Does United Healthcare Cover Liposuction?

UnitedHealthcare In June of 2021, UnitedHealthcare (UHC) settled a class-action lawsuit alleging that it failed to cover lipedema. They issued a coverage policy for liposuction for lipedema that is effective on October 1, 2021. Once an insurer has a coverage policy, you cannot expect to pay upfront and submit a claim later.

• You need to request pre-certification, and getting a “coverage” letter doesn’t guarantee you will be paid fairly.
• We do not recommend paying an out-of-network surgeon and submitting a claim later because insurers may only reimburse a few thousand dollars or less for your surgery.
• It’s far better to work with a surgeon who will lower their rates and enter into an agreement with an insurer in advance, so they are treated like an in-network surgeon.

The new UHC policy does not address finding a qualified surgeon. If you plan on using an out-of-network surgeon, it will take our knowledge, experience, and connections to get covered. Depending on your state, insurance plan, and employer, your success rate can vary widely without our help.

Sometimes a surgeon or patient gets lucky, but we can get patients approved for an out-of-network surgeon most of the time and, if not, assist with finding a qualified in-network surgeon. The coverage policy prevents UHC from arguing that surgery is experimental or unproven. However, we expect that instead of issuing blanket denials, their clinical team will scrutinize individual requests and deny them based on the diagnosis, conservative measures, and functional impairment.

We have been helping women with UHC get covered for years and have the connections, data, and experience that quickly resolves these issues. We recommend that you work with us from the start to minimize the chances of having to appeal a denial which is more costly and time-consuming.

1. The UHC policy doesn’t cover skin excisions as other plans do, but we have been able to get UHC to cover excisions which can include a panniculectomy rather than liposuction on the abdomen.
2. The UHC coverage policy is also more restrictive than many of other insurer policies in regards to conservative treatment.

UHC requires six months instead of three months of conservative therapy. UHC also seems to want more documentation for women who have a BMI over 35. If you have a BMI over 35, we do not believe you need to undergo bariatric surgery or take diet drugs to get covered.

We are happy to work with you to document your weight loss efforts, and we have a dietician you can consult with who understands the difficulty of weight loss for lipedema patients. The UHC policy also requires a referral from a Primary Care Provider (PCP) or a vascular specialist. We have several non-surgeon lipedema experts who can help you document lipedema.

Some have a primary care specialty, and some can assist you in gaining support from your PCP. We also have several strategies and suggestions to educate your PCP on lipedema. We generally do not recommend seeing a vascular specialist because they tend to recommend vascular procedures before recommending lipedema surgery.

• If vascular surgery is recommended, we suggest you speak with a lipedema surgeon as lipedema surgery can often improve vascular flow restricted by lipedema tissue pressing on veins.
• If you do use a vascular specialist, then it’s very important that they properly document the lipedema by following our Coverlipedema.com process.

At Coverlipedema.com we always recommend that our members have a detailed independent functional capacity evaluation or FCE to have a strong coverage request. Several years ago, we found a company that performs FCEs for worker’s compensation and disability cases and helped them adapt their assessment to lipedema.

We also use FCEs extensively in the out-of-network request and contract negotiation process. Regarding out-of-network surgeons in states like California and Ohio, UHC will likely refuse to pay for surgery with them because there are in-network surgeons. So, we do not recommend traveling to these states for surgery.

In other states, we are usually able to help Coverlipedema.com members work with the surgeon of their choice. For the best chance of being covered for an out-of-network surgeon, we don’t recommend traveling too far from your home state. Plans have been clear that, if you will travel for an out-of-network surgeon, you can travel for an in-network surgeon.

Does liposuction work for lipedema?

Context and Policy Issues – Lipedema is a disorder characterized by large amount of subcutaneous fat in the upper and lower legs due to both hyperplasia and hypertrophy.1 It occurs almost exclusively in females, although a few cases in men have been reported.1, 2 The condition is relatively rare and often seen in patients with a family history of the disease.1, 2 Lipedema does not yet have a registered diagnosis in the International Classification of Diseases (ICD-10) of the World Health Organization (WHO), making it difficult to establish its prevalence.2 However, lipedema is believed to affect nearly 11% of adult women, 3 with noted significant differences in prevalence worldwide.2, 4, 5 The literature search for this report did not find epidemiological data for lipedema in Canada.

The cause of lipedema is unknown, and it is likely that the condition is frequently misdiagnosed or wrongly diagnosed as lifestyle-induced obesity or lymphedema (i.e., localized fluid retention and tissue swelling).2, 6 However, although lipedema and obesity can co-occur, unlike obesity, lipedema usually targets the legs and thighs, without affecting the feet or hands, and the adipose tissue in lipedema is painful.1, 4, 7 – 9 The lymphatic system remains unimpaired in the initial stages and can keep up with the increased amount of interstitial fluid.1, 7 However, patients with lipedema may develop secondary lymphedema (lipolymphoedema) if the fatty deposits compromise the lymphatic system.8 Lipedema targets both legs (and sometimes, also both hands) to the same extent and has a bilateral, nearly symmetrical presentation.2 – 5 The excessive fat deposits are typically unresponsive to traditional weight loss interventions such as physical activity or dietary measures.1, 6, 9 Symptoms of the condition include pain in the lower extremities, particularly with pressure, loss of strength, easy bruising, and deterioration in daily activity levels that can greatly impact the health and quality of life of the individual with lipedema.1, 2, 6 Untreated lipedema may result in secondary problems including osteoarthritis, reduced mobility, psychological impairment, and lowered self-esteem.4 Over time, the weight of the excessive fat build-up can cause the knees to knock inward or droop to the side of the leg, and impair the inability to walk.10 As mentioned, in the later stages, secondary lymphedema can occur due to imbalance in the amount of fluid produced and drained by the lymphatic system.1 – 3, 6, 7, 10 Lipedema poses a significant psychosocial burden for most patients, and associated effects often limit capacity for exercise.

In severe cases, lipedema may lead to absence from work or occupational disability.1 There is no known curative therapy for lipedema. The primarily focus of treatment is to reduce its related lower extremity symptoms, disability, and functional limitations to improve patients’ quality of life, as well as preventing disease progression.1 – 3, 6, 11 Treatment is divided into conservative therapy and surgical interventions.

The conservative therapy includes promotion of individually adjusted healthy lifestyle, combined decongestive therapy (CDT), and other supportive measures, such as psychosocial therapy and orthopedic counseling.2 Conservative therapy can alleviate some lipedema symptoms such as heaviness, pain, and secondary swelling.12 However, these benefits are short-lived, usually requiring repeat treatment within days.9 Liposuction is the main surgical interventions for lipedema.5 Commonly used liposuction methods for lipedema are tumescent anesthesia (TA) liposuction, and water assisted liposuction (WAL).2 In TA liposuction, tumescent is infused in the subcutaneous tissues to cause the fat cells to swell and vessels to constrict; then blunt micro-cannulas are used to suction the fat.3, 13, 14 Water assisted liposuction uses a pressure spray of tumescent fluid to dislodge the fat from the connective tissue, rather than utilizing a cannula.10 Unlike traditional liposuction, both TA and WAL rely on the local anesthetics in the tumescent fluid and do not require general anesthesia.

