Conventional Liposuction Research Articles

Use of Radiofrequency-Assisted Liposuction (BodyTite) for Upper Arms Lifting

BackgroundBody contouring surgery is increasingly requested by patients, both for aesthetic and post-bariatric purposes. There has also been a rapid increase in demand for noninvasive aesthetic treatments. While brachioplasty is burdened by numerous complications and unsatisfactory scars, and conventional liposuction is unsuitable for all patients, nonsurgical arm remodeling performed with radiofrequency-assisted liposuction (RFAL) allows to effectively treat most of patients, regardless of the amount of fat and ptosis of the skin and avoiding surgical excision.MethodsA prospective study was conducted on 120 consecutive patients who presented to the author's private clinic and required upper arm remodeling surgery for aesthetic purposes or after weight loss. Patients were classified according to the modified classification of El Khatib and Teimourian. Pre- and posttreatment upper arm circumferences were taken after 6 months of follow-up to assess the degree of skin retraction obtained by treating the arm with RFAL. A satisfaction questionnaire regarding the appearance of the arms (Body-Q upper arm satisfaction) was administered to all patients before surgery and after 6 months of follow-up.ResultsAll patients were effectively treated with RFAL, and no cases required conversion to brachioplasty. The average reduction in arm circumference was 3.75 cm at 6 months follow-up, and patients’ satisfaction increased from 35 to 87% posttreatment.ConclusionsRadio frequency is a valid tool to treat most patients with upper limbs skin laxity, with significant aesthetic results and a high degree of patient satisfaction, regardless of the degree of skin ptosis and lipodystrophy of the arm.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Laser-Assisted Liposuction for Autologous Fat Grafting Following Elective Breast Explant Surgery

Background: The demand for breast implant removal increased globally. This study assessed an infrared diode laser's intraoperative and immediate postoperative features for fat harvesting when autologous breast lipograft is performed following breast explantation surgery. Methods: A prospective analytical nested case-control study was conducted comparing patients submitted to laser-assisted liposuction (cases, n=5) and conventional liposuction (controls, n=10). The analytical variables collected included the duration of surgery, the total volume of aspirated fat, the total volume of fat injected into the breasts, the time elapsed between the end of the surgery and the request for the first dose of analgesia, the total number of analgesics requested in the recovery room, and visual analogue scale for pain administered 6 hours after surgery. Results: In the transoperative period, cases have significantly increased rates of surgery time, total volume of aspirated fat, and total volume of fat injected into their breasts. Regarding pain, controls showed significantly higher consumption of analgesics, requested pain medication earlier, and obtained higher rates on the visual analogue scale. Conclusion: Patients submitted to laser-assisted liposuction had lower pain scores and used fewer analgesics than patients who did not use intraoperative lasers.

Aesthetic Outcome of Gynecomastia Management with Conventional Liposuction and Cross-Chest Liposuction: A Prospective Comparative Study

BackgroundLiposuction is the most accepted technique for treatment of gynecomastia at present with or without residual gland tissue excision. Conventional liposuction uses incisions for introduction of cannula, made usually at the inframammary crease or axilla resulting in consequent scars. Cross-chest liposuction technique was introduced to avoid these additional scars and improve the aesthetic outcome. This study aimed to evaluate the difference between aesthetic outcome of conventional liposuction and cross-chest liposuction in treatment of gynecomastia.MethodA prospective comparative study between 2 groups with 15 patients in each was conducted, one with conventional and the other cross-chest liposuction. Excision of residual gland tissue was performed through circum-areolar incision in both the groups. Aesthetic outcome was evaluated in both the groups using Likert scale and compared.ResultThe mean age of the patients was 22.6 years and the mean duration of presentation was 8.13 years. Satisfaction rate with conventional and cross-chest liposuction was 80% and 86%, respectively, as assessed by the patients. The rate was 80% and 77%, respectively, in both the groups as assessed by independent observer. The complication rate was 13.3% in conventional and 20% in cross-chest group. The difference in outcome was not statistically significant between two groups. Difference between the mean Likert scores of pre-operative and post-operative satisfaction was statistically significant for both the techniques.ConclusionThe conventional and the cross-chest liposuction, both yield comparable results when used for treatment of gynecomastia in terms of aesthetic outcome.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

