I am now two years into exploring the benefits of lymph sparing liposuction for women suffering from lipedema. As a busy Fellowship trained Board-Certified Vascular Surgeon, I did not undertake this venture lightly. I have great respect for the German and American surgeons who have pioneered this field. Two years ago, I went to Germany and spent time with Dr. Stutz who practices the water assisted liposuction or WAL technique and Dr Rapprich who uses power assisted liposuction or PAL. I was lucky to have had a Johns Hopkins trained Plastic surgeon colleague who has offered advice and assistance with the first 25 surgical cases of PAL. I am now using WAL and see advantages of each.