Frequently Asked Questions

The aim of our surgical protocol is to remove diseased lipoedema tissue from the affected compartments of the limbs to address pain, improve mobility, and help manage disease progression. This is disease-focused surgery, not cosmetic body contouring or aesthetic liposuction and is designed to be minimally invasive and avoid long skin excisions and optimise safety by avoiding mega liposuction.  

Our approach follows a phlebology-led, lymphatic-sparing protocol aligned with European S2K lipoedema guidelines, informed by more than 30 years of clinical experience in Germany, including the work of pioneer Dr Falk Heck. Dr Chris Lekich undertook training in this surgical approach with Dr Heck in 2017 in the technique of removing diseased lipoedema tissue using the Heck protocol. 

During surgery, the doctor works carefully within the anatomical compartments affected by lipoedema tissue. The intra-operative endpoint is reached when the firm, inflammatory lipoedema tissue can no longer be palpated, indicating that the majority of the diseased tissue in that compartment has been addressed. At this point extraction in that compartment is stopped. 

Further extraction beyond this point is avoided because pushing beyond the diseased compartment may increase the risk of injury to surrounding structures, including: 

• skin
• sensory nerves
• arteries
• lymphatic vessels
• muscle
• deeper venous structures 

The aim is therefore as complete a removal as safely possible within the affected compartment, rather than aggressive over-extraction. This approach avoids long scars and large-volume cosmetic liposuction techniques that are not aligned with European lipoedema guidelines. 

Because of these safety considerations, surgery is typically performed in stages. 

For many patients, treatment of the lower limbs from waist to ankles can be achieved in two procedures, while patients with more advanced disease may require three staged procedures. More stages may be required for very progressed lipoedema. 

Where the arms or abdomen are also affected, these areas may sometimes be combined within a surgical stage of the legs when it is considered safe to do so. This can help reduce the total number of procedures required. 

Importantly, patients do not need to commit to all surgeries at the outset. Each stage is assessed individually, allowing treatment decisions to be made progressively based on recovery, clinical response, and patient preference. 

Procedures are typically spaced approximately two months apart to allow recovery and safe surgical planning between stages. 

Safety considerations during surgery include careful management of: 

• local anaesthetic volumes to avoid cardiac or neurological toxicity
• total operative time and surgical exposure
• intraoperative and postoperative fluid management
• minimising blood loss
• reducing postoperative bruising or haemoglobin reduction 

Specific compression and bandaging techniques are used following surgery to support healing and reduce swelling and bruising. 

Adjunct technologies may also be used during surgery in selected cases. For example, Renuvion technology may be used in appropriate areas to assist with haemostasis and tissue contraction, which may support skin collagen stimulation in areas such as the thighs or arms where tissue stretch may be more pronounced. 

These measures may assist in reducing bruising and supporting recovery, although individual outcomes vary. 

Costs vary depending on the areas treated and the number of surgical stages required. 

As a general guide: 

Lower limb procedures typically cost approximately $20,000 per surgery. 

This usually includes: 

• hospital theatre and facility fees
• overnight hospital stay
• surgical consumables
• surgical team and procedural costs
• routine immediate postoperative care
• blood tests and ultrasound assessment before discharge 

Anaesthesia fees are typically approximately $1,800 to $2,700, depending on the duration and complexity of the procedure. Fees may be higher when multiple areas or additional procedures are incorporated. 

In some cases, additional areas such as arms or abdomen may be safely combined within the same operation. When procedures are combined, the overall surgical cost may tend to $28,000, depending on the specific surgical plan and the areas treated. 

Because phlebologists also assess and treat venous disease, vein treatments may sometimes be incorporated into the surgical plan where clinically appropriate. When this occurs, it may reduce the need for separate procedures and additional visits. The suitability of this approach varies between patients. 

Following assessment, your doctor will confirm: 

• the diagnosis and stage of lipoedema
• the areas requiring treatment
• associated venous or lymphatic conditions
• suitability for surgery 

A personalised treatment plan and cost estimate will then be provided to ensure informed financial consent before any procedure is undertaken.

At present there is no specific recognition of lipoedema surgery within the Australian private health insurance system or Medicare, and therefore surgery directed specifically at lipoedema is generally privately funded. 

