The National Institute for Health & Care Excellence (NICE) Interventional Procedures Guidance

Liposuction for chronic lipoedema

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Lipoedema UK are disappointed that NICE are not yet in a position to fully recommend the provision of liposuction for lipoedema by the NHS, especially as we have been heartened by the recognition that the committee gave to the impact that lipoedema has on peoples’ quality of life.  Our thanks go to all our members and those who responded to our survey with their stories, which enabled us to help the NICE committee understand the need for better treatment options than the current highly limited provision.  Those personal stories led them to conclude that lipoedema is still under-recognised and can be “extremely debilitating”. 

NICE have published cautious recommendations that do not endorse widespread UK NHS access to liposuction for lipoedema at this time.  They want to see more published evidence first into longer term improvements to quality of life, how different patients’ outcomes vary etc.   NICE have recognised and reinforced that lipoedema is different to obesity and lymphoedema, and that limited NHS treatments are currently available.  The people we have worked with at NICE appreciate the need for better NHS lipoedema treatment and Lipoedema UK will continue to keep NICE informed of any new research developments 

Our surveys and case studies tell us how hard it has been for some people to fund their surgeries, and how much they can improve quality of life, so we continue to campaign for NHS liposuction provision.   NICE have agreed they will review their guidance again after the publication of a current German lipoedema liposuction study in the next couple of years.    

As we write this, some doctors in the UK are in discussions with their insurers and/or the clinics where they perform liposuction, to understand the impact of the NICE review on their practices and if they will need to make any changes; at the time we are writing this is still being worked out and we are in communication with them.

What exactly did NICE say?

NICE classify their recommendations into four types, based on risk reduction: 

• Standard Arrangements.  NICE consider there to be enough evidence for doctors to offer this procedure
• Special Arrangements.  NICE consider there to be uncertainties about the safety and effectiveness about a procedure, resulting in an increased focus on informed consent and collecting data on surgical outcomes
• Only In Research.  NICE consider there to be unresolved uncertainties or that a procedure is still considered experimental, so they recommend clinicians only carry out the procedure in formal research studies which were approved by ethics committees.  
• Do Not Use. Where NICE think there is either evidence that a procedure does not work well or has unacceptable safety risks.  

The guidelines on liposuction for lipoedema have been classified by NICE as Only In Research.  They want to see more research into patient selection and outcomes (eg age and severity of lipoedema before surgery), longer term improvements to quality of life and measureable outcomes including changes to weight.  

Thank you to everyone who completed our 2021 Survey Living with Lipoedema, Liposuction and other Treatments. We had an overwhelming response from 933 patients with Lipoedema.  

The 756 responses to our survey who said they lived in Great Britain and Northern Ireland provided the data for Lipoedema UK’s response to NICE below. 

Click on the front page below to download the full report.