Assessment of Skin Redraping After Liposuction In Treatment of Gynecomastia Grade III Simon`s Classification

Background: Gynecomastia is the most common breast disorder in men. The usual treatment of grade III is surgical excision of the excess skin which may cause embarrassment and dissatisfying results Objective: To evaluate skin redraping after traditional liposuction in management of grade III gynecomastia Simon`s classification. Patients and methods: 20 patients with grade III gynecomastia with age group between 18 and 40 years old with mean 28.25 ± 4.18. It was a prospective observational cohort study. 11 cases underwent surgical gland excision through a semicircular infraareolar incision while 9 cases didn’t need to. The study was conducted at Alazhar university hospitals Results: The subjective results for all patients at 3 months assessment point. Four patients were very satisfied, eight satisfied, four neither satisfied nor dissatisfied while three patients dissatisfied. only one was very dissatisfied. The average sternal notch to nipple length pre and 3 months postoperative were respectively 27cm, 22cm. Our overall success rate is easily explained by several factors. The selection of young nonsmoker patient with no comorbid diseases or defective elasticity (varicosities or hernias), and the proper choice of the corset size and fiber as well as wearing it for the whole time of the study (3 months). The semicircular periareolar incision scars are not well defined as it become camouflaged by the color change between normal skin areola Conclusion: Conventional liposuction alone could be a reliable method to treat grade III gynecomastia in young patient with a good skin quality and helps in avoidance of undesirable scars.

High-Definition Lipoplasty in Male Patients: A Systematic Review of Surgical Techniques and Outcomes.

Lipoplasty has undergone a series of refinements since its inception. It is now possible to apply superficial suction to enhance the outline of a muscle in order to improve the results of aesthetic lipoplasty. The aim of this study was to summarize the available evidence on the techniques and surgical outcomes of high-definition lipoplasty (HDL) in male patients. A systematic search across PubMed MEDLINE, Web of Science, Ovid MEDLINE In-Process & Other Non-Indexed Citations, and SCOPUS was performed in accordance with the PRISMA guidelines. Data regarding the surgical techniques, outcomes, and complications were extracted. Thirteen studies comprising 1280 patients fulfilled the inclusion criteria. The age of patients ranged from 18 to 71 years. The average BMI was 26.5 kg/m2. The follow-up ranged from 2 weeks to 10 years. The liposculpting concepts reported were abdominal etching, high-definition, muscular sculpture, and dynamic definition. Four studies used conventional liposuction, 3 used VASER-assisted HDL, and 6 studies used power-assisted liposculpting. Eight studies reported the use of fat grafting. All studies reported the use of postoperative garments and a well-established wound treatment protocol. Overall satisfaction ranged from 84% to 100%. The most common complications reported were fluid collection, hyperpigmentation, contour irregularities, anemia, and port dehiscence. A wide variety of techniques are available to perform HDL with a variable degree of definition. Careful patient selection is critical for successful results because HDL is not suitable for every patient. Finally, proper training and adequate knowledge of abdominal anatomy is necessary to avoid complications.

Endoscopic Lipoabdominoplasty.

Endoscopic lipoabdominoplasty is the surgical technique utilizing endoscopy, as in a conventional abdominoplasty, to repair acquired abdominal wall defects, such as diastasis recti or ventral hernias. A conventional liposuction is carried out through 4 ports, which shall be used later to place the laparoscopic trocars for fat removal and supra-aponeurotic undermining. Three trocars are introduced through these ports, one for the camera and the others to introduce surgical instruments. A CO2 insufflation is carried out; the supra-aponeurotic space is undermined up to the xiphoid process. Then a rectus muscle plication is carried out with slow-absorbing sutures in 2 or 3 sections. Two Jackson Pratt drains are placed, and the incisions are closed. The objective of this article is to describe the technique and establish the necessary safety criteria to obtain good results in patients with minimal skin laxity, with moderate fat tissue distribution, with musculofascial diastasis, with ventral hernias, and who do not need or do not accept a visible surgical scar.

The efficacy of high-frequency ultrasound-guided injection lipolysis in reducing fat deposits located on the inside of the knees.

