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