Table 3. Overview of liposuction techniques in included studies.

Study ID	Number of treatment sessions, SD	Volume of fat removed per sessions (mL), SD	Use of compression garments	Injection technique and protocol	Follow-up duration (months)
Cornely and Gensior, 2022 19	3 procedures at intervals of no less than 4 weeks	–	• Modified CDT involves accentuated manual lymphatic drainage with compression and physical treatment • Postoperatively, the treatment lasts for 4 weeks • Initially, four AMLD sessions are performed per week, gradually reducing to one session per week	• Tumescent local anesthesia is commonly administered with analgesia or general anesthesia • Power-assisted liposuction employs a motor-driven suction system to aid in the suction process • To facilitate proper drainage, incisions made during the procedure are intentionally left open without suturing	NM
Kruppa et al, 2022 5	3 (2–3)	6,355 ± 2,797	Yes	• General anesthesia was used with 24-hour postoperative monitoring • Power-assisted or water jet-assisted liposuction techniques were employed, using a tumescent solution of saline and epinephrine, up to 6,000 mL per session. The surgical goal often involved megaliposuction, targeting approximately 6% of body weight in fat removal • Intraoperative “pinch test” determined the amount of lipoaspirate; postsurgery, a single dose of antibiotic prophylaxis was administered and hemoglobin and serum electrolytes were checked on the first day	20
Wright and Herbst, 2022 21	1	Case 1: 6,000 mL in one session Case 3: first session (arms, calves to ankles = 6,000 mL) second session (inner and anterior thighs, hips, and knees = 7,200 mL) 3rd session (knees, lower posterior thighs, and ankles = 1,800 mL)	Yes	• Case 1: Underwent ultrasound-assisted liposuction with 6 L of aspirate removed from arms and legs under general anesthesia • Case 2: Treated with power-assisted liposuction on hips and thighs under general anesthesia • Case 3: Received three water-assisted liposuction surgeries, totaling 13,050 mL of aspirate removal, with focus on arms, calves, thighs, hips, and knees	Case 1: 12 Case 2 and 3: 6
Baumgartner et al, 2020 22	NM	NM	Yes	NM	4, 8, and 12 years
Sandhofer et al, 2021 23	–	5,585	No	Tumescent fluid injection technique • Freshly prepared tumescent fluid heated to 37 °C was used • Two people simultaneously introduced the fluid under pressure using a KMI Surgical Infusion/Irrigation Pump • Infiltration cannulas were wiped toward the upper layers until the tissue became firm, indicating tumescence • “Vivomed infiltration needles 1.2 × 100 mm” were used Liposuction technique • The PAL liposuction system from MicroAire was utilized • Cannulas with a diameter of 3 to 4 mm were inserted through small incisions • Attention was given to the position and course of lymphatic vessels • Minimal secondary infiltration was performed if the patient experienced pain using a blunt, 40-cm long infiltration cannula with a diameter of 2 mm	For 4, 8, 12, 16, 20, 28, and 44 hours after the procedure
Schlosshauer et al, 2021 24	2.9 ± 1.9	1,868.0 ± 885.5 per side	No	NM	6 months on 20 patients only out of 69
van de Pas et al, 2020 25	NM	NM	No	• Lymphoscintigraphy technique: Subcutaneous injection of 99mTc in the first web space, followed by sequential imaging over feet, knees, and inguinal regions. Used mean clearance percentages of radioactive protein and inguinal uptake percentages at 2 hours postinjection as functional parameters. Abnormal clearance defined as <30% (with <20% considered abnormal and 20–30% questionable), and disturbed inguinal uptake as <10% (with <5% abnormal and 5–10% questionable) • Tumescent liposuction protocol: Performed according to standard treatment by Klein, executed by an experienced professional specializing in lipoedema treatment for over 15 years
