Lipedema · New York and New Jersey
Lipedema Surgery
Lipedema is a chronic condition in which tender fat builds up in the legs, hips, and often the arms. It does not go away with diet or exercise. Dr. Steven Ovadia is a board certified plastic surgeon who evaluates lipedema and performs lipedema reduction surgery, with offices in New York City and New Jersey.
Overview
What lipedema is
Lipedema is a condition of the fat and connective tissue under the skin. Fat builds up in the legs, hips, and buttocks, and often in the arms, in the same pattern on both sides of the body. The tissue is often tender, and it bruises easily.
It affects women almost exclusively. It often starts or gets worse around puberty, pregnancy, or menopause, and it tends to run in families.
Lipedema is often mistaken for weight gain or for lymphedema. Many patients have been told for years to diet and exercise, and have watched their upper body change while their legs stayed the same. Lipedema is not caused by what you eat or how much you exercise.
Signs
Signs and symptoms of lipedema
- Legs, hips, or buttocks that are out of proportion to your upper body
- The same pattern on both sides of the body
- Feet and hands that stay their usual size, sometimes with a cuff at the ankle or wrist
- Tissue that is tender or painful, especially when pressed
- Bruising easily, often without remembering an injury
- Legs that feel heavy or tired, and swell as the day goes on
- Small, firm lumps that can be felt under the skin
- Affected areas that change little with diet and exercise, even when the rest of the body does
You do not need every one of these to have lipedema. If several sound familiar, an examination can tell you more.
Where lipedema shows up
Lipedema is grouped into types by where the tissue is. Many patients have more than one type, most often the legs together with the arms.
Stages
The stages of lipedema
Stage 1
Smooth skin
The skin surface is smooth. Underneath, the tissue is thicker and can feel like small pebbles or grains.
Stage 2
Uneven skin
The skin surface becomes uneven and dimpled. The lumps under the skin are larger and easier to feel.
Stage 3
Folds of tissue
Larger folds of tissue form, often around the thighs and knees. They can change the way you walk and make it harder to get around.
With lymphedema
Sometimes called stage 4
Over time the lymphatic system can have trouble keeping up, and swelling from lymphedema develops along with the lipedema. This is called lipo-lymphedema.
The stage describes how the tissue looks and feels. It does not measure how much pain you have. Symptoms can be significant at any stage.
Diagnosis
Lipedema, lymphedema, or weight gain
Lipedema is diagnosed from your history and a physical examination. There is no blood test for it. At your consultation, Dr. Ovadia examines you and goes over when the changes started, your symptoms, and what you have already tried.
Part of the diagnosis is telling lipedema apart from conditions that can look similar.
| Lipedema | Lymphedema | Weight gain | |
|---|---|---|---|
| Where it shows | Legs, hips, and buttocks, and often the arms | An arm or a leg, usually including the foot or hand | The whole body, including the trunk |
| Both sides | Both sides, in the same pattern | Often one side, or uneven | Both sides |
| Feet and hands | Usually spared | Usually swollen | Change along with the rest of the body |
| Tenderness | Common. The tissue can hurt when pressed | Heaviness and tightness more than tenderness | Not typical |
| Bruising | Bruises easily | Not typical | Not typical |
| Diet and exercise | Affected areas change little | Does not go away with weight loss | Responds to weight loss |
These are general patterns, and the conditions can overlap. Lipedema can lead to lymphedema over time, and many patients have lipedema along with weight gain.
Treatment
Treatment starts without surgery
Conservative care is the starting point for every stage of lipedema. It does not remove lipedema tissue, but it can ease pain, swelling, and heaviness.
Compression
Compression garments support the tissue and help limit swelling and heaviness through the day. The strength and style are chosen for your stage and what you can comfortably wear.
Lymphatic therapy
Manual lymphatic drainage is a gentle, hands-on technique done by a trained therapist. Some patients also use a compression pump at home.
Movement
Low-impact exercise such as walking, swimming, and cycling helps circulation, strength, and mobility without stressing the joints.
Nutrition and weight
Losing weight does not remove lipedema tissue. Staying at a stable, healthy weight still matters, because added weight can make symptoms worse.
Surgery is considered when symptoms continue despite conservative care. Insurance plans that cover lipedema surgery usually ask for a period of conservative care first.
Surgery
Lipedema reduction surgery
Lipedema reduction surgery removes lipedema tissue with liposuction techniques that are designed to protect the lymphatic vessels. It is the only treatment that removes the tissue itself.
The goals are less pain and heaviness and easier movement. A change in the shape of the legs or arms comes with it, but it is not the reason for the surgery.
Fluid is placed first
A fluid containing numbing medicine and a medication that limits bleeding is placed into the tissue. This is called the tumescent technique.
Small incisions
The tissue is removed through small incisions with thin, blunt tubes called cannulas. Water-assisted and power-assisted liposuction are variations of this approach.
Protecting the lymphatic vessels
The cannula is moved along the length of the limb, in the same direction the lymphatic vessels run, to protect them.
