This lady has significant problems with excess fat around her thighs. For early lipoedema liposuction can provide patients with an improvement in aesthetics and quality of life. This lady has had almost 6 liters of fat removed from her legs in one operation. There is a limit to how much fat can be removed in one sitting and often with substantial fat removal there can be associated fluid shifts and drops in haemaglobin. Water assisted liposuction is Mr Ross’s preferred technique and the fluid helps to reduce the bleeding and allows more fat to be harvested. Mr Ross advises patients to have this surgery under general anaesthetic and to stay in overnight to be monitored postop. It is important that patients undergo physio with manual lymphatic drainage and Mr Ross advocates the use of the lymphotouch device to help with the recovery. The results are seen at 6 weeks and there will still me some improvement over the coming months as the oedema continues to settle. There is a limit to how much fat can be removed and patients need to be aware that as they heal that the legs can be itchy afterwards.