In some situations, private health rebates may apply for recognised medical comorbidities that are treated as part of the overall care plan. These may include conditions such as venous disease or other medically recognised disorders identified during consultation. Eligibility for any rebate depends on the diagnosis, procedures performed, and the patient’s individual level of private health insurance cover, and this will be discussed with your doctor during consultation. 

Lipoedema surgery at our service is performed at Miami Private Hospital, which is a fully licensed and regulated private hospital in Queensland. The hospital operates with accredited operating theatres, anaesthesia services, overnight accommodation, and trained nursing staff. 

Miami Private Hospital is a specialised surgical hospital, similar to many accredited private surgical hospitals across Australia that focus on planned procedures rather than functioning as large tertiary hospitals with intensive care units. This model is widely used for elective procedures that are appropriate for a specialised surgical environment. 

Patients are carefully assessed before surgery, and procedures are only undertaken when they are considered appropriate and safe within this accredited hospital setting. 

At present, patients travel internationally seeking treatment for lipoedema. Our aim is to provide access to medically supervised, disease-focused care within Australia, allowing patients to receive treatment closer to home in a regulated hospital environment. 

Our clinic sees patients from across Australia, New Zealand, and internationally who are seeking assessment and management of lipoedema within a phlebology-led medical framework. 

We also continue to support clinical education, research, and advocacy to improve recognition and understanding of lipoedema within the broader healthcare system. As awareness and scientific understanding of the condition continues to develop, it is hoped that future recognition within healthcare systems may improve access to appropriate funding pathways and rebates for patients. 

Appropriately planned treatment contributes to improvements in pain, mobility, and day-to-day functioning, although outcomes vary between individuals and treatment decisions are made on a case-by-case basis following medical assessment.

We do not offer payment plans, as these are discouraged by the medical board AHPRA. However, there are medical finance companies that can help patients with payment plans for surgeries. We recommend you do a Google search and conduct your own research about the suitability of such services. 

Where appropriate, patients may explore Compassionate Release of Superannuation (CRS) through the Australian Taxation Office (ATO) to assist with funding medical treatment. 

Our clinic can assist by providing appropriate medical documentation to support the process where a patient meets the relevant requirements. This may include working with your GP and, where required, an independent third-party medical specialist who understands lipoedema and its clinical impact. 

These doctors may help document: 

• the diagnosis
• the severity and functional impact of the condition
• the recommended treatment plan 

The ATO ultimately determines eligibility for compassionate release of superannuation and manages the application process directly with the patient. 

Our role is limited to providing accurate medical information and reports where requested to support your application. 

All documentation and processes are undertaken in accordance with Medical Board of Australia guidelines and relevant regulatory requirements, and our clinic is Medical Board compliant in the way compassionate release documentation and processes are managed. 

Patients may consider several options when planning how to fund treatment. These may include self-funding, medical finance options, or applying for compassionate release of superannuation through the Australian Taxation Office (ATO) where eligibility criteria are met. 

Our clinic can provide medical documentation where appropriate to support an application for compassionate release of superannuation. This may involve working with your GP and, where required, an independent third-party specialist who understands lipoedema and its impact. 

The ATO manages the application process and determines eligibility, and patients apply directly through the ATO portal. 

When considering funding options, it is advisable to seek independent financial advice so that you can compare the implications of compassionate release of superannuation, medical finance options, or self-funding and determine what is most appropriate for your individual circumstances. 

DO YOU DO STANDARD LIPOSUCTION TOO? 

No. Our clinic focuses on disease-focused lipoedema surgery within a phlebology-led medical framework. The surgical approach used for lipoedema differs from standard cosmetic liposuction because it is designed to address pathological lipoedema tissue and the medical aspects of the disease, rather than purely aesthetic body contouring. 

For this reason, our doctors primarily assess and treat patients with suspected or confirmed lipoedema and related venous or lymphatic conditions. 

Where patients are seeking cosmetic liposuction or skin resection procedures, referrals can be made to independent cosmetic and plastic surgeons who work within the broader medical network associated with Miami Private Hospital. These surgeons operate independently of Lipoedema Surgical Solutions. Our doctors also receive referrals from cosmetic and plastic surgeons across Australia where patients may require assessment of possible lipoedema or related venous conditions. 

These independent specialists are available for consultations, second opinions, and aesthetic procedures where appropriate. 

Many cosmetic surgeons focus primarily on body contouring procedures, whereas our clinic focuses specifically on the medical assessment and disease-focused management of lipoedema. In some cases, patients may access both services as part of their overall treatment journey.

