Liposuction for facial lipedema – facial liposuction

Painful fat deposits on the face can be very distressing for lipedema patients. In the course of the progression of the disease, this phenomenon may occur in some sufferers. We are the first practice in the world to specialize in the treatment of painful facial fat deposits associated with lipedema and have the experience & expertise to do so. Liposuction of the face – facial lipo – is not a beginner’s procedure and should only be performed by an experienced surgeon.

What happens in the face with lipedema?

Our face has different structural layers, which are named from superficial to deep as follows:

The first layer is the skin, the second – in this case relevant layer for facial liposuction – is the subcutaneous fat tissue with retinacula cutis (fibrous connective tissue). The third layer is called superficial musculoaponeurotic system (SMAS). The fourth layer consists of deep adipose tissue (buccal fat), which cannot be removed by liposuction. The deepest tissue layer, called preist or deep fascia, brings up the rear.

The fat compartments are located in the second and fourth layers.

In the course of lipedema, we have observed for some time that many patients report an increase in volume in the second and rarely in the fourth tissue layer. This phenomenon can occur both before liposuction and during it.

The second tissue layer, the subcutaneous fat tissue, behaves similarly to the painful fat deposits on the arms and legs: hypertrophy (proliferation) and hyperplasia (enlargement) of the fat tissue occurs. Consequently, fat volume may increase in the face and even in the neck area. Lipolytic resistance of fat deposits occurs. This means that the adipocytes (fat cells) become “metabolically blind” as the extracellular structures now formed consisting of bound water and protein force the cells to inactivate their AQP7 channels to avoid membrane rupture. The fat now coated with water, gel (hyaluronan) and protein cannot be lost through exercise and dieting.

Whether this redistribution is lipedema fat cannot yet be conclusively answered, this still needs to be researched. However, there is already a tendency for more and more patients to come to us with painful fat accumulation in the face and neck area.

Symptoms of lipedema in the facial area

The fact that this phenomenon in lipedema patients is not merely a problem of a cosmetic nature is made clear by the symptoms. The painful fat accumulation in the face and neck area manifests itself as follows:

  • The consistency of the fatty tissue in the affected areas is hardened.
  • Patients report a feeling of being able to feel “grains of rice” under the skin
  • A lump-like feeling in the neck is often described
  • The thickened fatty tissue hurts, feels dull, and a burning sensation is felt

→ The same pain symptoms that can also occur in the extremities

  • At night and when lying down, many patients report that they experience regular breathing difficulties, as if the fat is squeezing the windpipe
  • The contours of the face are often no longer visible, the area appears bloated.
  • Lymphatic congestion can occur, and water retention can increase due to the menstrual cycle.
  • Some patients report that the face does not tan when exposed to sunlight.
  • A pressure pain is permanently present and the slightest touch is felt as unpleasant.
  • In contrast to water retention in the face, the swelling remains constant

We will be happy to clarify with you whether facial lipo is an option for you in the course of a consultation, in which we will not only take a thorough medical history and document the photos, but also measure the fat thickness in the face sonographically using ultrasound.

Which areas of the face can be suctioned?

In principle, everything in the facial area that is felt to be a burden is suctioned – face, neck, nape of the neck, down to the décolleté. Mostly, suction is applied in the area below the chin, the chin line can be suctioned very well, down the neck to the décolleté a smooth transition can be created. Upward, the chin line is accentuated, and suction can be applied upward to the orbital fat rim (to below the eyes). The entire cheek area can be treated, starting at the ear, to the outer edge of the nasolabial fold.

Gesichtslipo® Lipödem Gesicht Liposuktion Lipocura

Procedure of the facial lipo

Facial liposuction, i.e. liposuction of fatty tissue in the facial area, according to LIPOCURA® standards is performed either as part of liposuction for lipedema under general anesthesia or as a single operation under local anesthesia.

In both procedures, the PAL technique, which is particularly gentle on the tissue, is used with the smallest vibration cannulas. To ensure that the procedure is less traumatic for the tissue, a tumescent fluid is injected in advance, which requires about half an hour to take effect. The adrenaline it contains causes the vessels to contract and the cannula can suction out the subcutaneous facial fat without damaging surrounding structures.

The fluid also contains an anesthetic that numbs the tissues, you will not feel any pain during the procedure. The alignment of the cannula should be on the face along the RST lines of the skin. Incisions are made in inconspicuous areas such as under the chin or behind the ears so that later scars are barely visible to invisible. The scars are not sutured so that fluid can drain more quickly and their healing can proceed more rapidly.

After the surgery, you will NOT receive a facial girdle from us, as we have noticed through our experience with this procedure that the swelling goes down much faster without any additional compression of the face.


Facial lipo is not a beginner’s procedure and should only be performed by a highly experienced plastic surgeon who has an intimate knowledge of the anatomical features of the face. The surgeon should be familiar with the structures of the mental nerve, R. marginalis mandibulae of the facial nerve and the A. Facialis and Glandula Parotis. When performed properly, facial lipo is a safe and effective procedure. As with any surgery, the following risks may occur in rare cases:

  • Intolerance to the tumescent solution.
  • A temporary feeling of numbness
  • Hematomas and postoperative swelling
  • Nerve injuries (very rare)
  • Wound healing disorders

With sufficient experience, anatomical knowledge, and careful handling of the cannulas, the risks are very manageable.

Results and success after facial lipo

Facial lipo according to the LIPOCURA® standard is sustainable according to our current knowledge. The fatty tissue that has been removed will not come back either, as the adipocytes are suctioned out. Pain is significantly reduced to completely eliminated, the face regains its contour and distinctive features, appears slimmer and often more youthful. Liposuction can work out the V-shape of the face, which makes the face look young. Nevertheless, in slightly wrinkled skin and older patients, the face may appear older. However, the first priority is symptom elimination and associated pain reduction. If you already suffer from slightly wrinkled skin, tightening procedures, e.g. laser or plasma tightening, can also be performed to meet aesthetic demands. With elastic and good connective tissue, a very good aesthetic result can be achieved by this procedure.

In addition, all patients report that after facial lipo the feeling of shortness of breath when lying down has completely disappeared. Although this procedure is relatively small, it achieves a great effect.

Differentiation Buccal Fat Removal

The so-called “Buccal Fat Removal” (BFR) must be clearly distinguished from facial lipo. While the painful fat is located in the second layer of the skin, the subcutaneous fat layer, the Bichat fat plug is located in the deep fatty tissue and cannot be removed with classic liposuction. With BFR, small incisions are made in the inside of the cheeks and the fat body is pulled out in one piece. If you suffer from painful fat deposits, the subcutaneous fat should always be removed first, as this is where the pain is located. Often, this procedure is sufficient. If you notice that you are constantly biting the inside of your cheeks and the Biachat fat plug has grown with the subcutaneous fat layer, the buccal fat can also be removed. We will be happy to discuss with you whether this is necessary in your case.