IntroductionMany women consider local fat deposits unacceptable for aesthetic reasons as they have negative impact on appearance and thus, contribute to reduced self-esteem. Injection lipolysis (intralipotherapy) may be an alternative for conventional liposuction in reducing fat deposits.AimThe aim of this paper was to assess the efficacy of high-frequency ultrasound-guided injection of deoxycholic acid (intralipotherapy) to remove fat deposits on the inner side of knees.Materials and methodsThe procedure was performed in 7 women (14 inner sides of knees). The formulation was administered under high-frequency ultrasound guidance. The procedure was performed twice at 4-week intervals in each patient. High-frequency ultrasound guidance was used to monitor such parameters as the thickness of the dermis (DermaMed, Dramiński S.A.) or the subcutaneous tissue (Philips Epiq 5, USA). Ultrasound was performed both before and after treatment. Additionally, anthropometric measurements were taken, a questionnaire was performed, and a photographic documentation was recorded.ResultsReduction in knee circumference and subcutaneous tissue occurred in 71.42% of patients.ConclusionsIntralipolysis with deoxycholic acid formulation is an effective method for reducing fat deposits on the inner part of the knees. Ultrasonography proved to be a useful method to monitor the procedure (correct administration of the preparation) and to assess treatment outcomes. A small sample size was a limitation of our study; therefore further studies are needed.

Does Water-Jet Force Affect Cryopreserved Adipose-Derived Stem Cells? Evidence of Improved Cell Viability and Fat Graft Survival.

Adipose tissue harvested by liposuctions is an available source of adipose-derived stem cells (ASCs). Water-jet-assisted liposuction is a favorable method for fat collection with little mechanical damage. This study aimed to investigate whether or not the water-jet-assisted liposuction made a difference in the biological characteristics of cryopreserved ASCs and fat graft survival in cell-assisted lipotransfer. Human lipoaspirates were obtained from the abdomen or thighs of 20 female participants for body contouring. A single surgeon randomly harvested 50 mL of adipose tissue by the water-jet-assisted liposuction and the conventional liposuction, respectively. Adipose-derived stem cells were isolated from lipoaspirates and then cryopreserved for 4 weeks. Cryopreserved ASCs were used to examine the surface markers, cell proliferation, migration, and adipogenic differentiation in vitro. The fat survival of ASCs-enriched grafts from different liposuctions was measured in animal models. The cryopreserved ASCs with the water-jet assistance had better capacities of cell proliferation, migration, and adipogenic differentiation and achieved a better survival result of ASCs-enriched fat grafting. Cryopreservation of ASCs with the water-jet force showed more excellent biological characteristics. The water-jet-assisted liposuction was superior to the conventional liposuction in obtaining ASCs and fat survival of coimplantation with grafts.

Efficacy and safety of 1440-nm Nd:YAG laser on lower face and neck rejuvenation.

Reviewing the literatures, we did not found-to our knowledge-any study using the Nd:YAG laser with wavelength 1440nm in assisted liposuction and rejuvenation of the head and neck region although of the higher absorption rate for fat and water. Evidence-based practice supports the benefits of laser-assisted liposuction over conventional liposuction with skin tightening in selected areas specifically the submental area and the neck. The aim of the work is to evaluate the efficacy and safety of Nd:YAG laser wavelength (WL) 1440nm on lipolysis of submental area and skin tightening of the lower face and neck area. Fifty-seven patients with submental localized fat deposits and mild to moderate skin laxity were subjected to laser liposuction using Nd:YAG laser with WL 1440nm (SmartLipo Triplex)® device. The efficacy of skin laxity improvement was assessed together with the whole satisfaction rate for each patient. Overall satisfaction rate was 97% of the patients. One sample test regarding skin laxity showed significant improvement (34.6%) after 6months follow-up (0.268 SD p < 0.05) (Table 4). Complications included edema, soreness, weakness in the lower lip, and ecchymosis that resolved conservatively except one case that complained of seroma which needed aspiration and healed without infection. In conclusions, Nd:YAG laser with WL 1440nm can be used safely and effectively for submental-assisted liposuction and lower face and neck rejuvenation. Less laser energy was needed for lipolysis and skin tightening as the fat and water have a higher absorption rate at wavelength 1440nm.

