Water Jet Assisted Liposuction Body Jet and Fat
Water Jet Assisted Liposuction (Body. Jet) and Fat Grafting LLC NIKE-MED Satellite Symposium Moscow - 13 th of December 2012 10/24/2021 BEAULI-Human. Med 1
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 3
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 4
Dr. Daniel Münch Liposuction since 1993 (5000 Op) Fat Transfer since 2010 (110 Op) liposuction. ch 10/24/2021 BEAULI-Human. Med 5
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 6
First Report on Fat Auto-Grafting in Humans in 1893 Gustav Adolf Neuber (1850 -1932) 10/24/2021 BEAULI-Human. Med 7
Meeting of the «Deutsche Gesellschaft für Chirurgie» , April 12 -15, 1893 10/24/2021 BEAULI-Human. Med 8
§ Holländer, 1910: Partial breast reconstruction through injection of autologous adipose tissue § Peer, 1950: Study of Loss of weigth and volume in human fat graft § After Introduction of liposuction: Fischer, Illouz, Fournier (1983): adipose tissue transplantation come into vogue 10/24/2021 BEAULI-Human. Med 9
Strong upswing in scientific investigation of autologous fat transfer with publications and research by Chajchir (1986, 1989), Coleman (1998, 2001), Delay (2005, 2009) and Rigotti (2008, 2009) Results depend essentially on the methode 10/24/2021 BEAULI-Human. Med 10
”…. structural fat grafting is going to revolutionize breast surgery and completely change the way plastic surgeons deal with the female breast. " -- Sydney Coleman, M. D. Original technique (Lipo. Structure) used by Coleman in bilateral breast enlargement took at least 5 – 7 h 10/24/2021 BEAULI-Human. Med 11
§ Coleman: Successfull transplant of fat is possible in principle § Problem: facility for harvesting large quantities in realistic surgery time 10/24/2021 BEAULI-Human. Med 12
WAL: Technique for cell friendly harvesting of fat cell particles which would reduce operation time and result in a high integration rate Reinjection of the fat after separation from superfluous water by means of the Lipo. Collector. R Water-Jet Assisted Liposuction (Body. Jet. R ) 10/24/2021 BEAULI-Human. Med 13
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 14
Fat Grafting Methode should be § § 10/24/2021 Clinically safe Easy to perform Fast to perform Render reproducible results BEAULI-Human. Med 15
Size of the fat droplets Blood supply 0 -300µm: survival 300 -550µm: regeneration ≥ 550µm: necrosis/cysts 10/24/2021 BEAULI-Human. Med 16
Fat droplets of until 1 mm diameter are save Survival max. 1 mm Regeneration 10/24/2021 BEAULI-Human. Med 17
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 18
Patient Selection Preliminary Consultation 10/24/2021 Great volume, desire absolute increase of cup size No fat transfer or implants Naturally improvement in breast size and breast form. Desire firmness and fullness, a better figure, a more female silhouette, a fuller decollete … Jet-Assisted Fat Transfer (J-AFT) BEAULI-Human. Med 19
Patient Selection Implant Great volume, desire absolute increase of cup size WAL Body. Jet/Lipocollector Naturally improvement in breast size and –form, desire firmness and fullness Foreign material equal No foreign material Heavy Smoker BMI ≤ 19 Dislike liposuction, Denial of multiple procedures 10/24/2021 No smoker BMI 19 - 30 Desire for liposuction benefit BEAULI-Human. Med double 20
Patient Selection Patients with lipodystrophy in the trunk/thighs and small breasts is are „good candidates“ 10/24/2021 BEAULI-Human. Med 21
Patient Selection: be aware § Slim, young women with small breasts and tight skin envelope, BMI under 19 § Unrealistic expections § Is there enough fat (and money) for later transfers? § Prevoius surgery, scarring § Weight loss after the transfer 10/24/2021 BEAULI-Human. Med 22
Patient Information: Volume gain § 200 ml injected Volume § 75% pure Fat, 25% Water: Volume 150 ml § Uptake: 70%: Volume 105 ml Volume gain: about half of the injected volume Shrinking: max. loss in 3 weeks, final result in 2 -3 months 10/24/2021 BEAULI-Human. Med 23
