Mr Karri’s response to the NICE guidance on lipoedema liposuction

You may be aware that the National Institute for Health and Care Excellence (NICE) has provided guidance on lipoedema liposuction. This was published on 29th March 2022.

For those who are unfamiliar with NICE, they are an organisation funded by and accountable to the Department of Health and Social Care. They provide technology appraisals, clinical guidance and quality standards on treatments and care.

I am aware some lipoedema sufferers are under the impression the NICE guidance has resulted in a ban of lipoedema liposuction.
This is not correct.

The purpose of this letter is to highlight important aspects of the guidance and to explain how my clinical practice follows the guidance.

The NICE guidance does not affect my practice and I will continue to perform lipoedema liposuction.

NICE guidance

My actions

[the guidance] does not override clinical judgement. It is not therefore a ban on all liposuction for lipoedema procedures. It has always been my position that the guidance is only guidance and clinical judgement takes precedence.
This procedure [liposuction for chronic lipoedema] should only be used in the context of research. My lipoedema patients will be invited to participate in a clinical outcome study on lipoedema liposuction. Inclusion in the study will be entirely voluntary and patients can still have surgery even if they refuse participation in the study.
Patient selection should be done by a multidisciplinary team, including clinicians with expertise in managing lipoedema. Prior to surgery, patients will be discussed by our multidisciplinary team that comprises myself, an anaesthetist, a specialist lipoedema nurse and counsellor (for selected patients).
The procedure should only be done in specialist centres by surgeons experienced in this procedure. I will continue to perform lipoedema liposuction at Kinvara Private Hospital and The Karri Clinic. Both facilities are appropriately suited for lipoedema surgery.
Having performed lipoedema liposuction for the past 8 years and not had a single major complication, I consider myself experienced in lipoedema liposuction.
The committee encourages the creation of a registry for all patients having liposuction for chronic lipoedema to support research. British Association of Plastic, Reconstructive & Aesthetic Surgeons (BAPRAS) are creating a registry and I will submit my data to it when invited.

The NICE guidance is a positive step forward and will hopefully advance our understanding of the benefits of the surgery and ensure surgery is performed in a safe manner.

As a lipoedema surgeon, I have seen first-hand the huge benefits of surgery for this under-recognised and debilitating condition.

I look forward to publishing my data on lipoedema liposuction in due course.

Mr Vasu Karri BSc(Hons), MBBS, MSc, FRCS(Plast)
Consultant Plastic Surgeon