The objective of this report is to summarize the evidence regarding the clinical effectiveness of liposuction for the treatment of lipedema and the recommendations of evidence-based clinical guidelines regarding its use for this condition.

What is the difference between a tummy tuck and a Panniculectomy?

A tummy tuck tightens the abdominal muscles and removes excess fat, skin, and tissue, while a panniculectomy is performed to remove a pannus. The pannus is a large flap of skin which is distended over the abdomen, genitals, and thighs following significant weight loss or complications from childbirth.

What type of liposuction is best for lipedema?

Are there different kinds of liposuction? – There are different kinds of liposuction, and the safest and most advanced form of the procedure is available at the Hunar Clinic. Thankfully, the days of general anaesthetic and overnight hospital stays are long gone.

Microcannular liposuction, known as the tumescent technique (or Microlipo), is a local anaesthetic procedure using tiny tubes that has a dramatic effect on lipedema. The procedure is so effective the individual is always out of the clinic just a few hours later. Medical journals indicate microlipo is overwhelmingly the best option when considering liposuction for lipedema due to its minimally invasive technique and its record of safety and results.

Dr Puneet Gupta is one of a select few doctors in the UK and Europe to offer both Vaserlipo and Microlipo’. He was trained extensively in the art of Microlipo by the American inventor of the procedure, Dr Jeffrey Klein, and has performed thousands of successful procedures.

Can you get a Panniculectomy without weight loss?

What to Know About Panniculectomy – First of all, let’s start with what a panniculectomy is not. Contrary to popular belief, a panniculectomy is not a tummy tuck, and it’s not weight loss surgery, although you may lose some weight with it. A panniculectomy is a surgical procedure designed to remove the pannus from your lower abdomen,

1. The pannus — or “apron” — is extra tissue and skin that has been left behind after you’ve lost weight.
2. Even though it will make the stomach appear to be flatter, it does not tighten any of the abdominal muscles, which is one of the ways it differs from a tummy tuck.
3. A panniculectomy involves the excess tissue below the umbilicus(belly button).

Any tissue from that area and above is almost always considered cosmetic by insurance companies. While there are some visual benefits to a panniculectomy, most of its benefits aren’t related to appearance, which is another way that it varies from a tummy tuck.

Can fat grow back after liposuction?

Fat Can’t Grow Back – During surgery, Dr. Raj uses a slender, hollow tube called a cannula to selectively break up and remove fat cells from a specific area of the body. The areas most commonly treated with liposuction include the stomach, hips, thighs, buttocks, upper arms, neck and under the chin.

By removing fat cells, Dr. Raj significantly improves the aesthetics of the treated area. Once fat cells have been removed through liposuction, those cells cannot grow back, and we cannot develop new fat cells. As adults, we have a fixed number of fat cells. However, our remaining fat cells can enlarge and shrink with weight gain or loss.

If you gain a significant amount of weight after liposuction, your body’s fat cells will enlarge. You may notice new “problem areas” appear — for example, if you had liposuction on your abdomen and then gain weight, your body may start to store it in your thighs or buttocks.

It is also important to keep in mind that liposuction does not remove all of the fat cells in the target area. Dr. Raj has to leave a thin layer of fat cells in the treated area of the body to maintain a smooth, normal looking contour. If you gain weight after liposuction, the remaining fat cells in the treated area can enlarge, but you will see less fat accumulation in that area since there are fewer fat cells remaining.

As you can understand, it is imperative to maintain your weight after liposuction to enjoy your sculpted results as long as possible. Dr. Raj encourages you to stick to a consistent exercise regimen and eat a nutritious diet after your surgery. You will probably find that you are more motivated to eat healthy and work out often after seeing your own dramatic transformation.

Does lipedema fat come back after liposuction?

Does Liposuction Remove Fat Permanently? – Despite the success associated with liposuction, many people still wonder if liposuction offers a permanent solution to the problem of stubborn fat deposits. To answer this question, you first need to understand what the procedure does.

What is the best surgery to get rid of belly fat?

What is Liposuction? – Liposuction is a surgical fat removal procedure that first became popular in the 1980s. During the procedure, a board certified cosmetic surgeon carefully and precisely removes excess fat through a small, hollow tube called a cannula.

Can I get rid of my apron belly?

– If you’d like to reduce or remove your apron belly, you have several options. Keep in mind that your overall health is the priority, and any exercise or eating plans should focus on your general wellness. It’s impossible to spot treat an apron belly. The only ways to reduce one are through overall weight reduction and surgical/non-surgical options.

Can I fix my saggy tummy?

1. Exercise – At-home treatment options are ideal for minor sagging. One such option is exercising. Any workouts that build muscle mass or tighten muscles — especially around the stomach — can reduce the appearance of loose skin. Try incorporating exercises two to three times per week, including:

Weight training Resistance training Pilates Yoga

Do I have lipedema or just fat legs?

You’ve been working out every day for months, eating healthy, and getting enough sleep. While you can see the results in your upper body, what about the lower half? Your legs are looking like tree trunks. Salameh Plastic Surgery LLC will discuss all you need to know about the condition called lipedema.

• Lipedema can occur even if you have done everything right.
• It causes swelling in the legs and can be painful.
• If you have concerns like swelling of the fat in your lower extremities, Salameh Plastic Surgery Center has the best lipedema surgeons in the US who can reestablish your natural body structure and dismiss uneasiness.

Lipedema refers to a condition where excess fat accumulates in the lower half of the body. Lipedema is most common in the lower limbs. Lipedema can also affect the upper arms. This condition does not affect the feet or hands. How Does Classic Lipedema Look and its Symptoms A woman with lipedema that is classic” is one who has a more petite upper body but a large lower body. The fat is often painful. There is often more to lipedema than that. Non-classical symptoms can also be present, which appear only at certain stages of the disease progression, and other symptoms may be shared with other conditions.

Let’s start by looking at the most common symptoms of lipedema. Lipedema is almost always seen in women. It has been reported in men with liver disease or hormonal imbalance. The affected area is the lower body. The most common sign is excessive fat accumulation in your lower body. This usually starts at the top of your iliac crest (the bones at your waist) and continues to the lower body.

Lipedema is unlikely to occur if the upper body looks obese. Approximately 30% of patients with lipedema also experience arm edema. Typically, the upper arm is impacted in such situations. The feet and ankles are unaffected. The feet don’t accumulate as much fat as regular weight gain.

1. However, secondary swelling can affect them.
2. A collar of fat can often appear just above the ankles.
3. The fat buildup could be symmetrical.
4. Both sides of the body are impacted by fat accumulation, just like with typical weight gain.
5. Fat accumulation can cause the legs to look lumpy or like columns.
6. You may also notice fat deposits below your knees.

Fat can feel abnormal and even painful. Lipedema, which is a form of fat accumulation, can make fat areas feel unusually tender. Fat deposits can cause the skin to feel softer and can even cause pain. If you’re wondering if you can get plastic surgery on your thighs, you can make an appointment with our Salameh Plastic Surgery Bowling Green, KY, and Salameh Plastic Surgery Evansville, Indiana so that we can assess if you’re a good candidate or not.

