Hagopian Plastic Surgery: Thomas Hagopian, MD 99 Krog St. NE, Unit C110
Atlanta, GA 30307 Phone: (404) 885-8542 Tuesday–Friday: 8 a.m.–5 p.m.
If you’ve been diagnosed with lipedema—a painful disease in which fat accumulates in the buttocks, thighs, calves, and sometimes the upper arms—you can find relief through a specialized fat removal surgery. Board-certified plastic surgeon Dr. Thomas Hagopian performs lipedema surgery in Atlanta, GA, using an advanced, lymphatic-sparing liposuction technique that produces long-term results.
Lipedema is a lymphatic disease that involves excess fat accumulation in the lower body. It affects 10 to 17 million people in the U.S., mostly women. It is not clear what causes some people to develop lipedema, although it is likely linked to hormonal changes because symptoms tend to get worse during puberty, pregnancy, and menopause. Researchers also believe the condition can be inherited.
Lipedema symptoms include:
Increased accumulation of fat in the buttocks, thighs, calves, and sometimes upper arms
Trouble walking as the condition worsens
Anxiety and depression related to physical symptoms
As fat accumulates over time, it can block the lymphatic pathway and cause a buildup of fluid called lymph (secondary lymphedema or lipo-lymphedema).
Are There Nonsurgical Lipedema Treatments?
Some people diagnosed with lipedema can benefit from nonsurgical treatments that alleviate pain and tenderness, although there is no cure for the condition. These treatments include:
Compression therapy: Wearing compression garments increases pressure on swollen legs and reduces fluid buildup.
Exercise: Swimming or other low-impact exercises can also minimize fluid buildup and help you become more mobile.
Massage: Manual lymphatic drainage stimulates the flow of lymph fluid to healthy vessels.
Because lipedema isn’t a condition caused by obesity, it doesn’t respond to dieting and increased exercise. Ultimately, surgical intervention is needed to reduce fat.
How Is Lipedema Surgery Performed?
Dr. Hagopian uses a specialized liposuction technique to address lipedema. It is designed to relieve pressure and congestion caused by the buildup of fatty tissue without damaging nerves, blood vessels, or the delicate tubes that drain lymph fluid (called lymphatics).
Dr. Hagopian performs the procedure at a certified surgery center or hospital, with patients placed under general anesthesia during the procedure to ensure they remain comfortable.
Before starting the liposuction, Dr. Hagopian injects the treatment area with a solution that combines saline, a local anesthetic called lidocaine, and epinephrine, a hormone also known as adrenaline. This solution is used during traditional tumescent liposuction to make the fat swell (become tumescent) and reduce bleeding.
After saturating the treatment area with the tumescent solution, Dr. Hagopian makes small incisions and inserts a thin tube, called a cannula, that rapidly vibrates to break up fat cells and suction them from the body. This power-assisted liposuction technique enables Dr. Hagopian to remove more fat in less time without the trauma caused by manual liposuction. The gentler power-assisted liposuction procedure produces enhanced results and reduces recovery time.
Is More Than One Surgery Needed?
The number of liposuction procedures needed to treat lipedema effectively depends on the severity of the condition. Some patients get the desired results after 1 surgery. Others require 3 or 4 liposuction treatments to remove the fat. Dr. Hagopian discusses the recommended surgical plan with you during the consultation.
Meet The Team
Dr. Thomas M. Hagopian
Plastic surgery is the perfect field for Dr. Hagopian, who has a knack for fixing things and helping people. He’s a former firefighter/paramedic, and he had a business building highly sought-after custom taillights in medical school. He met his wife, Nurse Hagopian, at Emory University, and they bonded over many shared interests, including a commitment to exceptional patient care.
Nurse Hagopian is an Atlanta native, a self-identified nursing ethics nerd, and an ANCC board-certified adult-gerontology acute care nurse practitioner. She’s passionate about studying informed consent, empowering fellow nurses to use their voices, and collaborating with people in addressing their aesthetic care needs.
The cost of lipedema surgery in Atlanta depends on the number of surgeries needed and the number of treatment areas targeted, in addition to several other factors. We will give you a personalized pricing estimate as part of your consultation.
Hagopian Plastic Surgery is in-network with most insurers, and will work with your insurance company to obtain coverage for these procedures if you meet the insurance-specific criteria.
What Is Recovery Like After Lipedema Surgery?