High Definition Liposuction Using Third Generation Ultrasound Versus Conventional Liposuction of the Lower Back and Upper Thigh Region: A Comparative Study

Introduction: The accuracy of results of liposuction hadlong been related to the aspiration cannulas as much as it isrelated to surgeon experience. The cannulas tips, length,diameter, design, number of holes shapes and negative pressurehad drawn the attention of all surgeons in order to modifytheir outcomes. The addition of technologies that provideenergy based devices has enriched the procedure and improvedpatient satisfaction. Ultrasound assisted liposuction had severalcomplications included severe burns and other problems, lessenergy is used in third generation ultrasound assisted liposuctionthan second generation liposound which make it saferwith better results. A much more accurate technique wasdescribed by Hoyos to improve body contouring by usingVASER assisted liposuction.Aim of the Study: To investigate the superiority of highdefinition liposuction using third generation liposound inlower back and upper thigh region as regarding patient satisfactionand their need for secondary procedures.Patients and Methods: 20 patients with age ranged from18-40 years old and BMI=25-30 having lipodystrophy of thelower back and upper thigh and trochanteric areas with moderateskin tone, only non-smoker-non diabetic-non hypertensivewere included in the study. Patients were divided into twogroups; Group A included 10 patients who undergone suctionassisted liposculpture and Group B: Included 10 patients whohad high definition liposuction using third generation internalultrasound machine. Both subjective and objective evaluationwas done. Objective evaluation was done by measurement ofboth pre operative drawn line starting from mid sacral pointto highest point of iliac crest and post-operative measurementat one and six month in both groups.Results: This study involved 20 women divided into twogroups. Group B patients had less blood content of the aspirate,longer time of the procedure (add ultrasound timing) morepost-operative edema, more obvious skin retraction alongpost-operative period. While Group A patients showed overallless edema and more ecchymosis with less satisfaction andmore irregularities and need for secondary procedures.Conclusion: High definition liposcution using third generationinternal ultrasound showed higher skin contraction,better body shape and contour.

Development and Evaluation of the Airtight, Minimal-Invasive, and Fast Device Harvesting Adipose Tissue for Autologous Fat Grafting

The present study was undertaken to develop the device that can be used to harvest adipose tissue for fat grafting with an airtight, minimal-invasive, and fast approach. The abdominal liposuction was performed in six women under local tumescent anesthesia. Fat from left abdomen was harvested by the classical 20-ml-syringe technique while fat from right abdomen was harvested by a reformative vacuum-assisted suction device (negative pressure, 25 to 35 kPa). This device includes a 1-L sterile canister, a cannula with 2.5 mm inner diameter, a conventional liposuction machine, and a one-way valve connected between the canister and the liposuction machine. The operative time of harvesting 200-ml fat grafts was recorded and calculated. The collected adipose tissue was used for adipose-derived stem cells (ADSCs) extraction and culture, glucose transport test (GTT), and bacteriological culture. First, we found that the operative time of harvesting 200-ml adipose tissue using 20-ml-syringe aspiration technique was 71.3 ± 4.3 min compared with 30 ± 3.5 min by the new device (p 0.05). Additionally, the samples harvested from both methods showed no bacterial growth. The results from the XTT test revealed that there was no significant difference on ADSCs growth between two methods (p > 0.05). In conclusion, the results support that the innovative device for adipose tissue harvesting is minimal-invasive, fast, and can prevent the fat grafts from contamination.

Postoperative Complications and Patient Satisfaction After Abdominal Etching: Prospective Case Series of 25 Patients.

Conventional liposuction has provided good outcome for years. Abdominal etching (or abdominal high definition liposuction) allows the surgeon to shape and enhance the abdominal muscles by removing specific grooves of subcutaneous fat. The aim of this study is to describe the technique and the complications and to assess patients' satisfaction rate. Between January 2015 and January 2017, 25 patients (21 men and 4 women) underwent abdominal etching procedures in our department. The authors describe the technique and the specific key points of the procedure. All patients were seen at day 5, 10, 30, and 180. At day 180, everyone answered a modified Likert scale survey relating to their satisfaction. No hematoma, infection, or seroma was reported. One patient experienced a superficial pressure wound caused by an improper positioning of the final dressing. Almost all patients (96%) were happy or very happy with the overall outcome of their abdominal etching. The number of requests for abdominal liposculpture should increase in the coming years, and plastic surgeons specialized in silhouette surgery should be able to master this technique in order to add it to their therapeutic arsenal. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Autologous Fat Grafting with Percutaneous Fasciotomy and Reduction of the Nipple-Areolar Complex for the Correction of Tuberous Breast Deformity in Teenagers.

