Lipedema is a disorder that occurs mostly in women and is characterized by symmetrical fatty excess in the legs and sometimes arms and trunk. It may be misdiagnosed as obesity. The cause is not known but it may run in families. Some patients experience pain or discomfort in the affected areas.
Before and after first liposuction procedure, then after second liposuction procedure with thigh lift by Dr Gutowski.
Lipedema treatment may include conservative modalities such as massage, compression, appropriate nutrition, exercise, and physical therapy. In cases where these efforts are not effective in reducing the problems associated with lipedema, liposuction and surgical tissue removal can help. While most patients are pleased with the results of liposuction, often two or more treatment sessions may be needed. In some cases, loose skin can be removed after liposuction. However, liposuction is not a cure for lipedema and continued lifestyle activities and compression garments will be needed.
What type of Lipo is best?
There are claims that water-assisted liposuction (BodyJet) and VASER-assisted liposuction are better for lipedema than other types of liposuction. Unfortunately, the are no well done medical studies to show that this is true. Moreover, there is much misinformation on the internet about which technique is best. Dr. Gutowski has been treating lipedema patients since 2001 and has used traditional tumescent liposuction, power-assisted liposuction, VASER liposuction, ultrasound-assisted liposuction, water-assisted liposuction, and laser-assisted liposuction (SmartLipo). Based on his experience with over 250 lipedema patients, he has found that power-assisted liposuction (PAL) gives the best results. While the “power” may sound like it can cause more tissue damage, it is actually the opposite and is usually more gentle when done by an experienced plastic surgeon. The PAL technique uses a small liposuction tube (cannula) which has small vibrations at the tip. This breaks up the fat cells but does not injure nerves, blood vessels, or lymphatic vessels. Since the vibrating tip breaks up the fat, the cannula can be moved in and out through the tissue more gently than with other techniques. Because PAL is more efficient, more fat can be removed in less time compared to other techniques, resulting in lower surgery costs. In fact, the only medical study that demonstrated good the long-term results (8 years) after lipedema treatment used PAL for fat removal.
Dr Gutowski demonstrating PAL
How much Fat can be removed ?
Each state may have regulations about how much fat can be removed at one time. In Illinois, there is no state limit but hospitals and surgery centers commonly set the limit at 5000 mL (5 liters, or about 5 quarts). This includes not only the fat removed but the tumescent fluid that also comes out. For this reason, Dr Gutowski is very careful about how much tumescent fluid is used, and can removed more fat in one treatment session. In most cases, doing the procedure with an anesthesiologist involved will allow for more fat removal. Also, since WAL adds more water to the fat removed, it results in less overall fat being taken out since the 5000 mL limit is reached faster.
Before and after liposuction with removal of 18,000 mL of fat and tumescent fluid. (From Scheller in BJD, 2012)
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Dr Gutowski Lipedema Research
With his research background, Dr. Gutowski contributes to finding a cure for Lipedema by collaborating with researchers at the University of Chicago who are studying the fat tissue in Lipedema patients.
How many patients with lipedema has Dr Gutowski operated on?
Since 2001, Dr Gutowski has treated over 250 patients with lipedema.
What type of liposuction does Dr Gutowski perform?
Dr Gutowski performs super-wet and tumescent liposuction using traditional (SAL), power-assisted (PAL), water-assisted (WAL, BodyJet), VASER-assisted (VAL), ultrasound-assisted (UAL), and laser-assisted (LAL, SmartLipo) techniques. Although each of these can be used for treating lipedema, PAL tends to have the best results.
What type of anesthesia does Dr Gutowski use?
Dr Gutowski commonly does liposuction with just local tumescent anesthetic. However, for larger volume fat removal procedures, it is safer to have an anesthesiologist who can offer sedation or general anesthesia.
What is the number of procedures Dr Gutowski recommends?
Each lipedema patient is unique. In most cases, 2 or 3 liposuction treatments are recommended for better results.
What pre-operation evaluation is needed? What tests are done before surgery?
In most cases, simple blood tests may be done. For older patients, and EKG and assessment by a primary care doctor may be needed.
What post-operative recommendations does Dr Gutowski suggest?
All patients wear premeasured compression garments for at least 4 weeks after the procedure. Early activity is recommended.
Will Dr Gutowski put me in touch with other lipedema patients he has operated on?
Due to patient privacy laws, we cannot give out names of patients we treated.
What kind of long-term tracking Dr Gutowski do of his outcomes?
All patients can see Dr Gutowski at any time, even years, after treatment. Since many patients travel long distances to see Dr Gutowski, they often do not continue to follow up in person after a year. But we do encourage keeping in touch by phone or email.
Will Dr Gutowski show pictures of surgeries he performed?
Pictures of patients who have been treated and given permission for viewing their pictures are available on Dr Gutowski’s website.
How do they define and measure a ‘successful’ procedure?
Success can be different for each patient. While Dr Gutowski cannot guarantee specific outcomes or results, nearly all patients have been happy with treatment and would do it again.
When and how is follow-up done?
Dr Gutowski typically sees liposuction patients within 1 week of surgery, then again at 2 weeks, 1 month, 3 months, 6 months, and 1 year. However, all of Dr Gutowski’s patients can see him anytime.
Does lymphatic function testing need to be done before surgery?
If needed, Dr Gutowski will refer to a lymphedema specialist.
What qualifications does Dr Gutowski have in plastic surgery?
Dr Gutowski is a Board Certified plastic surgeon. He has performed over 2500 body contouring procedures using liposuction.
Has Dr Gutowski done any medical research or education of other plastic surgeons?
Yes, Dr Gutowski does both clinical and basic science research which has resulted in over 100 peer-reviewed medical publications and book chapters. He is a regular invited speaker at leading plastic surgery conferences and has given over 150 national and international teaching presentation, lectures, and courses. He has worked with scientists at the University of Chicago in researching lipedema.
Are Dr Gutowski affiliated with any professional organizations?
Dr Gutowski is an active member of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS), American College of Surgeons (ACS), American Association of Plastic Surgeons (AAPS), and other organizations.
How is liposuction on the lipedema fat different from liposuction with regular fat?
Dr Gutowski uses a technique which avoids touching the deeper lymphatic system and also uses PAL which is more gentle than other types of liposuction and has been shown to have good results after many years.
How much pain does the typical patient experience during surgery and what is recovery like?
Each patient experiences some level of discomfort but most patients tolerate liposuction very well and describe it as a sore feeling. There is improvement day to day and week to week. Full recovery may take a month but final results can take 1 to 2 years.
What risks should I be aware of?
You may learn more about this at Lipedema Liposuction Consent
How much will my procedures cost? Do you take insurance?
Since insurance does not cover liposuction, we cannot submit the costs to your insurance company. The cost depends on how many areas are treated and how much time is needed.
How far apart will my procedures be?
Depending on how much fat needs to be removed, procedures can be a few days apart or longer.