Your expert for lipoedema operations in Bonn

A lipoedema (lipohyperplasia dolorosa) is a congenital, symmetrical lipodystrophy (maldistribution of fat) that occurs on the limbs and in the hip area. Pain is the main symptom.




Lipoedema is a painful, lipodystrophy that is presumed to be congenital. The condition is generally chronic and tends to affect women and girls on the limbs and in the torso area. Men are only rarely affected.

The condition is accompanied by vague pain, usually during the second half of the day (lipohyperplasia dolorosa). So-called orthostatic oedema are clearly visible on the legs – they are caused by prolonged strain, such as from sitting or standing for long periods. As the torso area is also commonly affected, we refer to this as a systemic disease.

If the aforementioned symptoms are not present, the case is referred to as a lipohypertrophy and is treated in exactly the same way by plastic surgeons. Both conditions are characterised by the swellings and fatty deposits on the legs, which end at the ankle.

The first symptoms of lipoedema usually occur at the end of puberty. But the illness can also take effect at other stages of life.

According to epidemiological studies, around 10% of all women are affected by lipoedema. As little is still known about the causes of this chronic condition – which, incidentally, has nothing to do with the patient’s weight – and it is difficult to make a clear diagnosis as a result, we expect that the actual figure is far higher than this.

If you believe you may be affected, please consult a specialist who has a clear understanding of how to diagnose and treat lipoedema or lipohypertrophy. Alternatively, contact us for a consultation here in Bonn.

At a glance


1-3 hours


Local (tumescent) anaesthetic or general anaesthetic


6-8 weeks
of compression clothing


After 2-3 days


After 6-8 weeks


Most women notice the first symptoms during puberty. Despite no differences to their daily routine, patients suffer from painful swellings, which develop uncontrollably on the arms and legs. The extremities become sensitive to pain and contact. They lose their shape. The upper legs and upper arms begin to sag due to the increasing weight, and gradually start to conceal the elbow and knee joints. The increased mass around the lower legs means that it is suddenly no longer possible to wear boots. In addition, patients have an excess of bruises, as even the slightest touch causes haematoma to form. A permanent sense of heaviness develops. The legs start to feel like permanent weights that you can barely lift. Pronounced relapses of the condition can occur, particular during pregnancy. It is presumed that oestrogen and the female hormonal balance are key factors causing the disease. However, there is no evidence to prove this yet.

Yes. We refer to lipoedema as a “systemic” condition. This means that it can affect the entire body, including the abdomen, back and chin area.

The first step is to talk to a vascular surgeon. We believe that a vascular surgeon is the best person to consult for an initial diagnosis, as they are able to rule out symptoms and can differentiate between lipoedema and lymphoedema. The vascular surgeon will also be able to investigate your circulation and the quality of the flow of blood in your veins. These points are vital when it comes to developing a comprehensive treatment plan for lipoedema. The first stage of therapy also usually begins with the vascular surgeon: compression clothing and manual lymphatic drainage can slow the progress of the condition and are the best way to prepare for any operations that may be required down the line. Important: Please ensure that the vascular surgeon notes down all of their findings and diagnoses in writing. Please bring these documents with you when you visit us for your initial consultation.

Please bear in mind that if you do not have an official diagnosis from a vascular surgeon, consultations and possible operations are viewed as cosmetic surgery by law and are, therefore, subject to VAT.

Of course! The more weight that you can lose prior to the surgery, the better the results will be.

A difficult question. Our experience suggests that the earlier you have the operation, the better. Your skin will thank you for it.

Of course. But you should be aware that lymphoedema can be a chronic condition and that you may need to wear compression clothing for the rest of your life. An operation will generally not make the condition any worse.

In our experience, it is the mental trauma caused by the condition that dictates when an operation is necessary. There are some mild and very slowly progressive forms of the illness and these patients can prevent the condition from developing for many years using conservative therapies and, as such, can still enjoy a good quality of life. Despite this, we do recommend that the operation takes place in the very early stages of the condition, as experience shows that it can considerably slow the progression of the disease.

