Power of water

A water jet system for liposculpture has won over a fair share of practitioners, impressed by its method for removing fat and harvesting. Dr Hugo Kitchen discusses his use of Body-Jet

German company Human Med in 2001 released a machine called the Helix Hydro, a water jet-powered device that pressurised water for physiological dissection. In 2004 it was refined for body sculpting and aesthetic work and renamed the Body-Jet system, which also harvests fat.

With liposculpture techniques, fat was often thrown away. By reducing the power of the water just enough to dislodge the fat cells, the quality of the Body-Jet cells have an extremely high viability, which is precious to us when we’re transferring the fat into other parts of the body.

The Body-Jet uses a fine lamina, fan-shaped jet to dislodge the fat cells. The same cannula is used to put a small amount of anaesthetic into the tissues. It’s a dry technique that doesn’t require much tumescent. For the average tummy, only about 200–300cc might be used. By comparison, Vaser might use one or two litres of fluid.

Because of the protocols involved with tumescent anaesthesia, we shouldn’t do many multiple areas at the same time because much fluid is in the body. With the Body-Jet, the tumescent fluid that we put in is sucked out simultaneously, so we can go from one area to the next, and move on to do multiple areas.

I did some Body-Jet harvesting on the side of a patient’s thighs, and I could see the shape develop right in front of me—it’s a sculpting tool. If anyone is in any doubt about the power of water, a 1mm cannula can blow a hole through a surgical drape.

Its system of delivery of anaesthetic fluid is weighed by the machine. You know exactly how much has been used. It also tells you exactly how much you take out.

We have an array of cannulas, including an infiltration cannula. We can put the tumescent in and jet the fat gently to get some nice fat out. Fat comes out without blood content. If you subtract what goes in from what comes out, we’re getting pretty much all of the fluid out.

Often with post-Vaser lipo procedures there’s still much fluid left in the patient, which will go, but there is no reason to leave it in there.
Body-Jet works by dislodging and separating the fat cells from each other while simultaneously sucking the fat out. We tend to take about 10 to 15 minutes to do one area in terms of tumescence. Again, we’re using small volumes.

We wait for 10 or 15 minutes so that the adrenaline within the tumescent fluid can cause the vasoconstriction so we get less bruising, and bleeding, and so on. Then we infiltrate the tissue.

The tip is selected for the type of volume that we want to get out. If we’re trying to separate the fat from itself, we would take probably only 15 to 20 minutes to do a whole abdomen, as much as that. I’ve done some gynaecomastia in 40 minutes maximum, start to finish. It was that fast; with Vaser lipo it might take me one and a half to two hours.

As the fat comes out, your assistant—should you desire to harvest that fat—can draw it up into syringes, ready for re-injection. As we take the fat out, you can see the perfectly neat, beautiful preservation of all the connective tissue between the skin and the underlying muscle, and this is key to remodelling after any lipo procedure.

In traditional liposuction, all this is just torn to shreds; it’s ripped out. So it’s a very gentle way of getting the fat out and preserving the soft tissue.

There’s a little skin puncture, a small aperture, 1–2mm only required to put the harvest jet probe in. It’s a pulsating jet, so you advance it slowly. The patient hardly feels it, because of the few nerves in fat.

The fat goes into a lipo collector, because of gravity, the fat cells float to the top, leaving the tumescent at the bottom, which is taken out into the waste.

The quality of this fat is like banana milkshakes—just creamy, all pure cells, with no fibrous globules or bits of fibrous tissue. We then put it into syringes, ready for injection. All the fat cells are preserved; all their walls are preserved.

In the face we might use 1cc syringes, but elsewhere, such as the breast, we might use a larger syringe. You draw it out of the canister, transfer it into a syringe, and it takes minutes to do. With water jet the important connective tissue fibres are preserved, enabling us to model and shape afterwards.

Patients like it because the procedure time is cut in half, and there’s no pain. I was surprised, because the probes are 2.5–4mm in diameter, which is quite large. The tumescent anaesthetises quickly. We don’t have any large volumes going in, so we don’t have to have any worry about any volume shifts in the body, and after the procedure, absolutely no leaking, either.

So you don’t get the bed mattress soaked in blood-stained exudate or have people going home with messy garments.
It takes 10 minutes to infiltrate. We wait five minutes, depending on the amount of work or areas that we’re doing, of course, but the procedure time is much, much less.

I treated eight areas in one patient and it took me two hours, 15 minutes. By comparison, with the Vaser, I wouldn’t have been able to do eight areas, and I’d have been there all night.

For an average procedure, you will get 400–600cc of fat. At no time is the fat exposed to the air. It’s sterile. Also, no centrifugation is required.

Volumetric MRI studies have been done on patients post-op one month, three months, six months, and one year later. At three months after the procedure, they found there was no more loss of fat cells. Every technique incurs some loss of fat cell viability. Their results average 76% (±10%). That’s unheard of in liposculpting.

The system is wonderful for hand rejuvenation. You can create a small one-hole skin biopsy and inject 15cc of beautiful harvested fat cells into the hand, and it lasts forever.

Dr Hugo J Kitchen practises at the Stratford Dermatherapy Clinic  www.skincareclinic.co.uk