Water Jet-assisted Liposuction Research Articles

Хирургическая реабилитация больных с постмастэктомической лимфедемой верхней конечности

This study highlights the key aspects of the diagnosis of postmastectomy edema of the upper limb. Clinical examination that allows the diagnosis of lymphedema with a high degree of accuracy should be enhanced with lymphoscintigraphy and fluorescent lymphography to establish the diagnosis and predict the outcome of potential surgical intervention. We share our experience with lymphography in women with breast cancer and upper limb postmastectomy edema and various surgical interventions for lymphedema. In stage 2 lymphedema and ineffective therapy, microsurgical intervention (lymphovenous anastomosis) should be performed if indicated on the basis of lymphoscintigraphy and/ or fluorescent lymphography. Upper limb liposuction is recommended in stage 3–4 lymphedema and ineffective conservative treatment or lack of stable results. Water-jet assisted liposuction has established its efficacy based on the data of various authors and our findings, i.e., lymphedema reduced by 70–100% over 1–5 years of follow-up. KEYWORDS: breast cancer, lymphedema, water-jet assisted liposuction, long-term outcomes, lymphatic outflow patterns. FOR CITATION: Ermoshchenkova M.V., Myasnikova M.O., Zikiryakhodzhaev A.D., Galkin V.N., Startseva O.I., Reshetov I.V., Berestok T.S. Surgical rehabilitation of women with upper limb postmastectomy lymphedema. Russian Medical Inquiry. 2023;7(6):372–382 (in Russ.). DOI: 10.32364/2587-6821-2023-7-6-6.

Combining reconstructive and ablative surgical treatment of chronic breast cancer-related lymphedema (BCRL): safe and effective

PurposeWe investigated whether a one-stage combination of vascularized lymph node transfer (VLNT) with water jet-assisted liposuction (WAL) can be safely performed and results in improved patient outcomes such as a greater reduction in arm volume when treating chronic breast cancer-related lymphedema (BCRL).MethodsIn this retrospective cohort study, we included all patients from our encrypted lymphedema database treated for chronic BCRL with VLNT or VLNT + WAL who had a minimum follow-up of two years. We analyzed patient-specific variables including arm circumferences as well as patient-reported outcomes before and after surgery as well as surgery time, surgery-related complications and patient satisfaction.ResultsOnly the mean preoperative differences of the circumferences between the lymphedematous and the unaffected arm in individual patients showed a statistically significant difference between treatment groups (p < 0.05). Indeed, patients treated with VLNT + WAL had consistently larger differences in individual sets of arms and therefore more pronounced chronic BCRL. The mean surgery time was significantly longer in the VLNT + WAL group (p < 0.05). Complications were seldom and similar in both groups. Using a numeric rating scale, the level of patient satisfaction following treatment did not differ significantly between groups (p = 0.323).ConclusionsOur findings suggest that a one-stage combination of VLNT with WAL does not result in more complications even though it also entails a longer surgery time. This is acceptable as secondary interventions resulting in overall longer surgery times and higher costs can be avoided. A one-stage combination might be especially favourable for patients suffering from more severe chronic BCRL.

Water jet-assisted lipoaspiration and Sepax cell separation system for the isolation of adipose stem cells with high adipogenic potential

Water jet-assisted liposuction has gained popularity due to favourable fat grafting outcomes. In this study, we compared stem cells obtained from fat isolated with manual or the water jet-assisted procedure. Liposuction of abdominal fat was performed using the two methods on each donor (n = 10). Aspirate samples were collagenase digested and the isolated cells seeded in vitro prior to proliferation, adipogenic differentiation and angiogenic activity analyses. Cells from either procedure proliferated at similar rates and exhibited a similar colony-forming ability. The cells expressed stem cell markers CD73, CD90 and CD105. In the water jet cell preparations, there were higher numbers of cells expressing CD146. Robust adipogenic differentiation was observed in cultures expanded from both manual and water jet lipoaspirates. Gene analysis showed higher expression of the adipocyte markers aP2 and GLUT4 in the adipocyte-differentiated water jet cell preparations, and ELISA indicated increased secretion of adiponectin from these cells. Both cell groups expressed vasculogenic factors and the water jet cells promoted the highest levels of in vitro angiogenesis. Given these positive results, we further characterised the water jet cells when prepared using an automated closed cell processing unit, the Sepax-2 system (Cytiva). The growth and stem cell properties of the Sepax-processed cells were similar to the standard centrifugation protocol, but there was evidence for greater adipogenic differentiation in the Sepax-processed cells. Water jet lipoaspirates yield cells with high adipogenic potential and angiogenic activity, which may be beneficial for use in cell-assisted lipotransfers.

