Lipoedema is a chronic condition characterised by a painful and abnormal accumulation of fat cells in the hips, thighs, buttocks, legs and often in the arms.  The legs may become swollen, bruise easily, feel tender and uncomfortable.

Sufferers of early-stage Lipoedema often have column-shaped legs and as the condition worsens the fat continues to build up and the lower half of their body becomes heavier.  The lipoedemic fat can also build up in the arms.  The fat cannot be exercised or dieted away; nor will weight loss surgery pills potions or powders make the lipoedema weight disappear in the legs in the arms.  Many patients eat well and exercise yet continue to develop fat on their lipoedemic areas.

Lipoedema extraction surgery on the arms when affected is often part of the surgical protocol either at the beginning before leg surgery or at the end. There are cosmetic and plastic surgeons that work alongside our Lipoedema doctors that can perform liposuction on the abdomen as well as performing skin resection surgery if needed.

By removing the lipoedema tissue before skin resection will avoid the lipoedema tissue from continuing to grow.  For appropriate patients, the Lipoedema Extraction surgery and skin surgery where there is excessive skin could be performed at the same time.

Some women report Lipoedema on other areas of the body including the abdomen as well as painful deposits at the back of the neck … Lipo Extraction surgery can be performed on these areas as well to reduce the pain and suffering.

Lipoedema is almost always triggered at puberty however some patients may not see changes until later in life due to triggers of pregnancy, menopause or other comorbidities.

Lipoedema is a progressive condition & will typically progress as a woman ages and goes through hormonal changes.  It will progress differently in different women and can depend on the age of onset – some women don’t report symptoms until menopause and others report having symptoms from pre-teen years.  Most patients feel they have had a predisposition to Lipoedema their whole life, based on the shape of their legs & ankles or associated symptoms such as swelling, even those with late onset.

While it is most likely Lipoedema will progress, it can be slowed through conservative management.  It’s important to realise that no matter how good conservative management is hormonal triggers often worsen the condition.

Pregnancy

Lipoedema is a progressive condition & it is typically recommended for a patient that is a suitable surgical candidate to have their surgeries completed as early as practical & possible.

Given that pregnancy often progresses lipoedema, as with any progressive disease it is best managed early for those patients where progression is significant.  As the aim of this Lipoextraction surgery is to remove all the fat so it does not return,  pregnancy is encouraged after surgery for those wishing to start or enlarge their families.  The earlier the surgery less number of surgeries will need to be performed.  If not managed in a timely manner,  Lipoedema can result in further complications including reduced mobility, lymphoedema (due to scarring of the lymphatics secondary to the inflammatory nature of the lipoedema tissue); as well as depression, anxiety, body dysmorphia or eating disorders.

Lipoedema that has been completely removed using the Lipoedema Extraction surgery protocol should not return during pregnancy and after pregnancy.  This has been confirmed over 20 years at the lipo clinic in Germany where Dr Lekich has been trained; as well as Dr Lekich performing high volume Lipoedema Extraction surgery since 2017 in Australia.

Post surgery, you would have wait at least 3 – 6 months for it to be safe to have a baby.

Menopause

The same holds true with Lipoedema Extraction surgery and Menopause.  Once the surgery has occurred the fat should not return, even with menopause as a trigger.

Choosing private health insurance can be complicated as everyone’s circumstances are unique.  Please find below some links to resource pages that can help you understand if health insurance can work for you and policy comparisons.

• https://www.privatehealth.gov.au
• https://www.health.gov.au/topics/private-health-insurance
• https://www.accc.gov.au/consumers/specific-products-and-activities/private-health-insurance

Some patients are keen to know what rebates they would be entitled to.

Common item codes that our patients use to treat swollen legs are listed below.  You may find it useful to call your health insurer and seek a quote for rebates on these codes.  If you have other health concerns or comorbidities as well as Lipoedema, ask your treating doctor for those relevant item codes too when seeking quote for rebates.

