The pre-tibial fat pad in lipoedema develops as a localised, symmetrical thickening of fatty tissue directly over the tibia, creating a convex or pillow-like appearance on the front of the lower leg. This area is especially painful because the fat presses against the unyielding bone beneath, and even light bumps cause large bruises due to fragile vessels.

Water-assisted liposuction is ideal here because the anterior lower leg has very little loose tissue and a high concentration of lymphatics; the gentle water jet loosens only the abnormal fat without damaging the overlying skin or deeper structures. Mr Vasu Karri uses fine cannulae and low-pressure settings to achieve smooth flattening while preserving the natural hollowing along the tibial crest.

Patients typically see a dramatic change in shin profile, with the bone becoming visible again and pressure symptoms disappearing almost immediately. Combining this with calf or full lower limb treatment in the same or staged sessions is common for balanced results.

The benefits of this procedure include:

• Removal of painful pre-tibial fat pad and restoration of visible shin bone
• Elimination of pressure and tenderness when kneeling or wearing boots
• Smoother, flatter anterior lower leg contour
• Significant reduction in bruising over the shins
• Improved comfort and appearance in fitted trousers or leggings