WILL LIPOEDEMA COME BACK AFTER SURGERY? 

Lipoedema is a chronic medical condition, and ongoing medical management is often required. The aim of surgery is to remove diseased lipoedema tissue within the affected anatomical compartments in order to address pain, improve mobility, and help manage disease progression. 

The surgical protocol used in our clinic is informed by more than 30 years of clinical experience in Germany, including the work of Dr Falk Heck, combined with a phlebology-based understanding of venous and lymphatic disease. Experience with this protocol suggests that when the diseased lipoedema tissue within an affected compartment is removed, the tissue itself is less likely to regrow in that same location. 

Dr Chris Lekich has been performing surgery using this disease-focused protocol since 2017 and has performed more than 1,500 lipoedema procedures. In our experience, many patients treated using this approach experience long-term improvements in symptoms and function, although outcomes vary between individuals and expectations should be distinguished from those associated with cosmetic body contouring procedures and expectations. 

Our doctors also assess patients who have previously undergone general cosmetic liposuction or extensive skin excision procedures, where only selected areas of fat were contoured rather than the diseased lipoedema compartment being addressed. In these situations, patients may notice that lipoedema tissue continues to enlarge or symptoms persist in untreated compartments or areas where the disease was not specifically targeted. 

For this reason, the aim of disease-focused lipoedema surgery is to remove the pathological tissue within the affected compartment as completely and safely as possible, rather than performing cosmetic contouring of selected areas. 

It is important to understand that surgery is one component of long-term lipoedema management. Ongoing care may include compression therapy, particularly in more advanced stages where lymphatic function may be affected by fibrosis, as well as lifestyle measures aimed at optimising overall health. This may include anti-inflammatory dietary approaches, weight management, and avoidance of excessive processed sugars and highly processed foods to reduce the risk of secondary obesity and support general metabolic health. 

While surgery may significantly improve symptoms for many patients, individual results vary, and no surgical procedure can guarantee that lipoedema will not progress in other areas that have not been surgically treated over time. 

WHAT AGE GROUPS HAVE YOU OPERATED ON? 

Our doctors have treated patients across a broad age range, from approximately 16 to 78 years of age. 

Suitability for surgery is not determined by age alone. Each patient undergoes a comprehensive medical assessment to evaluate overall health, stage of lipoedema, and any associated medical conditions. 

For patients with complex medical histories, care may involve optimisation before surgery and, where appropriate, a multidisciplinary approach involving the patient’s GP and relevant medical specialists to ensure treatment is planned with safety as the priority. 

The goal is to ensure that any surgical decision is made carefully and individually, considering the patient’s health, symptoms, and the potential benefits and risks of treatment. 

IS THERE A WEIGHT LIMIT FOR SURGERY? 

There is no single weight or BMI cut-off that automatically determines whether a patient is suitable for surgery. However, each patient is carefully assessed to ensure surgery can be performed safely and appropriately. 

In some patients, secondary obesity may be present alongside lipoedema. Where this is the case, patients may be advised to optimise weight and general health before surgery as part of the overall treatment plan. This optimisation can often occur through conservative management, including medical guidance, compression therapy, and lifestyle measures aimed at improving metabolic health and mobility. 

One of the challenges in diagnosing lipoedema is that the disproportionate fat distribution in the legs or arms can lead to an elevated BMI, which may sometimes be interpreted as general obesity by clinicians unfamiliar with the condition. For this reason, assessment does not rely on BMI alone. Clinical examination, fat distribution patterns, and overall health assessment are considered, and measures such as waist-to-height ratio may be more informative indicators of metabolic health than weight alone. 

Lipoedema tissue differs from typical fat associated with obesity and may include inflammatory tissue and fluid within the affected compartments. Once secondary obesity is addressed where present, the remaining disproportionate tissue may be recognised as lipoedema. 

Surgery is therefore planned based on clinical assessment and safety considerations, and when appropriate it is performed in stages to address the affected compartments. Staged surgery allows treatment of diseased tissue while maintaining safe operative times and recovery. 

Improving pain, mobility, and function may also help patients increase physical activity after treatment. This can support ongoing health improvements alongside anti-inflammatory dietary approaches, weight management strategies, and lifestyle measures as part of long-term lipoedema management. 

ARE THERE ANY MEDICATIONS THAT CAN HELP PREPARE FOR SURGERY? 

