Water-jet assisted fat transfer

More than 100 years ago autologous fat was transferred for the first time: the procedure of autologous fat transplantation is therefore older than all other procedures that use implants (such as breast augmentation with silicone implants) or synthetic fillers (such as smoothing out wrinkles using hyaluronic acid) for body contouring. The body’s own fat is ideal for body contouring because it is a natural material that can be shaped and does not trigger either allergic reactions or immune responses. Nevertheless, autologous fat transplantation or the use of autologous fat as a ‘filler’ is far less familiar than hyaluronic acid, collagen or silicon implants. Why is this?

Errors in the past

This is primarily due to complications that occurred and the contradictory information that is still circulating about these complications. Fat cells are by their very nature exceptionally fragile. Complications due to ruptured fat cells justified the poor reputation fat transplantation had at the time. The complications included inflammatory responses with dead and unhealed fatty tissue, calcifications and the formation of oil cysts. Previous procedures for fat transplantation also did not produce reliable results and as a result autologous fat transplantation was considered problematic. We now know that the complications that used to develop (oil cysts, calcifications) were due to errors in the fat harvesting, preparation and injection back into the body. Autologous fat must be harvested, prepared and re-injected as gently as possible to achieve planned, reliable and lasting results. In the 1980s the US plastic surgeon Sydney R. Coleman was able to harvest undamaged fat cells for the first time. Dr Coleman suctioned off body fat through needles using a gentle vacuum. This procedure lasted seven hours. The majority of the cells were damaged, and the intact cells still had to be isolated using a centrifugation procedure. But the start had been made. Nowadays, several procedures for fat harvesting and fat transfer are available: one of these is AquaShape™. Using AquaShape™, the harvesting (liposuction) and the preparation of the autologous fat (without centrifugation) was decisively improved.

Fat harvesting

Improved and gentle fat harvesting

The less damaged and more vital the harvested fat, the better the prospects of a successful and permanent growth of the injected fat cells. Only undamaged fat cells can become established while the body breaks down any that have been damaged.

To harvest undamaged fat cells, it is essential to avoid factors such as mechanical stress, high vacuum and extensive contact with the anaesthetic solution (usually the tumescence solution).

With water-jet assisted liposuction, high quality micro-fat tissue droplets can be harvested by reducing the negative impact of the effect of mechanical forces, high suction pressure, tumescence solution and unnecessary handling.

Thanks to the gentle power of the water-jet, the fat cells are gently detached from the tissue connection. The pressure of the fine, fan-shaped water-jet is adjusted to the different connective tissue structures so that fat cells can be specifically detached from the tissue and suctioned off at the same time.

With water-jet assisted liposuction the tissue is also minimally affected by the low quantity of anaesthetic solution (tumescence solution). Hardly any of the fat cells are ruptured as a result but instead they remain intact and unstressed and can be suctioned off as vital fat cells.

Fat preparation

Gentle preparation without centrifugation

During water-jet assisted liposuction, the suctioned fat is harvested, filtered and collected in a sterile, enclosed system.

The suctioned fatty tissue and the rinsing fluid are immediately separated by the physical buoyant force and the gravitational force under vacuum. This makes centrifugation or additional treatment of the fat prior to transplantation unnecessary.

The water content of fatty tissue harvested in this manner is about 20–25%. This also facilitates the distribution of the transplanted fatty tissue into the recipient tissue such as the breast or the face.

Fat transfer

Immediate and efficient

The survival of the transplanted fat cells depends on them very quickly developing connections to the vascular system.

For this reason, only small quantities of fat should be injected in multiple layers that are as thin as possible to ensure that the injected fat is optimally surrounded and supplied by blood vessels.

If too many fat cells are transplanted, they die before they can be supplied with nutrients. The gentle AquaShape® procedure significantly improves the chances of the fat cells surviving after transplantation.

Innovation

A summary of the innovations

Low mechanical force during removal due to gentle suction and the selective power of the waterjet
Precise but still gentle detachment of the fat cells from the surrounding tissue
Simultaneous rinsing and suction: less stress on the body due to smaller volume of tumescence solution
Centrifugation or other preparation of the fat is not necessary – this saves time and improves the vitality of the fat cells
The fat separates continuously from the rinsing fluid – no additional rinsing is necessary
The pressure equalisation (‘floating filtration’) helps to protect the fat cells
Gentle and passive mixing of the fat in the container improves the consistency of the fat taken from different areas of the body (for example, fat from the stomach and thigh)
Easy and direct removal of the untreated fat cells from the container

Benefits

Synergistic effect

Natural and extensive body contouring using autologous material
Liposuction itself also contours the body

Natural appearance

Breasts, face and hands have a natural appearance, uses the patient’s own natural fatty tissue (no foreign body feeling)
Evens out skin irregularities (the fatty tissue that is applied improves the surface structure and elasticity of the skin)

Permanent

Long-lasting results that are only subject to the body’s own natural processes (such as natural ageing)
No repeat surgery necessary (for example, due to implants that have slipped or been damaged; capsular fibrosis)

Gentle and safe technique

Protects the surrounding tissue
Relatively less bruising and swelling
Treatment can be done under local anaesthetic
Very little medication required (about 70% less tumescence solution than for conventional liposuction techniques)
Short surgery times
Little scarring and foreign bodies are not used
Rapid healing
No foreign body reactions (no risk of capsular fibrosis, allergies, etc.)

Fat Transfer