Witte et al, 2020 26	3 (1–4)	12,922 ± 2922 over the course of all operations	Preop: 60 Postop: 20	• Infiltration volume varied depending on the specific body area: 200–400 mL for the lower legs, 400–700 mL for the upper legs, and 200–300 mL for the upper limbs • The infiltration process had an approximate duration of 10 minutes	21.5
Bauer et al, 2019 27	3 ± 2	10,100 ± 9,600	Yes Preop: 163 Postop: 80	NM	12
Wollina and Heinig, 2019 28		4,700 ± 7,579	No	• Liposuction was performed using 2–3 mm blunt cannulas connected to a vacuum pump, generating a negative pressure of 686 mm Hg • General anesthesia was not utilized during the procedure • After the liposuction, the small 5-mm incisions were closed using polyamide sutures	2.0 ± 2.1, with follow-up duration between 5 and 7 years for 18 patients
Dadras et al, 2017 29	3	3,106	Yes	Tumescent liposuction was performed using a solution of saline with epinephrine (1:1,000,000) following the patient's consent	First postoperative follow-up: 16 Second postoperative follow-up: 37
Baumgartner et al, 2016 30	NM	NM	No	NM	48 and 96 months (4 and 8 years)
Rapprich et al, 2015 31	2.61 ± 1	NM	Yes (postoperative for 3–7 weeks)	• Sattler's method was used to infiltrate the tumescence solution • A continuously operating roller pump system aided in the infiltration process • Aspiration was performed using a blunt 4-mm-thick vibrating microcannula with three blunt openings	6 months
Wollina et al, 2014 32	5	4,000–6,000	Yes, postoperatively for 6 months	• Liposuction was performed using a 980-nm diode laser integrated into the cannula • Cannulas with diameters of 3 to 5 mm were utilized for the procedure • The cannulas were applied longitudinally, with smaller cannulas used for finer sculpting at the end	24–48 months (2–4 years)
Rapprich et al, 2011 33	2.5 ± 1.1	1,909 ± 874	Yes	• Vibrating cannulas with a 4-mm diameter and a handpiece attached (VibraSat®, Möller Medical, Fulda) were used • Aspiration was conducted using vibrating cannulas with three blunt openings at the tip arranged in a Mercedes star shape	6 months
Wollina et al, 2010 34	2	Case 1: 3,600 Case 2: 1,800	Yes, postsurgically for 6 months	• Liposuction was performed using blunt cannulas ranging from 2 to 5 mm in diameter • The cannulas were applied longitudinally during the procedure • Smaller cannulas were employed toward the end of the procedure for finer sculpting	Case 1: 6 Case 2: 48
Stutz and Krahl, 2009 35	NM	1,115 ± 554	No	• Infiltration was performed in all cases using a body-jet infiltration cannula (diameter = 3.5 mm) at Range 2 until sufficient anesthesia was achieved with the infiltration solution • The aspiration procedure commenced immediately without waiting for fluid infiltration	NM
Schmeller and Meier-Vollarth, 2006 36	NM	3,017	No	• All liposuction procedures were conducted under local tumescent anesthesia • The administration of intramuscular Demerol (35–100 mg), Vistaril (25 mg), and Versed (5 mg) preceded the procedure • The amount of aspirate was limited to less than 5 L • Tumescent anesthesia included 1 L of normal saline solution, 1 mL of 1:1,000 epinephrine, 50 or 75 mL of 1% lidocaine, and 12.5 mL of 8.4% sodium bicarbonate • The procedures utilized either Xomed or MicroAire power cannulas • Initially, accelerator and Mercedes-type cannulas ranging from 3.0 to 4.0 mm were used to treat all areas • Final contouring was accomplished using cannulas ranging from 2.0 to 2.5 mm	12.2 (1–26) months
Schmeller et al, 2012 37	NM	3,077	No	• Liposuction was performed on the legs, hips, and arms of each patient • Pure tumescent local anesthesia was administered for the procedure • Blunt vibrating microcannulas with diameters of 3 and 4 mm were used • The liposuction technique employed was power-assisted liposuction	NM
Herbst et al, 2021 38	2.4 ± 1.3	NM	No	NM	NM

Abbreviations: AMLD, accentuated manual lymphatic drainage; CDT, complex decongestive therapy; LAL, laser-assisted liposuction; NM, not mentioned; PAL, power-assisted liposuction; SD, standard deviation; TL, tumescent liposuction; TLA, tumescent local anesthesia; UAL, ultrasound-assisted liposuction; WAL, water-assisted liposuction.