Lipedema is a condition that affects millions of women worldwide, often misunderstood, frequently misdiagnosed, and typically resistant to diet or exercise. It leads to the symmetrical buildup of fat, often in the legs and arms, causing pain, heaviness, and mobility issues. 

When conservative measures are no longer enough, lipedema reduction surgery becomes a valuable treatment option. But for patients with early-stage lipedema and otherwise good health, a common question arises: Is it safe to treat the front and back of the legs in a single surgery, or should the procedure be split into two stages?

Dr. Iacovos Georgiou, Director of Plastic Surgery at the German Medical Institute in Limassol, Cyprus, weighs in on this nuanced decision. 

One surgery or more? What we know

The traditional approach to lipedema reduction often involves multiple surgeries first addressing the front of the legs, then the back, or vice versa. This staged method is rooted in safety: by limiting the volume of fat removed in each session, the risk of complications such as blood loss, fluid shifts, and prolonged recovery is reduced.

However, 360-degree liposuction, treating both the front and back of the legs in a single session, is becoming more common under very specific circumstances. Dr. Georgiou stresses that only a select group of patients are candidates for this approach:

• They must be in early stages of lipedema, where tissue changes are still mild
• They must be in excellent general health, with no underlying conditions that could increase surgical risk
• The surgery must be carried out in a highly specialised medical center, where close monitoring and expert postoperative care are guaranteed

Importantly, the total amount of fat removed should not be compromised. 

Whether in one session or two, the goal remains the same: to safely reduce as much pathologic adipose tissue as possible while protecting the patient’s health.

Balancing safety and results

A key challenge with 360-degree liposuction is managing blood loss and haemoglobin levels. Dr. Georgiou explains that a combination of surgical techniques is often required to stay within safe limits, particularly not exceeding 10% of the patient’s body weight in lipoaspirate. This requires planning, precision, and surgical skill, all of which are essential to avoid complications while achieving meaningful results.

Recovery, too, plays an important role in this decision. Swelling and bruising may be more pronounced, and the body’s recovery systems can be more taxed when both sides of the legs are treated at once. Patients must understand that while a single surgery may seem more convenient, recovery can be longer and more demanding.

A patient-centered approach

For Dr. Georgiou, it’s not about a one-size-fits-all answer. “We look at the whole picture of the stage of the disease, the patient’s health, their lifestyle, and their expectations,” he says. “Some will benefit from a staged procedure. Others may be suitable for a more comprehensive approach, but only if all safety boxes are checked.”

For those considering lipedema reduction surgery, especially the possibility of treating the full circumference of the legs in one go, the decision must be made with care. Patient safety, long-term outcomes, and surgical expertise all carry equal weight. As Dr. Georgiou notes, “It’s not about doing more, it’s about doing what’s right for each individual.”