What works best for Lipoedema: Surgery vs. Hands-on treatments
Lipoedema is a chronic condition and its main characteristic is the abnormal buildup of fat deposits (resistant to exercise and diet). Most seen in legs and sometimes arms. Other symptoms are: pain, swelling, easy bruising and reduced mobility (in advanced stages). Lipoedema has no known cure yet, however, there are treatments focused on managing symptoms and improving quality of life from 1 to fourth 4 stages; besides, liposuction which is suggested for specific cases (link liposuction and lipoedema blog). Once patients get their lipoedema diagnosis, they and clinicians often deal with a critical decision: Non-Surgical Treatments vs. Surgery- What works best for lipoedema? Let´s have a closer look…
What are the stages of lipoedema?
- 1: Skin is smooth, but you may feel little nodules underneath.
- 2: Skin becomes uneven, with visible indentations and larger palpable nodules.
- 3: Large, lobular fat deposits cause visible deformity and may severely impact mobility.
- 4: Secondary lymphoedema develops (because fat nodules blockage lymphatic circulation), leading to additional swelling and complications.
What work best for lipoedema: surgical and non-surgical treatments treatments
Non-Surgical Treatments: First-Line and Foundational Care
Non-surgical (conservative hands-on treatment) therapies are the first step and foundational care (even after lipo) in managing lipoedema’s symptoms. They are:
- Manual Lymphatic Drainage (MLD): this specialised massage technique reduces swelling, boosts your immune function while increases lymphatic and blood flow and improves your general wellbeing.
- Compression therapy: Compression garments (socks, pants, sleeves, etc.) help reduce pain, swelling, and discomfort while supporting mobility.
- Physiotherapy and exercise: Gentle movement (supervised exercises) and physiotherapy improve mobility, general well-being and support weight management. Even though lipoedema fat is resistant to diet and exercise, a tailored treatment might avoid progression and reduce symptoms.
- Weight management: while losing weight may not reduce lipoedema fat; however, when you maintain a healthy weight, it helps manage symptoms and prevent complications and disease progression.
- Skin care: Regular moisturising protects skin from rash, cuts and stress due to compression garments.
- Psychological support: your mental health is crucial, as depression and anxiety are common among lipoedema patients due to self-image and social criticism issues.
This tailored holistic treatment can significantly improve quality of life, manage symptoms and avoid advanced stages for many patients. However, not always conservative treatments do not reverse or stop the underlying fat accumulation, and some patients eventually find their symptoms progress despite best efforts (Don’t blame yourself, keep walking and never give up!).
Surgery: Is it necessary and effective?
Liposuction is the most studied surgical option for severe cases of lipoedema. It physically removes abnormal fat tissue, offering relief from pain, improved mobility, and a reduction in the need for compression therapy. Key findings from recent studies include:
- Long-term benefit. A 12-year follow-up study found that improvements in pain, swelling, bruising, and mobility persisted over time,
- Quality of life. Patients report improvement in quality of life, less reliance on compression therapy, and improved self-image/esteem.
- Safety. There are few adverse effects, especially when performed with modern techniques like wet-jet assisted liposuction, which minimises damage to lymphatic vessels.
- Limitations. Liposuction is recommended for severe cases, patients who do not respond adequately to conservative management by itself. Remember that for those undergoing liposuction traditional therapies will be part of their daily care treatment, too.
Non-Surgical vs. Surgery-Liposuction
| Aspect | Non-Surgical Treatments | Surgery (Liposuction) |
| Symptom Relief | Good for many, especially early stages | Significant, especially after conservative therapy fails |
| Fat Reduction | Does not reduce lipoedema fat | Directly removes abnormal fat pockets |
| Quality of Life | Improves with time | After the surgery recovery process, patients reported notorious improvement. |
| Risks/Side Effects | Minimal | Usual surgical risks |
| Long-term Outcome | Lifelong management | Benefits can last 12 or more+traditional maintenance treatment |
| Who Benefits Most | 1,2,3 stages/mild symptoms | Moderate/severe, non-responsive cases or those where the surgeon also agrees that is time to perform surgery. |
A final word
As in most chronic conditions, there is one-size-fits-all treatment. Non-surgical treatments are effective for a lot of patients (especially in early or mild cases) and should always be the first line of management. On the other hand, surgery, particularly liposuction, is the suggested next step for those with persistent, life-limiting (mobility) symptoms who do not get adequate relief from conservative therapies. However, remember that after liposuction, patients should continue with their lipoedema tailored symptoms management treatment (includes conservative therapies). The best outcomes and quality of life are achieved with a personalised, holistic approach always assisted by your lipoedema team.
We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC11219175/
https://lipoedema.co.uk/wp-content/uploads/2021/07/Baumgartner-12-year-follow-up-after-lipo.pdf