In recent years, we have enjoyed the extraordinary privilege of being able to perform TAL, PAL and WAL treatments. And there is one thing we can say: there is no perfect therapy. Your surgeon’s level of expertise is what counts when it comes to the results. If performed by an experienced specialist, it doesn’t matter too much which technology you use. The results are usually good and more or less equal. Colleagues who declare that their system is “the best” have not always tested other techniques in sufficient detail. Alternatively, their preferred system may simply be the safest for them to use, so they state their preference based on their results. Water-assisted liposuction (WAL) is, in our opinion, a good and very gentle procedure, which allows for very short operation times, as the local anaesthetic barely needs to take effect. Due to the mostly very pronounced symptoms with lipoedema, the water jet must be used frequently but at a significantly lower pressure during the operation, and sometimes it even needs to be paused – otherwise too much water can be applied to the patient, which can lead to post-operative onset anaemia and circulation issues. In addition, many patients often have severe cramp-like pain after the operation, as the powerful water jet irritates the muscle fascia. In our experience, WAL is a modified and better version of TAL. However, both procedures are undoubtedly very good.
In terms of PAL (power-assisted liposuction), which is the procedure we tend to use, we inject the maximum possible amount of tumescent solution to correspond with the expected fat aspirate at the end of the surgery. In the case of vibration-assisted liposuction, the fat cells dissolve from the cell structures without the use of force. The mechanical irritation of the skin also tends to improve the condition of the skin following the procedure. Here too it is crucial that the surgery is carried out by an experienced surgeon, since unlike other procedures, the constant vibration makes it harder to find the tissue. In our view, the best thing about PAL is that it is possible to use several different cannulas – each suiting different specific regions of the body – so that we can utilise the best tool for each treatment area. Furthermore, we believe that this method is far superior to the other methods when it comes to subsequent liposuction and corrections, as the vibration-based technique allows you to easily move through the scar tissue and patients suffer significantly less pain after the surgery. It should be expressly noted that all findings described here are based on personal experience; they make no claim to being perfect or complete. We can only share what we discovered through our own experience and work – after conducting hundreds of treatments with all 3 techniques.

We are not big fans of absolute numbers. When all things are equal, we can remove up to 10% of the body weight. We usually keep operating until we believe that we have achieved the best result possible. This may be after removing three litres, or it may be after removing eight litres. You need to trust us here. We are a very experienced team and have always demonstrated a good eye for knowing how to achieve the best possible results in the past.

BODYTITE is one of the most effective and modern liposuction methods for intraoperative skin tightening. Bipolar radio frequency therapy is used to send energy directly where it is needed – the skin.
The skin becomes thicker, more supple and tauter. The procedure is especially gentle on the lymphatic pathways, nerves and blood vessels.

You can find out more information about Bodytite here:

We currently operate at two locations:

At the Linz-Remagen Hospital ( and at the

Beethoven Clinic in Cologne (

The Linz-Remagen Hospital is a public hospital with its own intensive care unit. The Beethoven Clinic is a private clinic without an intensive care unit.
Both hospitals can provide you with the finest medical care. Treatment at the Linz-Remagen Hospital is only available to patients weighing less than 130 kg, as this is the maximum load capacity of the operating tables on site.

We can only perform leg surgery on patients with a BMI of less than 32 at the Beethoven Clinic in Cologne.
As there is no intensive care unit on site, patients must not be suffering from any relevant secondary illnesses.

It is not possible to state the number of operations required at the start of the treatment. Our rule of thumb is as follows: we will perform as many surgeries as our patients require in order to lead a pain-free and happy life. Sometimes, this can be achieved after just one operation, sometimes it takes four or five. Experience shows that the lower extremities (legs) are best operated on in two sessions (front/rear). The arms and trunk are treated in separate procedures.


