TREATING LIPEDEMA

TREATING LIPEDEMA

Lipedema is a complex and misunderstood disease. Women suffering with lipedema were most often misdiagnosed or told they just had to live with it. But there are answers and an effective treatment. Dr. David Amron has established a close relationship with Dr. Karen Herbst, a world renowned medical authority on fat lipedema, and together they have established detailed pre and post-surgical protocols for lipedema patients.

Dr. David Amron’s approach to treating lipedema patients is outlined as follows:

SECTION 1:  CONSULTATION

Dr. Amron strongly believes in creating proper balance and proportion in a patient’s body, and all his patients are evaluated from their necks to their ankles in order to determine the areas of disproportion, and locate where the diseased fat is concentrated to target it with liposuction. Patients who suffer from lipedema tend to have very disproportionate figures, and the goal of liposuction surgery in any patient — especially with lipedema patients — is to create a balance and proper proportion of the patient’s body.  

Dr. Amron treats patients from all over the world, and the majority of his patients come from outside of the Los Angeles area. Dr. Amron offers a unique photo or phone consultation process, or alternatively an online video consultation using Skype. This process allows Dr. Amron to see patient photographs, review previous medical records and create a personalized surgical treatment plan without requiring the patient to fly to Los Angeles. After a treatment plan is created, Dr. Amron asks his patients to arrive one day prior to their first surgery.

There’s also an in-person consultation with the doctor to confirm the prospective treatment plan. Typically, the first surgery is done the day after the face-to-face consultation, and usually, subsequent surgeries can be performed during the same trip. Patients are typically able to fly back/return to their homes as early as two days after their last surgery.

SECTION 2:  PREOPERATIVE WORKUP AND CARE

Lipedema is a complicated disorder that many doctors are still learning how to properly diagnose and treat, both medically and surgically. Until recently, lipedema has been a troubling medical mystery, so most women have had to live with it. Many of the patients Dr. Amron sees have been to numerous physicians, but never received a proper evaluation or diagnosis. However, there are answers and an effective treatment.

Dr. Amron stresses that the diagnosis of lipedema must be done on a clinical basis and categorized into three stages: mild, moderate and severe or advanced. After a correct diagnosis, Dr. Amron carefully evaluates his patients to determine whether they are candidates for liposuction.

Prior to liposuction surgery, it may be helpful to reduce the tissue load of swelling. This can either be done with compression therapy, or pre-compression pump therapy. Patients are also placed on an antibiotic one day before surgery and will continue for the duration of five days. It’s also necessary that elderly patients, or patients with additional medical problems, receive medical clearance prior to the operation.

SECTION 3: PHILOSOPHY ON BODY CONTOURING AND LIPOSUCTION SURGERY

Dr. Amron’s philosophy is to target disproportion on the patient’s body, so as the patient loses weight, he or she does so in a very proportioned and balanced fashion. Liposuction surgery is performed to remove all the diseased fat from the lipedema patient’s body. However, there is careful attention and skill employed in order to achieve the perfect cosmetic unit.

In order to achieve a functional improvement in each patient, liposuction should accomplish two things in every surgery. First, liposuction should reduce the pain and symptoms lipedema patients are accustomed to living with. Second, liposuction should always result in a beautiful aesthetic improvement. Ideally, the two results go hand-in-hand when performed by the correct doctor.  

SECTION 4: DR. AMRON’S APPROACH TO LIPEDEMA PATIENTS WITH LIPOSUCTION

One of the most crucial elements of liposuction for lipedema patients is that the surgeon approaches it in a lymphatic sparing way. Dr. Amron uses a lymphatic sparing technique combining Water-Assisted Liposuction (WAL) in a semi-tumescent fashion, which allows for proper hydro-dissection of the fatty tissues, and properly prepares the area prior to liposuction surgery. Dr. Amron has adapted this technique in a unique way in order to safely anesthetize the patient under local anesthetic.

Dr. Amron strongly believes performing the surgery under purely tumescent Water-Assisted Liposuction is the safest approach, and there are numerous advantages to this method. First, it’s a much safer than performing liposuction under general anesthesia. Second, the recovery time using purely tumescent Water-Assisted Liposuction is much faster. Patients are typically able to get up and walk around as quickly as 15 or 20 minutes after the surgery. Additionally, they show a dramatic improvement in pain, discomfort and bruising. Lastly, Dr. Amron believes it is his surgical experience and his unique 3-dimensional method of performing liposcultpture along with precise patient positioning that is responsible for the best possible aesthetic results.

By using a lymphatic sparing, semi-tumescent approach, Dr. Amron is able to perform liposuction surgery while the patient is conscious under local anesthesia. With this specific positioning of the patient (which is only truly possible with purely tumescent Water-Assisted Liposuction), Dr. Amron is able to remove the diseased fat while achieving the best functional and aesthetic result. Liposuction is a very precise technique, and since the patient is conscious, it allows Dr. Amron to stay within the subcutaneous layer of fat and perfectly position the patient.

Curing lipedema can be difficult, and various medical treatments have been met with limited success. However, Dr. Amron’s approach to treating lipedema has proven to be extremely effective and successful.

SECTION 5: DR. AMRON’S SURGICAL TECHNIQUE

Dr. Amron has a unique three-dimensional contouring approach to treat lipedema, and views each body part in a complete, comprehensive three-dimensional fashion. He approaches each cosmetic unit one at a time, rather than breaking it up into different procedures and surgeries. This allows Dr. Amron to remove all the diseased fat from a particular body part in one single surgery.

With more than two decades of liposuction experience, Dr. Amron has perfected his surgical technique, which involves precise placement of the axis, or incision points, to approach every area of the body with respect for tissue settling and lymphatic flow. Dr. Amron is extremely careful to stay only within a specific layer of fat to ensure he performs each procedure in a lymphatic sparing manner.