GLP-1 AGONISTS AND SURGICAL PREPARATION 

In some patients, medications such as GLP-1 receptor agonists (for example semaglutide or similar medicines) may be used under the supervision of a GP or relevant medical specialist to assist with managing secondary obesity or improving metabolic health prior to surgery. 

These medications are not treatments for lipoedema itself, which is a chronic adipose tissue disorder. However, in selected patients they may help improve metabolic health and assist with weight optimisation before surgical treatment is considered. 

Within a phlebology-led disease management framework, the goal of preparation for surgery is to optimise the patient’s overall metabolic and vascular health, reduce systemic inflammation, and improve the safety profile of the procedure. 

Any decision to use GLP-1 medications should be made in consultation with the patient’s GP or treating specialist, who can assess whether this approach is appropriate for the individual patient. 

For surgical planning, many anaesthetists recommend stopping GLP-1 medications, one month prior to surgery to optimise anaesthetic safety and reduce the risk of delayed gastric emptying during anaesthesia. The medication can usually be recommenced after surgery once normal diet and recovery have resumed, based on advice from the prescribing doctor. 

Many patients also work on metabolic optimisation through diet and lifestyle, including lower-carbohydrate or ketogenic dietary strategies when appropriate. These approaches may help reduce systemic inflammation and support long-term metabolic health when implemented with guidance from a GP, dietitian, or metabolic health practitioner. 

SUPPLEMENTS AND GENERAL HEALTH OPTIMISATION 

Some patients choose to use nutritional supplements as part of preparing for surgery and supporting general health. While certain supplements may contribute to overall wellbeing, their use should always be discussed with the treating doctor or healthcare provider before surgery. 

As a general guide, preparation for surgery focuses on improving overall physiological resilience. This may include attention to: 

• a nutrient-dense, whole-food diet
• adequate protein intake to support tissue repair and healing
• optimisation of metabolic health
• reduction of systemic inflammation
• minimising highly processed foods and excess sugars 

Some patients may discuss supplements such as vitamins, minerals, or anti-inflammatory nutritional support with their healthcare providers. However, supplement use varies between individuals and should not replace appropriate medical care. 

It is important to note that some supplements can increase bleeding risk or interact with medications or anaesthesia, so all supplements and medications should be disclosed to the treating medical team before surgery. 

Within a phlebology-led staged treatment model, careful preparation and optimisation of the patient’s health prior to surgery is an important component of reducing risk and improving recovery. 

Can you perform surgery on the armpits, Mons pubis, or rump areas as well? 

If lipoedema is affecting the abdominal or mons pubis regions, or other areas of the body, the same lymph-sparing technique used for the limbs can be applied. Where appropriate, these areas can be addressed within the same operative session by allocating additional surgical time, reducing the need for separate procedures. 

For upper limb treatment, the surgical stage is planned comprehensively from the axilla (armpit) through to the wrist. This includes targeted treatment of the axillary region, which is commonly involved and can contribute to symptoms and contour irregularity if left untreated. Extending the approach from armpit to wrist ensures a more complete, disease-focused outcome while maintaining lymphatic safety. 

What is the wait time for surgery? 

Our priority is the timely management of lipoedema to reduce disease progression, symptoms and functional decline while patients are waiting for treatment. As lipoedema care forms the core of our practice, the service is structured to support efficient assessment and progression to surgery where appropriate. 

With a dedicated hospital for lipoedema surgery and an 8-bed overnight recovery ward within our purpose-built, licensed private hospital, most patients are able to move from diagnosis and consultation to surgery within approximately 8 to 12 weeks. This helps avoid the extended wait times, often up to 2 years, seen in more generalised surgical settings. 

Lipoedema extraction surgery is a targeted, disease-focused approach designed to treat pathological lipoedema tissue in the limbs, with the aim of managing pain, mobility, function and disease progression. It is not cosmetic fat removal or body contouring. 

Our protocol is phlebology-led and aligned with the European S2k lipoedema guidelines, reflecting a disease-focused model developed through over 30 years of German clinical experience. 

Surgery is performed in a staged, minimally invasive and lymph-sparing manner, using small, strategically placed access ports (typically 3–4 mm) to allow controlled, compartment-based removal of affected tissue while preserving surrounding structures. 

Key principles of the protocol 

• Clinical endpoint, not cosmetic.