Other Symptoms of Lipedema Weight increase has the potential to exacerbate the primary signs and symptoms of lipedema, excessive fat storage, and pain. Psychological conditions like stress and sadness can also make people more sensitive to pain and have poorer overall health. Individuals with lipedema will experience increased weight gain and psychological distress if their general health and fitness are not maintained at a current level.

Lipedema, contrary to popular belief, is not considered a progressive disease. This means that it shouldn’t get worse if all else remains the same. Lipedema can often worsen as a result of an increasing trend in obesity(which itself is a progressive disease).

• Psychological distress can also be a progressive disorder.
• It is characterized by increased feelings of pain, diminished willpower, and general health problems.
• Fluid can build up in tissues due to fat accumulation.
• This can cause swelling and further health problems.
• The so-called “lipo-lymphedema” stage appears to be the onset of what we would call obesity-induced Lymphedema.

This is a condition that results from sufficient fat deposits blocking the lymph fluid’s flow out of the tissue. Understanding the relationship between obesity, lipedema and lymphedema is helpful in determining which condition you are suffering from. If you’re curious about our lipedema surgery before and after, you can check our website to provide you with useful information before considering one. Why is it that some women develop lipedema while others don’t? It appears that the disease has a strong genetic component. Lipedema is more common in women who have close relatives who have lipedema.15% of people with lipedema have a family history. The underlying causes of lipedema are not yet known.

Symptoms typically first appear around puberty. However, they can also develop after menopause or after pregnancy. Whatever the biological cause, the initial accumulation of fat seems to trigger the development of fat deposits and pain. It is not surprising that additional fat accumulation can lead to lipedema symptoms, particularly in cases of obesity.

Statistics show that body weight is closely related to lipedema. Numerous studies have shown that most patients with lipedema in Europe or North America are obese. Even after considering the fact that lipedema patients have a high level of fat in their legs, the relationship between obesity and lipedema remains.

Despite being visually striking, people with classic lipedema are quite uncommon. The size of their bottom body is greater than their upper body. This observation aligns with what we’ve seen in clinics personally. It is clear that women are more susceptible to developing lipedema when there is a lot of fat accumulation.

Lipedema can also be brought on by obesity, in addition to this. It appears that body weight is related to lipedema symptoms. Weight gain is generally accompanied by an increase in abnormal fat and pain. This can lead to obesity. Exacerbates lymphedema (fluid accumulation/swelling) and can persuade the onset of lymphedema in patients.

1. At high levels, can even persuade lymphedema in patients with no known prompting.
2. Lipedema patients tend to gain weight, which can exaggerate their symptoms.
3. If left unchecked, weight gain can become progressive and eventually lead to lymphedema.
4. The legs, where lipedema fat deposits are frequently very high, are also where lymphedema is more common.

It is also caused by an excess of adipose tissue, which physically blocks lymphatic pathways. A person’s risk of getting lymphedema increases if they have lipedema from being overweight. Although this common overlap might explain why the term “lipo-lymphedema” is used, we now know it to be two separate conditions: obesity and lymphedema. Lipohypertrophy, which is an abnormal accumulation of fat that causes no pain, starts early in lipedema. This eventually leads to lipoedema. It can be difficult to distinguish early lipedema from weight gain in otherwise healthy people. The likelihood of lipedema not getting worse if the individual’s health and weight remain stable is high.

1. It is common for an individual to lose weight and become obese over their lifetime.
2. At Salameh Plastic Surgery Center, we have the best lipedema plastic surgeons who will assist you from consultation up to recovery in case you consider getting one.
3. Lipedema seems to be increasing due to the close relationship between obesity, lipedema, and lymphedema.

This is why we need to understand the physiology and fluid transport of fat. This is a quick explanation of fat cells and how excess fat deposits, fluid transport limitations, and lipedema can all work together to cause a worsening condition. Although the exact cause of these conditions is still unknown, there are some general principles that can be used to explain them.

Fluid transport is a key factor, as you’ll see. Fat is made up of cells that need a lot of blood flow. Adipocytes are fat cells that synthesize, store and metabolize fat. These cells don’t increase in number but grow in size with weight gain. These cells play an important role in maintaining blood sugar balance and are fed by a lot more blood capillaries than muscle.

Fluid exchange occurs in fat, which is why there is so much of it. What is the Cause if the Lipedema Appears to be Progressive Fluid balance must be maintained in fat tissue. Otherwise, swelling can occur. Fluid is constantly entering fat tissue and must be removed via the lymphatic system (lymph vessels, lymph nodes) and the venous (veins, venules).

• These systems work together to remove the accumulated fluid.
• Insufficient systems can lead to swelling.
• Lymphedema, a chronic condition that causes swelling and is caused by lymphatic damage or congenital abnormalities, can be an example.
• Patients with lipedema have abnormal fluid circulation.
• Hypoxic stress (low oxygen), and inflammation are believed to cause abnormal fat.

Hypoxia and inflammation could result from insufficient fluid transport. One study found that the blood vessels that feed the fat deposits of people with lipedema are fragile and leaky. The small lymphatic vessels also appear to be leaky. This suggests that patients suffering from lipedema may be more susceptible to fluid accumulation.

• People with lipedema have less skin elasticity.
• Lipedema sufferers may be more susceptible to poor fluid transportation.
• The skin’s elasticity creates tension that acts on the underlying tissue.
• This pressure helps fluid get into the lymphatic, venous, and other systems.
• Studies have shown that lipedema sufferers don’t usually have visible fluid buildup, as assessed by MRI.

Recent studies have shown that fluid is not usually seen in the tissue unless there is obesity-induced lymphedema. No matter if fluid circulation is affected in lipedema, it can cause disruptions in fluid transport, which in turn can lead to swelling and lymphedema.

The lower body’s fat tissue is subject to greater pressure to maintain fluid balance and is therefore more susceptible to swelling. Gravity can lead to an increase in fluid accumulation in the lower body, particularly in fat tissue. This causes an increase in the demand on the lymphatic and venous systems, which drain fluid from the area.

Gravity can cause fluid accumulation in feet even in healthy people. This is why they can experience swelling from prolonged sitting or standing. The lower body’s fat tissue is more susceptible to swelling. Lipedema patients may also have abnormalities in blood vessels and a higher rate of fat accumulation. Chronic swell promotes fat buildup. Swelling and inflammatory processes have been associated with fat deposition in late-stage lymphedema. Chronic excessive fluid buildup appears to promote the expansion of fat cell size and volume of tissue (nonfluid).

Although it is unclear if inflammation and blood vessel abnormalities in patients with lipedema may also be contributing to abnormal fat deposits, this hypothesis remains flawed. Lipedema doesn’t seem to progress by itself without weight gain. However, patients with lipedema at high risk for lymphedema have the incentive to stop chronic swelling.

Fat accumulation promotes even more fluid. A tissue that is larger than normal, especially fat tissue, draws more blood flow. The lymphatic drainage system has a limit on the amount of fluid it can remove from tissue. It is thought that obesity can cause secondary lymphedema.

• This is a condition where excess fat deposits damage and overburden the lymphatic system’s delicate vessels.
• Lipedema and obesity can lead to excessive fat accumulation, which will cause fluid buildup in the lower body.
• If this happens, it will lead to swelling.
• Excess fat and swelling are common in so-called “late-stage” lipedema.

