Lipedema surgery techniques compared, by practice
Technique is one of the few things nearly every practice does state publicly, and it affects how many sessions a full course takes, what anesthesia is used, and recovery. All US practices, side by side.
Practices frequently offer more than one technique.
| Practice | Location | WAL (water-assisted) | PAL (power-assisted) | Tumescent | Lymphatic-sparing | Anesthesia |
|---|---|---|---|---|---|---|
| ArtLipo | Tampa, FL | Yes | — | Yes | Yes | Local anesthesia only; liposuction only |
| De La Cruz Plastic Surgery | Houston, TX | — | Yes | Yes | Yes | AAAASF facility with board-certified… |
| Josef Hadeed MD | Beverly Hills, CA | — | Yes | Yes | Yes | General anesthesia |
| DC Cosmetics | McLean, VA | — | Yes | Yes | Yes | Both, awake (smaller/staged) and general in… |
| Premier Lipedema Clinic | Spokane, WA | — | — | — | Yes | Tumescent-style infiltration described |
| Byrd Lipedema Surgery Center | Roswell, GA | Yes | Yes | Yes | Yes | Local tumescent anesthesia, stated explicitly as… |
| Azouz Plastic and Cosmetic Surgery | Dallas, TX | — | Yes | Yes | — | Most commonly local + sedation rather than general |
| AP Aesthetics (Amor Propio) | Southlake / Dallas, TX | Yes | — | Yes | Yes | — |
| Bluemont Plastic Surgery | Fairfax, VA | Yes | Yes | Yes | Yes | General, patients are asleep |
| Ditesheim Cosmetic Surgery (EmpowerMD) | Charlotte, NC | Yes | — | — | — | Both, general, or awake local for select… |
| Kare Plastic Surgery | Santa Monica, CA | — | — | Yes | — | General anesthesia or tumescent local with deep… |
| Hakimi Plastic Surgery | Beverly Hills, CA | — | — | Yes | — | Lipedema lipo typically awake under local; general… |
| Panache Plastic Surgery | Newport Beach, CA | — | — | Yes | — | Awake, local anesthesia and oral sedation |
| La Jolla Cosmetic Surgery Centre | San Diego, CA | — | Yes | Yes | — | Tumescent solution with local anesthetic; general… |
| Gruber Plastic Surgery | Tampa, FL | — | — | Yes | — | Both, general, or local with no sedation (awake) |
| Lipedema MD | West Long Branch, NJ | — | — | — | Yes | — |
| Falcone Center | Bala Cynwyd, PA | Yes | — | — | Yes | Local-tumescent, awake, in-office |
| Larson Plastic Surgery & ZL Medspa | Tucson, AZ | Yes | Yes | Yes | Yes | Tumescent anesthesia mentioned; general vs awake… |
| Hagopian Plastic Surgery | Atlanta, GA | — | Yes | Yes | Yes | General anesthesia, at a certified surgery center… |
| Karol Gutowski, MD | Glenview, IL | Yes | Yes | Yes | — | Both, commonly local tumescent only; sedation or… |
| Markelov MD Plastic Surgery | Tampa, FL | — | — | Yes | Yes | Awake (local/tumescent) |
| The Elston Clinic | Gig Harbor, WA | — | Yes | — | — | Both, awake in-clinic (numbing + nitrous oxide) for… |
| Sentara Plastic Surgery | Virginia Beach, VA | — | — | — | — | — |
| Advanced Plastic Surgery | Grand Rapids, MI | — | Yes | Yes | Yes | General anesthesia, delivered by fellowship-trained… |
| Beautiful Self | Encino, CA | — | — | — | — | — |
| Dr. Georgina Nichols | Fort Lauderdale / Palm Beach / Boca Raton, FL | Yes | — | Yes | — | — |
| Greenberg Cosmetic Surgery | Woodbury, Long Island / NYC, NY | — | Yes | Yes | — | Local anesthesia with sedation (lipedema page) |
| Sun Vein & Vascular | Dallas, TX | — | — | — | — | — |
| Larson Aesthetics | Newport Beach, CA | — | Yes | Yes | Yes | Both, general typically; awake offered |
| Pasadena Plastic Surgery | Pasadena, CA | — | — | Yes | Yes | Tumescent local infiltration described; general vs… |
| Adam Schaffner MD PLLC | New York, NY | — | — | — | Yes | Both, option of local or general |
| The Roxbury Institute | Los Angeles, CA | — | — | Yes | Yes | Local or twilight anesthesia; states general… |
| Dr. Mark Plastic Surgery | Paradise Valley, AZ | Yes | Yes | Yes | Yes | — |
| Natural Results Plastic Surgery | Scottsdale, AZ | — | Yes | — | Yes | Hospital setting; type not specified |
| Repta Plastic Surgery | Scottsdale, AZ | Yes | — | — | — | — |
| Plastic Surgeons of Northern Arizona | Flagstaff + 3 cities, AZ | — | — | Yes | — | Both, typically general; local with sedation… |
| CosmetiCare | Newport Beach, CA | Yes | Yes | Yes | Yes | Both, local with sedation or general depending on… |
| Saber Plastic Surgery | Encino + RSM, CA | — | Yes | Yes | Yes | Tumescent with lidocaine described; general vs… |
| LSK Plastic Surgery | Sacramento, CA | — | — | — | — | — |
| Liposuction Denver LLC | Denver, CO | — | — | Yes | — | Local or general depending on plan (general lipo) |
| The Collins Center | Guilford + Mystic, CT | Yes | — | Yes | Yes | Local; outpatient or short hospital stay by volume |
| Eden Plastic Surgery Institute | Miami/Ft Lauderdale, FL | — | — | — | — | — |
| 360 Surgery Center (Arviv) | Tampa, FL | Yes | Yes | Yes | Yes | Local |
| AdventHealth, Omar Beidas MD | Orlando, FL | — | — | — | — | — |