• Lymphoedema / Lipoedema Extraction – 45585 x 2 (per leg)
• Anaesthetic for lymphoedema and lipoedema surgery – 21460
• 1 leg, 1 vein, GSV or SSV – Endovenous Laser Ablation – 3250
• 1 leg, 2 veins, GSV and SSV, Endovenous Laser Ablation – 32522
• Ultrasound Guided Sclerotherapy – 32500
• Sonography for Endovenous Laser or Radio Frequency Ablation – 55296
• Sonography for Ultrasound Guided Sclerotherapy – 55054
• Anaesthetic for vein surgery – 21520

Provider number for Miami Private Hospital is 0057440T

When calling to confirm your rebate, please advise your health fund that Miami Private Hospital is a Tier 2 contracted Hospital.

Yes. Lymphoedema is not inflammatory tissue, rather it is a condition where the lympathics are not functioning and the isolated limb affected by lymphoedema fills with fluid and is not generally painful. However, where lymphoedema is secondary to lipoedema due to the lipoedema tissue causing significant burden & scarring on the lymphatics, the limbs (often both limbs affected symmetrically) are painful.

Yes, performing safe exercise is encouraged to reduce secondary obesity, and is a part of the conservative management plan.

Consultation and diagnosis is part of our Lipoedema Management Pathway. Patients can choose between two pathways including:

• Conservative Management Pathway. The typical out-of-pocket cost of this pathway is $245.
• Surgical Pathway. The typical out-of-pocket cost of this pathway is $245.

You can read more about our Lipoedema Management Pathway here

You don’t need a referral to see Dr Lekich, however, we recommend getting a referral from your GP if you can, so that our doctors can communicate with your GP to access your medical history.  We also use this as an important opportunity to provide information and education to GPs and specialists about Lipoedema. When filling out your questionnaire please be comprehensive with contact details for the doctors, specialists and therapists that you want to be included for copies of communication from our doctors.

Lipoedema is a chronic condition characterised by a painful and abnormal accumulation of fat cells in the hips, thighs, buttocks, legs and often arms. The legs become swollen, bruise easily, feel tender and uncomfortable.

Lipoedema does not involve the feet and often presents with a cuff between the swollen ankle and unaffected feet.  However, the feet can be affected if the Lipoedema is so progressed that the feet are also swollen due to advanced lipoedema causing scarring of the lymphatics leading to secondary lymphoedema.  Patients with lipoedema have disproportionate fat in their legs and as a result, often suffer from foot and ankle related problems such as plantar fasciitis and arthritis.

Sufferers of early-stage Lipoedema often have column-shaped legs and as the condition worsens the fat continues to build up and the lower half of their body becomes heavier. The lipoedemic fat can also build up in the arms.

The fat cannot be exercised or dieted away, many patients eat well and exercise yet continue to develop fat on their lipoedemic areas.

If not diagnosed and managed properly Lipoedema can result in further complications including reduced mobility, lymphoedema (due to scarring of the lymphatics secondary to the inflammatory nature of the lipoedema tissue); as well as depression, anxiety, body dysmorphia or eating disorders.

Given that many doctors do not know about Lipoedema, it can be challenging to receive a diagnosis through a GP or medical specialists – it is important to consult with a doctor who has a thorough understanding of Lipoedema.

There is no test for Lipoedema, this is a clinical assessment and diagnosis based on the history and examination.  Even experienced doctors managing swollen legs such as vascular surgeons and phlebologists may miss the condition, particularly in the subtler or earlier forms.

The first step of the process to get a diagnosis with our team is to book a group zoom call with Dr Lekich.  This is your opportunity to hear an overview of lipoedema, the way it is diagnosed and treated, and what to do before seeing a doctor for a one-on-one consultation. Group zoom sessions are typically held once or twice a month; you can click here to see available times.

Our head office is located in Miami on the Gold Coast with weekly consultations available Gold Coast and in Brisbane.

We also have monthly clinics in Sydney and Melbourne; as well as at least one clinic throughout the year in Perth, Hobart and Adelaide (depending on travel restrictions). Patients in Cairns and Mackay can consult monthly with one of the Vein Doctors Group phlebologists that are well trained and also manage swollen legs due to varicose veins.