You can expect to feel groggy immediately after the procedure as the general anesthetic wears off. You’ll need a family member or friend to drive you home on the day of the surgery. Getting plenty of rest is important to help you heal more quickly, but we encourage patients to take short, easy walks around the house to enhance circulation. You can manage your discomfort with prescription or over-the-counter pain relievers.
Each patient’s recovery process differs and depends on the procedures and areas treated. However, compression is key to a good recovery for anyone undergoing lipedema surgery, and many patients will need several compression garments. We work with a number of physical therapists who are very familiar with lipedema recovery, and we make referrals for garments and massage to help with post-operative swelling.
Dr. Hagopian provides detailed instructions on what to expect and how to care for yourself after lipedema surgery.
Begin Your Journey
If you would like to learn more about lipedema surgery, please request a consultation online or call
(404) 885-8542. Our Atlanta office welcomes people interested in lipedema surgery from Inman Park, Druid Hills, Decatur, and throughout Georgia.
Frequently Asked Questions
Why do doctors differ on what they deem lipedema and regular fat?
Lipedema diagnosis includes several distinct clinical criteria, and some providers may require all of these to be present before making a diagnosis. Diagnosing patients requires clinical decision-making, which is not always clearly outlined. It is important to seek a diagnosis from doctors who have experience with patients who have lipedema or lipedematous features.
How long is it necessary to take off work?
Post-operative work leave is specific to each patient’s healing progress and the type of work they do. Patients who have the ability to work from home can usually return after 2 weeks. Patients with high-activity jobs, such as teachers, mail carriers, healthcare workers, etc., should expect to take longer off work or have decreased physical duties assigned to them.
Can surgery remove lobules on sides of knees?
A fat pad overhanging the knee is one of the cardinal characteristics of lipedema. Liposuction will be needed to remove the fat initially. Later on, a knee lift can be performed to improve the excess skin that remains.
Can Lipedema regrow? Does lipedema fat come back in other places?
Liposuction permanently removes fat; however, remaining fat cells could still be affected by the underlying disease that is lipedema. The majority of research states that lipedema fat presents in the lower extremities, occasionally in the hips and buttocks, and in the arms (Herbst et al., 2015). Significant weight gain in any post-liposuction patient could cause an increase in the size of remaining adipose cells.
How long can I expect to have swelling after surgery? Is it normal to have “hard” legs after surgery?
YES! The “hard” feeling in the legs is due to swelling that your body naturally creates, as well as fibrosis and the “proliferative phase” of wound healing. Manual lymphatic drainage as early as day 3-5 post-op can help the body remove fluid more quickly. Areas of greatest dependency, like the ankles and inner knees, can take a very long time to return to normal and, occasionally, can be permanent.
What is the difference between debulking and high volume? What are the requirements for these if you also have lipedema?
Debulking is the general term for fat removal via liposuction performed before skin excision. High volume liposuction is a term used to describe liposuction removal of over 2 liters of fat. For the integrity of the patient’s skin, no more than 10 liters of fat are removed at one time in a single surgery. This fits into the stepwise plan of lipedema surgeries. In my experience, patients who have more than 10L of fat removed tend to have a higher incidence of complications.
What diet or nutritional school of thought is best for dealing with the symptoms of lipedema?
Lipedema is not a disease caused by obesity or being overweight; however, there is anecdotal evidence that following certain diet plans can reduce the severity of symptoms. Please seek guidance from a registered dietitian when following any diet plan. We want our patients to understand that no amount of calorie restriction will prevent lipedema symptoms and progression. Further aesthetic improvements can be achieved with weight loss after surgery.
How many liposuction surgeries can someone have throughout life? In other words, is two the limit or could you have another surgery every ten years or so, after regrowth?
There is no set limit; however, there are diminishing returns, and repeated surgeries carry the risk of lymphedema developing. The best way to limit the number of surgeries is to ensure that you maintain the healthiest lifestyle possible post-op.
What is best order of surgeries?
Your surgical plan is unique to you. No two plans are the same, and your surgeon will customize your steps to ensure maximal benefit while maintaining safety guidelines. With that being said, liposuction precedes skin excision, and high-volume liposuction is not performed on the same part of the body where skin is being excised. Our practice prefers to allow one “half” of the body to recover at a time. For example, we would not perform liposuction on the arms and perform a leg lift in the same surgery. We stage our surgeries 3 months apart, and they typically follow this sequence: Lower body stage → upper body stage → lower body stage → upper body stage. This alternates between lower and upper body until the goal is achieved.