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Uwe Wollina,1 Birgit Heinig,2 Andreas Nowak31Department of Dermatology and Allergology, 2Centre of Physical Therapy and Rehabilitative Medicine, 3Department of Anaesthesiology and Intensive Medical Care, Emergency Medicine and Pain Management, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, GermanyBackground: Lipedema is a rare female disorder with a characteristic distribution of adipose tissue hypertrophy on the extremities, with pain and bruising. In advanced stages, reduction of adipose tissue is the only available effective treatment. In elderly patients with advanced lipedema, correction of increased skin laxity has to be considered for an optimal outcome.Methods: We report on a tailored combined approach to improve advanced lipedema in elderly females with multiple comorbidities. Microcannular laser-assisted liposuction of the upper legs and knees is performed under tumescent anesthesia. Medial thigh lift and partial lower abdominoplasty with minimal undermining are used to correct skin laxity and prevent intertrigo. Postsurgical care with nonelastic flat knitted compression garments and manual lymph drainage are used.Results: We report on three women aged 55–77 years with advanced lipedema of the legs and multiple comorbidities. Using this step-by-step approach, a short operation time and early mobilization were possible. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and postsurgical pain. No severe adverse effects were seen. Patient satisfaction was high.Conclusion: A tailored approach may be useful in advanced lipedema and is applicable even in elderly patients with multiple comorbidities.Keywords: lipedema, tumescent anesthesia, liposuction, subdermal diode laser, medial thigh lift, lower abdominoplasty |
