Cutaneous Sensory Alterations After Lower Limb Liposuction for Lipedema: A Comparative Study with Aesthetic...

Liposuction is effective for body contouring but may cause transient cutaneous sensory changes. In lipedema, therapeutic liposuction involves higher aspirate volumes, fibrotic tissue, and exposure of distal-leg zones at risk. We hypothesized that postoperative sensory alterations are more frequent and persistent after lipedema surgery than after aesthetic lower-leg liposuction, with disease severity-rather than technique-driving outcomes.

In this prospective, single-center cohort (January 2023-March 2024), 90 women underwent lower-leg liposuction (knee-to-ankle) by one surgeon: Control (aesthetic; n = 30), lipedema Stage I (n = 20), Stage II (n = 20), Stage III (n = 20). All procedures used VASER-assisted emulsification and MicroAire PAL aspiration under standardized tumescent infiltration. Sensory testing (Semmes-Weinstein monofilaments, thermal discrimination, pinprick, 10-point VAS) was performed at baseline and 1, 3, 6, and 12 months. Persistent alteration was defined as > 6 months. Satisfaction was assessed at 6 and 12 months with the BODY-Q Lower Leg module and a functional questionnaire. Logistic regression identified predictors of 12-month hypoesthesia.

Aspirated volume increased with disease stage (Control 2400 mL; Stage I 2600 mL; Stage II 3500 mL; Stage III 4600 mL; p < 0.01) and correlated with persistent hypoesthesia/paresthesia (p < 0.01). Twelve-month hypoesthesia was seen in 3.3% (Control), 5% (Stage I), 15% (Stage II), and 25% (Stage III). Despite this, satisfaction was high across groups (BODY-Q: Control 90, Stage I 91, Stage II 88, Stage III 86). Lipedema patients also reported substantial improvements in pain (85-95%), mobility (80-92%), heaviness (88-96%), and bruising (78-91%). These findings indicate that advanced disease, not surgical method, accounts for prolonged sensory alterations.

Lower-leg liposuction in lipedema provides significant symptomatic and functional relief, with consistently high satisfaction despite persistent sensory changes in Stage II-III disease. Disease severity and aspirated volume, not technique, are the main determinants of postoperative hypoesthesia. Counseling should balance sensory risk with the strong likelihood of life-changing benefits.

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