Surgery is guided by clinical feel rather than appearance. Surgery continues within each compartment until the firm, nodular lipoedema tissue has been adequatelyaddressed, and no obvious diseased fat is further extracted. The goal is thorough treatment while maintaining a high safety profile. 

• Eligibility and preparation

Surgery is offered to suitable candidates following a period of conservative management, typically for at least 8 weeks. This helps prepare the tissues and optimise outcomes.

• Hospital-based care

Procedures are performed in a licensed hospital setting, with overnight stay and care tailored to lipoedema patients.

• Bilateral approach

Both limbs are usually treated in the same stage to support balance,symmetry and functional recovery. 

• Staged, disease-focused treatment
  – Lower legs are often treated first, as they commonly have the greatest impact on mobility
  – Upper legs, thighs and buttocks are usually addressed in a second stage 
  – Additional stages may be required depending on disease extent 
  – Arm treatment is generally performed after the legs, but may be prioritised if more symptomatic. Where appropriate, additional arm treatment can be incorporated into lower limb or abdominal stages to reduce the total number of procedures. 
• Individualised planning

The sequence and extent of treatment are tailored to each patient’s symptoms, diseasedistribution and goals. Patients are not required to commit to all stages upfront. 

• Timing between stages

Stages are usually spaced around 8 weeks apart, with compression and lymphatic support used between procedures. Longer intervals (even years) between stages are also acceptable and do not result in lipoedema spreading to previously treated areas. 

• Anaesthesia and mobilisation

Procedures are performed with specialist anaesthetic care as heavy twilight or generalanaesthesia where appropriate. Early mobilisation is encouraged after surgery to support recovery and reduce risk. 

• Ultrasound-integrated care

Ultrasound is used for mapping, intraoperative guidance and early postoperative assessment, including screening for deep vein thrombosis and managing fluid collections whererequired. It is also used to assess and, where appropriate, treat venous disease at the same time as lipoedema extraction surgery. 

• Recovery and travel

Most patients are fit to travel, including flying, approximately one week from Day 1 after surgery (the day following the procedure), depending on individual recovery.

• Different to cosmetic liposuction

This approach is focused on managing a medical condition. It aims for structured, compartment-based treatment of diseased tissue rather than partial volume reduction or aesthetic reshaping.

• Technical considerations

Lower leg treatment is often more technically demanding and may involve more postoperative discomfort compared to other regions.

• Lymph-sparing, minimally invasive technique

A minimally invasive approach using small (3–4 mm), strategically placed access portsallow controlled treatment within anatomical compartments while preserving lymphatic structures. The technique uses tumescent fluid (containing dilute local anaesthetic and adrenaline), often in the range of 6–8 litres for a lower limb stage, to support safe extraction. Careful dilution and monitoring are important to minimise the risk of anaesthetic toxicity. 

As a result, surgical canisters typically contain a mixture of fat and fluid, rather than pure fat as seen in cosmetic procedures. 

• Key feature of treatment in the lower legs- Hallmark of Lipoedema Extraction Surgery
  A key feature of this protocol is often seen in the lower legs. Following surgery, many patients experience improvement towards a more normal anatomical lower leg, including clearer definition of the ankles, shins, calves and knees. This reflects compartment-based treatment of pathological tissue from the knees down to the ankle level using minimally invasive access points. 

The lower legs often demonstrate favourable skin retraction and can provide a useful indicator of treatment response. In contrast, areas such as the thighs and other gravity-dependent regions may show greater variability in skin retraction and residual laxity. Lower leg treatment is also technically demanding, particularly in earlier-stage disease, where careful technique is required to support a durable outcome. 

• Adjunctive technology (Renuvion)
  Whereappropriate, Renuvion may be used during the same operative stage as an adjunct to lipoedema extraction. While it adds operative time, performing it at the same time may reduce the need for additional procedures. It is delivered through the same small access ports and is intended to assist with haemostasis through controlled coagulation of small vessels, which may help reduce oozing and bruising. 

It may also support skin contraction in selected areas, particularly where laxity is a concern. 

Important information 

All surgical procedures carry risks. Suitability for surgery, expected outcomes and recovery vary between individuals and are discussed in detail during consultation. 

Lipoedema is a medical condition requiring a disease-focused approach. Patients are encouraged to seek assessment from a doctor with specific training, experience and recognised qualifications in lipoedema assessment and surgical management. 

