Lipedema surgery
LIPEDEMA SURGERY - Houston
Understanding Lipedema
Lipedema is a progressive and often misdiagnosed fat disorder that predominantly affects women. It is characterized by the abnormal accumulation of fibrotic, painful adipose tissue, typically in the lower and upper extremities—including the thighs, legs, buttocks, and arms. Unlike obesity, lipedema fat is resistant to diet and exercise and often accompanied by:
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Symmetric swelling of the legs (sparing the feet)
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Tenderness and pain to touch
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Easy bruising
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Reduced mobility
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Disproportionate body silhouette
Lipedema can lead to significant physical and psychological distress and, if untreated, may progress to lipo-lymphedema, where lymphatic fluid builds up, compounding mobility issues and inflammation.
Our Comprehensive Approach to Lipedema Surgery
Dr. Emmanuel De La Cruz offers a highly specialized and integrative surgical treatment plan tailored to each patient's stage and severity of lipedema. Leveraging his dual board certification and advanced training in high-definition liposuction, Dr. De La Cruz employs a functional-aesthetic hybrid approach—restoring both physical comfort and body confidence.
Lipedema surgery under his care incorporates a full-body evaluation, lymphatic preservation, and minimally traumatic techniques using the most advanced devices available.
One-Stage vs. Two-Stage Lipedema Surgery
Lipedema can be treated effectively using either a one-stage comprehensive procedure or a two-stage surgical sequence, depending on skin quality, fat volume, comorbidities, and patient goals.
One-Stage Lipedema Surgery
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Lipedema Surgery – Comprehensive Advanced Approach
Lipedema is a chronic condition that requires a specialized surgical approach for effective treatment. At De La Cruz Plastic Surgery, we use advanced, minimally traumatic technologies designed to safely remove large volumes of lipedema fat while protecting lymphatic structures, reducing complications, and improving long-term results.
This procedure is ideal for patients with good baseline health and preserved skin elasticity. It combines state-of-the-art technologies to address multiple regions in one session, allowing for both large-volume fat removal (5+ liters) and full-body contouring.
Key Components of Lipedema Surgery
1. Large-Volume Liposuction
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Removal of 5 liters or more of fat in a single session.
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Allows treatment of multiple affected regions at once (thighs, legs, arms, trunk).
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Reduces the need for multiple separate surgeries.
2. VASER® Liposuction (Ultrasound-Assisted Liposuction)
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Uses ultrasound technology to emulsify fibrotic lipedema fat.
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Preserves vital structures including lymphatic channels, blood vessels, and nerves.
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Clinical studies show less bleeding, fewer contour irregularities, and faster recovery compared to traditional liposuction.
3. MicroAire® PAL (Power-Assisted Liposuction)
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Employs a mechanized reciprocating cannula system for efficient fat removal.
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Enhances precision in removing dense, fibrous lipedema tissue.
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Dr. De La Cruz utilizes small 3.0 mm VentX Cannulas, minimizing trauma to tissues and reducing the risk of post-operative contour irregularities.
4. Renuvion® (J-Plasma)
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Combines radiofrequency energy with helium plasma to induce controlled skin tightening.
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Contracts fibrous septae and dermal structures, improving contour and skin adherence after fat removal.
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Especially useful for patients with mild to moderate skin laxity.
5. Quantum RF + Morpheus8 (Alternative to Renuvion)
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Provides radiofrequency-assisted skin tightening and collagen remodeling.
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Improves skin quality, firmness, and texture.
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Reserved for patients with more significant laxity or contour irregularities, offering an advanced solution where skin support is compromised.
Benefits of This Comprehensive Approach
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One-Stage Treatment: All affected areas can be addressed in a single surgery, reducing the cumulative risks of multiple operations.
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Lymphatic Preservation: Techniques are specifically chosen to minimize damage to delicate lymphatic channels, crucial for lipedema patients.
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Enhanced Recovery: By combining technologies, patients may experience reduced post-operative pain, swelling, and bruising.
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Improved Skin Retraction: Advanced skin-tightening technologies help avoid residual laxity that often follows large-volume fat removal.
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Long-Term Symptom Relief: Many patients report significant improvements in mobility, pain reduction, bruising, and quality of life.
