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Questions and Answers

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.

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

  • Conservative Management Pathway with Nurse. The typical out-of-pocket cost of this pathway is $120.
  • Surgical Pathway with Doctor. The typical out-of-pocket cost of this pathway is $245.

You can read more about our Lipoedema Management Pathway here

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 to be safe and 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, the anaesthetist fee 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.

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 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.

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 LipoExtraction 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.

 

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.

It’s important to note that as well as specialising in Lipoedema, Dr Lekich is also an expert Phlebologist (vein doctor).  He specialises in treating 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.

Our head office is located in Miami on the Gold Coast with weekly consultations available Gold Coast and in Brisbane.  All surgeries take place at our purpose-built facility on the Gold Coast with a specialised overnight Lipoedema service.

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.

Lipoedema-Extraction surgery is a targeted form of liposuction to remove the diseased Lipoedema from the legs and arms, aiming to arrest the disease. This option is available for patients that are a suitable candidate for surgery, and only after 6-8 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.

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.

  • How is this procedure different from liposuction?
    • This is a specific protocol developed in Germany where Dr Lekich was trained to remove fat from every square centimetre of the limb completely and circumferentially all the way 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. Everyday doctor Lekich sees patients who had passed general liposuction where the fat has continued to grow.  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.

 

 

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.

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. For younger patients without comorbidities six weeks is possible 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.

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.

  • Is there anything I can do to help prepare my skin for surgery as far as retraction is concerned?
    • Almost universally the skin retracts to a relatively normal state even in patients wear over 10 litres have been removed from the knees to the ankles. where there has been significant swelling in the size they 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

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.

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.

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

  • 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.

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