Frequently Asked Questions

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 an all inclusive surgery cost of $28,500 (Doctor, Hospital and Anaesthetist Fee). 

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

At this point in time there is not a clear understanding of Lipoedema-related comorbidities, such as secondary Lymphoedema, both in Australia and globally, which is evidenced in the push to change the name of Lipoedema. The current Australian healthcare system does not understand Lipoedema and Lymphoedema and issues can arise from the lack of up-to-date research and awareness.

For this reason, we offer privately billed lipoedema surgeries until there is a broader understanding of the condition in the medical community.

Our focus is on providing accessible lipoedema surgeries to women in Australia and New Zealand and this change allows us to dedicate our doctor and management resources to providing our service, and to be focused on patientcare and continual improvements.

While we will continue to advocate for improved science, increased awareness, and better understanding for Lipoedema, the Healthcare System needs some time to catch up.

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

Compassionate Release of Super (CRS) is administered by the ATO. We don’t encourage or assist with applications and we don’t provide financial advice. The ATO manages CRS and provides the eligibility criteria and application process. 

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.

Will Lipoedema come back after surgery?

Thanks to 20 years of surgery using this protocol in Germany, Dr Heck has shown that the lipoedema fat should not return.  This has been Dr Lekich’s experience performing over 1,100 lipoedema surgeries using the Lipoedema Surgical Solution protocol since 2017.  Our doctors see patients who have had general lipoedema to target specific areas or contour sections of the body where the fat has continued to grow, as it has not been removed with a lipoedema-specific protocol.   The goal of Lipoedema surgery is to remove the fat so it does not return.

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.
Can you 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.

What is the wait time for surgery?

We are committed to ensuring timely treatment to prevent disease progression while waiting for surgery. With an 8-bed overnight recovery ward at our purpose built, licensed private hospital, as well as three fully trained doctors and a formal training program for new doctors, our increased capacity reduces wait times significantly. Most patients can progress from diagnosis and consultation to surgery within 8 weeks, avoiding the typical wait of up to 3 years at other clinics. 

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 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 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 recovery pain levels, 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. 

Although consultations can take place at any of our clinics, all surgeries take place at our purpose-built, licensed 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 Call 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. 

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.

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

Dr Lekich and his team use a very specific protocol developed in Germany where Dr  Lekich 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. 

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.