Treatment of insulin-induced skin lipohypertrophy: Costs and sustainability of liposuction and education

In the last decade, numerous studies concerning insulin-induced skin lipohypertrophy (LH) were published, mainly addressing epidemiological aspects or presenting case series without placing a focus on LH treatment, among which only a small series (34 cases) has recommended liposuction as LH treatment, albeit not in adherence with the latest American Diabetes Association guidelines. The cost of liposuction, which constitutes a huge financial burden to patients rather than insurance companies or the National Health System (NHS), varies within the range of 1000 – 8000 € with the technique used and the extent and texture of altered skin areas. Primary and secondary prevention through structured educational activities on correct injection techniques with periodic reminders seems to be the only genuinely effective large-scale solution against LH at a much lower, fully NHS-reimbursed cost at 60 € for two annual five-session cycles. However, more research findings, from the angle of esthetic medicine, in support of liposuction as a viable therapeutic solution for LH patients are warranted.