Volume gain Water 200 ml injected Volume 10/24/2021 Not Absorbed Pure Fat Volume gain BEAULI-Human. Med 105 ml Volume gain 24
Volume gain 100 ml 10/24/2021 BEAULI-Human. Med 25
Patient Information § General information about possible cyst formation or calcification § Mammogram § Infections § Bleeding 10/24/2021 BEAULI-Human. Med 26
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 27
Prevent Cooling § Klein Solution: 350 C § Patient warming blankets (Inditherm, Bair Hugger) 10/24/2021 BEAULI-Human. Med 28
Prophylaxis § Antibiotic for 7 days § Low dose Liq. for 3 days 10/24/2021 BEAULI-Human. Med 29
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 30
Klein Standard Tumescence Solution (Body temperature) Lidocain 1% 50 ml Adrenalin 1 mg 1 ml Natriumbicarbonat 12, 5 ml 8, 4% Na. Cl 0, 9% 10/24/2021 BEAULI-Human. Med 1000 ml 31
Fragmentation Infiltration (Cannula 2 mm) 10/24/2021 BEAULI-Human. Med 32
Additional Analgesia § Entonox (50% nitrous oxide + 50% oxygen) § Analgesic + anxiolytic agent § Effective § Rapide § Patient acceptable § Safe (no anesthesiologist!) 10/24/2021 BEAULI-Human. Med 33
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 34
Cannula Applicator Body. Jet 10/24/2021 Collector BEAULI-Human. Med 35
Water Jet Harvest § Water carries the delicate fat tissue (pulsing water jet, 30 bar, 90 ml/min, 300 angle) § Small openings (0, 9 mm): tiny parcels of fatty tissue § Reduced negative pressure (-0, 5 bar) § Gentle movements 10/24/2021 BEAULI-Human. Med 36
Infiltration and aspiration Result 10/24/2021 BEAULI-Human. Med 37
Water Jet Harvest • Residue of 30% fluid permits easy reinjection and leads to a uniform distribution of the fat in the tissue • Duration of the invervention: only 1 ½ - 2 h Ueberreiter BEAULI Thieme 2010 10/24/2021 BEAULI-Human. Med 38
Water Jet Harvest § Water Jet Liposuction yields harvested fat of consistent quality (immediatly re-use without centrifugation) § Small cell packages containing adipocytes and pre-adipocytes are transferred 10/24/2021 BEAULI-Human. Med 39
No Seperation of Stem Cells § 500 ml of fat must be extracted in addition § The enzymatic preparation process takes 3 h § Additional costs 10/24/2021 BEAULI-Human. Med 40
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting/Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 41
to Body. Jet From Patient Lipo Collector 10/24/2021 BEAULI-Human. Med 42
Lipo. Collector. TM 10/24/2021 BEAULI-Human. Med 44
Lipo Collector 10/24/2021 BEAULI-Human. Med 45
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 46
Fat Injection Cannula: § Diameter 2. 00 mm § Lenght 150 mm § 2 Lateral Eyes 10/24/2021 Syringue: § 10 ml § Luer Lock BEAULI-Human. Med 47
Fat Filling § 2/3 in the subcutis § 1/3 in the muscle and retroglandular § Not in the glandular tissue § Decollté § Compensating for asymmetry 10/24/2021 BEAULI-Human. Med 48
Fat Filling § 2/3 in the subcutis § 1/3 in the muscle and retroglandular § Not in the glandular tissue § Decollté § Compensating for asymmetry 10/24/2021 Gland 2/3 1/3 m. pectoralis BEAULI-Human. Med 49
Cave: seeding fat lumps 10/24/2021 BEAULI-Human. Med 50
Yoshimura/Autologous Fat Transfer Shifmann (Edit) Springer 2010 § § Fan shaped § « 3 D» -Filling Several planes § Not overfill (to much Rotating the cannula fat kills the fat) Strung like pearls § Patient in a upright 450 position 10/24/2021 BEAULI-Human. Med 51
§ § Fan shaped § « 3 D» -Filling Several planes § Not overfill (to much Rotating the cannula fat kills the fat) Strung like pearls § Patient in a upright 450 position 10/24/2021 BEAULI-Human. Med 52
Fat Filling Leave the breats soft: to much fat leads to necrosis! High pressure Reduced circulation For more volume 10/24/2021 2 Operations BEAULI-Human. Med 53
