Liposuction Surgery, Varicose Veins, and Joint Replacement: Which One Should Come First?

Addressing the priority of surgeries for lipedema women.

Photo by Lucaxx Freire on Unsplash

As I get ready for my second knee replacement next week, I’ve been thinking about how I’ve managed my health with all the different medical issues I have, like lipedema, hEDS, and vascular and arthritis problems. Over the past few years, I’ve had several surgeries, and I’m grateful that I’ve recovered well from each one.

Here’s my story…

I’d had knee osteoarthritis for years and managed it conservatively, first with steroid injections, then with Euflexxa injections, until those didn’t work anymore.

Then, I went to an orthopedic surgeon consultation for a knee replacement. He wouldn’t operate on me because of my BMI, even though my BMI was 32. He wanted me to lose weight instead. At that time, I didn’t know I had lipedema, and I had already tried losing weight for two years without success.

I left that appointment in angry tears.

As my knee slowly deteriorated and I was going through menopause, my legs started aching. I thought that my leg pain was maybe from varicose veins, so my first inclination was to make an appointment with a vascular surgeon for a diagnosis (This is another step when most women should also be diagnosed with lipedema, but that wasn’t the case for me).

I was diagnosed with varicose veins and scheduled myself for vein ablation. While I was waiting for that procedure, I kept researching what was possibly wrong with my body.

That’s when I discovered lipedema. I immediately flew down to see Dr. Herbst and was diagnosed with Stage II Lipedema, and had a surgical consult with Dr. Schwartz for liposuction surgeries.

I went on to get my vein ablations, my liposuction surgeries, and finally, a right knee replacement (with a different orthopedist). My left knee replacement is scheduled for next week.

These surgeries weren’t planned that way; they happened in this order only because that’s how it all worked out.

I didn’t realize at first that many women with lipedema deal with a mix of these medical issues: varicose veins, lipedema fat, and joint deterioration.

It turns out that having vein ablation, liposuction, and joint replacements is pretty common for us. The question I hear the most is, "In what order should I have these surgeries?"

Is there a typical sequence of getting these surgeries?

Which surgeries should you first do: liposuction, varicose vein ablation, or joint (hip or knee) replacement?

I’m not a doctor and cannot recommend the succession of one surgery over another. Medical teams prioritize multiple surgeries, considering each patient's comorbidities, contraindications, and complications.

However…

Based on my research, here’s the usual recommended order for these surgeries:

1. Varicose vein treatment: Most sources suggest starting with varicose vein treatment to reduce bleeding risks during future surgeries. 

2. Lipedema liposuction: Reducing the volume of lipedema fat can help improve mobility and reduce pain. This can be beneficial for future surgeries, including joint replacement.

3. Joint replacement surgery: This surgery is typically recommended after liposuction in patients with lipedema, as reducing extra tissue volume may help optimize the surgical approach and recovery. However, joint replacement may sometimes be prioritized if joint pain, damage, or other health factors are severe enough to require immediate attention.

Joint replacement surgery should be evaluated individually by your orthopedist. While the additional volume of lipedema fat can complicate surgery and affect recovery, lipedema is not universally considered a contraindication. However, some orthopedists may factor it into their decision-making process. And although weight loss can reduce surgical risks, traditional weight-loss methods are often less effective for reducing lipedema fat.

Key points to consider: 

• Bleeding risk:

  Varicose veins can be prone to bleeding during surgery, so addressing them first minimizes this risk for subsequent procedures like liposuction. Vein ablation is a straightforward procedure with minimal downtime, and is typically covered by insurance.

• Lymphatic drainage:

  Lipedema liposuction aims to improve lymphatic drainage, and treating varicose veins beforehand can also improve lymphatic function, potentially optimizing the surgery's results. 

• Reducing tissue volume through liposuction before joint replacement:

  This can make joint replacement surgery and recovery easier for some patients, improving mobility and decreasing joint strain. However, any surgical decision should be made under the guidance of healthcare providers as they will evaluate the risks, benefits, and timing of each procedure.

• Consulting a specialist: Always consult with qualified medical professionals to discuss your specific situation and determine the best treatment plan based on your individual needs and medical history. 

For those of us facing multiple surgeries, thoughtful planning and the right support can make a big difference in recovery and long-term health. In working closely with your medical team and taking each step with your surgical care, you’re setting yourself up for the most optimal recovery for all these conditions. Stay positive—every small step forward is a victory.

Take care,

Michelle