Patients affected by lipedema and operated on by Dr. Nicolas Zwillinger experience post-operative edema in the lower limbs. These swellings can take time to subside and can sometimes cause stress for these women. In this article, we will review this aspect of recovery.
Definition of Post-Operative Edema
Edema is a protective reaction of the body against an external aggression. In the case of WAL liposuction, the aggression is caused by the back-and-forth movements performed by the surgeon using the suction cannula of the Body-jet throughout the procedure.
These edemas manifest as swelling in the interstitial tissues, caused by the accumulation of fluid (mostly water).
These swellings are present in the operated areas (lower or upper limbs), with more significant edema typically observed in the “ankle” and “calf” regions.
The volume of fat aspirated during the surgical treatment of lipedema is temporarily replaced by edema. In some cases, the operated areas may appear more voluminous than before the procedure, but there is no cause for concern.
Duration of Post-Operative Edema
The body inevitably presents post-operative edema, but these will gradually decrease and eventually disappear. The peak of swelling is typically observed between day 3 (D+3) and day 10 (D+10) after the procedure.
The duration for the disappearance of post-operative edema varies significantly depending on the patient.
It can take a minimum of 6 weeks, on average 3 to 6 months, and up to a year in some cases.
Sometimes, we observe an asymmetric distribution of swelling between one limb and the other. There is no cause for concern; in some patients, a slowdown in the lymphatic system on either the left or right limb can explain this asymmetry.
This is why Dr. Nicolas Zwillinger recommends lymphoscintigraphy of the lower or upper limbs before surgery for certain patients. This examination, performed in nuclear medicine centers, helps identify a normal lymphatic system, unilateral or bilateral lymphatic slowdown, or in some cases, lymphedema. Regardless of the results of this test, it does not affect the surgery, but it can provide useful information for the post-operative phase, particularly regarding the possibility of asymmetric swelling or longer resolution in certain patients.
How to help edemas drain more quickly
1. Post-operative compression
It is applied at the end of the procedure, directly in the operating room, and helps limit the onset of edema. This compression should be worn during the first weeks or months after the procedure and will gradually be reduced depending on the rate of swelling reduction.
Here is the post-operative compression protocol recommended by Dr. Zwillinger and his team:
Day 0 to Day 10: double compression (class 3 stockings or tights + BIFLEX compression bandages or LIPOELASTIC panty), both day and night.
Day 10 to Day 15 (ideally until Day 30): simple class 3 compression, both day and night.
Day 15 or Day 30 to Day 60: simple class 3 compression, either day or night.
Day 60 to Day 90: simple class 2 compression, either day or night.
To ensure appropriate compression from the day of the surgery, you need to take measurements and order your compression garments before the procedure. We also recommend ordering new stockings 2 to 3 weeks after the surgery with your updated measurements. You should always ensure that your compression is well-fitted and provides proper support.
2. The practice of manual lymphatic drainage
Lymphatic drainage is also strongly recommended post-operatively. Starting 7 to 10 days after the surgery, it helps activate the elimination of post-operative edema. The drainage sessions can be performed by physiotherapists, estheticians, and other qualified professionals.
It is recommended to undergo two drainage sessions per week for a minimum duration of 5 weeks. For some individuals, these drainage sessions may continue for several months. The drainage techniques used may include the following:
- Leduc
- Vodder
- Renata
It can sometimes be difficult to find a professional trained in these techniques, so we recommend having pressotherapy sessions as an alternative.
3. Cold therapy
Applying cold to the areas with swelling can relieve pain and help reduce post-operative edema. This application can be repeated several times a day over the course of several weeks.
4. Physical activity
From the day of the surgery, walking will be possible and is highly recommended to encourage proper drainage of post-operative edema. Although walking time is limited in the first few days, it is advised to walk regularly. As recovery progresses, the walking time and distances covered will gradually increase, and swelling will become less noticeable. However, it is important not to overexert oneself during the first two weeks and always listen to your body.
In the second phase (3 to 4 weeks after the surgery), water-based sports will be possible. Movements in the water help drain post-operative edema. We recommend starting with swimming, aquabiking, aquajogging, or aquagym, always beginning gently.
5. Time
The most important factor in the disappearance of post-operative edema is time. No matter how closely you follow all of our recommendations, the reduction of post-operative edema varies greatly from one patient to another. We encourage you to be patient and allow your body the time it needs to recover from this WAL liposuction surgery for the treatment of your lipedema.
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