Dr. Amron uses a combination of various techniques and devices to precisely remove the diseased fat and sculpt particular areas of the body.  After the incision points are placed, using various cannulas, Dr. Amron utilizes water-assisted liposuction to anesthetize and hydrodissect the fatty layer, gradually de-bulking from the bottom up.

He will commonly employ the use of Power-Assisted Liposuction as a vibration device to help emulsify the fat and soften the firm fibrotic nodules, which are common in lipedema patients. However, with certain patients who may have more fibrous areas or suffer from Dercum’s disease, Dr. Amron may employ the use of Laser-Assisted Liposuction to further emulsify fibrous areas of the body. 

Depending on the degree of tissue and skin elasticity, Dr. Amron may also use another laser with three other energy settings (1320, 1064 and 1440 nanometer wavelengths) to obtain additional skin tightening and improve cellulite. His approach aims to achieve not only the best functional results, but also the best aesthetic results for every patient. Dr. Amron will then leave the majority of the incision points open for proper drainage of the excess fluid.

Regardless of this procedure being performed under local anesthesia, liposuction is still a serious surgery and should be treated as such. For this reason, Dr. Amron performs every procedure in a fully licensed and fully accredited surgical center with proper intraoperative monitoring on every patient.

SECTION 6: POST OPERATIVE CARE

Dr. Amron has devised a specific postoperative care plan for each patient who undergoes surgery at his practice. Directly after the operation, patients are drained on the table to remove excess fluid. After this, patients are placed in custom-made compression garments, which they are advised to wear 24 hours a day for two weeks after their surgery, followed by an additional two weeks wearing the garments, but for 12 hours a day.

Patients with stage one lipedema often require little to no bandaging; however, patients with stages two, three or four lipedema will have their feet and legs bandaged immediately after surgery. The next step in the recovery process is to schedule Manual Lymphatic Drainage (MLD) therapy for the patient once or twice a week, with possible additional bandaging. 

Directly following surgery, patients will be up and walking within 15-30 minutes, and will leave the surgical center in the care of a family member or nurse. Patients are instructed to take it easy on the day of surgery, and are encouraged to resume a normal diet, and drink one glass of water every hour on the day of their surgery. The following day, Dr. Amron recommends patients take a 1-2 mile walk to help drain out any fluid remaining. This also helps mobilize fluid from the tissues.

SECTION 7: GROUPING OF BODY PARTS

Depending on the severity of the disease, a patient may only need one surgery if just one area is affected. On average, Dr. Amron will perform two separate surgeries to remove all the diseased fat. Rarely three surgeries may be necessary to completely treat the patient.

The first surgery is typically comprised of the calves, ankles and arms. The second surgery involves the circumferential thighs, and possibly buttocks. If a third surgery is necessary, Dr. Amron will remove the diseased fat from the abdomen and/or circumferential torso.

With patients who have stage one lipedema, Dr. Amron suggests surgeries be performed fairly close together, anywhere from 2-7 days apart. If a patient suffers from stage two lipedema, he suggests waiting 5-14 days between surgeries. But, for patients with more advanced cases of lipedema, Dr. Amron prefers to wait as long as 2-4 weeks between surgeries. 

SECTION 8: PAIN DURING AND AFTER SURGERIES

Lipedema patients experience a significant amount of discomfort, pain and numbness prior to surgery, and are relieved to hear liposuction greatly improves their pain, or eliminates it completely. A vast majority of testimonials from Dr. Amron’s patients state the pain they endured prior to surgery is almost completely gone the following day, or within a week after surgery.

During the surgical procedure itself, Dr. Amron uses Water-Assisted Liposuction to put the fluid into the fat to anesthetize it. Patients typically experience a slight discomfort and pinching feeling as the fluid is being placed into the fatty tissue. However, it’s a quick process to complete, so this period of discomfort only lasts for approximately 15-30 minutes. As Dr. Amron performs the extraction part of the surgery, most patients feel a slight pressure, but do not have any significant pain.

After surgery, patients are given prescription pain medications, but in Dr. Amron’s experience, only 10-15 percent of patients have needed to take them on the evening of their surgery. As mentioned, many lipedema patients experience little to no pain the day after surgery. However, the degree of discomfort in subsequent days is entirely dependent on the amount of bruising and swelling after surgery.

Approximately 10 percent of Dr. Amron’s patients experience moderate to extensive bruising. Unfortunately, these patients tend to be sorer and experience more swelling after the procedure until the bruising has subsided, which occurs within two to three weeks. Patients tend to experience swelling after the surgery because many times it’s the lower part of the legs, like the calves and ankle areas, where swelling generally takes longer to subside.

SECTION 9: RESULTS

For liposuction in general, the recovery time is about a year to see the final results, and this is also true for lipedema patients, in particular. Patients will immediately start to see results after surgery, and a reduction of fullness in their bodies due to the amount of fat removed during surgery.

As the body continues to heal, patients will experience a remodeling and restructuring of body tissue, as it develops new connective tissue to tighten up areas of looseness. This remodeling process takes a significant amount of time to heal, and many patients won’t see final results until approximately 12 months after surgery. 

A vast majority of patients start to see a significant improvement within the two to four weeks of surgery, but results vary from person to person, and it’s important to remain patient in terms of seeing final improvement. At the three-month mark, most patients see between 50-70 percent of final improvements. At the six-month mark, this normally increases to about 80-90 percent. 

To learn more about lipedema and see if you are a candidate for Dr. David Amron’s advanced lipedema liposuction, CALL: 424.394.1610 and schedule your personalized consultation.