Download PDF
CC BY 4.0 · Arch Plast Surg 2024; 51(05): 510-526
DOI: 10.1055/a-2334-9260
Extremity/Lymphedema: Original Article

Safety and Effectiveness of Liposuction Modalities in Managing Lipedema: Systematic Review and Meta-analysis

Hatan Mortada 
1   Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
2   Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
,
Sultan Alaqil 
3   College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Imtinan Al Jabbar  Medical Student
4   College of Medicine, King Khalid University, Abha, Saudi Arabia
,
Fatimah Alhubail  Medical Student
5   College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
,
Nicolas Pereira 
6   Specialized Center in Lymphedema and Lipedema, Clínica Nea, Hospital del Trabajador, Región Metropolitana, Chile
,
Joon Pio Hong 
7   Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
,
Feras Alshomer 
8   Division of Plastic Surgery, Department of Surgery, King Saud Bin Abdulaziz University for Health and Sciences, Riyadh, Saudi Arabia
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background Lipedema is a chronic, incurable disorder characterized by painful fat accumulation in the extremities. While the application of liposuction in lipedema management has become increasingly popular, the safety and effectiveness of this approach remain contentious. Our systematic review and meta-analysis aimed to assess various liposuction modalities in lipedema management to verify their safety and efficacy.

Methods In-line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a comprehensive literature review from inception until March 2023 using the following electronic databases: CENTRAL, MEDLINE, Google Scholar, and EMBASE.

Results From the 562 initially identified articles, 20 met our inclusion/exclusion criteria for evaluation. Our review encompassed 14 prospective cohort studies, 3 retrospective studies, 2 case series, and 1 cross-sectional study. A meta-analysis of nine articles revealed a notable improvement in the quality of life, pain, pressure sensitivity, bruising, cosmetic impairment, heaviness, walking difficulty, and itching among lipedema patients who underwent liposuction. Although complications such as inflammation, thrombosis, seroma, hematoma, and lymphedema-related skin changes were reported, severe complications were rare. Crucially, no instances of shock, recurrence, or mortality were reported.

Conclusion Liposuction is a safe and beneficial therapeutic intervention for managing lipedema symptoms and enhancing quality of life. However, the impact of liposuction on secondary lymphedema remains unreported in the literature. Further high-quality, large-scale trials are necessary to assess the safety and effectiveness of different liposuction modalities. These studies will contribute valuable insights to optimize liposuction as a therapeutic option for individuals with lipedema.

Level of Evidence I, risk/prognostic study.

Keywords

lipedema - liposuction - lipoedema - liposculpture - lipoplasty - quality of life - suction-assisted lipectomy

Authors' Contributions

H.M. conceptualized and designed the study.

S.A., I.A.J., and F.A. conducted the literature search, study screening, data extraction, and quality assessment.

H.M. performed the statistical analysis.

H.M., S.A., and F.A. contributed to data interpretation.

H.M. drafted the initial manuscript.

H.M., S.A., I.A.J., F.A., N.P., J.P.H., and F.A. critically reviewed and revised the manuscript for important intellectual content.

F.A. provided study supervision.

H.M., S.A., I.A.J., F.A., N.P., J.P.H., and F.A. approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Ethical Approval

This study was performed in-line with the principles of the Declaration of Helsinki. Approval was waived due to the nature of the study.


Patient Consent

Not applicable.




