Cutaneous Sensory Alterations After Lower Limb Liposuction for Lipedema: A Comparative Study with Aesthetic Liposuction Patients.

[INTRODUCTION] Liposuction is effective for body contouring but may cause transient cutaneous sensory changes. In lipedema, therapeutic liposuction involves higher aspirate volumes, fibrotic tissue, and exposure of distal-leg zones at risk. We hypothesized that postoperative sensory alterations are more frequent and persistent after lipedema surgery than after aesthetic lower-leg liposuction, with disease severity-rather than technique-driving outcomes.

[MATERIALS AND METHODS] In this prospective, single-center cohort (January 2023-March 2024), 90 women underwent lower-leg liposuction (knee-to-ankle) by one surgeon: Control (aesthetic; n = 30), lipedema Stage I (n = 20), Stage II (n = 20), Stage III (n = 20). All procedures used VASER-assisted emulsification and MicroAire PAL aspiration under standardized tumescent infiltration. Sensory testing (Semmes-Weinstein monofilaments, thermal discrimination, pinprick, 10-point VAS) was performed at baseline and 1, 3, 6, and 12 months. Persistent alteration was defined as > 6 months. Satisfaction was assessed at 6 and 12 months with the BODY-Q Lower Leg module and a functional questionnaire. Logistic regression identified predictors of 12-month hypoesthesia.

[DISCUSSION] Aspirated volume increased with disease stage (Control 2400 mL; Stage I 2600 mL; Stage II 3500 mL; Stage III 4600 mL; p < 0.01) and correlated with persistent hypoesthesia/paresthesia (p < 0.01). Twelve-month hypoesthesia was seen in 3.3% (Control), 5% (Stage I), 15% (Stage II), and 25% (Stage III). Despite this, satisfaction was high across groups (BODY-Q: Control 90, Stage I 91, Stage II 88, Stage III 86). Lipedema patients also reported substantial improvements in pain (85-95%), mobility (80-92%), heaviness (88-96%), and bruising (78-91%). These findings indicate that advanced disease, not surgical method, accounts for prolonged sensory alterations.

[CONCLUSION] Lower-leg liposuction in lipedema provides significant symptomatic and functional relief, with consistently high satisfaction despite persistent sensory changes in Stage II-III disease. Disease severity and aspirated volume, not technique, are the main determinants of postoperative hypoesthesia. Counseling should balance sensory risk with the strong likelihood of life-changing benefits.

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