{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T16:54:45Z","timestamp":1773680085384,"version":"3.50.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Lipedema is a chronic and potentially progressive fat distribution disorder. Disease-related symptoms, such as pain and discomfort, can require surgical intervention when conservative therapies are exhausted. These megaliposuctions are functional in nature and need to be distinguished from esthetic liposuctions. This new surgical approach, the hybrid technique combining power-assisted liposuction (PAL) with manual extraction (ME), has been developed to more effectively treat fibrotic nodules, particularly in the lower legs, where conventional liposuction techniques often fall short.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 24 patients with advanced lipedema were included in a matched cohort analysis: 12 treated with the hybrid technique and 12 treated with PAL alone. Patients were matched by age (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.9416) and BMI (\n                      <jats:italic>p<\/jats:italic>\n                      =0.6489). Outcome measures included pain and heaviness reduction on the visual analog scale (VAS), changes in a comprehensive lipedema symptom score, intraoperative blood loss, complication rates, and total lipoaspirate volume.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      While statistical significance was not reached, the hybrid group demonstrated a trend to greater symptom relief, with median reductions in pain (6.5 vs. 5.0,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.1958), leg heaviness (7.5 vs. 6.5;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.2293), and composite symptom score (68.0 vs. 52.5,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.3254) compared to the PAL group. The hybrid technique also resulted in fewer postoperative complications and enabled the removal of larger total aspirate volumes; Hybrid group (mean: 17.88 liters), PAL group (mean: 16.62 liters) without increased risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The hybrid approach shows promising trends in clinical outcomes and safety compared to PAL alone. Despite the absence of statistical significance due to the limited sample size, the consistent directional improvements and reduced complication rates support the further evaluation of this method in larger, prospective studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence V<\/jats:title>\n                    <jats:p>\n                      This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-025-05329-2","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T21:13:46Z","timestamp":1761599626000},"page":"1201-1206","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Large-Volume Liposuction and Manual Extraction in Lipedema: A Hybrid approach"],"prefix":"10.1007","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6882-1911","authenticated-orcid":false,"given":"Giw","family":"Mostofizadeh-Haghighi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Zaharie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mojtaba","family":"Ghods","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"issue":"6","key":"5329_CR1","doi-asserted-by":"publisher","DOI":"10.1111\/dth.14534","volume":"33","author":"M Ghods","year":"2020","unstructured":"Ghods M, Georgiou I, Schmidt J, Kruppa P. Disease progression and comorbidities in lipedema patients: a 10-year retrospective analysis. Dermatol Ther. 2020;33(6):e14534. https:\/\/doi.org\/10.1111\/dth.14534.","journal-title":"Dermatol Ther"},{"key":"5329_CR2","doi-asserted-by":"publisher","first-page":"396","DOI":"10.3238\/arztebl.2020.0396","volume":"117","author":"P Kruppa","year":"2020","unstructured":"Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema\u2014pathogenesis, diagnosis and treatment options. Dtsch Arztebl Int. 2020;117:396\u2013403. https:\/\/doi.org\/10.3238\/arztebl.2020.0396.","journal-title":"Dtsch Arztebl Int"},{"issue":"12","key":"5329_CR3","doi-asserted-by":"publisher","first-page":"2626","DOI":"10.3390\/jcm10122626","volume":"10","author":"M Al Zoubi","year":"2021","unstructured":"Al Zoubi M, Herpertz U, Hirsch T, et al. Long-term efficacy of liposuction in lipedema patients \u2013 a follow-up study after 12 years. 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The authors declare that they have no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and Animal Rights Statement"}},{"value":"All study participants provided informed written consent prior to study enrollment.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}