High-Volume Liposuction in Lipedema Patients: Effects on Serum Vitamin D

Abstract

Background: Lipedema is a subcutaneous adipose tissue disorder characterized by increased pathological adipocytes mainly in the extremities. Vitamin D is stored in adipocytes, and serum levels inversely correlate with BMI. As adipocytes are removed during liposuction, lipedema patients might be prone to further substantial vitamin D loss while their levels are already decreased. Therefore, we examined the effect of liposuction on perioperative serum 25-hydroxyvitamin D levels. Methods: In patients undergoing lipedema liposuction, blood samples were obtained pre- and postoperatively. Statistical analyses were performed to correlate the volume of lipoaspirate, patients' BMI and number of sessions to vitamin D levels. Results: Overall, 213 patients were analyzed. Mean liposuction volume was 6615.33 ± 3884.25 mL, mean BMI was 32.18 ± 7.26 kg/m². mean preoperative vitamin D levels were 30.1 ± 14.45 ng/mL (borderline deficient according to the endocrine society) and mean postoperative vitamin D levels were 21.91 ± 9.18 ng/mL (deficient). A significant decrease in serum vitamin D was seen in our patients (p < 0.001) of mean 7.83 ng/mL. The amount of vitamin D loss was not associated with BMI or aspiration volume in our patients (p > 0.05). Interestingly, vitamin D dynamics showed a steady drop regardless of volume aspirated or preoperative levels. Conclusions: Many lipedema patients have low vitamin D levels preoperatively. Liposuction significantly reduced these levels additionally, regardless of aspirated volume or BMI. However, vitamin D loss was constant and predictable; thus, patients at risk are easily identified. Overall, lipedema patients undergoing liposuction are prone to vitamin D deficiency, and the long-term effects in this population are currently unknown.

Keywords: BMI; lipedema; liposuction; vitamin D.

Figure 1

Illustration demonstrating the depletion of vitamin D during liposuction.

Figure 2

Organigram of patient selection for study inclusion.

Figure 3

Key data chart of included study patients and clinical findings. Arrows and dotted lines in the upper left window show the suction path (arrows) of lipoaspirate (dotted lines) during liposuction.

Figure 4

Histogram of preoperative vitamin D. Mean vitamin D levels were 30.1 ng/mL in total. Std. was 14.45 ng/mL (N = 46). Preoperative vitamin D insufficiency (according to the endocrine society) can be observed as most bars are shifted to the left. This vitamin D insufficiency is often seen in lipedema patients. Dotted line indicates the threshold of vitamin D deficiency to non-deficiency in preoperative patients.

Figure 5

Histogram of postoperative vitamin D levels. Mean vitamin D was 21.91 ng/mL. Std. was 9.18 ng/mL (N = 46). A vitamin D insufficiency can clearly be seen in postoperative values as the bars are shifted to the left. Pre-existing vitamin D insufficiencies are further aggravated through liposuction. Dotted line indicates the threshold of vitamin D deficiency to non-deficiency in postoperative patients.