While consultations can take place at any of our clinics, all surgical procedures are performed at our purpose-built, licensed facility at Miami Private Hospital on the Gold Coast, with a dedicated overnight lipoedema ward. 

Patients who wish to proceed to an in-person consultation and potential surgery are required to complete the initial steps of the Lipoedema Management Pathway. This typically includes participation in a Lipoedema Education Session followed by a one-on-one telehealth consultation with the doctor prior to booking a face-to-face appointment. 

You can read more about our Lipoedema Management Pathway here. 

Please note that Medicare rebates are not available for the initial video consultation. However, eligible follow-up consultations may attract a rebate. 

To support timely care and minimise delays in management, one-on-one telehealth consultations and face-to-face appointments are prioritised following the Lipoedema Education Session, where appropriate within the Lipoedema Management Pathway. 

Dercum’s disease involves painful fatty nodules within the subcutaneous tissue, which can coexist with lipoedema and contribute significantly to pain and tenderness. Our approach does not treat these nodules in isolation but integrates their management within a phlebology-led, disease-focused surgical strategy. 

Painful nodules that are clearly identified by the patient, clinically palpable and consistent with areas of maximal tenderness can be targeted during surgery using water-assisted liposuction (WAL). This is done in conjunction with a broader approach of compartment-based decompression of lipoedema tissue, using a lymph-sparing technique and staged treatment aligned with European S2K guidelines. 

The nodules themselves are abnormal fat, but the pain is not simply due to the fat alone. It is more likely driven by nerve irritation or entrapment within the fatty tissue, increased pressure within the compartment and local inflammation. In simple terms, the fat forms the structure, but the nerves within that environment drive the pain. 

This understanding underpins the combined treatment approach. Decompressing the affected compartment helps reduce pressure on embedded nerve fibres and improves the overall tissue environment, while selectively targeting dominant nodules addresses focal areas of highest symptom burden. This allows for reduction in overall disease burden and meaningful pain relief, without the need for multiple individual excisions. 

It is important to recognise that lipoedema is a diffuse disease rather than a collection of isolated lumps. Treating nodules alone does not address the surrounding pathological tissue and may lead to incomplete or short-lived relief. In practice, nodules are treated where clinically meaningful during WAL, but they are not removed as standalone lesions, with the priority remaining global disease control combined with targeted symptom relief. 

The aim is a balanced approach that combines decompression with selective nodule treatment to improve pain, mobility and function, while maintaining a high safety profile consistent with a staged, disease-focused protocol. 

Management follows a structured, staged pathway aligned with European S2K guidance. 

The typical order is:

• conservative optimisation first (compression, movement, metabolic support)
• venous assessment and treatment where indicated
• lipoedema extraction surgery 

This sequence is important because, in many patients, what is labelled as “lymphoedema” is secondary to lipoedema and venous overload. By addressing these drivers first, the lymphatic burden is often significantly reduced. 

In practical terms, this means that while conservative care aims to reduce swelling as much as possible before surgery, it is not always possible to fully resolve lymphoedema if significant lipoedema tissue remains. For most patients, proceeding to lipoedema surgery at the appropriate point leads to meaningful improvement in swelling, pain and function, and is often sufficient without the need for additional lymphatic procedures. 

Importantly, lipoedema extraction surgery is not expected to cause lymphoedema when performed using a staged, lymph-sparing technique. However, in more advanced lipoedema, there may already be underlying lymphatic compromise or scarring, which can influence recovery and outcomes. 

Where there is a question of true primary or focal lymphatic dysfunction, further workup such as ICG lymphography or lymphoscintigraphy may be considered. However, this is usually not required upfront in the presence of clear lipoedema, and is often more appropriately assessed after lipoedema reduction, when the underlying lymphatic system can be evaluated more accurately. 

A key technical consideration is that performing lymphatic microsurgery (such as LVA) before lipoedema extraction is generally not recommended by the S2K guidelines, as subsequent WAL cannula use to remove lipoedema tissue will more likely disrupt these delicate reconstructions. 

Summary                                                             

• Conservative care and venous optimisation come first
• Lipoedema surgery addresses the main disease driver
• Secondary lymphoedema often improves following lipoedema treatment
• Lymphatic-specific investigations or surgery are rarely first-line and are usually considered later, if needed 

Our phlebology subspecialised doctors will guide you through this pathway and advise when you are appropriately optimised and ready for surgery. 