Please note that we only combine these surgical areas in the rarest of cases. The flanks, for example, may be combined with the dorsal side of the legs.
By contrast, an operation on the arms cannot be combined with an operation on the legs or abdomen. This is in part due to the size of the resulting wound, but also due to the length of operation that would be required. We treat each area as best we can and that takes time.

We will send you an email around 8 weeks prior to your operation. This email will contain everything that you need to know about the operation itself, how to prepare and your post-op care. The email also includes all the documents that we need from you before we can operate, plus information about insurance to cover any subsequent costs of treatment, and the compression clothing you will require.

We will also send your invoice with this email. Your invoice needs to be paid in full before your surgery.

Prior to the procedure, you will also be contacted to arrange your pre-op consultation. This appointment is used to discuss anaesthesia as well as the procedure for your hospital admission.

  • Linz-Remagen Hospital:
    2-4 weeks before your operation
  • Beethoven Clinic:
    1-2 weeks before your operation

Of course not. 99% of our lipoedema patients are women. Please make the necessary preparations, e.g. by bringing hygiene products with you to the hospital.
For reasons of hygiene, we must ask you to please use a tampon or menstrual cup during the operation. You are welcome to switch to a sanitary towel after the surgery.

Please do. You should shave both your legs and your pubic area before surgery. Please ensure that you shave at least 48 hours before your operation.

  1. Wear the compression clothing regularly for 4 to 6 weeks before the operation. This softens the tissue and makes it easier for us to operate.
  2. After surgery, you need to undergo lymphatic drainage twice a week for 6 to 8 weeks. Please remember to arrange your appointments for this BEFORE THE OPERATION.
  3. 10 days prior to the operation, we need up-to-date results, including a complete blood count without differential, electrolytes, renal function markers, liver function reading and coagulation levels for every patient.
  4. Please do not take any blood-thinning medication in the two weeks leading up to your operation. This includes pineapple extract and globules.
  5. Please remember to order your compression clothing (not flat knitwear) in time for the surgery. Please heed the following:
    – Trousers to fit your current size (without hygiene opening) + compression socks
    – Arms and trunk one size smaller + compression gloves
    During the course of your treatment, your clothing size will drop by one to two sizes, so you will need to order new compression clothing. Ideally, after 14 days, you will be able to switch to your usual flat knitwear.
  6. Please ensure that you take out an insurance policy to cover any subsequent costs of treatment 14 weeks prior to your operation and bring proof of this insurance policy to your appointment.
  7. Please bear in mind that we must have the signed originals of the documents 14 days before surgery. The documents that must be provided include: Your fee agreement(s), the “Information document on liposuction surgery” and the “Information document on blood transfusions”.
  8. Please shave your legs and pubic area 48 hours before surgery.
  9. Please remove any artificial nails and nail polish.
  10. Please make sure that you have paid your invoice in full prior to the operation.
  • Dark clothing
    Large, comfortable socks
  • Compression clothing
  • Any medication that you need to take regularly
  • Comfortable shoes and sliders / flip-flops for the shower
  • Sanitary products (tampons, pads, menstrual cups)
  • Long charging cable for your mobile devices
  • Headphones / ear plugs if necessary

Towels are provided.

Please inform us / the hospital / the clinic about any food intolerances or allergies at least 14 days before the planned operation.

Only the following are offered:

    • Vegan food
    • Vegetarian food
    • Fish and meat dishes

If we are informed in good time, we can also accommodate intolerances, e.g. to lactose or gluten.

Please bring any special food that you require yourself. Refrigerators are located either on the ward or in the rooms – depending on the ward and where your operation is being performed.

Unfortunately, we cannot take any special requests into account.

As a rule, the procedures take 2 to 3 hours. We only perform liposuction procedures on inpatients. We require patients to be monitored in hospital for at least one night. You will sleep more soundly, and so will we. Smaller operations can be carried out on an outpatient basis in some cases.

As a rule, all incision sites are sewn – our operations are very dry due to the surgical techniques we use, so there is little risk of our patients “leaking” after surgery.