Facial Rejuvenation with Concentrated Lipograft-A 12 Month Follow-Up Study.

Lipofilling is a popular technique to treat volume loss in aging patients. The isolated adipose tissue is composed of adipocytes and stromal vascular fraction cells, which include adipose-derived stem cells (ASC). We hypothesize that the patient’s wrinkle severity scale (WSS) and patient’s satisfaction on the global aesthetic improvement scale (GAIS) can be improved after using concentrated lipoaspirate. Fourteen patients (54 years ± 11.09 years) with volume loss in the midface area underwent waterjet-assisted liposuction (Human Med AG, Schwerin, Germany). Fat was centrifuged in an ACP Double Syringe (Arthrex GmbH, Munich, Germany) using Rotofix 32A centrifuge (Andreas Hettich, GmbH & Co.KG, Tuttlingen, Germany). Homogenization was performed using the double syringe and a 1.4 mm female–female luerlock connector. After a second centrifugation, patients received periorbital (PO) and nasolabial (NL) lipografting. ASC count was performed after enzymatical digestion. Vitality of cells was assessed using a resazurin assay. During long-term follow up (12 months, n = 10), we found a high patient’s satisfaction (GAIS 1+/−0.52) and a good improvement of the WSS during short- and long-term follow-up. The ASC count of processed lipoaspirate was 2.1-fold higher than of unprocessed lipoaspirate (p < 0.001). The difference of ASC in sedimented and simply centrifuged lipoaspirate was also significant (p < 0.05). Facial rejuvenation with concentrated fat graft offers good results concerning objective aesthetic outcome and patient’s satisfaction.

Shear Force Processing of Lipoaspirates for Stem Cell Enrichment Does Not Affect Secretome of Human Cells Detected by Mass Spectrometry In Vitro.

Lipofilling is one of the most often performed surgical procedures in plastic and reconstructive surgery. Lipoaspirates provide a ready source of stem cells and secreted factors that contribute to neoangiogenesis and fat graft survival. However, the regulations about the enrichment of these beneficial cells and factors are ambiguous. In this study, the authors tested whether a combination of centrifugation and homogenization allowed the enrichment of viable stem cells in lipoaspirates through the selective removal of tumescent solution, blood, and released lipids without significantly affecting the cell secretome. Human lipoaspirate was harvested from six different patients using water jet-assisted liposuction. Lipoaspirate was homogenized by first centrifugation (3584 rpm for 2 minutes), shear strain (10 times intersyringe processing), and second centrifugation (3584 rpm for 2 minutes). Stem cell enrichment was shown by cell counting after stem cell isolation. Lipoaspirate from different processing steps (unprocessed, after first centrifugation, after homogenization, after second centrifugation) was incubated in serum-free cell culture medium for mass spectrometric analysis of secreted proteins. Lipoaspirate homogenization leads to a significant 2.6 ± 1.75-fold enrichment attributable to volume reduction without reducing the viability of the stem cells. Protein composition of the secretome did not change significantly after tissue homogenization. Considering the enrichment effects, there were no significant differences in the protein concentration of the 83 proteins found in all processing steps. Stem cells can be enriched mechanically without significantly affecting the composition of secreted proteins. Shear-assisted enrichment of lipoaspirate constitutes no substantial manipulation of the cells' secretome.

Influence of varying intensities of water-jet force on autologous fat draft viability: an in-vitro study

Objective To observe the effect of varying intensities of water-jet force on autologous fat graft viability. Methods Lipoaspirate was taken from 12 female patients undergoing water-jet assisted abdominal liposuction at our department. According to the intensity of water-jet force, the experimental group was divided into four subgroups: R1 (pressure, 30 bar), R2 (pressure, 50 bar), R3 (pressure, 70 bar) and R4 (pressure, 90 bar). Hand-held suction was taken as the control group C. Adipose tissue was filtered with cotton cushion and centrifuged at low speed, and the composition ratio of water and fat tissue from each group was observed. Calcein-AM/Hoechst 33342 staining was used to detect the viability of adipocytes. Results Fat aspirates was divided into four layers: oil layer, pure fat tissue, liquid and bottom sediment. Oil ratios of R1, R2, R3, R4 and C were (8.9±2.3)%, (9.6±2.1)%, (10.3±1.3)%, (14.2±1.6)% and (9.5±1.8)%, respectively. There was no statistically significant difference between R1, R2, R3 and C (P>0. 05). Statistically significant difference was found between R4 and other groups (P 0.05). Statistically significant difference was found between R3, R4 and C (P<0.05). Conclusions Viability of fat graft harvested under lower intensity of water-jet force (R1, R2) is higher than that harvested under higher intensity of water-jet force (R3, R4). Key words: Breast Beauty; Transplantation; Abdominal fat; Water-jet system; Calcein-AM/Hoechst 33342 staining; Intensity of water-jet force

3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia.

Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume. To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume. Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System® before and 6months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume. When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4mL) showed significant differences (p < 0.001) 6months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5mL) and after (120 ± 34.6mL) centrifugation. Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic gynecomastia. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical application and effects of two different liposuction methods in breast augmentation by autologous fat grafting

Objective To explore the effect of different harvest methods of liposuction on the autologous fat grafting. Methods The clinical data of 60 patients with fat grafting for breast augmentation from January 2014 to January 2017 were analyzed retrospectively. According to the method of liposuction, 60 patients were divided into the water-jet assisted liposuction group (30 cases) and negative-pressure machine liposuction group (30 cases). The surgical time of different liposuctions and the fat survival were compared after breast augmentation. The clinical effect of different liposuction methods was analyzed by follow-up one year after operation. Results Sixty patients completed the surgery. The fat survival rate of water-jet assisted liposuction was (66.71±2.68)%, and the fat survival rate of the negative-pressure machine liposuction was (51.44±1.16)%. There were statistically significant difference between the two groups (P 0.05). Conclusions Compared with negative pressure liposuction, water-jet assisted liposuction using autologous fat grafting in breast augmentation can improve the survival rate of fat transplantation. This technique has good clinical application value. Key words: Transplantation, autologous; Fats; Breast; Negative-pressure liposuction; Water-jet assisted liposuction

The liquid facelift: First hands-on experience with facial water jet-assisted liposuction as an additive technique for rhytidectomy – a case series of 25 patients

Recently, water jet-assisted liposuction (WAL) was successfully applied by several other authors to remove fat and induce skin contraction in nonfacial body areas. Extending the range of indications for this new method, the authors of this article report on their first experience with its use in facial contouring, fat harvesting, and hydrodissection of the facial skin flap in rhytidectomy in a case series of 25 patients. Twenty-five patients (median age: 56 years) had facelift surgery under sedation, and the WAL technique was used for facial contouring, fat harvesting for facial lipotransfer, and hydrodissection of the facial skin flap. Patients were monitored for discomfort during the procedure. Complications such as bleeding, postoperative swelling, and hematoma formation were observed during a 1-week follow-up period, and intensity was rated by two independent surgeons using a special grading system. Furthermore, a patient survey (FACE-Q) was performed to analyze the patients' satisfaction and perception of the postsurgical esthetic results. The WAL technique can be applied under intravenous sedation without causing any discomfort in all treated patients [mean 1.16, standard deviation (SD) 0.31]. Intraoperative bleeding during WAL-assisted facial dissection was judged as not present at all times (mean 1.3, SD 0.32). Postoperative swelling (day 1: mean 1.82, SD 0.28; day 7: mean 1.18, SD 0.28) and hematoma formation following surgery (day 1: mean 1.58, SD 0.34; day 7: mean 1.18, SD 0.31) were judged as minor in all cases. Overall, no skin necrosis was detected. There was no need for revision surgery. More than half of our treated patients (n = 13) answered the FACE-Q questionnaire, verifying a high satisfaction rate with beneficial treatment results without the occurrence of any major complications. The WAL technique seems to offer a safe and efficient treatment approach for facial contouring, facial fat harvesting, and simultaneous facial flap hydrodissection with only minor postoperative swelling and hematoma formation. Therefore, the authors believe that the WAL technique is a powerful and useful tool and should be used in modern facial plastic surgery.

The Collection of Adipose Derived Stem Cells using Water-Jet Assisted Lipoplasty for their Use in Plastic and Reconstructive Surgery: A Preliminary Study.

The graft of autologous fat for the augmentation of soft tissue is a common practice frequently used in the field of plastic and reconstructive surgery. In addition, the presence of adipose derived stem cells (ASCs) in adipose tissue stimulates the regeneration of tissue in which it is applied after the autologous fat grafting improving the final clinical results. Due to these characteristics, there is an increasing interest in the use of ASCs for the treatment of several clinical conditions. As a consequence, the use of clean room environment is required for the production of cell-based therapies. The present study is aimed to describe the biological properties of adipose tissue and cells derived from it cultured in vitro in clean room environment according to current regulation. The collection of adipose tissue was performed using the water–jet assisted liposuction in order to preserve an high cell viability increasing their chances of future use for different clinical application in the field of plastic and reconstructive surgery.

