Le rendez-vous avec le Dr Nicolas Zwillinger (en réel ou en virtuel via Doctolib) est l’examen clinique qui permet de diagnostiquer le lipoedème, de déterminer les zones touchées. Il vous expliquera ce qu’est la maladie du lipœdème, ses conséquences et ses méthodes de traitement, notamment la technique de liposuccion WAL.

He will give you all the information you need about the operation and its follow-up. You can ask any questions you may have during the appointment, or afterwards by e-mail or telephone. At any time, you can ask for a new appointment if you still need clarification.

2. Other medical appointments before lipoedema surgery

A. The appointment with the angiologist

The angiologist helps to diagnose lipedema, thanks in particular to Doppler ultrasound. If you have significant varicose veins, you will need to consult a phlebologist (a specialist in the treatment of varicose veins) and treat them before the lipedema operation.

At this appointment, the angiologist will ask you about your medical history, any venous surgeries you may have had, current treatments, previous pregnancies, and whether you have family members who also suffer from vascular pathologies.

Next comes a clinical examination, which will focus particularly on the legs, with observations and palpations, including peripheral pulses (on the popliteal artery, the dorsal artery of the foot, the femoral artery…). After this, the angiologist will decide whether an ultrasound and/or a Doppler ultrasound are necessary.

Nous travaillons notamment avec le Docteur Cazaubon spécialisée en Médecine Vasculaire (Angéiologie), elle vous reçoit dans son Centre d’Explorations Vasculaires, à Paris (XVI).

Thanks to the experience she has acquired in the leading hospital departments in Paris (Bichat, La Pitié, Ambroise Paré) and the surrounding region (Hôpital Américain de Neuilly, Clinique du Val d’Or à St Cloud), she can offer you the most modern vascular exploratory methods adapted to vessel diseases (arteries of the neck and limbs, veins and lymphatics), with a recent specialization in the exploration of large legs, lipedema in particular.

General Secretary of the Société Française d’Angéiologie for over 20 years, she has built up a network of correspondents in all specialties, not only in Paris, but also outside mainland France and in so-called “developing” countries ».

With a multidisciplinary background (cardiology and angiology), she has opted for a comprehensive approach to the management of vascular disorders.

Available and easy to contact, she manages emergencies (phlebitis in particular) as well as long-term follow-up.

An update on venous Doppler ultrasound

Doppler ultrasound is performed using a probe that is moved over the limbs under observation. There are many advantages to this technique: it is completely painless, harmless and non-intrusive. As a result, it can be recommended at any age, and repeated as often as necessary – which is extremely useful for monitoring the progression of lipedema and the impact of treatments. It can also be used to identify and define the location of venous thrombosis, as well as the size of the clot obstructing the vein. This is particularly useful if you suffer from lipedema, which is frequently associated with an increased risk of thrombosis.

B. The appointment with the nuclear medicine physician for your lymphoscintigraphy

Lymphoscintigraphy is a method that enables you to analyze your lymphatic network in detail, and thus determine the drainage function in your upper and lower limbs. In other words, in the case of oedema, the examination enables us to determine whether or not the cause is of lymphatic origin. In the case of lipedema in particular, the examination also makes it possible to assess the area where lymph flow is impacted, whatever the origin. Please note that for this examination, there’s no need to come fasting or to stop taking your medication, as others require.

This examination is particularly useful in differentiating lipoedema from lymphedema.

In lipedema, fat accumulates in excess in the affected limbs (lower limbs and arms) and does not disappear with daily exercise or a special diet. This excess of abnormal fat results in swelling of the legs and arms.

In the case of lymphedema, the lymphatic vessels no longer drain lymph efficiently enough, which then accumulates in the tissues beneath the skin. The swelling then appears on one leg or arm, unlike lipedema, where the swelling of the affected limbs is symmetrical. Unilateral swelling is therefore a sign of lymphedema.

In very advanced stages of lipoedema, the disease can develop into lipolymphoedema. The lymphatic system then malfunctions bilaterally.

In some cases of milder lipoedema, it may still be associated with moderate lymphatic insufficiency.

C. Appointment with the anaesthetist

It should be scheduled one month before your operation. On this occasion, the anesthetist will explain all the stages of the operation and give you all the information you need to ensure that the anesthesia runs smoothly. He will also study your medical and family history. In some cases, he or she may prescribe additional tests (blood tests, electrocardiogram, etc.).

Nous travaillons notamment avec le Docteur Gloulou, médecin anesthésiste réanimateur formé en anesthésie polyvalente et prise en charge des patients en réanimation chirurgicale. Il a eu un parcours universitaire puis une formation à l’hôpital. Il a un poste de praticien hospitalier pendant quelques années dans un hôpital universitaire. Depuis quelques années, il travaille dans le privé et fait exclusivement de la chirurgie esthétique et plastique, notamment à la clinique de l’Etoile.

You will see the surgeon again just before the operation to review the situation with you and make markings with a felt-tip pen on the areas to be operated on.

In this article, we’ve outlined the various medical appointments you’ll need to make before surgery, so that you can learn more about the different pre-operative stages. If you have any further questions, please don’t hesitate to make an appointment.