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Recovering from lipoedema surgery involves more than the operation itself. Compression therapy, manual lymphatic drainage (MLD), and careful post-operative planning all play an important role in supporting healing.
In this expert Q&A, Dr Damir Kosutic MD PhD FRCS (Plast), Consultant Plastic and Reconstructive Surgeon, answers some of the most common questions about lipoedema surgery recovery, sharing practical advice on compression garments, MLD, recovery timelines and patient expectations.
Can you explain your approach to liposuction for lipoedema versus standard cosmetic liposuction?
My approach to lipoedema liposuction, unlike cosmetic liposuction offered by most other plastic surgeons, is centred around preservation of viable lymphatic pathways, achieving significant reduction in volume while maintaining patient safety at all times, using tumescent liposuction with tourniquet control to minimise blood loss, bruising, swelling and pain.
By utilising ICG lymphatic mapping before, I am able to avoid performing liposuction blindly as I can map and avoid damage to lymphatics. Lipoedema patients often have a degree of lymphatic insufficiency; therefore every effort should be made to preserve their limb lymphatic drainage which I can do utilising this modern technology.
When doing surgery for lipoedema or lymphoedema, what criteria do you use to decide who is a good candidate?
My approach to lymphoedema and lipoedema patients is personalised and customised, no patient is the same. Medical and surgical history, together with clinical examination, are extremely important, as is the result of ICG imaging and sometimes other diagnostic tests I use in decision making as to which technique or combination of surgical techniques would work best for the individual patients’ situation.
Also, the sequence of surgeries is important as well as patients’ understanding and expectations. Careful planning and establishing trust between myself and the patient are key to my success I have had for many years in this field.
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How do you integrate compression garments and Manual Lymphatic Drainage (MLD) into your post-op protocols?
The role of post-operative conservative management by lymphoedema physiotherapists and MLD-practitioners is crucial to the success of surgery and if that is not in place ahead of the procedure, I would not book anyone for surgery. The patient needs to have a compression garment ready for their procedure as I would always apply the garment towards the end of the procedure, to reduce blood loss, swelling, bruising and pain.
The patient should already have been seen by an MLD specialist or a Lymphoedema Physiotherapist and pre-book manual lymphatic drainage at least twice a week in the first 6 weeks post-surgery, starting from 2nd week post-operatively, once wounds are already healed. This should continue for 3 months ideally when frequency can reduce. After 6 weeks, the initial post-surgical swelling will start to subside and the patient would need to get remeasured for a tighter set of garments.
- Preparing for surgery
As Dr Kosutic explains, patients should have their compression garments ready before surgery. Having the correct compression garment prepared in advance can help make the transition from hospital to home more comfortable.
What are your recommendations for garment strength immediately after lipoedema surgery, and how does this change over time?.jpg)
The patient would usually already have their existing garments which I would normally use at the end of their procedure and apply in the operating theatre. After 4-6 weeks when swelling will start to subside, they should get remeasured by the lymphoedema physiotherapist or MLD practitioner for a tighter set of garments.
At 3 months after surgery, they would likely go into even smaller size garments as most of the swelling would be gone in the majority of patients. Most patients with lymphoedema wear class II or class III garments whilst lipoedema patients can more quickly transition to lighter compression, as they still have viable lymphatic drainage.
- Recovery continues after the first few weeks
As swelling gradually reduces, patients are often remeasured for a new compression garment. Depending on your surgeon's recommendation, transitioning to a garment such as VBfLg can provide continued support throughout the next stage of recovery.
Can you walk through your recommended timeline for recovery after lipoedema liposuction?
It usually takes 2 weeks for wounds to heal and at that point Manual Lymphatic Drainage (MLD) can commence. The patient should take the garment off in the evening to shower and moisturise the limb to avoid any skin cracks which could introduce infection. Manual Lymphatic Drainage (MLD) can be ideally done 2x a week and then after a few months once a week is usually enough. It is best to take it easy and reduce mobility as well as avoid any sports activities in the first 6 weeks after surgery, otherwise, the patient will end up having more swelling. The use of compression garments is crucial in that period of time. After 3 months, the use of compression garments can be reduced in lymphoedema patients, whilst this usually happens in lipoedema patients after 6 weeks.
- Need help choosing the right garment?
Read our guide: How to Measure for Lipoedema Compression Garments
What features do you look for in compression leggings or garments when selecting something for your patients (fit, fabric, fastenings, breathability)?
I prefer made-to-measure garments in general and those that are made of materials that are ‘kind’ to patient's skin. This is very important as the patient spends most of the time in the garment and rough materials can rub against the skin, which can cause skin cracks and introduce infection. Infection in lipoedema and in particular lymphoedema patients can be catastrophic, not only damaging the results of surgery but also could progress to sepsis if not treated immediately and with adequate antibiotics, therefore quality of garments and their fit is very important after surgery. I also like those that would not slip easily when the patient is mobilising, especially if single leg is operated on as opposed to surgery on both legs. I do both, depending on the particular patients' situation and what can be achieved.
- Want to learn more about choosing the right compression garment?
Read: Lipoedema Leggings: Which Ones Should I Choose?
What might be a common misunderstanding patients have about lipoedema surgery or recovery?
A common misconception is that patients will lose the volume with dieting or exercise, unfortunately, it does not happen with lipoedema or lymphoedema and surgery is necessary to reduce the volume (lipoedema) or restore lymphatic drainage (lymphoedema procedures like LVA bypass and Lymph-node transfer). Liposuction cannot cure the condition, but can improve patients' quality of life, their mobility, self-confidence, social interactions, and physical/psychological well-being. The patient needs to be realistic about their expectations and outcomes. Sometimes additional procedures are necessary to improve the outcome later on, especially if large volume has been removed and there is excess skin, requiring thigh lift or similar procedures.
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