Fat Grafting with Tissue Liquefaction Technology as an Adjunct to Breast Reconstruction.

BackgroundTissue liquefaction technology (TLT) delivers warmed saline from the liposuction cannula tip at low pressure pulses to disaggregate adipocytes. This technology differs significantly from that used in other liposuction devices including water jet-assisted liposuction. Here we introduce our early experience with this technology in the setting of fat transfer for revision breast reconstruction.MethodsA retrospective chart review of 136 consecutive patients who underwent fat harvest with TLT and subsequent transfer into 237 breast reconstructions was conducted at a single institution. This two-surgeon series examined donor and recipient site complication rates over a median follow-up of 143 days [87–233].ResultsThe overall complication rate was 28.7 %, of which the majority (22.1 %) was fat necrosis at the recipient site as documented by any clinical, imaging, or pathologic evidence. The abdomen served as the donor site for half of the cases. Donor site complications were limited to widespread ecchymosis of the donor site notable in 10.4 % of cases. Twenty-five percent of patients had received postmastectomy radiotherapy prior to fat transfer. Prior to revision with fat transfer, implant-based breast reconstruction was used in 75.5 % of cases, and autologous flaps in the remainder. Fat transfer was combined with other reconstructive procedures 94.1 % of the time.ConclusionsTLT can be used to harvest adipocytes for fat transfer with donor site morbidity and recipient site complications comparable to other modalities. The efficiency and quality of harvested fat makes this technology appealing for wide spread adoption during fat transfer.Level of Evidence IVThis journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Cytokine-Rich Adipose Tissue Extract Production from Water-Assisted Lipoaspirate: Methodology for Clinical Use

Proper functioning wound healing strategies are sparse. Adequate vascular formation to the injured area, as well as replacement of the volume loss, is fundamental in soft tissue repair. Tissue engineering strategies have been proposed for the treatment of these injury sites. Novel cell-free substance, human adipose tissue extract (ATE), has been previously shown to induce in vitro angiogenesis and adipogenesis and in vivo soft tissue formation. This study reports the translation of ATE preparation from laboratory to the operating room (OR). ATE samples for this study were derived from adipose tissue obtained with the water-jet assisted liposuction technique from 27 healthy patients. The variables studied included incubation time (15, 30, and 45 min), temperature (room temperature vs. 37°C), and filter type to determine the optimal method yielding the most consistent total protein content, as well as consistent and high expression of adipose-derived growth factors and cytokines, including: vascular endothelial growth factor, basic fibroblast growth factor, interleukin-6, adiponectin, leptin, and insulin-like growth factor. Following the optimization, samples were produced in the OR and tested for their sterility. No significant differences were observed when comparing extract incubation time points or incubation temperature. Nonetheless, when studying the different filter types used, a syringe filter with PES membrane with larger filter area showed significantly higher protein concentration (p ≤ 0.018). When studying the different growth factor concentrations, ELISA results showed less variation in cytokine concentrations in the OR samples with the optimized protocol. All of the OR samples were tested sterile. The devised protocol is an easy and reproducible OR-ready method for ATE generation. As an attractive source of growth factors, ATE is a promising alternative in the vast field of tissue engineering. Its clinical applications include volume replacement as a complement to fillers and improvement of the permanence of fat grafts and wound healing, among other bioactive functions.

Breast Augmentation by Water-Jet Assisted Autologous Fat Grafting: A Report of 300 Operations

Background The BEAULI -method (Breast Augmentation by Lipotransfer) is available for extraction and processing of large transplantable fat quantities. The aim of this work is to describe the surgical technique precisely and reproducibly and to provide an overview of the autologous fat transfer based on surgical experience. Method The author performed 300 autologous fat transplantations on 254 women between September 3, 2010, and May 13, 2015. Patients desiring moderate volume increase, fuller and firmer breasts, as well as an optimization of the silhouette, ideally with the concurrent desire of the correction of unwanted fat deposits, were selected. The fat was extracted via water-jet assisted liposuction (Body-jet, Human Med AG, Schwerin, Germany), and the fat cells were subsequently separated with the Lipocollector ® (Human Med AG, Schwerin, Germany). Results The results were assessed with a control exam and photo comparison and were based on the responses on a questionnaire. Overall, 35.9% of the patients defined the result as very good, 38.6% as good, 22.4% as satisfactory, and 3.1% as poor. Conclusion This study shows that the autologous fat cell transplantation into the female breast via water-jet assisted liposuction achieves a moderate and harmoniously appearing breast volume enlargement as well as contour improvement. Further studies with more cases and longer observation periods over several years could contribute to improving the method of the autologous fat transfer regarding the grow-in rate, efficiency, and safety.