One area at a time
There is a limit to how much can be removed safely in one operation. Treatment is often planned as more than one surgery, each on a different area.
What surgery can do
- Reduce pain, tenderness, and heaviness in the treated areas
- Reduce the size of the treated areas
- Make walking and daily activity easier
- For some patients, reduce the need for compression and therapy
What surgery does not do
- Cure lipedema. It is a chronic condition
- Treat every area in one operation
- Replace compression and a healthy routine for everyone
- Tighten loose skin. Some patients choose skin removal later
Every surgery has risks. For lipedema reduction surgery these include bleeding, infection, blood clots, uneven contours, and swelling that lasts longer than expected. Dr. Ovadia goes over them with you, and over which areas to treat and in what order, at your consultation.
Recovery
What to expect after surgery
Swelling and bruising are normal and expected
The treated areas are swollen and bruised at first. Swelling goes down gradually over the following weeks and months.
Compression garments are important
You wear compression garments after surgery. The compression helps prevent and minimize swelling and supports the tissue while it heals.
Fluid from the incisions
For the first day or two, fluid that was placed during surgery drains from the small incisions. It is often tinged with blood. This is expected, and absorbent pads take care of it.
Walking starts early
Short walks begin right after surgery. Walking helps circulation and lowers the risk of blood clots.
Lymphatic therapy
Manual lymphatic drainage is often part of recovery. It can help the swelling settle.
Results come gradually
Because swelling takes months to settle, the final result takes time to see. Relief from heaviness and tenderness often comes sooner.
Call the office right away if one leg or arm becomes much more swollen or painful than the other, or if you notice spreading redness, warmth, or a fever. These are best taken care of early. For chest pain or trouble breathing, call 911.
A general timeline
This is a general guide. Everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Insurance
Insurance coverage for lipedema surgery
Lipedema is a medical condition, and surgery for it is done to treat symptoms. Some insurance plans cover lipedema surgery when their medical criteria are met and it is a covered benefit of your policy.
Common criteria for insurance coverage
- A diagnosis of lipedema, with findings on examination such as the same pattern on both sides, tenderness, and easy bruising
- Symptoms that limit walking or daily activities
- Conservative care already tried, such as compression garments and manual lymphatic drainage, often for three months or longer
- Little or no improvement in the affected areas with weight loss or elevating the legs
- Photographs and a letter from your surgeon
Every plan sets its own criteria, and some plans do not cover lipedema surgery. Coverage is not guaranteed.
If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
He performs lipedema reduction surgery, along with liposuction and body contouring and complex reconstruction. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about lipedema
What is lipedema?
Lipedema is a chronic condition in which fat builds up under the skin of the legs, hips, and buttocks, and often the arms, on both sides of the body. The tissue is often tender and bruises easily. It affects women almost exclusively. It is not caused by diet or lack of exercise.
Is lipedema the same as lymphedema?
No. Lymphedema is swelling from fluid that the lymphatic system is not draining. It often affects one side and usually includes the foot or hand. Lipedema is a condition of the fat tissue. It affects both sides and usually spares the feet and hands. The two can occur together, and over time lipedema can lead to lymphedema.
Will losing weight get rid of lipedema?
Weight loss does not remove lipedema tissue. Many patients lose weight from the upper body while the legs change very little. Staying at a stable, healthy weight still matters, because added weight can make symptoms worse.
How is lipedema diagnosed?
Lipedema is diagnosed from your history and a physical examination. There is no blood test for it. Imaging is sometimes used to look at the veins or the lymphatic system when another condition is suspected.
Do I need a diagnosis before my consultation?
No. Many patients come in without one. Dr. Ovadia examines you, goes over your symptoms and history, and tells you whether your findings fit lipedema.
How is lipedema surgery different from cosmetic liposuction?
The tools are similar, but the goals are different. Cosmetic liposuction shapes an area. Lipedema reduction surgery removes diseased tissue to relieve pain and heaviness and to improve mobility. It usually removes more tissue, is planned to protect the lymphatic vessels, and is often done in more than one operation.
How many surgeries will I need?
It depends on how many areas are affected and how much tissue there is. Some patients need one operation. Many need two or more, each on a different area, with time to recover in between. Dr. Ovadia goes over a plan with you at your consultation.
Does lipedema come back after surgery?
Studies that followed patients for years after surgery have reported lasting improvement in pain, bruising, and mobility. Lipedema is a chronic condition, though, and surgery does not cure it. Areas that were not treated can still change, especially with weight gain.
Will I still need compression after surgery?
Compression garments are part of recovery for every patient. After recovery, some patients need compression and therapy less than before, and some continue to use them. It depends on your stage and whether you also have lymphedema.
Is lipedema surgery covered by insurance?
It can be. Some insurance plans cover lipedema surgery when their medical criteria are met and it is a covered benefit of your policy. Each plan sets its own criteria, and some plans do not cover it. If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will examine you, go over your symptoms and what you have already tried, and explain whether your findings fit lipedema and what your options are.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com