These signs are not systematically present, nor are they very specific; in fact, the post-operative phase of lipedema surgery is characterized by pain in the operated areas and significant oedema. As phlebitis is generally unilateral, you need to be vigilant when these symptoms are more present on one side. It can also lead to a slight fever.

But it’s also important to remember that phlebitis can be asymptomatic!

What factors exacerbate this risk?

Venous insufficiency

It is characterized by a faulty venous network, which makes it difficult for blood to return to the deep network. It’s a common condition, affecting between 15 and 20 million people in France, particularly women. The most common symptoms are

The sensation of heavy legs,
The presence of telangiectasias (blue or purplish veins under the surface of the skin), or even varicose veins (dilation of a vein under the skin that has become swollen and tortuous).

In the case of varicose veins, it is important to have them treated by a phlebologist at least 2 months before the WAL liposuction procedure performed by Dr Nicolas Zwillinger, a lipedema specialist in France.

Blood hypercoagulability

It promotes clot formation through imbalance in the blood’s coagulation system. It may be due to a genetic predisposition (constitutional thrombophilia), such as a congenital deficiency in certain coagulation factors (protein S, protein C, antithrombin).

Hypercoagulability can also occur in certain contexts: pregnancy, obesity, smoking and advanced age all favor thrombus formation.

Certain medications, such as hormonal contraception or corticosteroids, also increase this risk.

The pre-operative blood test and the pre-operative appointment with the anaesthetist will enable us to assess the risks of hypercoagulability, and if the risk is too great, the operation may be cancelled.

Our 6 tips to avoid phlebitis after lipedema surgery?

1. Post-operative compression

We recommend double compression with class 3 compression stockings + BIFLEX bands (day and night) for 5 to 10 days, followed by single compression with class 3 compression stockings + BIFLEX bands for a further 3 weeks.

This double compression is an important element in preventing this post-surgical complication in legs affected by lipedema.

phlebitis post-surgery complication — *Double compression immediately after surgery*

2. LOVENOX injections

To limit the risk of venous thrombosis, you will be prescribed an injection of anticoagulant (LOVENOX) for 10 days, one injection per day.

This injection is carried out at the clinic on the day of the procedure (at the end of the day) and must be performed at a fixed time throughout the treatment. You will be given a prescription for these injections to be carried out by a homecare nurse, but you can also do them yourself.

A nurse from the Etoile clinic shows us how to proceed:

Phlebitis complication surgery 5 — Disinfection of injection area

Phlebitis complication surgery 4 — Disinfection of injection area

It is important to alternate the injection areas: upper thighs or stomach. It is normal to see a small bruise appear on the injection areas.

3. Walking

Walking improves venous return, and you will be able to walk from the day of your operation. Your walking pace will be slower, and the distance covered will be short to begin with, but will gradually increase in the days following the operation.

We advise you to remain active (walking around your home) and not to exert yourself too much in the first few days. From a week after the operation, you will be able to walk longer distances. We strongly advise against bed rest for several days after the operation, to avoid postoperative venous thrombosis.

4. Smoking cessation

As smoking increases hypercoagulability, we strongly recommend that youstop smoking (or taking nicotine substitutes) 1 month before and up to one month after the operation. Don’t hesitate to plan to stop smoking several months before the operation.

5. Drink plenty of water

Keeping well hydrated helps blood to flow smoothly, thereby reducing the risk of postoperative phlebitis. We recommend drinking at least 1.5 to 2 liters of water a day for 10 to 15 days. However, we recommend that you avoid drinking tea, which prevents iron binding.

6. A follow-up examination: the echo-Doppler

Despite all this advice, phlebitis after WAL liposuction surgery is always a possibility. To control this risk, you will be given a prescription for a follow-up Doppler ultrasound . The angiologists performing this follow-up examination will be able to tell you whether you are suffering from venous thrombosis, and if so, prescribe prolongation of your anticoagulant treatment and continued compression (usually double compression).

This article gives you a better understanding of what phlebitis is and how to avoid this complication by following our 6 tips for avoiding venous thrombosis after lipedema surgery. If you have any further questions, please do not hesitate to make an appointment with Dr. Nicolas Zwillinger.