I do remove both Dercums lipomas and fatty lipomas of any size via either direct excision or liposuction.
BMI limits are hard to apply in lipedema. I evaluate your overall health and decide case by case.
I will not operate on patients with life-threatening health complications, who have an untreated mental illness, or on patients who I do not deem to have realistic expectations from surgery.
I do not advise this. In small areas, I can. In larger areas, this can prove quite painful and dangerous.
This depends on the severity of the lymphedema and the damage to the skin. I will often request other specialist opinions if I am in doubt.
Yes, venous disease, if present, should be evaluated and treated to avoid bleeding complications.
I feel that in most cases, the skin does retract. Even more so than in patients without lipedema. This is best with post-operative compression and the use of other modalities such as Renuvion. It takes up to a year to see the final result, but the bulk of the result can be seen typically in 4-6 months.
I remove excess fluid by manual massage after surgery. Then I close the incision to avoid a very messy post-operative couple of days. Preserving the lymphatics should allow the excess fluid to be naturally resorbed. Occasionally I will place drains.
Walk the day of surgery and every day after. Whatever does not cause excess discomfort, depending on the site of surgery.
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