Patients who wish to see our doctors in person at one of the above locations, must complete the first steps in the Lipoedema Management Pathway before a face-to-face consultation can be booked.  This includes participating in the Group Zoom Information Session and a one-on-one telehealth call with the doctor.

You can read more about our Lipoedema Management Pathway here

Please note that Medicare rebates are not possible with video consults, however, follow-up consultations are rebated.

The first step of the process is to book a group zoom call with Dr Lekich, this is your opportunity to hear an overview of lipoedema, the way it is diagnosed and treated, and what to do before seeing a doctor for a one-on-one consultation. Group zoom sessions are typically held once or twice a month; you can click here to see available times.

Yes, we offer Lymphoedema mapping where patients are most likely to have secondary Lymphoedema from Lipoedema. Other causes of Lymphoedema apart from Lipoedema could be cancer lymph node surgery related, the most appropriate mapping for this is Indocyanine Green ICG with a view to Lymphovenous Anastomosis (LVA) Microsurgery.

Many women have great results with conservative management alone including things like compression, manual lymphatic drainage, lipoedema-friendly diet and exercise.

These conservative measures must be done as a prelude to surgery. However, even if a patient is not considering surgery it is important to ensure all elements of conservative management are understood and implemented to avoid serious implications of Lipoedema in the long term.  This is living with lipoedema and doing your best to control it however it will not stop the disease from progressing or being painful, nor will it make the fat go away. The aim of surgery after the conservative management protocol is to remove the fat so it does not return and to alleviate pain and improve mobility

Conservative Management is a life-long management technique and will be detailed during your initial consultation with Dr Lekich.

A chronic health care plan can be organised by your GP to assist with some of the above management. Dr Lekich will write to your GP outlining your condition. A letter should be received within 3 weeks.

Conservative management is an important and ongoing requirement during recovery, which may take 6 to 12 months.  Maintaining a good, healthy, anti-inflammatory diet is important, not just for lipoedema patients.  It is the goal of surgery to remove the lifelong commitment to wearing compression and having MLD once the patient is fully recovered from surgery.  Patients who have had progressed lipoedema for many years, may have some residual swelling and damage to the lymphatics that may require intermittent compression and MLD, but the lipoedema tissue is not expected to grow back.

The role of compression is vital as it helps reduce the swelling by encouraging the flow of the lymphatic fluids out of the affected limbs. The longer you are not in compression, the more scarred your lymphatic system can become. Start where you feel most comfortable. Ask your online support community for advice. They will be able to give you contacts you can follow up with.

Your MLD therapist will be extremely helpful also and will be able to assist you with your compression garment. Ideally, you will progress to FLAT KNIT, waist to foot, Class II compression garments. These are custom made and unfortunately, can be expensive. However, the pain levels of patients with lipoedema are better managed with Flat Knit Class II Compression Garments. If you have a health care card or are registered with NDIS you may be eligible for funding towards your compression. A health fund rebate may also be available. Further, you may require clearance of your arterial system to safely wear compression. Please note, compression of this form is CUSTOM made and can take up to 4 weeks to be produced. These are part of our surgical protocol.

Pre surgery:

• have an assessment with our doctor, which may require further investigations to exclude any comorbidities and determine underlying causes for swollen legs that may need to be treated prior to Lipoedema-Extraction Surgery
• a minimum 8 weeks of conservative management to soften the lipoedema tissue so it can be removed via liposuction. Conservative management is made up of three parts and you can read more about conservative management on our website 
• reduce secondary obesity
• some patients may be required to undergo psychological assessment, such as very young patients
• be determined surgically ready by one of our doctor team

Post surgery:

• For the first 2 weeks post op, wear your compression garment 24/7 including while showering
• 3 to 8 weeks post op, you can have an hour out of compression each day
• 9+ weeks post op, wear compression as directed by your MLD therapist or our doctor
• Flat knit compression will be required for a minimum of 8 weeks post-operatively, but it may be needed for 6 to 12 months

Prior to surgery, your doctor will decide if your flat knit compression or our lipoedema elastic garment (Lipoelastic) will be used as your post-surgery garment. In general however, a second set of compression is required for lipoedema surgeries, this is for while your flat knits are being washed or when your flat knits may be too tight for a short period of time following surgery due to swelling.