Publication History

Received: 29 September 2023

Accepted: 19 May 2024

Accepted Manuscript online:
28 May 2024

Article published online:
06 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Allen EU, Hines EA. Lipedema of the legs: a syndrome characterized by fat legs and orthostatic edema. Proc Staff Mayo Clin. 1940; 15: 184-187
    Search in Google Scholar
  • 2 Wold LE, Hines Jr EA, Allen EV. Lipedema of the legs; a syndrome characterized by fat legs and edema. Ann Intern Med 1951; 34 (05) 1243-1250
    CrossrefPubMedSearch in Google Scholar
  • 3 Langendoen SI, Habbema L, Nijsten TE, Neumann HA. Lipoedema: from clinical presentation to therapy. A review of the literature. Br J Dermatol 2009; 161 (05) 980-986
    CrossrefPubMedSearch in Google Scholar
  • 4 Warren Peled A, Kappos EA. Lipedema: diagnostic and management challenges. Int J Womens Health 2016; 8: 389-395
    CrossrefPubMedSearch in Google Scholar
  • 5 Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-pathogenesis, diagnosis, and treatment options. Dtsch Arztebl Int 2020; 117 (22-23): 396-403
    CrossrefPubMedSearch in Google Scholar
  • 6 Katzer K, Hill JL, McIver KB, Foster MT. Lipedema and the potential role of estrogen in excessive adipose tissue accumulation. Int J Mol Sci 2021; 22 (21) 11720
    CrossrefPubMedSearch in Google Scholar
  • 7 Michelini S, Herbst KL, Precone V. et al. A multi-gene panel to identify lipedema-predisposing genetic variants by a next-generation sequencing strategy. J Pers Med 2022; 12 (02) 268
    CrossrefPubMedSearch in Google Scholar
  • 8 Földi M, Földi E, Kubik S. Textbook of Lymphology: For Physicians and Lymphedema Therapists. Urban & Fisher; 2006: 417-427
    Search in Google Scholar
  • 9 Forner-Cordero I, Szolnoky G, Forner-Cordero A, Kemény L. Lipedema: an overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review. Clin Obes 2012; 2 (3-4): 86-95
    CrossrefPubMedSearch in Google Scholar
  • 10 Caruana M. Lipedema: a commonly misdiagnosed fat disorder. Plast Surg Nurs 2018; 38 (04) 149-152
    CrossrefPubMedSearch in Google Scholar
  • 11 Christoffersen V, Tennfjord MK. Younger women with lipedema, their experiences with healthcare providers, and the importance of social support and belonging: a qualitative study. Int J Environ Res Public Health 2023; 20 (03) 20
    CrossrefPubMedSearch in Google Scholar
  • 12 Romeijn JRM, de Rooij MJM, Janssen L, Martens H. Exploration of patient characteristics and quality of life in patients with lipoedema using a survey. Dermatol Ther (Heidelb) 2018; 8 (02) 303-311
    CrossrefPubMedSearch in Google Scholar
  • 13 Herbst KL, Kahn LA, Iker E. et al. Standard of care for lipedema in the United States. Phlebology 2021; 36 (10) 779-796
    CrossrefPubMedSearch in Google Scholar
  • 14 Aksoy H, Karadag AS, Wollina U. Cause and management of lipedema-associated pain. Dermatol Ther 2021; 34 (01) e14364
    CrossrefPubMedSearch in Google Scholar
  • 15 Fetzer A. Specialist approaches to managing lipoedema. Br J Community Nurs 2016; (Suppl): S30-S35
    CrossrefPubMedSearch in Google Scholar
  • 16 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
    CrossrefPubMedSearch in Google Scholar
  • 17 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
    CrossrefPubMedSearch in Google Scholar
  • 18 Murad MH, Sultan S, Haffar S, Bazerbachi F. Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 2018; 23 (02) 60-63
    CrossrefPubMedSearch in Google Scholar
  • 19 Cornely M, Gensior M. Komplikationen und deren Management bei der chirurgischen Behandlung der Lipohyperplasia dolorosa. Dermatologie (Heidelb) 2022; (e-pub ahead of print)
    CrossrefPubMedSearch in Google Scholar
  • 20 Kruppa P, Georgiou I, Schmidt J, Infanger M, Ghods M. A 10-year retrospective before-and-after study of lipedema surgery: patient-reported lipedema-associated symptom improvement after multistage liposuction. Plast Reconstr Surg 2022; 149 (03) 529e-541e
    CrossrefPubMedSearch in Google Scholar
  • 21 Wright TF, Herbst KL. A case series of lymphatic injuries after suction lipectomy in women with lipedema. Am J Case Rep 2022; 23: e935016
    CrossrefPubMedSearch in Google Scholar
  • 22 Baumgartner A, Hueppe M, Meier-Vollrath I, Schmeller W. Improvements in patients with lipedema 4, 8 and 12 years after liposuction. Phlebology 2021; 36 (02) 152-159
    CrossrefPubMedSearch in Google Scholar