This is when the patient has lipedema and obesity combined with lymphedema. Although there is still much to be done to understand the biology of lipedema, it appears that the three are closely related. The above observations also suggest that lipedema and obesity may have a biological basis for lipo-lymphedema.

Three distinct, but interrelated disease processes are actually at work. These are two reasons why compression garments are popular in ongoing lipedema management. They can be used to reduce pain and fluid accumulation (when lymphedema may be present or at risk). Research has shown that compression garments have been shown to significantly reduce inflammation and oxidative stress, and improve microcirculation in both patients with venous conditions as well as healthy people.

This is a clear mechanism to reduce pain experienced by patients with lipedema who wear compression clothes. For those with lipedema who are obese enough to be at high risk for developing lymphedema, compression garments can help manage fluid swelling.

• While compression garments can’t reduce fat, they can reduce pain and manage swelling in people who are susceptible or have lymphedema.
• If you wish to undergo breast surgery for personal desires like contouring or aesthetics, Salameh Plastic Surgery has breast augmentation Bowling Green KY, and breast augmentation Evansville Indiana in which our double-certified plastic surgeons will assist you from the consultation up to the recovery.

Lipo-Lymphedema and Lipedema As we have discussed, lipedema can be seen as a progression through three conditions. These are weight gain, obesity, and lipedema. We will discuss the stages of lipedema in detail below. This coincides with how lipedema has been commonly understood and also the perceptions of many patients who have experienced the condition’s progression.

How to tell the difference between lipoedema fat and normal fat?

Unlike normal fat accumulation, fat areas resulting from lipedema tend to be very tender if you apply pressure and may be easy to bruise. The fat deposits can also hurt for no apparent reason, and the skin can become less elastic feeling.

Is it cellulite or lipedema?

The Bottom Line: Lipedema vs. Cellulite – Lipedema and cellulite are both distinct skin conditions that can pose similar skin alterations, such as dimples and unevenness. However, there is a stark difference between cellulite and lipedema. Lipedema is a medical condition that can result in pain, bruising, and swelling.

1. On the other hand, cellulite is purely cosmetic and doesn’t result in pain or require treatment.
2. Lipedema requires broader treatment options to manage symptoms and prevent progression, such as lifestyle changes, complete decongestive therapy, and possibly liposuction, while cellulite can be treated through topical creams and different types of laser treatments.

However, if you notice any symptoms of lipedema or cellulite, visit your doctor to ensure you get a proper diagnosis and discuss your treatment options. If you’re living with lipedema, talk to your doctor today about Tactile Medical’s Flexitouch Plus system.

1. With the Flexitouch Plus system, you can manage your symptoms of lipedema from the comfort of your home.
2. References 1. Sadick N.
3. Treatment for cellulite.
4. Int J Womens Dermatol.2018;5(1):68-72.
5. Accessed March 31, 2022.
6. Published 2018 Oct 22.
7. Doi:10.1016/j.ijwd.2018.09.002 2.
8. Lipedema Foundation.
9. What Is Lipedema? Accessed March 31, 2022.

https://www.lipedema.org/

Can fat grow back after Panniculectomy?

The Benefit of Liposuction – One of the benefits of liposuction is that it removes fat cells directly from the body, and once they are gone, they cannot come back. Your body cannot re-grow fat cells. As an adult, you have all the fat cells you will have for life as genetically predetermined for your body.

• Any fat cells removed through liposuction will not and cannot ever grow back.
• However, liposuction does not remove every single fat cell from your midsection.
• There will be some remaining fat cells, so if you do gain weight after your procedure is over, you may experience a negative change in your results due to the expansion of those fat cells.

At the end of the day, your results are completely within your hands. You can maintain permanent results after your procedure is over simply by choosing to live a healthy lifestyle.

What BMI do you need for Panniculectomy?

Clinical UM Guideline

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Subject: Panniculectomy and Abdominoplasty Guideline #: CG-SURG-99 Publish Date: 04/12/2023 Status: Reviewed Last Review Date: 02/16/2023

This document addresses the surgical procedures panniculectomy and abdominoplasty and when they are considered medically necessary, not medically necessary, and cosmetic. Medically Necessary : In this document, procedures are considered medically necessary if there is a significant functional impairment AND the procedure can be reasonably expected to improve the functional impairment.

Panniculectomy is considered medically necessary for the individual who meets the following criteria:

The panniculus hangs below the level of the pubis (which is documented in photographs); and One of the following:

there are documented recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do not respond to conventional treatment (for example, dressing changes; topical, oral or systemic antibiotics, corticosteroids or antifungals) for a period of 3 months; or there is documented difficulty with ambulation and interference with the activities of daily living; and

Symptoms or functional impairment persists despite significant* weight loss which has been stable for at least 3 months or well-documented attempts at weight loss (medically supervised diet or bariatric surgery) have been unsuccessful; and If the individual has had bariatric surgery, he/she is at least 18 months post-operative or has documented stable weight for at least 3 months.

Reaches a body mass index (BMI) less than or equal to 30 kg/m 2 ; or Has documented at least a 100 pound weight loss; or Has achieved a weight loss which is 40% or greater of the excess body weight that was present prior to the individual’s weight loss program or surgical intervention.

Panniculectomy is considered medically necessary as an adjunct to a medically necessary surgery when needed for exposure in extraordinary circumstances.

Not Medically Necessary:

Panniculectomy is considered not medically necessary when the criteria above are not met. Panniculectomy is considered not medically necessary as an adjunct to other medically necessary procedures, including, but not limited to, hysterectomy, or incisional or ventral hernia repair unless the criteria above are met. Panniculectomy or abdominoplasty, with or without diastasis recti repair, for the treatment of back pain is considered not medically necessary.

Cosmetic and Not Medically Necessary:

Liposuction is considered cosmetic and not medically necessary when used for the removal of excess abdominal fat. Abdominoplasty when done to remove excess skin or fat with or without tightening of the underlying muscles is considered cosmetic and not medically necessary. Repair of diastasis recti is considered cosmetic and not medically necessary,

The following codes for treatments and procedures applicable to this guideline are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.

CPT
15830	Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy
ICD-10 Procedure
	For the following codes when described as panniculectomy:
0HB7XZZ	Excision of abdomen skin, external approach
0J080ZZ	Alteration of abdomen subcutaneous tissue and fascia, open approach
0WBF0ZZ	Excision of abdominal wall, open approach
ICD-10 Diagnosis
	All diagnoses

When services are Not Medically Necessary: For the procedure codes listed above when criteria are not met or for situations designated in the Clinical Indications section as not medically necessary. Abdominoplasty, liposuction When services are Not Medically Necessary or Cosmetic and Not Medically Necessary: For the following procedure codes, or when the code describes a procedure designated in the Clinical Indications section as not medically necessary or cosmetic and not medically necessary.