Lipoedema surgery is performed using a staged, disease-focused approach, rather than attempting to treat the entire leg in a single operation. 

Dr Chris Lekich and his team follow a protocol developed through German experience and aligned with European S2K guidance. The aim is to comprehensively treat affected compartments, often circumferentially from the hips down to the ankles, while maintaining a high safety profile. 

In most cases, this means surgery is intentionally staged, for example: 

• lower legs (knees to ankles)
• upper legs – front and back of thighs from the waist
• occasionally hips or other involved areas 

This staged approach allows: 

• safer fluid and volume management
• reduced physiological stress
• preservation of lymphatic structures
• more controlled and complete disease removal within each compartment 

Not all patients require treatment of every segment. Some may have more advanced disease in one area, such as the lower legs, while other areas are less affected. 

In these cases: 

• surgery may be performed on the most symptomatic or advanced region first
• other areas, such as the thighs, may be deferred, or alternatively treated first if the lower legs are not significantly involved
• further surgery is only undertaken if clinically necessary 

Key principle-The goal is complete and safe treatment of diseased tissue within each targeted area, rather than trying to do everything at once. 

Summary-Full-leg treatment is usually not performed in a single operation. A staged approach provides a better balance of safety, effectiveness and long-term outcomes, while allowing treatment to be tailored to the distribution and severity of each patient’s disease. 

The fluid and lipoedema tissue are removed at the same time.  After 6 to 12 months recovery, fluid related swelling will have significantly reduced.  This depends on how progressed the Lipoedema was and the effects on the lymphatics from long standing Lipoedema.  

I am very fibrous and over 50? 

If you have completed optimal conservative management, your doctor will advise if you are surgery ready. Your age is not a limitation, many patients are over 50 years, with the oldest patient being 78 years. 

I have had previous surgeries? 

Lymphatics can be more compromised after knee surgery or any other surgery on the limbs however this is not a barrier to surgery and is common with our patients.  This also includes past plastic and cosmetic surgery including liposuction. 

I have chronic pain with fibromyalgia? 

Many patients with Lipoedema are significantly more comfortable after surgery, however, a full assessment by our doctor will determine whether there are no other connective tissue disorders that need to be investigated or managed.  

There has been some chatter recently about how much fat is being removed in lipoedema surgeries and if this is limited to 5 litres.

Please be aware that Lipoedema Surgical Solution surgeries are staged and the aim of surgery is to remove all the lipoedema fat, not to limit fat to 5 litres and stop. The protocol is based on Dr Lekich’s training in Germany where the focus is on maximising safety by limiting fat removal using a percentage of body fat and the amount of safe anaesthetic fluid that is used.

Cosmetic liposuction techniques involve liposuction from multiple areas of the body in the one surgery. There have been safety concerns about removing large volumes involving long surgery times and discharging patients home the same day.

For dedicated lipoedema surgery as per the German protocol where Dr Lekich has been trained, the aim is to remove all the lipoedema from the limbs/body with a staged surgical approach concentrating on the targeted area. It is routine that less than 5 litres are removed at each surgery.

You may have noticed that recently many of our case studies feature women who have had less than 5 litres of fat removed.  This is due to two reasons:

• many women are now starting their lipoedema surgery at earlier stages before significant progression of lipoedema has occurred, and as such, they require less fat to be removed per surgery.
• there is a recent shift in Australia for liposuction to be limited to 5 litres maximum for cosmetic and plastic surgery.  This is not based on lipoedema surgery expertise and is one that the medical defence organisations (who provide doctors insurances) are preferring and mandating in some instances.

Please be reassured, this does not mean your lipoedema journey will be impacted.  Many patients do not require more than 5 litres of lipoedema fat to be removed per surgery.

Dr Lekich is currently lobbying all of the medical defence organisations in Australia to reduce unnecessarily high insurance premiums for our doctors, as our work is not cosmetic, and our patients are admitted overnight rather than discharged the same day.  In addition to this, there is comprehensive post-operative clinical care for optimal safety and recovery for our patients.

Dr Lekich is lobbying for Lipoedema-Lymphoedema Extraction Surgery to be distinct from cosmetic plastic surgery and to have its own set of requirements, not limited to 5 litres.

Dr Lekich is very active in his advocacy for lipoedema patients in Australia raising awareness with all the major medical defence organisations, private health funds and Medicare. Please stay tuned! 