Flat knit compression will be required for a minimum of 8 weeks post-operatively but it may be needed for 6 to 12 months

Manual Lymphatic Drainage Therapy (MLD) benefits Lipoedema patients by removing excess fluid from the lymphatic system. Weekly MLD will help your lymphatic system function as best as it can. Please make sure you find yourself a therapist that knows lipoedema well. Again, your online community will be a great help on this matter. Ask your therapist to teach you some home techniques to stimulate your lymphatic system, this may include Dry Brushing.

MLD is part of our surgical protocol.

Some patients like to trial a Lymphatic Pump System.   This system does not replace the need for MLD, however, in addition to MLD, it can be extremely beneficial. Intermittent pneumatic compression mimics the body’s lymphatic drainage and promotes the circulation of blood/fluid throughout the body.

Please seek the guidance of your MLD therapist, they will direct you to the right pump and provide you with an appropriate treatment plan. Your therapist will also be able to write the prescription that is required to obtain the lymphatic pump such as the Lympha-press. Please note, the lymphatic pump system is not part of our surgical protocol, however, it is highly worth considering.

Some patients may find that they do not have fluid in their legs, however MLD would be considered appropriate by most therapists to optimise the lymphatic system and keep the lipoedema tissue soft.

Dr Lekich and Lipoedema Surgical Solution do not endorse specific MLD therapists, or offer a specific provider post surgery. However, we do have an online support register where you can find providers to support you on your lipoedema journey. Along with MLD therapists you may find lipoedema friendly providers for compression, dieting, GPs, and more.

For patients having a straight forward recovery, MLD in the first week is advisable and some of the local MLD therapists have a mobile service.

• I have started conservative management in preparation for surgery. I am about to start soccer season…do you have to wear the compression stockings as they are quite thick…running could be an issue?
  •  It is a balance of convenience. Removing the stockings for the duration of the game will not be damaging.

• Is compression necessary before surgery or can I just go with compressions after surgery? I have stage 4 lipoedema and lymphedema.
  • Conservative management must be used before any surgery to soften the fat, especially in stage 4!

• Is it necessary to wear grade one or grade two flat knits?
  • For patients undergoing surgery, grade 2 flat knits are required. Flat knits will be used after surgery, the aim of  surgery is to wean  you off compression

It is important to note that there is evidence that low inflammatory, no sugar, very low carbohydrate diets with high good fats and no caloric restriction helps to reduce pain and inflammation in Lipoedema patients. It also assists in weight loss.

We recommend that you consult with a Nutritionist or Dietician that works with Lipoedema patients and knows the disease well.

Do not start this on your own, you must get professional advice to support the implementation of this lifestyle change. We are all different, so it is never, one size fits all.

Enquire with us if you need assistance to find one.

There are a range of support programs available for patients with Lipoedema, some of these include rebates or subsidies that may be available for conservative management.  Please find more details here 

Yes of course technique is important, best to ask your MLD expert.

It’s important to note that as well as having extensive experience in managing Lipoedema, Dr Lekich is an expert Phlebologist (vein doctor).  He treats swollen and painful legs and has done so for over sixteen years.

Using ultrasound-guided technology, and with Dr Lekich’s understanding of the lymphatics and venous system, he could help to give you a clearer understanding of what’s happening with your legs and point you in the right direction in regards to a treatment plan, even if it turns out to not be Lipoedema.

If not diagnosed and managed properly Lipoedema can result in further complications including reduced mobility, lymphoedema (due to scarring of the lymphatics secondary to the inflammatory nature of the lipoedema tissue); as well as depression, anxiety, body dysmorphia or eating disorders. It is not uncommon for patients with significant mobility issues with advanced lipoedema to have permanent lymphoedema and issues with deep vein thrombosis

Some common conditions that co-exist with Lipoedema can include:

• Varicose veins are common and the reason legs are scanned at the time of the consultation.  Varicose veins can have a large part to play with swollen legs and fixing them reduces the risk of bleeding and clotting post-surgery.
• Autoimmune diseases affecting the thyroid and connective tissues (such as rheumatoid arthritis)
• Ehlers Danlos Syndrome
• Polycystic Ovarian Syndrome
• Fibromyalgia
• Ross River fever and Epstein Barr virus past infections
• Dizziness is secondary to POTS (Postural orthostatic tachycardia). Our sonographers specialise in thoracic outlet syndrome scanning and patients can be diagnosed and then referred to appropriate specialists for management.
• Often lymphoedema occurring in both legs is a result of progressed lipoedema.