CPT
15847	Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication)
15877	Suction assisted lipectomy; trunk
17999	Unlisted procedure, skin, mucous membrane and subcutaneous tissue
ICD-10 Procedure
0J080ZZ	Alteration of abdomen subcutaneous tissue and fascia, open approach
0J083ZZ	Alteration of abdomen subcutaneous tissue and fascia, percutaneous approach
0W0F07Z-0W0F0ZZ	Alteration of abdominal wall with/without tissue substitute, open approach
0W0F37Z-0W0F3ZZ	Alteration of abdominal wall with/without tissue substitute, percutaneous approach
0W0F47Z-0W0F4ZZ	Alteration of abdominal wall with/without tissue substitute, percutaneous endoscopic approach
ICD-10 Diagnosis
	All diagnoses

Repair of diastasis recti When services are Not Medically Necessary or Cosmetic and Not Medically Necessary: For the following procedure codes, or when the code describes a procedure designated in the Clinical Indications section as not medically necessary or cosmetic and not medically necessary.

CPT
22999	Unlisted procedure, abdomen, musculoskeletal system
ICD-10 Procedure
0KQK0ZZ-0KQK4ZZ	Repair right abdomen muscle
0KQL0ZZ-0KQL4ZZ	Repair left abdomen muscle
ICD-10 Diagnosis
	For the following diagnoses when specified as diastasis recti:
M62.00	Separation of muscle (nontraumatic), unspecified site
M62.08	Separation of muscle (nontraumatic), other site
O71.89	Other specified obstetric trauma
Q79.59	Other congenital malformations of abdominal wall

Discussion/General Information Panniculectomy The current medical evidence regarding panniculectomy consists mostly of individual case reports, review articles and a limited number of controlled trials. However, there is adequate clinical opinion to support the use of this procedure in some circumstances where an individual’s health is compromised. Early studies by Matory (1994) and Vastine (1999) demonstrated a direct relationship between BMI and operative risk with abdominal surgery and abdominoplasty in obese individuals. In a retrospective cohort series of individuals who underwent post-bariatric panniculectomy (n=126), the only factor that independently predicted postoperative complications after panniculectomy was pre-panniculectomy BMI (Arthurs, 2007). Those with a BMI greater than 25 kg/m 2 were at nearly three times the risk of postoperative wound complications. Although those who experienced a plateau in weight loss at a BMI of 30-35 kg/m 2 did have the largest functional improvement from a panniculectomy, they also experienced the highest risk postoperatively. The average weight loss following bariatric surgery prior to panniculectomy was 116 ± 35 lbs. A limitation of this study was its retrospective design and sample size. Acarturk (2004) compared the surgical outcomes of panniculectomy following bariatric surgery in another retrospective series of 123 participants (mean age 44.5 years). The outcomes of 21 participants with panniculectomy performed at the time of bariatric surgery were compared with the surgical outcomes of 102 participants who waited 17 ± 11 months to undergo panniculectomy. Overall, individuals who had panniculectomy simultaneously with bariatric surgery experienced more complications. Wound infections were 48% versus 16%; wound dehiscence 33% versus 13%; and there was a higher incidence (24% versus 0 %) of postoperative respiratory distress in individuals with the combined procedures. There were 3 postoperative deaths in the combined procedure cohort and none in the group that delayed panniculectomy until an average weight loss of 126 ± 59 lbs was achieved. The authors concluded that an initial period of substantial weight loss prior to the procedure results in a safer and more effective panniculectomy procedure. The American Society of Plastic Surgeons (ASPS) Practice Parameter for Surgical Treatment of Skin Redundancy for Obese and Massive Weight Loss Patients (2007b) recommends that body contouring surgery, including panniculectomy, be performed only after an individual maintains a stable weight for 2 to 6 months. For individuals who are post-bariatric surgery, this is reported to occur 12-18 months after surgery when the BMI has reached the 25 kg/m 2 to 30 kg/m 2 range (Rubin, 2004). If performed prematurely, a potential exists for a second panniculus to develop once additional weight loss has occurred and the risks of postoperative complications are increased. Weight loss and BMI are important when considering panniculectomy and a significant amount of weight loss may not bring the BMI of an individual to less than 30 kg/m 2 ; however, a panniculectomy may still be necessary (Arthurs, 2007). The American Society for Metabolic and Bariatric Surgery Consensus statement states weight loss can vary from about 25% to 70% of an individual’s excess body weight depending on the type of bariatric surgery that is performed (Buchwald, 2005). A study by Zemlyak and colleagues (2012) reported on a retrospective review of individuals who had panniculectomy alone versus individuals who had panniculectomy and simultaneous ventral hernia repair. There were 143 participants in the panniculectomy/ventral hernia repair group and 42 participants in the panniculectomy group. The rates for incisional complications and interventions between the two groups were not statistically significant. However, after controlling for age, gender, BMI, subcutaneous use of talc, and intraoperative pulse-a-vac irrigation in the multivariate regression analysis, the group that had both panniculectomy and ventral hernia repair was more likely to develop wound cellulitis. The authors note that while panniculectomy with ventral hernia repair reduces the stress on the hernia repair and potentially decreases the recurrence rate, this potential advantage remains to be proven in robust comparative studies. Fischer and colleagues (2014) conducted a large retrospective database analysis to assess the additional risk of ventral hernia repair (VHR) and panniculectomy (PAN) compared with hernia repair alone (n=55,537) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data sets. To account for potential selection bias given the non-randomized assignment of concurrent panniculectomy and the retrospective study design, propensity scores were used which yielded two comparable groups, VHR (n=1250) and VHR+PAN (n=1250). The study authors found that individuals who underwent the combined procedure were at significantly higher risk for wound complications (p<0.001), venous thromboembolism (p=0.044), reoperation (p<0.001) and overall medical morbidity (p<0.001). Two notable limitations of this study include that the ACS-NSQIP dataset only includes 30-day outcomes, precluding analysis of long-term differences in the two study groups. Secondly, the dataset did not include details on the type of panniculectomy skin resection or wound closure techniques, therefore propensity matching, and exploratory analysis of these potentially confounding variables was not possible. Nonetheless, at 30-day follow-up in this large retrospective cohort, outcomes of panniculectomy performed with a concurrent ventral hernia repair appear to result in a significant increase in morbidity compared to VHR alone. Giordano and colleagues (2017) published a retrospective study based on a prospectively maintained database of all consecutive midline abdominal wall reconstructions for an abdominal wall hernia or oncologic defect performed at a single site from 2005-2015. Of 548 consecutive surgeries, 305 individuals (56%) underwent abdominal wall reconstruction alone and 243 (44%) underwent abdominal wall reconstruction with concurrent panniculectomy. The mean follow-up period was 30 months. Prior to propensity matching, individuals with the combined procedure also had a higher number of previous abdominal surgeries and a larger mean abdominal wall defect size. After propensity matching, there were significantly higher incidences of fat necrosis, and surgical site abscess but no significant difference in hernia recurrence at follow-up. Abdominal wall reconstruction with concurrent panniculectomy was associated with higher wound morbidity with no difference in hernia recurrence rates in follow-up. Derickson (2018) published results from retrospective review of all post-bariatric surgery cases who underwent panniculectomy over a 10-year period (n=706). The overall rate of complication was 56%: dehiscence (24%), surgical site infection (22%), seroma (18%), and post-operative bleeding (5%). A total of 12% of individuals necessitated a return to the operating room. The study demonstrated a high morbidity for post-bariatric panniculectomy and authors noted higher BMI, higher ASA class, and the use of fleur-de-lis incision were particularly associated with worse outcomes. Nag and colleagues (2021) published results from another systematic review conducted by ACS-NSQIP to determine the benefit, if any, of adding panniculectomy to gynecologic surgery in obese and morbidly obese individuals. In total, 296 individuals were identified from the NSQIP database who fit the search criteria. A statistically significant association was found between the concomitant procedures and adverse outcomes, including superficial infection, wound infection, pulmonary embolism, sepsis, return to operating room, length of operation and length of stay. Furthermore, there was no significant benefit identified across the studies. Panniculectomy alone or with other abdominal surgical procedures, such as incisional or ventral hernia repair, or hysterectomy, is not clinically appropriate or an effective treatment of obesity. Recent meta-analyses have published mixed results of co-surgical procedures, but the studies lack documentation of a medical indication for removal of the pannus (Prodromidou, 2020; Rasmussen, 2017; Sosin, 2020). Although it has been suggested that the presence of a large overhanging panniculus may interfere with the surgery or compromise post-operative recovery, the presence of a pannus alone is not a medical condition which warrants surgical intervention. Removal of a pannus, for reasons other than those in the criteria for medical necessity is therefore considered cosmetic and not medically necessary. Abdominoplasty The literature addressing abdominoplasty and surgical repair of diastasis recti confirms the cosmetic benefits of these procedures. However, improvements in physical functioning, cessation of back pain, and other positive health outcomes have not been demonstrated. Carloni and colleagues conducted a systematic-review (2016) and confirmed that the quality of evidence surrounding abdominoplasty remains low and no standardization of surgical approaches has been established. Winocour (2015) reported results of a study which included 25,478 abdominoplasties and found high complication rates, compared to other cosmetic procedures, especially when abdominoplasty was combined with other procedures. Massenburg (2015) reported outcomes from 2946 abdominoplasties and found 8.5% of subjects were readmitted due to complications and 5% required revision surgery. Salari and colleagues (2021) conducted a systematic-review and meta-analysis to characterize the global prevalence of seroma following abdominoplasty and found the global prevalence following the procedure approaching 11% (95% CI, 9.3-3.6%). At this time, the evidence does not support abdominoplasty when done to remove excess abdominal skin or fat, with or without tightening lax anterior abdominal wall muscles, as an effective treatment for any medical condition, though it is an effective cosmetic procedure (ASPS Practice Parameter, 2007b). Surgical procedures to correct diastasis recti are not effective for alleviating back pain or other non-cosmetic conditions. There is insufficient evidence to support the use of surgical procedures to correct diastasis recti for purposes other than cosmetic. Similarly, the use of liposuction has been shown to produce cosmetic benefits in terms of appearance and body contour, however, liposuction has not been shown to be an effective treatment of obesity or other medical conditions and has been associated with significant complications, including death. Abdominoplasty: A procedure involving the removal of excess abdominal skin and fat with or without tightening lax anterior abdominal wall muscles and with or without repositioning or reconstruction of the navel. Bariatric surgery: A variety of surgical procedures designed to treat obesity by either reconstructing the stomach or intestines or placing restrictive devices in or on the digestive tract. Cellulitis: A diffuse, spreading inflammation of the deep tissues under the skin, and on occasion muscle, which may be associated with abscess formation. Diastasis recti: A condition characterized by a separation between the left and right side of the rectus abdominis, which is the muscle covering the front surface of the chest (abdomen). A diastasis recti appears as a ridge running down the midline of the abdomen from the bottom of the breastbone to the navel. Hysterectomy: Surgical removal of the uterus. Incisional hernia: A condition where tissues or organs are able to push through a surgical incision or scar. Intertrigo: An inflammation of the top layers of skin caused by moisture, bacteria, or fungi in the folds of the skin. Liposuction: A surgical procedure designed to remove fat from under the skin via a suction device. Panniculectomy: A procedure designed to remove fatty tissue and excess skin (panniculus) from the lower to middle portions of the abdomen. Pubis: A part of the pelvic bone that is located in the groin, also called the pubic bone. Peer Reviewed Publications:

