The following is in the conclusion of Dr Bertsch’s four-part series on Lipedema Myths.
Bertsch T et al. Lipedema – Myths … Phlebologie 2019; 48: 47–56 47
Some of the criteria below have not been well-defined. There is no international standard or US standard for performing liposuction for lipedema. One does not need to even be a surgeon. After spending hundreds of hours researching the topic I feel the author’s view to be conservative but valid (they are saying that liposuction should be an option for select patients under strict circumstances). As a patient if you meet the criteria below you have the best argument for your case to be accepted as reconstructive and medically necessary.
Criteria concerning the lipedema patient:
1. Pain in soft tissue must have persisted despite conservative treatment that has been carried out for at least 6 months.
2. Liposuction must be incorporated into a comprehensive therapeutic concept that also considers psychological, psychosocial, dietary and sports medicine aspects.
3. In the case of obese patients with lipedema, then of the two diseases, obesity must not predominate. In our view, this would be the case if the BMI of 32 kg/m2 named in the lipedema guidelines was exceeded. Exceptions to this should be justified.
4. In order to reduce the risk of a postoperative weight increase (that would negate the improvement achieved through liposuction), proof is needed that the weight has been largely stable for at least 2 years.
5. A preoperative psychological assessment by trained professionals must have been conducted to exclude eating disorders or severe psychological diseases that would stand in the way of a permanently successful treatment.
Criteria concerning the surgeon:
1. Definition of quality standards that the surgeon must meet.
2. Certification to ensure this quality standard – similar to that which also exists for surgeons carrying out bariatric-metabolic operations. The patient would then have the possibility of finding a surgeon who meets the defined quality criteria.
CONCLUSIONS We believe that selection of suitable patients as well the incorporation of liposuction into a holistic treatment concept is decisive for the success of liposuction. This concept should take into account the entire range of symptoms of the patient with lipedema: the pain as well as problems of self-acceptance, any psychological diseases and the problem of weight gain.
The complete article on liposuction for lipedema is below.