# Large-Volume Liposuction and Manual Extraction in Lipedema: A Hybrid approach

## TL;DR

A new hybrid surgical method combining power-assisted and manual liposuction shows potential for better symptom relief in advanced lipedema patients.

## Contribution

A hybrid surgical technique for lipedema treatment combining power-assisted and manual extraction is proposed and evaluated.

## Key findings

- The hybrid technique showed trends toward greater symptom relief compared to power-assisted liposuction alone.
- The hybrid approach enabled removal of larger aspirate volumes without increased risk.
- Fewer postoperative complications were observed in the hybrid group.

## Abstract

Lipedema is a chronic and potentially progressive fat distribution disorder. Disease-related symptoms, such as pain and discomfort, can require surgical intervention when conservative therapies are exhausted. These megaliposuctions are functional in nature and need to be distinguished from esthetic liposuctions. This new surgical approach, the hybrid technique combining power-assisted liposuction (PAL) with manual extraction (ME), has been developed to more effectively treat fibrotic nodules, particularly in the lower legs, where conventional liposuction techniques often fall short.

A total of 24 patients with advanced lipedema were included in a matched cohort analysis: 12 treated with the hybrid technique and 12 treated with PAL alone. Patients were matched by age (p= 0.9416) and BMI (p=0.6489). Outcome measures included pain and heaviness reduction on the visual analog scale (VAS), changes in a comprehensive lipedema symptom score, intraoperative blood loss, complication rates, and total lipoaspirate volume.

While statistical significance was not reached, the hybrid group demonstrated a trend to greater symptom relief, with median reductions in pain (6.5 vs. 5.0, p= 0.1958), leg heaviness (7.5 vs. 6.5; p= 0.2293), and composite symptom score (68.0 vs. 52.5, p= 0.3254) compared to the PAL group. The hybrid technique also resulted in fewer postoperative complications and enabled the removal of larger total aspirate volumes; Hybrid group (mean: 17.88 liters), PAL group (mean: 16.62 liters) without increased risk.

The hybrid approach shows promising trends in clinical outcomes and safety compared to PAL alone. Despite the absence of statistical significance due to the limited sample size, the consistent directional improvements and reduced complication rates support the further evaluation of this method in larger, prospective studies.

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The online version contains supplementary material available at 10.1007/s00266-025-05329-2.