Acarturk TO, Wachtman G, Heil B, et al. Panniculectomy as an adjuvant to bariatric surgery. Ann Plast Surg.2004; 53(4):360-366. Ali B, Petersen TR, McKee RG. Perioperative risk stratification model for readmission after panniculectomy. Plast Reconstr Surg.2022; 150(1):181-188. Arthurs ZM, Cuadrado D, Sohn V, et al. Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile. Am J Surg.2007; 193(5):567-570. Blomfield PI, Le T, Allen DG, Planner RS. Panniculectomy: a useful technique for the obese patient undergoing gynecological surgery. Gynecol Oncol.1998; 70(1):80-86. Carloni R, De Runz, Chaput B et al. Circumferential contouring of the lower trunk: indications, operative techniques, and outcomes-a systematic review. Aesthetic Plast Surg.2016; 40(5):652-668. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg.2002; 89(5):534-545. Coriddi MR, Koltz PF, Chen R, Gusenoff JA. Changes in quality of life and functional status following abdominal contouring in the massive weight loss population. Plast Reconstr Surg.2011; 128(2):520-526. Derickson M, Phillips C, Barron M, et al. Panniculectomy after bariatric surgical weight loss: analysis of complications and modifiable risk factors. Am J Surg.2018; 215(5):887-890. Fischer JP, Tuggle CT, Wes AM, Lovach SJ. Concurrent panniculectomy with open ventral hernia repair has added risk versus ventral hernia repair: an analysis of the ACS-NSQIP database. J Plast Recontr Aesthet Surg.2014; 67(5):693-701. Giordano S, Garvey PB, Baumann DP, et al. Concomitant panniculectomy affects wound morbidity but not hernia recurrence rates in abdominal wall reconstruction: A propensity score analysis. Plast Reconstr Surg.2017; 140(6):1263-1273. Harth KC, Blatnik JA, Rosen MJ. Optimum repair for massive ventral hernias in the morbidly obese patient-is panniculectomy helpful? Am J Surg.2011; 201(3):396-400. Hopkins MP, Shriner AM, Parker MG, Scott L. Panniculectomy at the time of gynecologic surgery in morbidly obese patients. Am J Obstet Gynecol.2000; 182(6):1502-1505. Hughes KC. Ventral hernia repair with simultaneous panniculectomy. Ann Surg.1996; 62(8):678-681. Iavazzo C, Psomiadou V, Fotiou A, et al. Concurrent gynecologic surgery and panniculectomy in morbidly obese women with gynecologic cancer, a single-center experience. Arch Gynecol Obstet.2021; 304(5):1271-1278. Kantar RS, Rifkin WJ, Wilson SC, et al. Abdominal panniculectomy: determining the impact of diabetes on complications and risk factors for adverse events. Plast Reconstr Surg.2018; 142(4):462e-471e. Lesko RP, Cheah MA, Sarmiento S, et al. Postoperative complications of panniculectomy and abdominoplasty: A retrospective review. Ann Plast Surg.2020; 85(3):285-289. Massenburg BB, Sanati-Mehrizy P, Jablonka EM, Taub PJ. Risk factors for readmission and adverse outcomes in abdominoplasty. Plast Reconstr Surg.2015; 136(5):968-977. Matarasso A, Wallach SG, Rankin M, Galiano RD. Secondary abdominal contour surgery: a review of early and late reoperative surgery. Plast Reconstr Surg.2005; 115(2):627-632. Matory WE, O’Sullivan J, Fudem G, Dunn R. Abdominal surgery in patients with severe morbid obesity. Plast Reconstr Surg.1994; 94(7):976-987. Nag S, Patel T, Gaughan JP, Bonawitz SC. Panniculectomy performed in conjunction with gynecologic surgery in obese and morbidly obese patients: A National Surgical Quality Improvement Program Analysis and systematic review of the literature. Ann Plast Surg.2021; 87(5):600-605. Nahas FX, Augusto SM, Ghelfond C. Should diastasis recti be corrected? Aesth Plas Surg.1997; 21(4):285-289. Pearl ML, Valea FA, Disilvestro PA, Chalas E. Panniculectomy in morbidly obese gynecologic oncology patients. Int J Surg Investig.2000; 2(1):59-64. Powell JL. Panniculectomy to facilitate gynecologic surgery in morbidly obese women. Obstet Gynecol.1999 94(4):528-531. Prodromidou A, Iavazzo C, Psomiadou V, et al. Safety and efficacy of synchronous panniculectomy and endometrial cancer surgery in obese patients: a systematic review of the literature and meta-analysis of postoperative complications. J Turk Ger Gynecol Assoc.2020; 21(4):279-286. Rasmussen RW, Patibandla JR, Hopkins MP. Evaluation of indicated non-cosmetic panniculectomy at time of gynecologic surgery. Int J Gynaecol Obstet.2017; 138(2):207-211. Rubin JP, Nguyen V, Schwentker A. Perioperative management of the post-gastric-bypass patient presenting for body contour surgery. Clin Plast Surg.2004; 31(4):601-610. Salari N, Fatahi B, Bartina Y, et al. The global prevalence of seroma after abdominoplasty: a systematic review and meta-analysis. Aesthetic Plast Surg.2021; 45(6):2821-2836. Sosin M, Termanini KM, Black CK, et al. Simultaneous ventral hernia repair and panniculectomy: A systematic review and meta-analysis of outcomes. Plast Reconstr Surg.2020; 145(4):1059-1067. Staalesen T, Olsén MF, Elander A. The effect of abdominoplasty and outcome of rectus fascia plication on health-related quality of life in post-bariatric surgery patients. Plast Reconstr Surg.2015; 136(6):750e-761e. Tillmanns TD, Kamelle SA, Abudayyeh I, et al. Panniculectomy with simultaneous gynecologic oncology surgery. Gynecol Oncol.2001; 83(3):518-522. Vastine VL, Morgan RF, Williams GS, et al. Wound complications of abdominoplasty in obese patients. Plast Surg.1999; 42(1):34-39. Warren JA, Epps M, Debrux C, et al. Surgical site occurrences of simultaneous panniculectomy and incisional hernia repair. Am Surg.2015; 81(8):764-769. Winocour J, Gupta V, Ramirez JR, et al. Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg.2015; 136(5):597e-606e. Zannis J, Wood BC, Griffin LP, et al. Outcome study of the surgical management of panniculitis. Ann Plast Surg.2012; 68(2):194-197. Zemlyak AY, Colavita PD, El Djouzi S, et al. Comparative study of wound complications: isolated panniculectomy versus panniculectomy combined with ventral hernia repair. J Surg Res.2012; 177(2):387-391.