Yes, usually 4 to 6 weeks is required post vein treatment.

As a part of our surgical protocol, treatment of comorbidities such as varicose veins are a requirement pre-surgery. When comorbidities are managed, the doctor may clear you for surgery. In relation to varicose veins in particular, having these treated can significantly reduce swelling and bring physical relief before any lipoedema surgery.

Best to discuss this with your MLD therapist

Yes it is more common with lipoedema due to disproportionate weight and abnormal gaits that occur due to growing lipoedema tissue. Best to see a podiatrist, orthopaedic surgeon or your GP. Patients generally find these improve with Lipoedema Extraction Surgery.

Yes, Dercums and Lipoedema often co-exist and many of our surgical patients have both conditions.

A hole in the heart or PFO (patent foramen ovale) is a common condition where a small flap-like structure in the heart allows blood to cross over from the right atrium into the left atrium of the heart.  This means that unfiltered venous blood bypasses the filtering of the lungs and mixing with freshly filtered arterial blood for recirculation through the brain and body.

It is normal for a foetus to have this hole as it would naturally close after birth, however for 25% – 30% of people it does not close.  It is not known why only a certain portion of the population retains a PFO.

50% of people who have a significantly sized PFO have one or more of the symptoms outlined below:

• fatigue – particularly from working legs
• strokes or TIAs (mini strokes)
• migraines with aura
• pain in the side of your belly, legs, or thighs
• high blood pressure
• shortness of breath
• exercise intolerance
• brain fog.

If you have had a TCD (transcranial doppler) test and been found to have a hole in the heart, it would be a requirement to get it closed before lipoedema surgery to reduce the risk of stroke.

If you would to read more about hole in the heart, as well as Dr Lekich’s protocol concerning them, please click here.

The Transcranial Doppler is the most sensitive way to flag a hole in the heart. It is more sensitive than a transoesophageal echocardiogram (TOE) and a trans-thoracic echocardiogram (TTE). A general anaesthetic is not required.

Apart from the ‘drip’ in the arm or leg, it is a painless test that uses ultrasound to detect real time measures of blood flow velocity throughout certain parts of the vascular system in the brain.

The TCD test requires a small amount of saline solution with micro bubbles to be injected into a vein while brain activity is monitored. If any of the micro bubbles have reached the brain, this is an indication that unfiltered blood is circulating through the body. The number of micro bubbles that reach the brain can be accurately counted to determine how significant the abnormality is.

If a PFO is found, we will refer you to a structural cardiologist, expert in PFO closures, and the wait time will depend on their next available appointments.  However, in some instances patients can have all their appointments aligned to have the closure within 2 weeks.

Please speak to our doctors as affordable PFO closures can be facilitated.
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This would be very rare.

The aim of this protocol of surgery is to remove the diseased lipoedema fat from the arms and the legs so that it does not come back. The surgery is designed with a high safety profile, is comprehensive and is not cosmetic surgery to remove portions of fat.

Surgical costs differ with every patient, depending on their condition and the number and type of treatments required. Dr Lekich will confirm your diagnosis, as well as assess your general health and any comorbidities during the initial consult. Our doctors will also determine if you are a suitable candidate for surgery, and can then provide a suitable treatment plan along with associated costs.

As a general rule, most patients need 2-3 surgeries (depending on the progression of the disease) with the typical cost of surgery being $13,100 + anaesthetist fee per surgery.  Each surgery takes place typically 2 months apart.  This surgery fee is comprehensive and includes all costs for the surgery namely the hospital bed and facility fee, the overnight accommodation fee, the consumable costs, and the surgery fee.