Postoperative § Injection site: Plaster Strip § Circular cotton bandage around the chest to avoid local cooling for 3 days § No bra or a wide nursing bra without any compression § Antibiotic for 3 days (Cephalosporin) § Analgesics (Paracetamol) 10/24/2021 BEAULI-Human. Med 54
Postoperative No compression! Keep breasts warm! 10/24/2021 BEAULI-Human. Med 55
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 56
Complications Large portions of fat Poor perfusion Pressure Necrosis Oil Cysts With the use of digital mammography MRI such changes can be easily distinguished from malignant changes 10/24/2021 BEAULI-Human. Med Calcifications 57
Complications § Haematoma formation § Infections § Subcutaneous granulomas 10/24/2021 BEAULI-Human. Med 58
Risk of Developing Breast Cancer § Cancer originates in the glands, outside the subcutaneous adipose tissue § In current state of data, an increased risk of cancer through fat transfer is unlikely and has not been recorded to date 10/24/2021 BEAULI-Human. Med 59
Task Force ASPS 1987: «The Committee is unanimous in deploring the use of autologous fat injection in breast augmentation. » 1992: «…strongly condems the use of fat injection for breast enlargement. » 10/24/2021 BEAULI-Human. Med 60
Task Force ASPS 2009: Fat graft can be considered a safe method of breast augmentation. The need of sterile technique should be emphasized. 10/24/2021 BEAULI-Human. Med 61
Task Force ASPS 2009 The result may vary depending on the surgeon’s technique and experience with the procedure. There are no reports sugesting an increased risk of malignacy associated with fat grafting. Plastic and Reconstr Surg 2009, 124; 1 p: 272 -80 10/24/2021 BEAULI-Human. Med 62
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anästhesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 63
Large volume fat transfers for Breastaugmentation: my experience § § § «One surgeon study» September 2010 – May 2012 93 Breast-Transfer Operations 81 Patients Age: 19 - 62 years (Ø 36, 5 years) BMI: 18, 6 – 29, 8 (Ø 22, 7) 10/24/2021 BEAULI-Human. Med 64
Large volume fat transfers for Breastaugmentation: my experience § § § § 45 Patients: correction of asymmetrie 3 Patients: unilateral 11 Patients: twice 1 Patient: three times Injected Volume: 140 ml – 540 ml (Ø 340 ml) Follow up: 1 – 20 months (Ø 5, 1 months) No Complications 10/24/2021 BEAULI-Human. Med 65
Patient Satisfaction 10/24/2021 BEAULI-Human. Med 66
Subjective Assessment 10/24/2021 BEAULI-Human. Med 67
§ § § 10/24/2021 My Person History of Fat Transfer Principles of Fatgrafting Patient Selection and Information Precautions Anaesthesia Fatgrafting with WAL/Body. Jet (Human. Med) Fat Collecting /Lipo. Collector (Human. Med) Fat Injection Complications My Results Conclusion BEAULI-Human. Med 68
J-AFT Advantages § § § § Simple collection process Gentle water-Jet releases fat Low suction force No centrifugation, no washing Avoids excess handling of fat No exposure to oxygen No waiting – fat is ready for transfer Excellent natural filler, no scars 10/24/2021 BEAULI-Human. Med 69
„it works“ § Good selected patients are very happy § after 110 procedures: no complications § naturally improvement in breast size and –form, more firmness and fullness for every patient 10/24/2021 BEAULI-Human. Med 70
Contraindication § Unrealistic expectations (great volume, desire absolute increase of cup size) § Denial of multiple procedures § Dislike liposuction § BMI under 19 10/24/2021 BEAULI-Human. Med 71
Caution Stay modest: more seeds on the same ground do not mean better harvest: overfilling necrosis overgrafting loosing fat 10/24/2021 BEAULI-Human. Med 72
Conclusion J-AFT using WAL (Body. Jet) combined with Lipo. Collector for harvesting, filtering and transferring of autologous fat tissue represents a very efficient unique technology for fat grafting 10/24/2021 BEAULI-Human. Med 73
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