Liquid Lipo Gel Recently, water jet-assisted liposuction (WAL) was successfully applied by several other authors to remove fat and induce skin contraction in nonfacial body areas. Extending the range of indications for this new method, the authors of this article report on their first experience with its use in facial contouring, fat harvesting, and hydrodissection of the facial skin flap in rhytidectomy in a case series of 25 patients. The 25 patients in the case series showed remarkable improvement in facial contouring after the WAL procedure, with fat harvesting yields ranging from 10–60 mL per side.
Twenty-five patients (median age: 56 years) had facelift surgery under sedation, and the WAL technique was used for facial contouring, fat harvesting for facial lipotransfer, and hydrodissection of the facial skin flap. Patients were monitored for discomfort during the procedure. Complications such as bleeding, postoperative swelling, and hematoma formation were observed during a 1-week follow-up period, and intensity was rated by two independent surgeons using a special grading system. Furthermore, a patient survey (FACE-Q) was performed to analyze the patients’ satisfaction and perception of the postsurgical esthetic results. Twenty-five patients reported a significant decrease in facial discomfort after the procedure, and the WAL technique was well tolerated by all patients.
The WAL technique can be applied under intravenous sedation without causing any discomfort in all treated patients [mean 1.16, standard deviation (SD) 0.31]. Intraoperative bleeding during WAL-assisted facial dissection was judged not to be present at all times (mean 1.3, SD 0.32). Postoperative swelling (day 1: mean 1.82, SD 0.28; day 7: mean 1.18, SD 0.28); and hematoma formation following surgery (day 1: mean 1.58, SD 0.34; day 7: mean 1.18, SD 0.31) were judged as minor in all cases. Overall, no skin necrosis was detected. There was no need for revision surgery. More than half of our treated patients (n = 13) answered the FACE-Q questionnaire, verifying a high satisfaction rate with beneficial treatment results without the occurrence of any major complications. These results suggest that our patients experienced minimal post-operative discomfort with no serious complications or need for revision surgery.
The WAL technique seems to offer a safe and efficient treatment approach for facial contouring, facial fat harvesting, and simultaneous facial flap hydrodissection with only minor postoperative swelling and hematoma formation. Therefore, the authors believe that the WAL technique is a powerful and useful tool and should be used in modern facial plastic surgery. The authors also suggest that further prospective studies should be conducted to analyze the safety and efficacy of this technique.
Facial aging is a multimodal process that consists of three factors: the loss of elasticity of the superficial musculoaponeurotic system (SMAS, representing the major tissue-supporting facial structure); the skin itself, which is exposed to daily environmental strains and stresses; and the tendency of volume deflation and tissue repositioning following continuous gravitational exposure. 1, 2, 3, 4 Each of these three factors contributes to the overall appearance of aging, with various physical changes such as wrinkles, sagging skin, and volume loss.
All of these changes contribute to the development of an aging face. The youthful appearance linked with the so-called “inverted triangle of youth” changes to a more rectangular shape as time progresses, resulting in classical signs of aging. 5 Over the past two decades, several attempts have been made to address each factor of the facial aging process in order to halt or even reverse it.
The first rhytidectomies, in the early 1900s, involved simply pulling up the skin. 2 A large step toward modern face lift procedures was associated with the 1974 discovery of the SMAS by Skoog et al., resulting in a multitude of surgical approaches in the following years. 2 In addition, the use of different peeling agents has become a widespread, well-researched, and accepted tool for facial resurfacing and rejuvenation. 6 Superficial, medium depth, and deep peels were developed to address different kinds of rhytides and wrinkles in different facial areas.
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