As stated above, it is important to understand the aim of this surgery protocol based on training in Germany with Dr Heck developed over 20 years is to remove all the diseased fat so it does not return, despite having children and menopause.  As opposed to cosmetic and plastic surgery approaches, which often involves multiple sites of the body with patients incorrectly being advised that lipoedema tissue will continue to grow.

Further, a lymphatic sparing approach is used as opposed to mechanical forms of liposuction or high-frequency ultrasound commonly used for cosmetic liposuction, less suited to surgery on the limbs.

PRIVATE HEALTH REBATES

In regards to private health rebates, there is a Lymphoedema item code (45585 + rebate on accommodation for surgery of 1-3 days) available to patients who suffer from secondary Lymphoedema; resulting in a rebate on surgery to reduce out of pocket expenses to the patients. The rebate is expected to range between $2,800 and $3,330 per surgery. The amount of the rebate and your qualification for it is out of our control and depends on your health fund. Dr Lekich will determine as part of your assessment if you have Lymphoedema as well as Lipoedema, and we recommend you discuss this with your private health insurer after the consultation to confirm your eligibility with them. It is important to know that lipoedema is a disease (however your health fund may consider it cosmetic) and that there is no facility that is a bulk billing hospital to treat lipoedema.

PAYMENT PLANS

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.

SUPER RELEASE FOR PAYMENT

Patients also seek Super release for medical and compassionate reasons, this is not encouraged.

• How is this procedure different from liposuction?
  • This is a specific protocol developed in Germany where Dr Lekich was trained to remove all the fat circumferentially right down to the ankles with the aim of surgery so it does not come back.  Up to 6 to 8 litres of fluid are used, the surgery can take up to three hours per stage.  Mechanical ultrasound liposuction or high-frequency ultrasound liposuction to break up the fat and to suck it out is NOT used. For this reason, canisters have fat floating on blood-stained fluid that is infused to protect the lymphatics and then removed as opposed to cosmetic canisters that are almost completely full of fat. This surgery is not to remove parts of fat or contour all over the body in one surgery as this will not enable all of the fat and the fat will continue to grow. With this protocol of surgery, the fat is removed smoothly and the changes are dramatic in the before and after photos all the way down to the ankles as well as the reduced pain and the increase in mobility

• What about with someone that has hard fatty nodules all over the thighs? Can that all be removed with Liposuction?
  • The form of liposuction that our doctors perform makes it possible to remove the harder nodules however it is most desirable for patients to go through a full conservative management programme to soften the fat as much as possible. For this reason, it is more desirable to perform surgery earlier in the stage of lipoedema development.

• Do you do standard liposuction too?
  • The cosmetic and plastic surgeons that work with Dr Lekich and the team perform standard liposuction and skin resection surgery.  His colleagues are independent of Lipoedema Surgical Solution and are available for consultations and second opinions.

• I have knee replacements; does it affect lipoedema surgery?
  • 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

• Will Lipoedema come back after surgery?
  • Thanks 20 years of surgery using this protocol in Germany with Dr Heck has shown that the lipoedema fat has not returned. This has been Dr Lekich’s experience performing high volume lipoedema surgery since 2017. Dr Lekich regularly sees 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. Despite past general liposuction, Lipoedema Extraction surgery is still possible however patients can be more scarred.

• What age groups have you operated on?
  • We have operated on patients ranging from 16 to 76 years.

• Is there a weight limit for surgery?
  • There is no specific weight limit for surgery, however, patients must reduce secondary obesity before being considered a suitable candidate for surgery. Secondary obesity is readily reduced in patients who have undergone appropriate conservative management as part of our surgical protocol.  Some patients have had their disproportionate fat in their legs and arms incorrectly deemed a high BMI by doctors who are unaware of Lipoedema.  We recognise this as Lipoedema, especially once secondary obesity has been reduced and we do not have a limit on the amount of Lipoedema tissue we can remove with staged surgery.

• Are there any medications that you think assist with prep for surgery – ie Ozempic?
  • This may be helpful in treating secondary obesity and you may wish to do this if your GP or specialist has suggested this.

