeks before the operation. An ECG or other special examination is only necessary if you have specific pre-existing conditions. If you have a body weight of more than 264 lb. accompanied by a core obesity, we will discuss with you whether weight loss is necessary beforehand.
What do I have to take care of after the operation?
Immediately after the operation, we will provide you with a post-operative compression garment. It is very important that you wear these compression garments consistently. We recommend a period of 8 weeks, whereby the garment should be worn 24 h for the first 2 weeks and only during the day for the remaining 6 weeks. The compression garment can be washed daily as it dries relatively quickly.
How long should the temporal distance between surgeries be?
Remember that there is an extensive wound area after liposuction. There should be a time interval of 6- 8 weeks between operations. However, if you are exhausted or tired, or simply do not feel ready for the next operation, this interval should be extended.
How can I prepare for surgery?
Before the operation you should be in a healthy condition and have as little stress as possible. Do not go on a diet right before the liposuction. Do not take any anticoagulant medication (aspirin, etc.) one week in prior to surgery and continue to wear the compression that has already been prescribed until the operation. If you have already made manual lymphatic drainage appointments, please take them. Also clarify with your friends and partner in advance who will drive you to the clinic and who will take you home again. Who has time to look after you and help you or just simply watches over you while changing the dressing.
How long does the operation take?
The complete operation including the run-in phase takes approximately 5-6 hours. You can sleep or talk during the operation.
How long does it take until I see the results?
The new silhouette can be seen immediately after the operation. Remember that the swelling phase begins approximately 10-14 days after the operation. However, this is short-lived. The final result can only be assessed after 6-12 months.
How long should I rest before flying home?
This depends on how you feel. If it is just a short flight there is no reason why you shouldn’t fly home the next day after surgery.
Most important questions concerning liposuction in lipoedema
Do all patients with lipoedema really need liposuction?
Lipoedema is a progressive disease with an increase of fatty tissue and of complaints over the years. If in stage I compression stockings can reduce pain and orthostatic oedema effectively, no liposuction is necessary. If there is a progression into stage II, what most patients experience at some stage in their life, liposuction is the only possibility for an improvement or even a cure of the disease. All lipoedema patients report about a tremendous increase in their quality of life after surgery.
When can liposuction be used in general?
Liposuction can be used, if there is an obvious increase of fatty tissue of the legs causing a disproportion of the body shape. An important aim of this surgical method is to create a proportionate body shape again. Basically, liposuction can be used for the reduction of lipohypertrophy, a condition with increased fatty volume without pain; this is a cosmetic problem. And it can be used for the treatment of lipoedema, a condition with increased fatty volume in combination with spontaneous pain, pain due to pressure and possibly orthostatic oedema and hematoma; this is a disease.
Does liposuction stop the progression of the disease?
This question we cannot answer for sure now, but it seems to be the case. Follow-up studies have shown a persistent improvement of complaints after 4 and after 8 years. In all age groups all or most of the complaints disappeared or improved significantly; about 30 percent of the patients did not need conservative therapy any more, about 60 percent still needed manual lymphatic drainage or compression stockings, but not as often and not as intensive as before. Many could change to stockings of a lower compression grade. The improvement of shape persisted as well in nearly all of them.
When should liposuction be performed in lipoedema?
This surgical method should be used, when there is a progression of the disease despite consequent conservative treatment. Most patients then notice an increase of subcutaneous fatty volume, mainly in the legs, sometimes in the arms as well. This is accompanied by a deterioration of complaints like feelings of tension, sensitivity to pressure, feeling of heaviness and often more hematomas. Many patients realize an increase of weight as well. The results after liposuction are not dependent on the duration of the disease. Though at an older age or after long duration of the disease the amount of fatty tissue is bigger and the complaints are more severe than in younger patients, the improvement after liposuction in most cases is bigger compared to lower age groups.
When should liposuction not be performed?
Patients need to be generally of a healthy constitution. In case of additional serious diseases their treatment has priority. The bodyweight should be less than 120 kg. The fatty volumes of people with a higher weight often are too big for liposuction, which would require too much volume of local anesthesia (TLA) – and result in toxic amounts. This is often seen in patients with stage III lipoedema with big volumes and hanging protrusions with loose and non-elastic skin.
What are the risks of liposuction?
Big studies with huge numbers of patients showed, that liposuction is a very safe and very effective method, if used in tumescent local anesthesia (TLA) by experienced surgeons. Problems with wound healing and wound infections may occur; bleeding, superficial and deep thrombosis have been described, but are extremely rare, if thrombosis prophylaxis is used for 5 days after surgery. No vital dangerous side effects after liposuctions in TLA have been reported in the new literature. Summing up: liposuction in lipoedema should be performed in specialized centers only.
Which liposuction technique is the best?
Nowadays power assisted liposuction (PAL) and water assisted liposuction (WAL) are used worldwide. Both techniques have advantages and disadvantages, but both can give excellent results. It should be mentioned here, that good results do not depend on technique that is used, but rather on the experience of the surgeon. The most important part of surgery is to remove the right amount of fat at the right place in the right depth.
Who decides if liposuction should be performed?
This decision is entirely up to the patient. The surgeon helps with his advice and his experience, informing about the possible benefits and the possible risks of the liposuction. And: there is always enough time for the decision. Liposuction this is not an emergency operation!
How much volume should be removed?
This depends on size and weight of the patient and of course of the area affected. There may be big differences in the same location to make an optimal result. Ultimately, the new shape of the body decides about the esthetic success and not the amount of fat that has been removed. In most cases patients need about 3 sessions until the optimal result has been achieved. The average removal of volume in our clinic is between 3.000 and 5.000 ml of fatty tissue per session. Some patients might think the amount too small until they see the result and understand that it only depends on where the fat tissue has been removed.
What cannot be achieved by liposuction?
Liposuction can remove subcutaneous fatty tissue, but it will not – or hardly – influence body weight. So, this technique is not effective in reducing weight. It is effective to eliminate the disproportion between upper and lower body. Additionally, there is a significant improvement in the complaints like heaviness, spontaneous pain, and pain due to pressure.