It also discusses getting 5 lipomas removed at a time vs hundred:
How to Shop For a Good Plastic Surgeon
I thought it might be helpful for me to advise you on how to find a
plastic surgeon in your area that uses the latest lipoma excision
techniques. This advice would apply to anyone with Familial Multiple
Lipomatosis, and may or may not be relevant to anyone else. I
recognize that some people reading this may not have insurance that
will allow them to shop for a doctor, but perhaps this will be of
value to someone.
I have had 40 lipomas removed by at least four different doctors over
the last 25 years. I've seen the good, the bad and the ugly
techniques. One doctor removed just one small lipoma, and I had an
uncomfortable recovery and a big scar. Yet, my current doctor
removes five at a time in an easy, fifteen-minute office visit. The
small scars that he leaves fade, and most are already much less
noticeable than the older scars from the other doctors. The reason
is that my current doctor uses a much more sophisticated technique.
My suggestion (for those lucky enough to be able to afford it) is
that you schedule consultations with a few plastic surgeons in your
area and ask them about their technique. Here is the technique my
1. First the surface is treated with an antiseptic—not just
alcohol, and not iodine. Prevention of infection has a huge impact
on both the scar and the ease of recovery.
2. Next, the lipoma is injected with a mixture of an anesthetic
and a vaso-constrictor. The vaso-constrictor is key—it causes the
lipoma to bulge up and also keeps it from bleeding during the
3. A thin incision is then made over the lipoma. This should be
longitudal to the muscle. This direction leaves less of a scar than
if the incision is made in the other direction.
4. The lipoma is then squeezed out by applying pressure—rather
than with a lot of fishing around with a scalpel.
5. The wound is then closed with internal stitches. This is
critical. These stitches do not lie on top of the skin, so the scar
has no stitch marks. (If a lipoma is located on your trunk or is very
large, it may not be possible to use internal stitches.) Next a glue
is applied over the incision, and this is then covered by tape that
is called "steri-strips".
6. Recovery consists of keeping the wound dry for a couple of
days and not putting any stress on it (no weight lifting) for a
couple weeks. After my last surgery (removing five lipomas) I did
not need to take a single Tylenol. You leave the tape on until it
falls off. The internal stitches dissolve. When going out in the
sun, use sunscreen on the scar for the first couple of years to keep
it from darkening.
Your first step would be to phone plastic surgeons and ask the person
who answers the phone how often the doctor performs excisions of
lipomas. When you find one that frequently performs excisions,
schedule a consultation appointment to ask him about his technique.
You may not be able to find a doctor that uses the exact technique
given above, but at a minimum you can ask him if he uses internal
stitches covered with steri-strips.
I did have to persuade this doctor to remove five at a time in his
office. His preference was to go into an operating room and remove
50 at a time. He also said that for more difficult lipomas he would
not agree to remove five at a time in an office visit. I may have a
type of lipoma that comes out easily, and I also tend to ask him to
remove only the ones closest to the surface of the skin (which are
more visible and perhaps easier to remove).
With the old technique, I was having only my largest lipomas
removed. However, since this new technique has an easier recovery
and less scarring, I have decided to have more removed. I am lucky
that my insurance happens to cover the full cost of this, and I have
no idea how widely this technique is available across the country.
A few days ago I noticed one of my excision scars from over 20 years
ago. That scar is more obvious than some that are only two years
old. I remember those old excision procedures as being uncomfortable
and the recovery being painful and bloody. But that was with a bad
old technique. My newer scars would be difficult to find if I would
do a better job keeping the sun away from them.
In January I was in my doctor's office and he had me cut open and was
squeezing out a lipoma. He said, "I call this the zit squeezing
technique…do you know what I mean by that?" I laughed and
said, "yes, I know what you mean, but I've never heard it called that
before". He then said "O.K. how about `expulsion of the lipoma by
application of manual lateroinferior pressure'". I smiled and
said "whatever you call it, it sure beats the days when they would
fish around with the scalpel." Part of the reason why he and I could
joke around while he is pulling out five lipomas from me in fifteen
minutes is that I am not bleeding. The vasoconstrictor--which was not
used in the old days--makes this a nearly bloodless surgery.
Yet the vasoconstrictor and use of pressure rather than dissection
are the least of the innovations—the incision closure technique is
more important. There is no "scab", no itching, no need to tape a
big cotton gauze over the incision after surgery, no "dot" marks from
suture holes, and none of the discomfort that I previously
experienced from nylon sutures. Normally even with the new procedure
I still feel some pain on the night after surgery, but this last time
I had virtually no pain and never took a single Tylenol. I recognize
that some people reading this might not have the easy-to-remove type
of lipoma (subcutaneous, well differentiated, non-infiltrating) that
I do. However, far more people suffer from my easy-to-remove type of
lipoma than the other types, so the surgical procedure above should
apply to most readers. Of course, incisions on the trunk are harder
to keep together than are incisions on the arms.
Anyway, there is NOT a lot of good news for lipomatosis patients on
the cure/treatment front, so I hope that as many people as possible
are at least benefiting from the huge advances in surgical excision
http://health.groups.yahoo.com/group/Li ... ssage/1541
http://groups.yahoo.com/group/LipomaSup ... ssage/1554