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  • INTRODUCTION: Lipedema is a chronic adipose tissue disorder characterized by disproportionate fat deposition, primarily in the lower extremities, leading to pain, functional impairment, and reduced quality of life. While Power-Assisted Liposuction (PAL) is the standard surgical approach, the integration of Ultrasound-Assisted Liposuction (UAL) with PAL has been proposed to enhance fat removal and improve patient outcomes. OBJECTIVE: To compare the clinical efficacy, postoperative outcomes, and complication rates of PAL alone versus UAL + PAL in patients with Stage II and III lipedema. METHODS: A retrospective cohort study was conducted on 60 female patients diagnosed with lipedema (Stage II and III). 30 patients underwent PAL alone, while 30 received UAL followed by PAL. Primary outcomes included the volume of fat aspirated, circumferential reduction, and postoperative pain, measured at multiple time points over a 12-month follow-up. Secondary outcomes assessed patient satisfaction, time to return to daily activities, and complication rates. RESULTS: The UAL + PAL group demonstrated a significantly higher mean fat extraction volume (5,500 ± 450 mL) compared to the PAL group (4,100 ± 380 mL; p < 0.01). Circumferential reduction was greater in the UAL + PAL group, with an average reduction of 12.5 cm versus 8.2 cm in the PAL group (p < 0.01). Postoperative pain, assessed using a Visual Analog Scale (VAS), was significantly lower in the UAL + PAL group (VAS 4.5 ± 0.7) compared to the PAL group (VAS 6.2 ± 0.8 at 24 hours post-surgery; p < 0.01). Additionally, patients treated with UAL + PAL reported a faster return to daily activities (9.3 ± 1.8 days vs. 12.8 ± 2.1 days; p < 0.01) and higher satisfaction scores (4.8 ± 0.5 vs. 4.2 ± 0.6 on a 5-point Likert scale; p < 0.05). Complication rates were comparable between the two groups, with no major adverse events reported. CONCLUSION: UAL + PAL offers significant advantages over PAL alone in the surgical management of lipedema, providing superior fat removal, reduced postoperative pain, faster recovery, and improved patient satisfaction. These findings support the integration of UAL into standard liposuction protocols for advanced-stage lipedema, emphasizing its efficacy in overcoming the challenges posed by fibrotic adipose tissue. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  • BACKGROUND: Lipedema is a chronic, progressive disorder of subcutaneous adipose tissue that mainly affects women. It is characterized by disproportionate fat hypertrophy, pain, bruising, and marked resistance to diet and exercise. Tumescent liposuction remains the only effective treatment to slow or reverse disease progression, but involves large volumes and fragile microvasculature, increasing bleeding risk. OBJECTIVE: This study aimed to evaluate whether perioperative tranexamic acid (TXA) reduces intraoperative blood loss, postoperative bruising, and early complications in lipedema liposuction. METHODS: We retrospectively analyzed 230 staged liposuction procedures for lipedema performed between 2021 and 2024 at a single center. Patients received TXA intravenously, locally, or in combination, or no TXA. Primary outcomes were estimated intraoperative blood loss and postoperative ecchymosis. Secondary endpoints included hematoma, transfusion need, thromboembolic events, infections, and recovery time. RESULTS: All TXA groups showed significantly lower intraoperative blood loss and hemoglobin drop versus controls (p < 0.01). Local and combined routes were most effective, with the combined approach yielding the lowest ecchymosis scores. Hematoma rates dropped from 12% (no TXA) to 0-6.7% (TXA), and no thromboembolic or infectious complications were observed. No TXA-treated patients required transfusions, while 6% of controls did. CONCLUSIONS: TXA use in lipedema liposuction significantly reduces bleeding and bruising without increasing thromboembolic risk. Combined systemic and local administration appears most beneficial. These findings support TXA as a safe, effective adjunct in multistage, high-volume liposuction for lipedema. Prospective trials are needed to confirm the optimal protocol in this unique population. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Last update from database: 5/12/26, 7:18 AM (UTC)

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