| Georgia Plastic & Reconstructive Surgery | Marietta, GA | Yes | Yes | — | — | Separate Awake Liposuction service line |
| Aesthera Plastic Surgery | Atlanta, GA | Yes | Yes | Yes | Yes | Both, often awake under local; high-volume in… |
| Krochmal Plastic Surgery | Hinsdale, IL | — | Yes | Yes | — | General (1-2 night hospital stay) |
| Kapadia Plastic Surgery | Chicago + Elk Grove Village, IL | Yes | — | Yes | Yes | — |
| Laser & Skin Surgery Center of Indiana | Indianapolis, IN | — | — | Yes | — | Local-awake (tumescent) |
| Ghere Plastic Surgery | Baton Rouge, LA | — | — | — | — | — |
| Avance Plastic Surgery Institute | Reno/Tahoe, NV | — | Yes | Yes | Yes | Tumescent local; outpatient |
| Scarpidis Aesthetics | New York, NY | — | Yes | Yes | Yes | Local-awake for lipedema (page states local rather… |
| Darren Smith MD | New York, NY | Yes | — | Yes | Yes | Under anesthesia in private Manhattan suite; larger… |
| Northwell Health Plastic Surgery | Long Island/NYC, NY | — | — | Yes | — | Tumescent with lidocaine and epinephrine |
| Cosmetic Surgery Affiliates | Oklahoma City, OK | — | — | — | — | General or IV sedation (patient chooses) |
| Minneapolis Liposuction Specialty Clinic | Minneapolis, MN | — | — | Yes | — | Local-awake |
| Advanced Cosmetic Surgery | Greenville, SC | Yes | — | Yes | — | Blog: local with sedation or general, depending on… |
| Tarola Plastic Surgery | Murfreesboro, TN | — | — | Yes | Yes | Tumescent with lidocaine described; local vs… |
| Micallef Plastic Surgery | Shavano Park, TX | — | — | Yes | Yes | — |
| Austin Plastic Surgeon | Austin + San Antonio, TX | — | — | Yes | — | — |
| New Life Cosmetic Surgery & Med Spa | Boerne and McAllen, TX | — | — | Yes | — | IV conscious sedation, CRNA-administered |
| Virginia Plastic Surgery | Suffolk + VA Beach, VA | — | — | — | Yes | Both, general or tumescent |
| Allure Esthetic | Seattle, WA | — | — | Yes | — | — |
| Dr. Stan Plastic Surgery | Sugar Land/Houston, TX | Yes | — | Yes | Yes | Awake local option exists in practice |
| Total Lipedema Care | Beverly Hills, CA | — | — | Yes | Yes | — |
| Laser Lipo and Vein Center / Lipedema Medical Solutions | O'Fallon, MO | Yes | — | Yes | — | — |
| Stanford Health Care, Plastic and Reconstructive Surgery Clinic | Palo Alto, CA | — | — | — | — | — |
| First State Lipedema | Wilmington, DE | Yes | — | — | Yes | — |
| Institute for Advanced Reconstruction | Red Bank / Shrewsbury / Brick / Florham Park / Marlton, NJ | — | — | — | — | — |
| Dr. Ellen Plastic & Reconstructive Surgery | Bloomfield Hills, MI | — | — | Yes | — | — |
| Missouri Vein Specialists | Liberty, MO | — | — | — | — | — |
| Lipedema Specialist | Marietta, GA | — | Yes | — | — | — |
| Kassis Salameh Plastic Surgery | Bowling Green, KY | — | — | — | — | — |
A caution on "lymphatic-sparing"
No medical board certifies "lymphatic-sparing liposuction" as a distinct qualification. Practices that name it are signalling awareness of the lymphatic considerations specific to lipedema surgery, which is meaningful — but the phrase alone remains a claim rather than a credential. Ask what training sits behind it.
What each technique involves →
Common questions
What is the difference between WAL, PAL and tumescent liposuction for lipedema?
Tumescent describes the fluid step rather than the instrument: the area is infiltrated with a large volume of dilute anesthetic solution before any fat is removed, and it underlies most of the other approaches. WAL, or water-assisted liposuction, uses a fan of pressurised fluid to loosen fat before it is drawn out. PAL, or power-assisted, uses a cannula that vibrates rapidly so the surgeon works with less force. Practices frequently combine them, and many list more than one.
Is one lipedema surgery technique better than the others?
There is no published head-to-head trial establishing one technique as superior for lipedema. Series have reported good results with each of them. Technique is worth asking about, and it is reasonable to weigh it alongside how much lipedema-specific experience the surgeon has.
What does lymphatic-sparing mean?
It describes an intention to work in a way that avoids damaging lymphatic vessels, which matters in lipedema because lymphatic function is already a consideration. It is not a credential. No medical board certifies lymphatic-sparing liposuction as a distinct qualification, so the phrase remains a claim a practice makes about its own approach, and it is fair to ask what training sits behind it.
Is lipedema surgery done awake or under general anesthesia?
Both are used. Some practices operate only under local tumescent anesthesia with the patient awake, others use general anesthesia, and several offer either depending on how much tissue is planned for one session. Each practice states its own approach on its listing.