What is the most effective solution of lipoedema treatment ?

Liposuction is the most effective solution for lipoedema. Because liposuction removes the inflammatory fat cells permanently, it may slow down or even stop the disease’s progression with a suitable postoperative program. Lipoedema may get back to its latent phase. Although it was a safe procedure, clinical studies for legs appeared in the literature in the 90s.

Who should perform liposuction in lipoedema ?

Liposuction of calves and ankles has always been considered a “difficult area,” and experienced liposuction surgeons with specific training should only perform it.

Why is the lower leg a difficult region for liposuction ? and the evolution of Superdry Liposuction ?

Liposuction is the main surgical intervention for lipoedema. Dr. Karacalar first published an article about the use of liposuction under a tourniquet for the kneecap area in the “Journal of Aesthetic Surgery” in 1998. It was a liposuction technique under a tourniquet which allowed the surgery to be performed conscientiously and safely. It is known that the leg has only one layer of subcutaneous tissue, leaving little margin for error. This peculiarity calls for a different approach than that of the other regions. This approach goes one step further in the process of leg sculpting. It aspirates pure fat with no blood. It is truly selective adipoaspiration. The technique renders easy the appreciation of the final result. What you see at the end of the procedure is the final result.

It evolved to the superdry 3D by the influence of accumulating experience, which became a circular and extensive technique. The critical point of liposuction was to aspirate fat in a circular way; otherwise, it would definitely recur without an aesthetically pleasing appearance. Using a tourniquet eliminated blood loss even during the preoperative period, which was further improved by the preemptive injection of a mixed solution for the postoperative third space blood loss. I particularly injected the solution alongside the major veins and lymphatic channels.
I used to treat my lipoedema patients from a surgical point of view, using mostly my personal technique, superdry 3D, and its combination of other liposuction techniques. I noticed that it was not sufficient to get the best result. Dynamic aesthetics and the appearance of movement should be taken into consideration. Therefore, I called the technique superdry 4D considering the movement of muscles.
In aesthetic surgery, some procedures are closely related to creating sculptures in terms of three-dimensional forms and composition. But nothing else can compare with lipoedema surgery.

Michelangelo Aproach to lipoedema

The process is very much like a sculptor’s subtraction technique, chipping away at the fat excess diligently and purposefully until the hidden beauty reveals itself. Beautiful legs are already inside the fat mass; I just release the form. A well-aligned skeletal and a good tone of muscles determine what the ultimate result will be. Michelangelo said, “Every block of stone has a statue inside it, and it is the sculptor’s task to discover it. I saw the angel in the marble and carved until I set him free.”

The advantages of Superdry 4D liposuction

Superdry 4D liposuction is curative liposuction that improves functionality, pain, swelling, physical appearance, and quality of life. It provides accuracy and symmetry, never achieved by other methods. This technique focuses on lymph vessel preservation as well. It eliminates the risk of fat embolization.

How many sessions are required ?

After liposuction, I wait to pass at least three months for the second session. In most cases, I tell the patients it is a bad strategy to finish the whole lower extremity in one session. It puts you at risk. It causes more sagginess. I tell them that their metabolic rates will increase, and their appetite will reduce.

When diseased fat cells are removed through liposuction treatment, your appetite is also reduced because fewer fat cells steal all those calories. Less hunger means less overeating, which means less insulin production, which adds to long-term weight loss.

Every patient experiences a higher level of energy after the surgery. World et al. found that women with lipoedema were found to have lower resting energy expenditure. The resting energy expenditure accounts for more than 50% of the total daily energy expenditure. Total energy expenditure is the sum of resting energy expenditure, physical activity energy expenditure, and the thermic effect of food. The lower resting energy expenditure represents a slower metabolism in lipoedema.

The basal metabolic rate measures how many calories you burn while you are resting. Our body performs the most basic (basal) functions to sustain life, such as breathing, cell production, and nutrient processing. A low metabolic rate is a higher risk of gaining weight. For women – especially if you are over 40 years old – losing weight can be extra challenging. This is because of metabolic changes in your body that happen leading up to and after menopause.

Holistic Approach to Lipoedema

As we understand the evolutionary roots of modern disease, we can develop a holistic approach to the treatment of lipoedema. Hunter-gatherer lifestyle might be a model in public health. Best management includes a multidisciplinary approach involving vascular medicine specialists, plastic surgeons, obesity and endocrinology specialists, dieticians, and physiotherapists.

A plastic surgeon should have a holistic approach. A Lipoedema Surgeon should take all of these into account: their environments, their habits, their dietary choices, and all the different treatments.

They should strive to improve every patient’s quality of health. Many psychological factors impact the results of treatment besides the surgery alone. If not addressed, these psychological issues can cause a patient to be dissatisfied with the perfect surgery.

Does the fat growth occur in the other regions after liposuction in lipoedema ?

I am often asked by the patients whether or not the fat growth occurs in the other regions of their bodies.
According to the lipostatic theory proposed by Kennedy, a long-term energy balance is achieved through feedback systems that constantly regulate adipose tissue depots. Thus, an abrupt liposuction-induced decrease in body fat may trigger compensatory mechanisms that would ultimately lead to body fat regain. Although it is a risk for non-lipoedema patients to have the possible compensatory fat growth, I have never noted compensatory adipose tissue expansion at intact depots but sometimes regrowth of the fat in aspirated depots.
The novel finding of a study was that exercise training is capable of counteracting the liposuction-induced compensatory growth of visceral fat in normal-weight women (Benatti). In lipoedema patients, liposuction cannot completely remove all lipoedematous fat, and it is possible that the remaining tissue can grow over time.

Psycological Benefits of Liposuction in Lipoedema

Patients receiving aesthetic surgery experience a wide range of physical, psychological, and social problems. Surgery was shown to be effective at addressing these problems. Further, it has been assumed that a positive change in the patient’s physical appearance will improve their psychological well-being, including their self-confidence and self-esteem.
Plastic surgery is a unique field of medicine that alleviates psychological distress through the restoration of the disfigured body. From this perspective, it would be better to call it psychoaesthetic surgery.