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Lipedema Update: 10/4/2024

Name: Ditesheim Cosmetic Surgery
Address: 9336 Blakeney Center Drive, Suite 130, Charlotte, AL, 28277, United States
Telephone: (704) 542-8686
Price range: Call for Pricing

group photo. Left to right: a woman, and then three men.

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Dr. Jeffrey A. Ditesheim MD FACS | drditesheim@empowermd.com

I am a board-certified plastic surgeon and passionate about helping women with lipedema overcome challenges such as isolation, disability, and loss of confidence. Everything I have learned has been self-taught, as lipedema is poorly understood and not familiar to most healthcare providers.

I have read every published study, most from larger German experiences (over 15 years). In 2018, I started to see women with lipedema who wanted treatment with water-jet liposuction. I had a large experience with water-jet liposuction in cosmetic patients (1000 patients since 2011).

Key Experiences

Earlier this year, I attended the FDRS ( Fat Disorders Resource Society https://www.fatdisorders.org/) lipedema meeting in St. Louis. I spoke with other lipedema doctors and therapists. Everyone seemed to have a different approach: local vs. general anesthesia, treating thighs or legs first, how many procedures, how much fat to take out, to do skin excision at the same time or later? Most of all, I spent a lot of time listening to patients. Many patients were unsure about surgery: when to have surgery, where to go, how much to pay, and how many procedures to have. There was a lot of talk about going to Germany to have lipedema surgery.

Visit to Germany

I knew that to give patients the best care; I needed to travel to Germany to the premier lipedema clinic and see for myself what they were doing. Last week, I visited with Dr. Thomas Witte (second from left) and his colleagues at LipoClinic in Mulheim, Germany. This is a dedicated lipedema clinic started by Dr. Heck 15 years ago.

I observed patients before, during, and after surgery. They had large volume fat removal (7-15lb) and were up walking 2 hours later, talking to me, pain-free. I was convinced that the LipoClinic protocol was giving women excellent care with quick recovery.

New Lipedema Surgery Protocol

Consultation:

I meet with all paients in person,

if possible, and historical data is collected to document the timeline of their lipedema disease, how the disease has progressed, and what strategies have been used. A complete examination is done to identify sensitive or painful areas or areas with shape distortion, like the thighs and legs. The new Lipedema Protocol follows the lessons learned from the German clinic

Holistic Approach:

We know from Dr. Amato’s work in Brazil that the identification of inflammatory triggers in the diet and decreasing gut and whole-body inflammation is critical to managing lipedema.

Treatment Differentiation:

At this time, it is not known who can be treated with diet modification alone and who is best to have early surgical debulking with liposuction. What is known is that for every lipedema patient, control of inflammatory triggers both before and after surgery is very important in fat accumulation, pain, and swelling control.

Preoperative and Surgical Protocol for Lipedema Treatment

Preoperative Preparation:

Compression Garment:

The best garments are custom-fitted, flat-knit, with a defined degree of external compression. (20-30mmHg, Class 2). I recommend wearing this tighter compression garment for six weeks, 23 hours per day before surgery. They are more expensive than off-the-shelf pantyhose, but are best to to control lipedema swelling.

Surgical Protocol

Lymphatic Massage:

Before surgery, manual lymphatic massage or pneumatic lymphatic massage can really help to decrease lipedema swelling.

Goals of Surgery:

Complete, aggressive removal of inflamed lipedema fat is critical to preserving or restoring mobility, minimizing or eliminating pain and swelling, and improving appearance.

Fat Removal Guidelines:

Borrowing from the German lipedema clinic experience over 15 years, the maximum amount of fat that can be removed safely (in one procedure) is 6-8% of total body weight. Water-jet liposuction with a “lymph-sparing technique” is always used.

Treatment Stages:

Thighs are treated first, in one or two stages, depending on patient weight. In women with higher weights (>180lb), the front of the thighs and knees are treated first, and the buttocks and back of the thighs are treated in the second stage. Legs circumferential are treated in the next stage, followed by arms and forearms. Occasionally, the lower abdomen will need treatment. Each area is treated aggressively to remove the deep fat layer, as this is the target of the lipedema disease. Complete debulking of the lipedema fat is predicted to give the best long-term surgical results. The superficial fat, including lymphatics, is preserved. Only in the lower leg around the ankle is the fat treated more superficially.

Postoperative Care:

In the first 24 hours, I strongly encourage patients to be up and walking, flexing their calf muscles. Oral hydration with electrolytes will replace fluids lost in surgery. Flat-knit compression garments that were worn before surgery are used after surgery for 23 hours per day for 6 weeks.