• Does Dr Lekich perform surgery on the armpits, Mons pubis, or rump areas as well?
  • If lipoedema is affecting abdominal and mons pubis areas, or other areas of the body, the lymph-sparing technique that is used for the limbs can also be applied.  This can also be applied in allocating extra surgery time when the arms are performed, obviating the need for a separate surgery. During arm surgery the armpits are also targeted.

• Can patients play their own music during surgery?
  • Yes
• What is the wait time for surgery?
  • The wait time for surgery is now reduced from 6 – 12 months to 2 months as a result of our new overnight ward with capacity for 8 patients, as well as having Dr Lekich and Dr Teo working in their own theatres.  A third doctor is undergoing formal training with Dr Lekich and Dr Teo under the Lipoedema Surgical Solution and Miami Private Hospital surgery protocol to manage growing capacity for surgeries.

Lipoedema-Extraction surgery is a targeted form of liposuction to remove the diseased Lipoedema from the legs and arms, aiming to arrest the disease. The aim of this protocol of surgery is to remove the diseased lipoedema fat from the arms and the legs so that it does not come back. The surgery is designed with a high safety profile, is comprehensive and is not cosmetic surgery to remove portions of fat. This option is available for patients that are a suitable candidate for surgery, and only after 8 weeks of appropriate conservative management.

All patients stay for 1 night at Miami Private Hospital on the Gold Coast with our specialised overnight facility for Lipoedema patients.

The surgical protocol will be explained to the patient in detail at the consultation.

The essential features of the surgery are:

• Bilateral (both legs treated at the same time) to optimise balance, function and form following surgery.
• The first stage of surgery is usually on the lower legs or targeting areas that are most problematic regarding mobility. The first surgery significantly improves mobility and reduces the gravity-damaging effects on the most vulnerable part of the legs affected by gravity.
• The second stage of surgery is usually done as a single surgery involving the upper legs/thighs/buttocks. Where the disease has progressed a third surgery may be required on the legs
• Surgery on the arms is usually last if required however patients may opt to start with this surgery as their legs are being prepared to combat the effects of gravity with conservative management or if the arms are more symptomatic.
• The intervals between surgeries are usually 8 weeks with continued use of flat knit compression garments and manual lymphatic drainage in the immediate postoperative period.
• The approach and order of surgery may be modified depending on the most impacting effects of the Lipoedema tissue.
• A specialist anaesthetist provides Twilight sedation where the patients can either be fully asleep or semi asleep with the aim of the anaesthetic to enable the patients to walk off the table to avoid DVT.
• Ultrasound is used not only for the assessment of the patient but also to check for any deep vein thrombosis within a few days after surgery.
• Patients can fly home after one week.

We do not operate on two whole legs at once because unlike cosmetic or plastic surgery to contour the body fat, the lipoedema surgical protocol is based on the German protocol to remove all the fat so it does not return.

In regards to most painful for recovery, the lower legs are more technical and may experience more discomfort.

As a lymph sparing technique is used to take all the fat out of the legs, all the way down to the ankles,  6 to 8 litres of anaesthetic fluid used up with local anaesthetic and adrenaline in the mixture for one stage of surgery.  It is important to not overdose the patient with cardiac or neurotoxicity. This is the reason why the canisters have fat floating on bloodstain fluid as opposed to canisters in cosmetic settings that are entirely fat where high-frequency ultrasound is used to break up the fat and then suck it out.  This technique is the reason why patients have post-op photos that show a return to a normal appearance of the lower legs, with fat removed all the way down to the ankles revealing ankles shins calves and knees.

All surgeries take place at our purpose-built facility on the Gold Coast with a specialised overnight Lipoedema service.

Patients who wish to see our doctors in person and proceed to surgery, must complete the first steps in the Lipoedema Management Pathway before a face-to-face consultation can be booked.  This includes participating in the Group Zoom Information Session and a one-on-one telehealth call with the doctor.

You can read more about our Lipoedema Management Pathway here

Please note that Medicare rebates are not possible with video consults, however, follow-up consultations are rebated.

Painful nodules associated with dercums disease can also coexist with Lipoedema and respond to water-assisted extraction of the fat nodules.

