High Volume Liposuction in Tumescence Anesthesia in Lipedema Patients: A Retrospective Analysis

March 2021 | Volume 20 | Issue 3 | Original Article | 326 | Copyright © March 2021


Published online January 29, 2021

Matthias Sandhofer MDa, Victoria Hofer MDa,b, Martina Sandhofer MDa, Mindt Sonani MDc, Werner Moosbauer MDa,d, Martin Barsch MD MBAa

aDermatologie Zentrum für Haut, Ästhetik, Laser, Venen, Praxis Dr. Matthias Sandhofer/Dr. Martin Barsch; Austrian Center for Lipedema, Wien/Linz, Austria
bDanube Private University, Faculty of Medicine/Dental Medicine, Krems-Stein, Austria
cInstitute for Clinical Chemistry, University Hospital Mannheim, Mannheim, Germany
dKepler Universitätsklinikum GmbH, Anästhesiologie und Operative Intensivmedizin, Linz, Austria

Abstract
Background: Lipedema is a chronic, progressive disease that occurs almost exclusively in women and leads to pathological, painful fat growths at the extremities. Only symptomatic therapy can be offered since the etiology of the disease has not yet been clarified. Liposuction in tumescent anesthesia has established itself as a surgical treatment method of choice. The complication rate associated with the procedure and the pharmacological course and safety of treatment in patients with lipedema has not yet been sufficiently studied. The aim of the study was to broaden the evidence on the safety of ambulatory high-volume liposuction in tumescent anesthesia in lipedema patients. Influencing factors of patients (weight, fat content, comorbidities) or the process technique (drug administration, volume of aspirates) should be investigated on the safety and risks of tumescent anesthesia. This was a retrospective data analysis in which data from 27 patients (40 liposuction procedures) treated at the Sandhofer and Barsch lipedema center between 2016 and 2018 were evaluated. The liposuctions were carried out in tumescent anesthesia and using a Power-Assisted Liposuction system. Clinical examinations and regular blood samples were carried out before the procedure, intra- and postoperatively. The procedures lasted an average of 118 minutes and an average of 6111 ml of aspirate was removed. For tumescent anesthesia, patients were given an average lidocaine dose of 34.23 mg/kg body weight and an epinephrine dose of 0.11 mg/kg body weight. No relevant complications associated with drug side effects, hypovolemia or hypervolemia or blood loss were detected. Liposuction under high volume tumescent anesthesia for the treatment of lipedema patients is, even for major intervention, a safe procedure.

J Drugs Dermatol. 20(3):326-334. doi:10.36849/JDD.2021.5828

INTRODUCTION

Liposuction is one of the most common surgical procedures in aesthetic surgery worldwide and was first described out in the mid-1990s as a therapy for lipedema.1,2 During this time, liposuction could be established as a safe and effective therapeutic alternative in the treatment of lipedema, especially by German, Austrian and Dutch operative dermatologists.3-9 Further development of the surgical procedure using lymph-friendly liposuction techniques with fine cannulas, liposuction has established itself as an important, minimally invasive therapeutic approach for lipedema.8 Several studies have shown that liposuction significantly reduced sensitivity to pain and pressure as well as the tendency to hematoma.10 Improving mobility after the procedure leads to an increase in energy turnover, which can contribute to further weight loss.8 Several studies describe a significant improvement in the quality of life due to the suction of the pathological fat tissue, which can still be demonstrated eight years after the intervention.10,11 To date a causal therapy for lipedema is not known. The treatment of lipedema is based on conservative physical decongestive therapy and surgical liposuction of the pathological adipose tissue augmentation. The appropriate treatment method should be determined individually for each patient.12 The excessive increase in adipose tissue and the resulting restrictions in mobility as well as the disproportionate appearance cannot be treated with conservative therapy,13 especially if there is no edema present. Manual lymphatic drainage (MLD), intermittent pneumatic compression, compression stockings, exercise, and skin care are often used to control pain and symptoms in lymphedema and therefore also in lipedema. Recent studies have shown that there is little or no lymphedema in lipedema.14,15 All over, the term lipedema is a misnomer, since more than 90% of typical lipedema patients do not have any edema. Especially the patients that are seen in the practice, in contrary to the patients seen in specialized lymph clinics, where the percentage of lipedema patients with an edema is a bit higher. Treatment with MLD showed no significant therapeutic effect