Recently, I had the opportunity to accompany the surgical procedure for lipedema reduction in a patient I have been following in consultation for the past two years. Being present during this surgery represented, for me, the culmination of a process that began long before the operating room. Throughout these two years, we worked in a multidisciplinary way, with a conservative approach focused on pain management, optimization of lymphatic health, and lifestyle regulation. However, the clinical nature of the condition and the persistence of certain symptoms demonstrated that, for this particular patient, the conservative approach had reached its therapeutic limit. The decision to proceed with surgery was a considered and necessary step to restore quality of life.
As a physiotherapist, being present in the operating room allowed me to observe the seamless synergy between Vascular Medicine, Plastic Surgery, and Physiotherapy intervention in the immediate postoperative phase.
The procedure focused on full-leg liposuction, led by Dr. Joana de Carvalho (Vascular Surgery). I also had the privilege of interacting with Prof. Dr. Sérgio Sampaio, who, with great generosity and extensive knowledge, provided a detailed explanation of the WAL method (Water-Assisted Liposuction) and its advantages. Through a pulsating jet of tumescent solution, fat cells are selectively released while preserving the integrity of lymphatic vessels and connective tissues. This real-time lesson in anatomy and technique was fundamental in understanding this approach as a cornerstone for the success of physiotherapy intervention.
Also present in the operating room was Dr. Carolina Andressen (Plastic Surgery), who introduced BodyTite technology, essential for addressing skin laxity that often accompanies large-volume fat removal. To conclude, Morpheus was applied — a radiofrequency microneedling technique that enhances skin retraction and improves tissue quality in the postoperative phase.
One of the most enriching moments of this experience was observing the physiotherapy intervention in the immediate postoperative period, conducted by Dr. Marianna Lou. Seeing compression therapy applied while still in the surgical environment reshaped my perspective on continuity of care. Through compression, we control edema, stabilize tissues, and ensure that the contour designed by the medical team is maintained. This true multidisciplinary approach, where Vascular Surgery, Plastic Surgery, and high-level Physiotherapy work in unison, is undoubtedly the gold standard in the treatment of lipedema.
Having followed the patient over the two years leading up to surgery gives me the advantage of deeply understanding her tissue and inflammatory response, which will be crucial for the success of the recovery journey.
This experience, alongside leading professionals in the field, reinforced a conviction I uphold daily in clinical practice: the treatment of lipedema is not an isolated act, but rather an ecosystem of care. Surgery removes the diseased fat and reshapes the tissue, but it is the continuity of rehabilitation that ensures these results are sustained and that the lymphatic system regains its full function.
Lipedema requires science, technology, and, above all, a team that speaks the same language. Today, more than ever, I feel prepared to guide this patient through the most important phase of her journey: returning to a life free from the burden of pain and with the freedom of movement she deserves.
For this patient, surgery was a long-awaited moment — a goal that, for years, seemed unattainable, particularly due to the high costs associated with this type of treatment. Seeing this barrier overcome brought a unique emotional weight to this day.
Finally, accompanying the patient through recovery and being present as she awoke from anesthesia deeply strengthened the bond and therapeutic empathy we have built. Being there, in that moment of vulnerability and relief, reaffirmed that my role goes far beyond technique — it is about support, presence, and human connection at every stage of the journey.
Sara Lourenço
Physiotherapist