Two-Stage Lipedema Surgery
Recommended for patients with excessive skin redundancy, massive weight loss, or those at increased surgical risk. It involves:
Stage 1: Full-body VASER/MicroAire liposuction to debulk affected fat zones, sculpt limb contours, and alleviate discomfort.
Stage 2: After 3–6 months of skin retraction, a secondary procedure is performed to excise remaining loose or redundant skin. This may include:
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Medial or lateral thigh lift
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Brachioplasty (arm lift)
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Circumferential body lift
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Buttock lift or vertical excision
Expected Benefits of Lipedema Surgery
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Improved mobility and joint function
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Decreased limb heaviness and pain
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Symmetry restoration and better body proportion
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Reduction in bruising and inflammation
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Delay or prevention of disease progression
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Enhanced self-esteem and quality of life
Postoperative Care & Recovery
Dr. De La Cruz and his team provide comprehensive aftercare to ensure optimal healing and long-term success:
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Customized compression garments
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Manual lymphatic drainage referrals
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Nutritional and exercise guidance
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Monitoring for seroma, contour irregularities, or lymphedema
Recovery time varies based on procedure scope, but most patients return to light activity in 7–10 days and resume normal activity by 4–6 weeks. Swelling and contour refinement may continue over several months.
Why Choose Dr. Emmanuel De La Cruz?
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Double Board-Certified Plastic & General Surgeon
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Specialized in High-Volume & HD Liposuction
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Pioneer of Quantum/Morpheus Integration
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Compassionate, Artistic, Safety-Focused Approach
Dr. De La Cruz brings not only surgical excellence but deep empathy and individualized attention to patients battling lipedema.
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Who is a candidate for liposuction?
Liposuction is ideal for patients who are in good overall health and maintain a healthy lifestyle, but have one or more problem areas with unresponsive fat deposits. It is important to realize that liposuction is not a means for major weight loss, but instead removes localized areas of stubborn fat after the patient has attempted other natural weight loss methods.
Figure 1: Before & After Photos of Large Volume Hi-Definition Liposuction (2 months after surgery) performed by Dr. Emmanuel De La Cruz, Houston Plastic Surgeon
Figure 2: Before & After Photos of 4 D VASER Liposuction (Back View 2 months after surgery)
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What areas of the body can be treated with liposuction?
Liposuction can be used to remove unwanted areas of localized fat from nearly any area of the body, and is most commonly used on the:
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Stomach
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Arms
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Back
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Hips
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Knees
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Love handles
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Saddlebags
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Neck
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Chin
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Thighs
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In many cases, more than one area can be treated during the same procedure in order to reduce operating costs and recovery times. Your doctor will develop an individualized treatment plan for you during your initial consultation.
Figure 3: Before & After Photos of Lipedema surgery with VASER Liposuction and Renuvion. Procedure performed by Dr. Emmanuel De La Cruz M.D.
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What happens during the 4D Hi-Definition liposuction procedure?
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This procedure consists of high-definition liposculpting of the abdomen, flanks, back, arms, and possibly the thighs or chest in men with gynecomastia. This procedure also involves reshaping the buttock in women as well which would involve either liposculpture or fat transfer to the buttock. In men, fat may be transferred to the deltoids to improve the shoulders or to the chest to create a more masculine pectoralis muscle.
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The extent of the procedure varies from individual to individual since every patient is different. Dr. De La Cruz will tailor the procedure based on the patient's body habitus and based on what the patient desires.
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What is the difference between VASER Liposuction versus Traditional Liposuction?
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Recent randomized clinical trials showed that the VASER liposuction is superior over traditional liposuction methods. With the VASER liposuction, there is LESS BLEEDING, and MORE SKIN RETRACTION compared to traditional liposuction methods. [1]
[1] Nagy, et al. A multicenter, prospective, randomized, single-blind, controlled clinical trial comparing VASER-assisted Lipoplasty and suction-assisted Lipoplasty. Plastic Reconstructive Surgery 2012 Apr;129(4):681e-9e
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There's also less contour irregularities with the VASER liposuction in the hands of an experienced plastic surgeon. Dr. De La Cruz refined and honed his lipoplasty techniques, especially the 4D VASER liposuction, under the tutelage of Dr. Alfredo Hoyos, the pioneer of the 4D VASER High-Definition liposculpture.