It is important to remember that Lipoedema tissue is extensive and removal of it in an isolated part of the limb will not stop it from progressing.

Dr Lekich does not remove fat nodules during surgery as it is not consistent with the protocol that he has been trained to perform from Germany.

• Is there anything I can do to help prepare my skin for surgery as far as retraction is concerned?
  • For the lower legs, the skin retracts to a relatively normal state even in patients where over 10 litres have been removed from the knees to the ankles.  For the upper legs, where there has been significant swelling in the size there will be redundant skin however patients vary depending on their general skin quality or how much it will contract. All patients are advised to wait 12 to 18 months post-surgery before one of our cosmetic plastic surgeons could facilitate the removal of skin. Lipoedema- extraction surgery promotes the laying down of collagen that shrinks the skin to some extent.

• If the skin has been stretched for too long, would you still go ahead with surgery?
  • Yes this is not a limitation to remove the lipoedema fat

• What’s the extra cost if skin needs to be removed after Lipoedema surgeries?
  • We are happy to refer you to one about plastic cosmetic surgeons for an assessment

• Do you have to have skin removed on the legs?
  • The answer is no for the lower legs from the knees down, and in most patients not even in the thighs.  Patients seeking perfect skin results can consult with the plastic cosmetic surgeons that work with Dr Lekich and the team.  It is advised that at least 12 months pass after the lipoedema surgery to allow the skin to retract

Optimising conservative management will reduce secondary lymphoedema and this is the goal before surgery.  However, to completely remove lymphoedema with significant lipoedema still present may not be possible.  It is not uncommon for patients to have secondary residual lymphoedema despite best endeavours with conservative management.  Our doctors will advise when you are surgery ready.

Yes, patients are typically administered a twilight sedation, either light or deep, depending on the patient’s preference.

Dr Lekich uses a very specific protocol developed in Germany where he was trained to remove all the fat circumferentially right down to the ankles. To ensure lipoedema is 100% removed from the legs, surgeries have to be performed in a staged manner targeting different areas of the lower body.

Some patients only require one surgery on the legs, if they have more progressed lipoedema in one area. 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.

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? I’ve had both knees replaced.
  • 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.

Yes our doctor and nursing team will manage seromas.

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.

Early intervention is recommended by Dr Lekich. 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.

Dr Lekich regularly sees 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.

For most patients, 6 to 8 weeks of recovery is required.  Often patients go back to work after two weeks, however, some sooner and some patients later.

For patients who have early lipoedema and are younger, the legs can normalise in 6 weeks.  However, this would take longer for established lipoedema and secondary lymphoedema, taking up to 12 months.

Consider driving at least 2 weeks after surgery if you are feeling strong and comfortable to operate your vehicle and not affected by pain. You should not drive if you still feel lightheaded or weak or if driving is contraindicated with your current medication.

Dr Lekich and the team will be available in the post-operative period for continued support.

Patients typically need 8 weeks to recover in between surgeries. It is not problematic if a patient needs to wait longer than 8 weeks between surgeries for practical reasons.  The fat will not return or migrate from another area.

Following surgery, you will stay overnight at Miami Private Hospital for one night. You will be discharged the following day at 7am, and then must stay locally to the hospital (10 – 15 minute drive) for the following 7 nights.  You will visit our team during this time if extra support is needed.  You will be in daily contact with your doctor via an sms update.  You will have your deep vein thrombosis (DVT) check done on approximately day 5, where are team will also check your vital signs and answer any questions before you return home.

Post surgery it is recommended that you take regular pain medication with food to avoid indigestion/heartburn. If you have no contraindications paracetamol is ideal, as well as non-steroidal anti-inflammatories (e.g Nurofen or Voltaren), as well as compression and regular walks alongside of manual lymphatic drainage.

It would be strongly recommended that patients seeks psychological / psychiatric / counselling before and after surgery, as the lipoedema can be a significant mental burden.

Post surgery it is required to arrange an able-bodied carer to help you for the first two weeks (24/7) post-surgery. Having a carer to pick you up on discharge from the hospital and stay with you is a hospital safety requirement.

Regarding compression stockings, this will depend on many factors individual to your situation – however, most patients would cope.