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Liposuction in lipedema is a safe and effective treatment, but there currently are no studies analyzing the individual complications of water-jet-assisted liposuction in lipedema or the impact of the cannula’s design.To answer the question which WAL cannula is the safest in lipedema patients, and providing practitioners with the data they need to make an informed decision about the cannula they choose.We retrospectively analyzed complications and their underlying risk factors in 117 patients across 243 cases. Groups were formed by diameter (Ø) and number of ports of the used cannulas. Unpaired t-Tests, Fisher’s exact tests and chi-squared tests were used to analyze the patients’ characteristics for the complication rates across the cannulas.Cannulas with 8 ports showed statistically significantly higher hemoglobin loss (p = 0.011), shorter incision-to-suture time (p = 0.023), and higher volume of aspirated fat (p < 0.001). The same results occurred when comparing the Ø 3.8mm cannulas that differ in the number of ports (4 versus 8 ports). The Ø 4.8mm group showed a significantly increased rate of wound healing disorders compared to the Ø 3.8mm group (p = 0.041) and a statistically significantly higher aspirated fat volume (p = 0.014).No specific cannula showed superior safety in terms of complication rates. However, 8 port cannulas facilitated a faster aspiration of large volumes and reduced the incision-to-suture time compared to 4 port cannulas. This benefit was accompanied by a grater loss of hemoglobin. In contrast, cannula diameter played a less significant role in aspiration speed and did not increase the hemoglobin loss.