  • 23 Sandhofer M, Hofer V, Sandhofer M, Sonani M, Moosbauer W, Barsch M. High volume liposuction in tumescence anesthesia in lipedema patients: a retrospective analysis. J Drugs Dermatol 2021; 20 (03) 326-334
    CrossrefPubMedSearch in Google Scholar
  • 24 Schlosshauer T, Heiss C, von Hollen AK, Spennato S, Rieger UM. Liposuction treatment improves disease-specific quality of life in lipoedema patients. Int Wound J 2021; 18 (06) 923-931
    CrossrefPubMedSearch in Google Scholar
  • 25 van de Pas CB, Boonen RS, Stevens S, Willemsen S, Valkema R, Neumann M. Does tumescent liposuction damage the lymph vessels in lipoedema patients?. Phlebology 2020; 35 (04) 231-236
    CrossrefPubMedSearch in Google Scholar
  • 26 Witte T, Dadras M, Heck FC. et al. Water-jet-assisted liposuction for the treatment of lipedema: standardized treatment protocol and results of 63 patients. J Plast Reconstr Aesthet Surg 2020; 73 (09) 1637-1644
    CrossrefPubMedSearch in Google Scholar
  • 27 Bauer AT, von Lukowicz D, Lossagk K. et al. New insights on lipedema: the enigmatic disease of the peripheral fat. Plast Reconstr Surg 2019; 144 (06) 1475-1484
    CrossrefPubMedSearch in Google Scholar
  • 28 Wollina U, Heinig B. Treatment of lipedema by low-volume micro-cannular liposuction in tumescent anesthesia: results in 111 patients. Dermatol Ther 2019; 32 (02) e12820
    CrossrefPubMedSearch in Google Scholar
  • 29 Dadras M, Mallinger PJ, Corterier CC, Theodosiadi S, Ghods M. Liposuction in the treatment of lipedema: a longitudinal study. Arch Plast Surg 2017; 44 (04) 324-331
    Thieme ConnectPubMedSearch in Google Scholar
  • 30 Baumgartner A, Hueppe M, Schmeller W. Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years. Br J Dermatol 2016; 174 (05) 1061-1067
    CrossrefPubMedSearch in Google Scholar
  • 31 Rapprich S, Baum S, Kaak I, Kottmann T, Podda M. Treatment of lipoedema using liposuction. Phlebologie 2015; 44 (03) 121-132
    Thieme ConnectSearch in Google Scholar
  • 32 Wollina U, Heinig B, Nowak A. Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty. Clin Cosmet Investig Dermatol 2014; 7: 35-42
    CrossrefPubMedSearch in Google Scholar
  • 33 Rapprich S, Dingler A, Podda M. Liposuction is an effective treatment for lipedema-results of a study with 25 patients. J Dtsch Dermatol Ges 2011; 9 (01) 33-40
    CrossrefPubMedSearch in Google Scholar
  • 34 Wollina U, Goldman A, Heinig B. Microcannular tumescent liposuction in advanced lipedema and Dercum's disease. G Ital Dermatol Venereol 2010; 145 (02) 151-159
    PubMedSearch in Google Scholar
  • 35 Stutz JJ, Krahl D. Water jet-assisted liposuction for patients with lipoedema: histologic and immunohistologic analysis of the aspirates of 30 lipoedema patients. Aesthetic Plast Surg 2009; 33 (02) 153-162
    CrossrefPubMedSearch in Google Scholar
  • 36 Schmeller W, Meier-Vollrath I. Tumescent liposuction: a new and successful therapy for lipedema. J Cutan Med Surg 2006; 10 (01) 7-10
    CrossrefPubMedSearch in Google Scholar
  • 37 Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol 2012; 166 (01) 161-168
    CrossrefPubMedSearch in Google Scholar
  • 38 Herbst KL, Hansen EA, Cobos Salinas LM, Wright TF, Larson EE, Schwartz JS. Survey outcomes of lipedema reduction surgery in the United States. Plast Reconstr Surg Glob Open 2021; 9 (04) e3553
    CrossrefPubMedSearch in Google Scholar
  • 39 Fife CE, Maus EA, Carter MJ. Lipedema: a frequently misdiagnosed and misunderstood fatty deposition syndrome. Adv Skin Wound Care 2010; 23 (02) 81-92, quiz 93–94
    CrossrefPubMedSearch in Google Scholar
  • 40 Meier-Vollrath I, Schmeller W. [Lipoedema–current status, new perspectives]. J Dtsch Dermatol Ges 2004; 2 (03) 181-186
    CrossrefPubMedSearch in Google Scholar
  • 41 Hoffmann JN, Fertmann JP, Baumeister RG, Putz R, Frick A. Tumescent and dry liposuction of lower extremities: differences in lymph vessel injury. Plast Reconstr Surg 2004; 113 (02) 718-724 , discussion 725–726
    CrossrefPubMedSearch in Google Scholar
  • 42 Peprah K, MacDougall D. Liposuction for the Treatment of Lipedema: A Review of Clinical Effectiveness and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019
    Search in Google Scholar
  • 43 Housman TS, Lawrence N, Mellen BG. et al. The safety of liposuction: results of a national survey. Dermatol Surg 2002; 28 (11) 971-978
    PubMedSearch in Google Scholar