TLA and WAL differ primarily in their approach to fluid injection and suction during surgery. In TLA, fluids are first injected under the skin before being suctioned out by the surgeon, whereas WAL involves simultaneous injection of fluids and suction.

WAL offers several advantages over TLA, particularly in terms of preserving the lymphatic network, nerves, and vessels, minimising damage to these structures. By injecting smaller volumes of water under the skin gradually, rather than all at once as in TLA, WAL reduces limb swelling and allows for easier sculpting by the surgeon.

The WAL technique incorporates flowing water jets and adjustable speeds, facilitating faster injections followed by immediate suctioning. This results in a shorter operation duration and greater control over the procedure’s progress. The rapid aspiration of injected liquids prevents deep penetration into the patient’s circulatory system, reducing the risk of discomfort and nausea associated with the anaesthesia and other products present in the fluids. Additionally, WAL liposuction technique has shown to reduce the severity and frequency of oedema, bruising, and swelling. 

Our doctors recommend early intervention. Early diagnosis is important as it leads to understanding the disease and taking appropriate measures to manage the disease conservatively. As progression occurs, surgical management can be considered in early stages while it is more straightforward, rather than waiting for the disease and comorbidities to progress. Early surgical intervention means less complicated surgery resulting in an easier recovery, and ultimately less surgeries required. 

Lipoedema-Extraction surgery is staged and the aim of surgery is to remove all the lipoedema fat, aiming to arrest the disease so that it does not come back.  To ensure lipoedema fat is completely removed from the legs, surgeries have to be performed in a staged manner targeting different areas of the body.

The surgery is designed with a high safety profile, is comprehensive, and unlike cosmetic surgery is not designed to contour the body fat by only removing portions. Instead, this is a specific protocol developed in Germany where Dr Lekich was trained to remove all the fat circumferentially right down to the ankles.

We regularly see patients who have had general liposuction to target specific areas or contour sections of the body where the fat has continued to grow because it was not removed in its entirety.

For patients who have more progressed Lipoedema in one specific area, they may only require one surgery on the legs.  For example, surgery on the lower legs from the knees to the ankles could be performed and surgery on the thighs could be deferred, only to be performed if deemed necessary in the future. 

What is Renuvion?

Renuvion is a minimally invasive procedure to improve skin laxity/redundancy that uses a combination of helium plasma and radiofrequency energy to stimulate collagen production.

Although skin contraction effect is often visible during the procedure, the maximum benefits are noted at about 9 to 12 months.

When is it best to have Renuvion?

Our doctors perform Renuvion either in combination during the primary lipoedema and lymphoedema extraction surgery or 9 to 12 months after surgery.  If having Renuvion after surgery has been completed, we can also manage any residual lipoedema or venous disease at the same time as targeting disproportionate redundant skin.

We do not offer Renuvion for cosmetic purposes.

Will it be effective for older patients?

Yes, Renuvion can be effective for older patients, but its suitability depends on individual circumstances, including skin condition, overall health, and treatment goals.

Factors to Consider

1. Skin Elasticity: Older patients may have reduced skin elasticity due to age. While Renuvion can improve laxity, results may vary based on the severity of sagging and the individual’s skin quality.
2. Overall Health: As with any procedure, it’s essential to consider your overall health and ability to undergo treatment.

For older patients seeking non-surgical procedure to improve skin laxity/redundancy, Renuvion is an excellent option with proven results. However, realistic expectations and a thorough consultation are essential to achieving the desired outcomes.

Is it better to have plastic/cosmetic procedure than Renuvion?

This is a minimally invasive solution to improve skin laxity/redundancy and most cost effective when combined at the same time as the lymphoedema and lipoedema surgery, however it should not be compared with the results of dedicated skin lift/skin excision surgeries which may still be required for very progressed lipoedema. There are no guarantees of results, and these will vary from patient to patient.

How much does Renuvion cost?

Adding Renuvion at the time of your lipoedema surgery is a highly cost-effective choice. While it can be performed 9-12 months later at a similar cost to the initial surgery, having it done during the procedure saves you both time and money. By combining Renuvion with your surgery, you’ll only pay a few thousand dollars more, compared to the full cost of a standalone treatment later. This approach not only maximises your investment but also streamlines your recovery and enhances your results in a single, efficient step. 

Patients are typically administered a twilight sedation, either light or deep, depending on their preference.