Enrichment with Adipose-Derived Stem Cells Does Not Enhance Water-Jet Fat Graft Survival in the Breast—A Prospective Comparative Study

Objective: Although research increasingly underlines the theoretical importance of adipose-derived stem cells (ASC) for successful fat transplantation, we could not prove this notion in cosmetic breast augmentation. Stem-cell-enriched breast fat transplantation did not yield better results than grafting based on the WAL (water-jet assisted liposuction) technique in terms of volume persistence. To overcome inter-individual variation, intra-individual comparison was performed. Material and Methods: Four women underwent breast augmentation utilizing WAL fat transplantation with and without ex-vivo ASC isolation performed with the Multistation System. All patients underwent two fat transplantations for breast augmentation. In the first procedure, the left breast was augmented with stem-cell-enriched fat grafts and the right with plain WAL fat grafts. In the second surgery, the lipofilling was performed the other way round to exclude intra-individual differences in fat cell persistence. Results: MRI volumetry revealed a mean volume survival of 56% of the whole (watery) graft in the breasts with WAL only and 56% in the breasts with WAL and stem cell enrichment. While centrifugation of the WAL grafts demonstrated an average adipose content of 68%, the average volume survival of the adipose tissue itself was 83% in the breasts augmented with WAL only and 83% in those with WAL with stem cell enrichment. Conclusion: Breast augmentation by means of lipofilling using WAL alone is faster and more inexpensive, carrying a lower risk of contamination and offering an equal take rate. We do not see any advantage in stem-cell-enrichment in cosmetic fat transplantation to the breast.

Lipofilling (fat grafting) in the secondary prevention of ischial tuberosity and pelvic pressure ulcers.

Retrospective study. Lipofilling was proposed to adult chronic spinal cord injury patients with history of ischial tuberosity pressure ulcers surgery, at risk of recurrence of pressure ulcers due to unsatisfactory adipose tissue thickness. Fondation Hopale, Berck, France. The three staged (Coleman) procedure for fat grafting consisted of water-jet assisted liposuction (Harvest-Jet), decantation, and reinjection of the autologous fat in three-dimensional plan. Ten consecutive patients (eight paraplegics and two tetraplegics) benefited from bilateral ischial lipofilling, with additional lipofilling of the sacrum (three patients) and the trochanters (two patients). All patients attended the seating clinic with pressure mapping before and after lipofilling for appropriate cushion prescription. Mean follow-up time was 16 months (4-24 months). Complications were limited to stage I (two patients) and stage II (one patient) pressure ulcers, due to negligence. Excellent results with minimal fat wasting (between 10% and 25%) underneath the ischial tuberosity were seen in eight patients, with significant improvement of adipose tissue thickness. Total fat waste was seen in two patients, one of whom following dramatic weight loss. Results were always good in the sacrum and trochanteric areas. Lipofilling allowed longer sitting times (three patients), improved skin quality (nine patients), improved quality of life (six patients), 'a better feeling of positioning in their wheelchair' (four patients), and decrease in pelvic pain (three patients). Pelvic lipofilling is safe, cost-effective, and can now be considered in the primary prevention of pelvic pressure ulcers in patients with insufficient adipose tissue.

Commentary on: isolation and differentiation potential of human mesenchymal stem cells from adipose tissue harvested by water jet-assisted liposuction.

In this article, Meyer et al examine the yield of mesenchymal stem cells (MCSs) with water jet-assisted liposuction (WAL).1 WAL uses simultaneous infiltration and suction to dissect and extract fat during liposuction. Using water to dissect tissues is an idea that evolved in the last century and was later geared towards the dissection of fat in 2001.2 Since that time, a number of studies have suggested advantages to the use of WAL, including decreased pain, decreased intraoperative swelling, better contouring, and decreased need for anesthesia.3-5 The gentle nature of WAL has been utilized in the treatment of lipoedema, where clinicians noted that this aspiration method may induce less trauma to lymphatics.6 With the evolution of fat grafting, the utility of WAL for fat harvest has been explored.5 Harvest method can certainly impact graft …

