Comparing the Safety and Effectiveness of Different Liposuction Techniques for Lipedema

Introduction Lipedema is a relatively common, frequently misdiagnosed, chronic condition often treated by liposuction when conservative therapies fail. Techniques such as traditional tumescent liposuction (TTL), power-assisted liposuction (PAL), and water-jet-assisted liposuction (WAL), are popular surgical interventions, although it is unclear how these techniques compare. This meta-analysis aims to assess the efficacy and safety of liposuction in patients with lipedema. Methods Relevant English lipedema studies published in PubMed from January 2003 to April 2023 were identified. Ten articles with postoperative outcomes and complications data were included (2 TTL, 5 PAL, 1 WAL, 2 articles used both PAL and WAL). Results were summarized using descriptive statistics, and a randomized effects model was used to evaluate heterogeneity. Results A total of 2,542 procedures in 906 patients were included. Combined outcomes for all techniques significantly improved pain, bruising, edema, tension, pressure sensitivity, cosmetic impairment, and general impairment (all P < 0.00001). Results for TTL, PAL, and WAL led to significant improvements in pain reduction (P = 0.0005), bruising, swelling, pressure sensitivity, or cosmetic impairment (all P < 0.05). WAL more effectively reduced tension and general impairment (all P < 0.005), but heterogeneity for these outcomes was high. Overall complication rates were low for studies that utilized TTL (1.5%), PAL (4.0%), WAL (0%), and both PAL and WAL (2.3%). Conclusion Liposuction techniques, including TTL, PAL, and WAL, result in significant symptom improvement in lipedema patients with a relatively low complication rate. WAL may potentially result in a more substantial reduction of tension and general impairment with fewer complications; however, only a single study performed this method of liposuction exclusively. This is the first meta-analysis investigating liposuction data in lipedema treatment.