Abstract
Water jet-assisted liposuction or water-assisted liposuction (WAL) is one of device-assisted liposuction characterized by water-jet force. WAL offers clinical benefits in decreasing operating time, postoperative swelling, ecchymosis, and pain. The device, operation modes, and techniques of WAL are illustrated in this chapter. In addition, published clinical studies support the high quality of transferrable fat using the LipoCollector system and BEAULI method.
12 Water-Assisted Liposuction
Key Points
WAL channels a fan-shaped water jet into adipose tissue to loosen the fatty layer and preserve vital structures.
The lipoaspirates obtained from WAL can be used for autologous fat transplantation immediately at the same surgical procedure.
WAL is superior to traditional manual tumescent liposuction in terms of decreasing operating time, postoperative swelling, ecchymosis, and pain.
12.1 Introduction
WAL has been in development since 2000. Inspired by water jet-assisted surgery, WAL is known for preservation of vessels, nerves, and surrounding connective tissue. 1 The German plastic surgeon Ahmed Ziah Taufig was involved in the early development of WAL. 2 The commercial WAL, Body-Jet (Human Med AG, Schwerin, Germany), came to the market in 2004. WAL can be done under local anesthesia, intravenous anesthesia, or general anesthesia. It uses a fan-shaped liquid jet with adjustable pressures to decompose the fat tissue into fragments. 2 The fragmented fat tissue can be suctioned off from the same cannula and then be collected in a lipocollector. 3
12.2 Patient Selection
The patient selection is as important as any other surgery procedure.
12.2.1 Indications
12.2.2 Contraindications
Heavy smoker.
Diabetes mellitus without control.
Severe coagulation disorders.
Unrealistic expectations.
12.3 Technique
WAL incorporates a dual-chambered cannula that simultaneously emits fan-shaped jets of tumescent solution and removes fatty tissue with the infiltrated subcutaneous fluid. The advantage of water-jet dissection is the preservation of vessels and nerves. According to one study on the abdominal fat tissue of fresh cadavers, the optimal pressure for water-jet dissection of fatty tissue lies between 30 and 40 Bar. 1
12.3.1 Device
Functional Elements (▶Fig. 12.1)
Rack with hooks and weighing system is used to hold the fluid bags. Each hook carries one fluid bag.
Swivel lever is used to fold the rack down for transportation.
Touch screen is used for operating the device.
Suction container includes suction bags with angle connector. There are two identical suction containers on the Body-Jet to house the disposable suction bags.
These are inserted into the suction containers and are used for collection of the excessive aspirate.
Control Panel for Device Operation (▶Fig. 12.2)
Touch-screen is used for operating the device.
Display of the operational state of the device.
‘Stop’ key is used for immediate deactivation of the water, jet generation, and the suctioning in case of hazardous or error situations.
Keys for selection of the suction container.
Cannulas
Infiltration Cannulas (▶Fig. 12.3)
Infiltration cannulas are used to preinfiltrate the suction area with tumescent solution for anesthesia and vasoconstriction. They have no side holes in order to avoid reflux of fluid. The spray-jet is pointing upwards.
Standard WAL Cannulas (▶Fig. 12.4)
Standard WAL cannulas come in four diameters (3.5 mm, 3.8 mm, 4.2 mm, 4.8 mm) and three lengths (15 cm, 25 cm, 30 cm). They have four suction holes. The spray-jet is pointing upwards.
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