Application of water jet-assisted liposuction in augmentation mammoplasty with autologous fat graft

Objective To investigate the clinical value of breast augmentation with autologous fat graft using water jet-assisted liposuction (WAL) technique. Methods From October 2010 to December 2012, 20 patients underwent Water Jet-Assisted Lipoplasty and breast augmentation with autologous fat tissue (average, 210 ml volume injected per breast). Pretreatment and posttreatment TN, bilateral SN and MP were measured, and the outcomes were statistically analysed using paired t test, combined with photos of pretreatment and posttreatment. Follow-up ranged from 3 months to 2 years. Results The results were satisfactory. All the patients got good shape of breasts. There was no infection in all the patients. TN and SN were signifigantly increased at 3 month after operation [(88.7±2.9) cm vs. (87.2±4.2) cm, P<0.01], [left (20.1±1.5) cm, right (20.1±1.5) cm, vs left (19.5±1.5) cm, right (19.5±1.6) cm, P<0.01]. MP was also increased compared with measurement of pre-operation [(4.6±0.4) cm vs. (4.2±0.9) cm, P<0.05]. Conclusions It is a good option to use water jet-assisted liposuction technique in the treatment of breast augmentation with autologous fat graft. Key words: Augmentation mammoplasty; Liposuction; Fat transfer, Autologous

Adipocyte and preadipocyte viability in autologous fat grafts: comparing the water jet-assisted liposuction (WAL) and Coleman techniques

Background Autologous fat transplantation is a promising technique for soft tissue augmentation. However, the long-term maintenance of fat grafts remains unpredictable. Based on Peer’s cell theory, techniques that cause less cellular damage will optimize graft integration. Water jet-assisted liposuction (WAL) was introduced as a gentle and efficient technique for harvesting a large volume of fat in a short period of time. In this study, we evaluated the viability and function of adipocytes and preadipocytes harvested using WAL and compared this with the Coleman technique.

Lipedema: A Clinical Challenge-revisited

Lipedema is a disfiguring disorder with abnormal and progressive deposition of adipose tissue in the hips and lower extremities almost exclusively occurring in women. There is a hereditary tendency and a substantial variability in disease severity. Lipedema is often misdiagnosed as lymphedema or morbid obesity. The etiology and pathogenesis are not understood. Early diagnosis and treatment are critical to minimize physical and psychological morbidity. The diagnosis is usually made by history and clinical examination. Non-invasive imaging techniques such as computed tomography or magnetic resonance can differentiate lipedema from other causes of edematous lower extremities. Lymphoscintigraphy may be helpful in cases which are associated with lymphedema (lipo-lymphedema). Management with manual lymphatic drainage and compression therapy are considered the most appropriate treatment. Use of conventional liposuction is controversial since it may further damage the lymphatic vessels. Newer techniques such as tumescent micro annular laser assisted liposuction and water jet-assisted liposuction have shown some promising results. Variety of other surgical procedures combined with manual lymphatic drainage and tailored post-surgical care are under investigation.

Does water-jet force make a difference in fat grafting? In vitro and in vivo evidence of improved lipoaspirate viability and fat graft survival.

Recent literature has revealed that water-jet-assisted liposuction offers a new method of conventional liposuction techniques by using the gentle spray of fluid. However, there has not yet been a systematic, randomized, controlled study to demonstrate its effect on the vitality and postoperative fat survival of fresh lipoaspirates. In this study, the authors compared liposuction with or without water-jet assistance in a blinded fashion. Human lipoaspirates were obtained from healthy Chinese female volunteers for body shaping. Lipoaspirates were harvested by a single surgeon using the same material and machine; water-jet assistance was the only variance in this study. At the beginning of surgery, the authors randomly performed conventional manual liposuction without water-jet assistance for one side to obtain 50 ml of lipoaspirate (group B). At the corresponding area of the other side, the authors used water-jet-assisted liposuction to obtain another 50 ml of lipoaspirate (group A). All of the harvested lipoaspirates were used in the in vitro and in vivo experiments to evaluate the effect of water-jet force on the vitality and postoperative fat survival of fresh lipoaspirates. Fresh lipoaspirates from group A had greater viability and a higher percentage of CD34/CD45 cells than group B. Grafted lipoaspirates in group A had better weight retention, less apoptosis, and greater angiogenesis. The fate of grafted lipoaspirates was affected by water-jet force. With the assistance of water-jet force during the harvesting procedure, the authors could obtain more viable lipoaspirates and achieve better fat survival.