Water-Jet Assisted Liposuction: Breakthrough or Gimmick?

More than in any other surgical technique, liposuction technology is marketed directly to consumers with little (to no) scientific evidence.  Some background...

• Standard suction assisted lipectomy employs a strong vacuum to remove stubborn fat deposits.
• Most surgeons add tumescent fluid to numb the surgical area and to constrict blood vessels (and thereby minimize bleeding).
• Power assisted liposuction involves a vibrating handle to minimize surgeon effort when removing the fat.
• Ultrasonic assisted liposuction uses ultrasonic energy to melt the fat before it is sucked out.
• Laser assisted liposuction uses a laser for melting fat before it is vacuumed out.
• Water-jet assisted liposuction supposedly limits intra-operative tissue distortion caused by the tumescent anesthetic fluid.

If all you knew about plastic surgery was learned from daytime television, then you would think that plastic surgeons perform liposuction...

• in their offices
• under local anesthesia--with tumescent fluid alone
• employing lasers to melt the fat
• water jets to minimize distortion

The truth is much less sexy.  The vast majority of Board Certified Plastic Surgeons prefer...

• an accredited surgical facility rather than the back room of their office
• heavy sedation--either "twilight sleep" or general anesthesia provided by an appropriately trained anesthetist
• some quantity of tumescent fluid for additional comfort and to decrease bleeding
• performing the actual liposuction with... standard techniques, power assisted devices, or ultrasonic machines

While I do like ultrasonic assisted liposuction (and I use the VASER system), as a Board Certified Plastic Surgeon, I have to admit that there are no good scientific studies documenting the superiority of ultrasound or laser-assisted liposuction relative to standard or power-assisted tumescent liposuction.

The water-jet is so new on the scene that there are exactly ZERO articles about it in the most prestigious plastic surgery publication Plastic & Reconstructive Surgery.  So, is water jet liposuction a breakthrough or gimmick?  I have absolutely no idea.

The best study on laser-assisted liposuction (from Chile, and published in Plastic & Reconstructive Surgery in 2006) demonstrated no major clinical differences between standard liposuction and laser assisted liposuction.  However, there were higher concentrations of free fat molecules floating in the blood of the laser patients, which alerts me to the possibility of potential damage to the liver, kidneys, or lungs.

So, truthfully, when patients ask me about laser and water-jet liposuction, I don't even know what to tell them.  In the past, I have mentioned the potential dangers of minimally tested technologies, and patients have actually become angry at me for my skepticism!  It's amazing to me that my caution turns people off.  Typically, patients express disbelief that lasers or water could be anything but positive.

The effects of marketing can obviously be pernicious.  It's incredible that the makers of these product have been able to convince the public of their products' efficacies before they have even convinced the surgical community!  Crazy!!

Comments

[New York liposuctions]

Here's the procedure of Water-jet assisted liposuction. A powerful jet of water is released from the cannula tip. This is strong enough to separate the fat cells without traumatizing other structures such as nerves and blood vessels. The water and released fat cells are immediately aspirated back into the cannula, thus limiting tissue swelling and the problems associated with tumescent fluid.

[Michael Pickart]

Thanks for your thoughts! Since I have never employed WAL (water-jet assisted liposuction), I will reserve final judgement. My beef is that aggressive device marketing for WAL and LAL (laser-assisted liposuction) has preceded blinded clinical trials published in the peer-reviewed literature. Caution is not the strong suit of most advertisers.

Michael C. Pickart, M.D., F.A.C.S.
Pickart Plastic Surgery, Inc.

428 Poli St.,#2C, Ventura, CA 93001
(805) 648-4567 | fax (805) 641-0811

To: info@pickartplasticsurgery.com
Subject: [Pickart Plastic Surgery Blog] New York liposuctions submitted a comment to Water-Jet Assisted Liposuction: Breakthrough or Gimmick?
Date: Wed, 13 Jan 2010 03:30:50 -0800

[weight loss]

Sounds very gimmicky. Don't get me wrong, I'm all for innovation, but...well I guess I'd have to see it to believe it.