To help distinguish one from the other, doctors may look for swelling that ends abruptly at the wrist or ankle and assess the ability to pinch the skin on the feet without difficulty, both of which would indicate lipedema.

What is lipedema surgery?

In a word: liposuction. In a few more words: It’s a more specialized, and riskier, form of liposuction than the standard cosmetic procedure, because a) significantly more tissue is being removed and b) the fat that’s being removed is of a different quality. “The fat in lipedema tends to be quite fibrous, so it’s harder to remove, so we use different tubes, or cannulas, than the ones used in cosmetic liposuction,” explains Dr. Neligan. “And the amount of tissue you’re removing is quite enormous. The most I’ve removed from a leg is 11 liters — 11 liters is huge, and that’s beyond the recommendations for cosmetic liposuction.” (To help you understand how much that is: 11 liters is equal to 46 cups, or almost three gallons. By comparison, the average cosmetic liposuction session removes about 2 liters of tissue, according to the American Society of Plastic Surgeons.)

The risks are greater with this kind of liposuction. “One of the problems with extensive liposuction is excessive bleeding and fluid loss,” says Dr. Neligan. “We generally do it under a tourniquet so the patient is not bleeding, and before letting [the tourniquet] down, we wrap the extremity in excessive bandages and the risk of bleeding is significantly reduced.” He adds, “With [cosmetic] liposuction you go home [right after], but we generally keep patients overnight [after lipedema liposuction].”

In some cases, a patient may need skin tightening after the liposuction to remove excess skin. This could mean another surgery, such as a leg lift.

What kind of doctor is qualified to perform lipedema surgery?

Not all doctors who offer liposuction offer lipedema treatment — nor should they. Allure did come across some general practitioners and dermatologists offering newly popular lipedema surgery, but it is important to see a board-certified plastic surgeon because of the bleeding risks associated with extensive liposuction.

Says Dr. Neligan, “The actual doing of liposuction, you could teach a monkey to do that — but knowing how much tissue is safe to remove and the precautions to take when you remove that amount of tissue, and keeping an eye on the patient overnight [to watch for bleeding and fluid loss], that’s really important.”

Board-certified plastic surgeon Dr. Lyle Leipziger, MD, chief of plastic surgery at North Shore University Hospital and Long Island Jewish Medical Center, is one doctor who performs liposuction, but not liposuction for lipedema. When he diagnoses patients with lipedema, he then refers them to a specialist. He advises that patients should go to a board-certified plastic surgeon who not only says they have worked with lipedema patients, but can also show you before and after pictures of their work. “It shows that that particular physician has a track record of performing the procedure,” says Dr. Leipziger.

What are the risks of lipedema surgery?

There are serious risks of excessive bleeding and fluid loss. According to a survey of women who have had lipedema surgery, the most common complications were growth of loose skin, tissue fibrosis (a hardening of tissue), anemia, blood clots, and lymphedema. “Whether participants developed lymphedema due to the procedure, or whether they developed lymphedema over time due to underlying lymphatic dysfunction is unclear,” the 2021 survey found. “Close and long-term monitoring of patients with lipedema post-surgery is needed to determine the risks of these procedures in the USA.” Blood clots — a risk after any surgery — can be life-threatening.

How long do the results of lipedema surgery last?

In the survey referenced above, in which “quality of life improved in 84% and pain improved in 86% of patients” after surgery, more than 50% of patients reported they had some new adipose tissue growth after surgery both in and outside the treated areas. However, the results of a separate survey published that same year were more promising: In most cases, the patients self-reported that their results lasted at least 12 years.

Who is a candidate for lipedema surgery?

Nearly anyone diagnosed with the condition who is cleared for surgery according to the American Heart Association and American College of Cardiology guidelines and wants it is a candidate.

What is the cost of lipedema surgery?

The cost can vary widely by provider and is based on the number of areas and surgeries necessary to treat a particular case. One surgery can typically run from $7,500 to $20,000. In some cases, insurance may offer partial coverage, so check with your provider before you book an appointment. But, adds Dr. Neligan, “there’s a real problem for a lot of patients — because insurance companies see the word ‘liposuction,’ they assume it’s cosmetic, so they don’t cover it. A lot of patients have difficulty getting coverage.”