ArticleAesthetic plastic surgery2026
Large-Volume Liposuction and Manual Extraction in Lipedema: A Hybrid approach.
Article in Aesthetic plastic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionLipedema is a chronic and potentially progressive fat distribution disorder. Disease-related symptoms, such as pain and discomfort, can require surgical intervention when conservative therapies are exhausted. These megaliposuctions are functional in nature and need to be distinguished from esthetic liposuctions. This new surgical approach, the hybrid technique combining power-assisted liposuction (PAL) with manual extraction (ME), has been developed to more effectively treat fibrotic nodules, particularly in the lower legs, where conventional liposuction techniques often fall short.
methodsA total of 24 patients with advanced lipedema were included in a matched cohort analysis: 12 treated with the hybrid technique and 12 treated with PAL alone. Patients were matched by age (p= 0.9416) and BMI (p=0.6489). Outcome measures included pain and heaviness reduction on the visual analog scale (VAS), changes in a comprehensive lipedema symptom score, intraoperative blood loss, complication rates, and total lipoaspirate volume.
resultsWhile statistical significance was not reached, the hybrid group demonstrated a trend to greater symptom relief, with median reductions in pain (6.5 vs. 5.0, p= 0.1958), leg heaviness (7.5 vs. 6.5; p= 0.2293), and composite symptom score (68.0 vs. 52.5, p= 0.3254) compared to the PAL group. The hybrid technique also resulted in fewer postoperative complications and enabled the removal of larger total aspirate volumes; Hybrid group (mean: 17.88 liters), PAL group (mean: 16.62 liters) without increased risk.
conclusionThe hybrid approach shows promising trends in clinical outcomes and safety compared to PAL alone. Despite the absence of statistical significance due to the limited sample size, the consistent directional improvements and reduced complication rates support the further evaluation of this method in larger, prospective studies. LEVEL OF EVIDENCE V: 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 .
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