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Patient Safety During Surgery
Dr. De La Cruz values patient safety during your surgery. For large volume high-definition liposuction, there are certain criterias that should be met before your plastic surgery.
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For patients who have co-morbidities, such as Diabetes, obstructive sleep apnea, a medical and cardiac clearance are required prior to surgery. For patients whose age >45, a cardiac clearance from a cardiologist is required by Dr. De La Cruz prior to your surgery. Safety is priority in our practice.
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Prevention of Infection: During your surgery, a peri-operative intravenous antibiotics are given to prevent a wound infection. Fat that is harvested for fat transfer (if included in your procedure) will be washed with antibiotic irrigation to further reduce your risk of infection.
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DVT Prophylaxis: Dr. De La Cruz calculates your Caprini Score to evaluate your risk for Deep Venous Thrombosis. All patients would have an intermittent sequential compression device during your surgery to prevent a DVT. Moreover, an anti-coagulant, such as Heparin or Lovenox, is given to further reduce your risk for a Deep Venous Thrombosis.
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For large volume high-definition liposuction patients, all patients are admitted in the hospital overnight to monitor your recovery. A hospitalist and Dr. De La Cruz would typically oversee your care while you are in the hospital.
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The use of the VASER liposuction system is associated with less bleeding when it comes to large volume liposuction. A randomized clinical trial had shown that the VASER liposuction is associated with less bleeding during surgery when compared with traditional tumescent liposuction. This is key when it comes to large volume liposuction. It is essential to minimize your risk of bleeding when it comes to undergoing this procedure.
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How long does recovery take?
After the liposuction procedure, patients will be able to return to work and other regular activities as soon as they feel comfortable, which is usually after a few days. Exercise and other strenuous activities should be avoided for a few weeks. It is not uncommon to experience mild swelling, bruising and discomfort in the treated area, which can be reduced through pain medication and the use of compression garments.​
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When will results be visible?
The results from the liposuction procedure are often visible right away, but will continue to improve as swelling and bruising subside. Typically, one would see the results 8 weeks after surgery. Swelling will continue to decrease, and skin will continue to retract up to 6 months after surgery. Scars usually heal well and will fade with time to become less and less noticeable.
The results of liposuction can be permanent as long as patients maintain a healthy and active lifestyle. If substantial weight is gained after this procedure, results may be altered.
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What is Large Volume Liposuction?
Large volume liposuction is when the liposuction aspirate exceeds over 5 Liters. Certain states, such as New York and Florida, are limited to 4-5 Liters of fat that can be aspirated. The maximum amount of fat that can be harvested or aspirated depends on the amount of tumescent fluid and lidocaine in the tumescent fluid infused. One cannot exceed over 35 mg/kg of lidocaine in the tumescent fluid. Some studies have shown that the safety level of lidocaine in the tumescent fluid that can be infused can be up to 50 mg/kg. Dr. De La Cruz does not exceed over 35 mg/kg to avoid any adverse outcome from lidocaine toxicity.
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Is there any criteria or pre-operative requirements before Large Volume Liposuction?
Dr. De La Cruz requires all patients undergoing lipedema surgery to obtain a cardiology clearance from a board-certified cardiologist to ensure medical safety and optimize surgical outcomes. Safety is our number one priority!
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Where is the procedure performed?
Large volume high-definition liposuction will be performed either in a hospital or a State-certified ambulatory surgery center. Patients will be subsequently admitted overnight for observation, and for fluid maintenance. Following surgery, Dr. De La Cruz will closely oversee your care while you recover in the surgical facility. You will typically be cared for by two dedicated nurses to ensure attentive monitoring and comfort during the immediate postoperative period.
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Are there any risks or complications associated with liposuction?
Liposuction is considered a safe procedure with only minimal downtime and a low occurrence of mild side effects. However, as with any kind of treatment, there is a risk of complications such as infection, scarring, allergic reactions, hematoma or unsatisfactory results. Liposuction is one of the most commonly performed cosmetic procedures and is almost always performed with no serious complications.
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Patients can reduce these risks by choosing an experienced doctor, such as a plastic surgeon, to perform their procedure and by following their doctor’s instructions before and after treatment.
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» Schedule your Liposuction Consultation with Dr. De La Cruz today by calling 832.776.1134