the studies of highest quality involve tumescent or super tumescent anesthesia and vibrating liposuction, powered, cannula used with lymph sparing techniques. the treatment of lipedema with tumescent liposuction requires multiple procedures. in the united states health insurance do not generally pay for liposuction for lipedema, making it expensive. liposuction under general anesthesia, without tumescent anesthesia, can be damaging and is not recommended for the treatment. however, wal liposuction is an exception. water assisted liposuction developed by doctor ziah taufig from germany is usually performed under general anesthesia and is considered to be lymphsparing and protective of other tissues such bloodvessels for instance.