Tuberous breast deformity in the adolescent can be a source of anxiety and social isolation. Current techniques of implant placement and flap reconstruction are not always feasible in this population. The authors evaluated the use of autologous fat grafting with percutaneous fasciotomy and reduction in the nipple-areolar complex for correction of tuberous breast deformity in teenagers. A retrospective chart review was conducted for nine teenaged patients with tuberous breast deformity who received autologous fat grafting between January 2016 and December 2018. The recipient site was prepared with the use of percutaneous fasciotomies to release the constricted lower pole of the breast, lowering of the inframammary crease, and reduction in the nipple-areolar complex. Fat was harvested by conventional liposuction prior to injection through three designated sites located at the inframammary fold, anterior axillary line, and upper pole. Complications were recorded. Patients had an average age of 14.9years at the time of surgery. An average of 1.8 filling sessions were required with a mean of 220cc of fat injected per breast. Patients were followed for an average of 21months postoperatively. No serious complications were noted. All patients reported satisfaction with their final outcomes. Autologous fat grafting in conjunction with percutaneous fasciotomy and reduction in the nipple-areolar complex is a safe and effective treatment of the tuberous breast deformity in teenage patients. It provides an esthetic result with minimal scarring and high satisfaction rates while eliminating the need for flaps or implants. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Redefining natural abdominal anatomy in abdominoplasty using conventional liposuction: A prospective study

Redefining natural abdominal anatomy in abdominoplasty using conventional liposuction: A prospective study

Comparison of laser-assisted liposuction and traditional liposuction combined with endoscopic surgical excision of grade II gynecomastia

Surgical excision and liposuction of fatty element are the standard in the treatment of grade II gynecomastia. The aim of this study is to evaluate the combined use of laser-assisted liposuction and endoscopic surgical excision. Thirty male patients with grades IIa and IIb were included. Fifteen patients underwent laser-assisted liposuction followed by endoscopic excision of glandular tissues (group I), and 15 patients underwent conventional (vacuum assisted) liposuction and endoscopic surgical excision (group II). Patients of group I showed good to excellent outcome with mild edema, indurations, and ecchymosis. Group II patients showed also overall satisfactory results but with moderate to severe edema, ecchymosis, and hematomas. Endoscopic surgical excision of grade II gynecomastia combined with traditional or laser-assisted liposuction can achieve satisfactory aesthetic results. Furthermore, the combined use of laser liposuction failed to show superior aesthetic results than traditional liposuction. However, the use of laser-assisted liposuction offers additional advantages such as intraoperative (less bleeding, less operative time) or postoperative either immediately (less pain, indurations, ecchymosis, and edema) or late as improved skin tightness. Level of Evidence: Level III, therapeutic study

Assessment of Tissue Perfusion Following Conventional Liposuction of Perforator-Based Abdominal Flaps.

BackgroundThe effect of liposuction on the perforators of the lower abdominal wall has been investigated in several studies. There are controversial results in the literature that have primarily demonstrated the number and patency of the perforators. The aim of this study was to determine the effect of liposuction on the perfusion of perforator-based abdominal flaps using a combined laser–Doppler spectrophotometer (O2C, Oxygen to See, LEA Medizintechnik).MethodsNine female patients undergoing classical abdominoplasty were included in the study. Perforators and the perfusion zones of the deep inferior epigastric artery flap were marked on the patient's abdominal wall. Flap perfusion was quantitatively assessed by measuring blood flow, velocity, capillary oxygen saturation, and relative amount of hemoglobin for each zone preoperatively, after tumescent solution infiltration, following elevation of the flap on a single perforator, and after deep and superficial liposuction, respectively.ResultsThe measurements taken after elevation of the flap were not significantly different than measurements taken after the liposuction procedures.ConclusionsThe liposuction procedure does not significantly alter the perfusion of perforator-based abdominal flaps in the early period. The abdominal tissue discarded in a classic abdominoplasty operation can be raised as a perforator flap and has been demonstrated to be a unique model for clinical research.

A comparative study of the influence of two types of PHEMA stents on the differentiation of ASCs to myocardial cells.