Government Agency, Medical Society, and Other Authoritative Publications:

American Society of Plastic and Reconstructive Surgeons (ASPS). ASPS recommended insurance coverage criteria for third-party payers: Surgical treatment of skin redundancy for obese and massive weight loss patients.2007a. Available at: https://www.plasticsurgery.org/Documents/medical-professionals/health-policy/insurance/Surgical-Treatment-of-Skin-Redundancy-Following.pdf, Accessed on January 03, 2023. American Society of Plastic and Reconstructive Surgeons (ASPS). Practice parameter for surgical treatment of skin redundancy for obese and massive weight loss patients.2007b. Available at: http://www.plasticsurgery.org/Documents/medical-professionals/health-policy/evidence-practice/Surgical-Treatment-of-Skin-Redundancy-Following-Massive-Weight-Loss.pdf, Accessed on January 03, 2023. Buchwald H; Consensus Conference Panel. Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. Surg Obes Relat Dis.2005; 1(3):371-381. Coleman WP, Glogau RG, Klein JA, et al. American Academy of Dermatology Guidelines/Outcomes Committee. Guidelines of care for liposuction. J Am Acad Dermatol.2001; 45(3):438-447.

Websites for Additional Information

National Institutes of Health. National Heart, Lung, and Blood Institute. BMI calculator. Available at: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm, Accessed on January 03, 2023. National Library of Medicine. Medical Encyclopedia: Diastasis recti. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001602.htm, Accessed on January 03, 2023.

Status	Date	Action
Reviewed	02/16/2023	Medical Policy & Technology Assessment Committee (MPTAC) review. Updated Discussion/General Information, References and Website sections.
Reviewed	02/17/2022	MPTAC review. Updated Discussion/General Information, References and Website sections. Updated Coding section; removed CPT anesthesia code 00802.
Reviewed	02/11/2021	MPTAC review. Revised MN definition text in the Description section. Updated Discussion/General Information, References and Website sections. Reformatted Coding section.
Reviewed	02/20/2020	MPTAC review. Updated References and Website sections.
New	03/21/2019	MPTAC review. Initial document development. Moved content of SURG.00048 Panniculectomy and Abdominoplasty to a new clinical utilization management guideline document with the same title. In the Cosmetic and Not Medically Necessary position statement section: (1) revised bullet “A” to indicate that liposuction is considered cosmetic and not medically necessary when used for the removal of excess abdominal fat; (2) revised bullet “C” by removing the words “for all indications”.

Will my stomach be flat after a Panniculectomy?

A panniculectomy is a surgical procedure to remove the pannus — the excess skin and tissue from the lower abdomen. People who have lost a lot of weight can have their loose skin removed with this procedure. The excess skin is sometimes referred to as an “apron.” However, unlike a tummy tuck, the panniculectomy does not tighten the abdominal muscles for a more cosmetic appearance, disqualifying it as a cosmetic procedure,

1. That said, removing the excess fat can make your abdominal area flatter.
2. The panniculectomy can also be performed alongside a tummy tuck or other abdominal procedures.
3. Surgical costs can range from $8,000 to $15,000 for this procedure to cover anesthesia, surgeon, and facility fees.
4. Since the panniculectomy is not typically seen as cosmetic surgery, your insurance provider may help pay for the procedure.

But, you must meet specific criteria, and the panniculectomy must be seen as a medical necessity. Contact your health insurance provider to discuss your payment options.

Why am I still big after lipo?

How can I help promote healing and good results? – While liposuction removes a certain number of fat cells in the treatment area for good, the remaining cells can continue to store fat and grow in size. Following a healthy diet, drinking plenty of water and participating in a regular exercise routine (once your surgeon clears you to do so) can help promote healing, maintain a healthy body weight and help you achieve your desired body contour after the swelling goes down.