Dr Jorjani generally visits you on the day of surgery and one day after surgery. On subsequent days you will e seen y the on duty medical staff. Dr Jorjani is in constant contact with the ward and is kept up to date. Needless to say, if strictly necessary, Dr Jorjani will pay daily visits.


This varies from patient to patient. Some patients only need to wear compression clothing for 6 to 8 weeks following their operation and can then discard them. Other patients have to wear compression clothing for a lifetime.

Yes. At least twice a week, for 6 to 8 weeks.

Yes. As a rule, they will swell up to their maximum size 14 days after the operation. After that, the treated areas will gradually reduce in size. This can be a quick process, but sometimes it takes longer. Please be patient.

The stitches are removed by us or your GP 10-14 days after your operation

Honestly? We don’t know. This is because the precise cause of the disease is still unknown. What we can tell you, however, is that after the operation many patients enjoy stable long-term results, provided they maintain a healthy lifestyle. After surgery, the metabolism of many patients changes for the better, causing them to lose a lot of weight quite suddenly. The reason for this is also unclear.

This varies from patient to patient and depends on the quality of your skin, your age, level of physical activity and, of course, the amount of fat that we remove. As a rule of thumb, the earlier we can treat your condition, the lower the risk that you will need an additional tightening operation, as younger skin is usually exceptionally good at healing itself. In our clinic, we offer a high level of expertise in liposuction and body tightening, so that we can provide holistic advice and treatment for our patients, including in the event of a worst-case scenario. We use the Bodytite™ system to achieve very good results with minimum excess skin.

Seromas are cavities in the body in which fluid accumulates. They are harmless. They are generally eventually absorbed by the body. However, in some cases they need to be popped. This procedure is usually pain-free, as the skin remains less sensitive due to the liposuction for a relatively long time after the operation, so patients barely feel a thing. Please inform us immediately if you notice any seromas. We can then discuss the next steps together.

Rest assured. This is perfectly normal after such a large-scale liposuction. The normal feeling will return in most cases. It just takes time. In some cases, it can even take a few months.

Aqua jogging, aquafit and gentle swimming are possible 2 to 3 weeks after surgery.
Please wait 4 to 6 weeks post-op before doing any strenuous exercise.

Liposuction for patients with lipoedema is quite unique.
It is important to address the fact that it represents a major intervention which involves risks. The better you are mentally prepared for everything, the easier it will be to deal with the very typical after-effects of the surgery.
Mega liposuction can lead to haematomas, swellings and oedema. Dysaesthesia may occur, especially in the upper and lower legs. Sensations generally return to normal after several months. These sensations may include numbness and tingling.
The risk of hypothermia (where the body temperature falls below 35°C) is increased in comparison with other interventions as larger areas of the body surface are exposed. This can lead to cardiac arrhythmia, coagulopathy, electrolyte imbalances and an increased risk of infection. Thermal regulation in our clinic involves patient warming systems on exposed parts of the body, as well as the prewarming of intravenously administered substances. Furthermore, we provide all patients with antibiotics before and after the operation, without exception, in order to reduce the risk of infection.
For reasons of safety, all of our lipoedema patients are admitted to hospital for liposuction procedures. This means that the vital signs can be monitored on a regular basis during the early stages post-op, and that patients can be mobilised under supervision.

In some cases, haemodilution and post-operative bleeding may cause a symptomatic decrease in the level of haemoglobin. In this case, a transfusion with concentrated red blood cells may be necessary.

We would like to point out that in addition to Dr Jorjani’s proven expertise and level of specialisation in this field, our practice differs from other practices in that we generally perform our operations in a hospital or in a licensed private clinic. We have the option of performing concentrated red blood cell transfusions for the worst-case scenario at both establishments in which we operate.

What does this mean for you?
You will be constantly monitored following the operation. Medical staff will always be on site or nearby and can respond within seconds if required. In the hospital in Linz, we have a large, fully equipped intensive care unit at our disposal, so we can offer treatment to even high-risk patients with a clear conscience.