In the present study, subcutaneous fat was obtained from adult women that had undergone conventional liposuction surgery. A comparative study was performed to investigate the effect of transparent and white poly-β-hydroxyethyl methacrylate (PHEMA) stents, which have different surface and cross-sectional morphological characteristics, on the differentiation of adipose-derived stem cells (ASCs) into myocardial cells. The cell counting kit-8 assay revealed that cell growth increased at varying rates among the different treatment groups. The absorbance of the experimental transparent PHEMA treated group increased in a time-dependent manner with the duration of incubation. The highest levels of proliferation were observed in the transparent PHEMA group. In addition, the transparent PHEMA treated group exhibited the strongest cell adhesion ability, which was significantly different to that of the white PHEMA group (P<0.01 and P<0.05 for Matrigel and fibronectin assay, respectively). Comparisons between the two stent materials with the inducer control group revealed statistically significant differences in the rate of ASC differentiation (P<0.05). The level of differentiation was the greatest in the transparent PHEMA group, and was significantly different to the white PHEMA group (P<0.05) and the blank control group (P<0.01). The results suggest that the inducers 5-aza-2-deoxycytidin and laminin, and material microstructure stents effectively promote the proliferation, growth and adhesion of ASCs. However, the transparent material microstructure may be a more suitable candidate for ASC-associated injections. The present study provides further evidence that a PHEMA stent structure, comprised of a high number of matrixes and a low water content, induces a high level of ASC differentiation to myocardial cells.

Simulation of cryolipolysis as a novel method for noninvasive fat layer reduction.

Regarding previous problems in conventional liposuction methods, the need for development of new fat removal operations was appreciated. In this study we are going to simulate one of the novel methods, cryolipolysis, aimed to tackle those drawbacks. We think that simulation of clinical procedures contributes considerably in efficacious performance of the operations. To do this we have attempted to simulate temperature distribution in a sample fat of the human body. Using Abaqus software we have presented the graphical display of temperature-time variations within the medium. Findings of our simulation indicate that tissue temperature decreases after cold exposure of about 30 min. It can be seen that the minimum temperature of tissue occurs in shallow layers of the sample and the temperature in deeper layers of the sample remains nearly unchanged. It is clear that cold exposure time of more than the specific time (t > 30 min) does not result in considerable changes. Numerous clinical studies have proved the efficacy of cryolipolysis. This noninvasive technique has eliminated some of drawbacks of conventional methods. Findings of our simulation clearly prove the efficiency of this method, especially for superficial fat layers.

A Standardized Method of Isolating Adipose-Derived Stem Cells for Clinical Applications.

White adipose tissue is the most abundant and accessible source of stem cells in the adult human body. In this paper, we present a standardised and safe method of isolating and maximizing the number of adipose-derived stem cells (ASCs) from conventional liposuction for clinical applications, which was carried out through both mechanical (centrifuge) and enzymatic (collagenase) means. Isolated cells were characterized through flow cytometry assay. Gathered data showed a greater amount (9.06 × 10(5) ASCs from 100 mL of adipose tissue) of isolated ASCs compared to previous protocol, also with high (99%) cell vitality; the procedure we presented is easy and fast (80 minutes), allowing collecting a significative number of mesenchymal stem cells, which can be used for clinical purposes, such as wound healing.

Lipedema: A Clinical Challenge-revisited

Lipedema is a disfiguring disorder with abnormal and progressive deposition of adipose tissue in the hips and lower extremities almost exclusively occurring in women. There is a hereditary tendency and a substantial variability in disease severity. Lipedema is often misdiagnosed as lymphedema or morbid obesity. The etiology and pathogenesis are not understood. Early diagnosis and treatment are critical to minimize physical and psychological morbidity. The diagnosis is usually made by history and clinical examination. Non-invasive imaging techniques such as computed tomography or magnetic resonance can differentiate lipedema from other causes of edematous lower extremities. Lymphoscintigraphy may be helpful in cases which are associated with lymphedema (lipo-lymphedema). Management with manual lymphatic drainage and compression therapy are considered the most appropriate treatment. Use of conventional liposuction is controversial since it may further damage the lymphatic vessels. Newer techniques such as tumescent micro annular laser assisted liposuction and water jet-assisted liposuction have shown some promising results. Variety of other surgical procedures combined with manual lymphatic drainage and tailored post-surgical care are under investigation.