Why am I bigger after liposuction?

Why Do I Weigh More After Liposuction? – The goal of liposuction surgery is not to lose weight, but to have a more desirable body shape by removing stubborn areas of fat. Patients often experience a rapid weight gain following the procedure as the body aims to recoup fat and the affected areas will fill with fluid that the body uses to heal.

What are the downsides of liposuction?

Risks – As with any surgery, liposuction has risks. These risks include bleeding and a reaction to anesthesia. Other risks specific to liposuction include:

Contour irregularities. Your skin may appear bumpy, wavy or withered due to uneven fat removal, poor skin elasticity and scarring. These changes may be permanent. Fluid buildup. Temporary pockets of fluid, called seromas, can form under the skin. They may need to be drained using a needle. Numbness. You may feel temporary or permanent numbness in the treated areas. Nerves in the area also may feel irritated. Infection. Skin infections are rare but possible. A severe skin infection may be life-threatening. Internal puncture. Rarely, if the thin tube used during surgery penetrates too deeply, it may puncture an internal organ. This may require emergency surgery to repair the organ. Fat embolism. Pieces of fat may break away and become trapped in a blood vessel. They then may gather in the lungs or travel to the brain. A fat embolism is a medical emergency. Kidney and heart problems. When large volumes of liposuction are performed, fluid shifts. This can cause possibly life-threatening kidney, heart and lung problems. Lidocaine toxicity. Lidocaine is a medicine that is used to help manage pain. It’s often given with fluids injected during liposuction. Although lidocaine usually is safe, lidocaine toxicity sometimes can occur, causing serious heart and central nervous system problems.

The risk of complications rises if the surgeon works on larger body surfaces or does multiple procedures during the same operation. Talk to the surgeon about how these risks apply to you.

What happens years after liposuction?

What Liposuction Does to Fat – The human body has only a certain amount of fat cells. The fat cells grow larger or smaller as we gain or lose weight, respectively. The number and distribution of our fat cells are set before we even reach adulthood. This is why we may have some stubborn areas where fat won’t seem to budge, even though we are losing weight in other areas.

• When fat deposits are removed through liposuction, those fat cells are gone forever.
• After liposuction, the body’s contour is improved, and ideally, the areas in question are now more in proportion to the rest of the body.
• That said, there will always be some fat cells left in the areas where liposuction was done.

If there is subsequent weight gain, the remaining fat cells will grow larger. However, since there will be fewer fat cells left, they will tend to stay in better proportion to the rest of the body even if a few pounds are gained after liposuction. If there is excessive weight gain after liposuction, parts of the body that were not liposuctioned may suddenly appear disproportionately bigger than the rest because there are more fat cells there.

Does cellulite come back after liposuction?

Why does this happen? – After undergoing liposuction, the skin will shrink back in order to adjust to the loss of fat in that area. Sometimes when this skin shrinks back, the connective tissue beneath the skin and healthy fat that’s left behind can result in pronounced appearance of cellulite.

Where do you gain weight after liposuction?

Fat Accumulation after Post-Liposuction Weight Gain – If the patient puts on a significant amount of weight (ten pounds or more) following their liposuction plastic surgery, then the body will potentially produce new fat, and this fat must go to various areas of the body.

Is weight loss surgery good for lipedema?

Conclusion – Our finding of a massive reduction in leg volume following bariatric surgery stands in clear contrast to earlier assumptions, Indeed, bariatric surgery is an effective option to reduce leg volume in patients with obesity and lipoedema and ought to be investigated further.

How do you break down lipedema fat?

Liposuction – Liposuction is a very effective treatment for lipedema when other treatment options fail. Liposuction involves removing the lipedema fat while sparing the lymphatic vessels. A surgeon inserts a hollow instrument called a cannula under the skin during liposuction.

Tumescent technique: This procedure involves injecting a saline solution into the fatty area before removing the lipedema fat. ​ Water-jet assisted liposuction (WAL): During this procedure, a surgeon uses Klein solution or saline as a jet that releases the fat for liposuction.

How much fat is removed in lipedema liposuction?

Women who underwent breast reduction surgery before age 25 continue to report lasting benefits 10 to 30 years following the procedure, according to a study in the November issue of Plastic and Reconstructive Surgery ®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Suppose you’re a teen or young woman who starts putting on fat, mainly in your legs. Doctors say you’re obese – but no matter how much you diet and exercise, you can’t lose the fat. After years of weight gain, pain, and swelling, you’re finally diagnosed with lipedema – a common but “enigmatic” disease of the peripheral fat.

That’s the experience of women with lipedema surveyed in the December issue of Plastic and Reconstructive Surgery ®, the official medical journal of the American Society of Plastic Surgeons (ASPS). To gain insights into this misunderstood condition, Anna-Theresa Bauer, MD, of Technical University Munich, Germany, and colleagues, surveyed 209 women with lipedema who were treated with liposuction.

• Lipedema is a congenital disease, causing disproportionate accumulations of fat, most often in the legs.
• Occurring almost exclusively in women, lipedema is usually misdiagnosed as obesity – but the abnormal fat deposits don’t respond to diet or exercise.
• In addition to cosmetic concerns, the fat accumulations cause pain, easy bruising, and progressive swelling.

Lipedema seems to run in families, as most patients have affected relatives. The women in the survey averaged 38 years of age. However, most noticed the first signs of lipedema in their teens or young adult years: average time to diagnosis was 15 years.

Frequently, lipedema patients go through a long period of uncertainty and self-doubt, before their disease is finally properly diagnosed,” Dr. Bauer and coauthors write. “They are helpless against their weight gain and their pain and also the social withdrawal they often experience.” Most of the women had other health problems besides lipedema, most commonly an underactive thyroid gland.

Other common problems included depression and migraine headaches. But the patients had low rates of common obesity-related conditions, including high blood pressure, high cholesterol, and diabetes. The patients underwent multiple sessions of liposuction to treat the abnormal fat deposits, most commonly in the thighs, calves, buttocks, back, and abdomen.

• The average amount of “pure fat” removed by liposuction was 10 liters, but was much higher in some patients.
• In nearly all of the women, liposuction led to decreased pain, bruising, and swelling.
• Other benefits were also apparent, including reduced frequency and severity of migraine attacks.
• Liposuction yields long-lasting positive effect in lipedema patients, leading to a marked increase in their quality of life,” Dr.

Bauer and coauthors write. The authors note some important limitations of their patient survey study. However, it adds to a growing body of evidence supporting the benefits of liposuction in reducing symptoms and improving quality of life for women with lipedema.

1. The findings may also provide new clues into the causes of lipedema – particularly hormonal factors. Dr.
2. Bauer and colleagues emphasize the need for further, in-depth studies to gain a clearer picture of the “physiological mechanisms underlying this progressive disease.” The Lipedema Foundation has more information on lipedema: https://www.lipedema.org/ Plastic and Reconstructive Surgery ® is published by Wolters Kluwer,

Click here to read “New Insights on Lipedema: The Enigmatic Disease of the Peripheral Fat” Article: “New Insights on Lipedema: The Enigmatic Disease of the Peripheral Fat” (doi: 10.1097/PRS.0000000000006280)