Ultrasound-assisted Lipoplasty Research Articles

Ultrasound-Assisted Lipoplasty in Addition to Suction-Assisted Lipoplasty for Perforator Free Flap Thinning

Perforator flaps are routinely used in upper- and lower-extremity reconstruction. Increased usage of these flaps as well as their intraoperative thinning has been described; however, there are limited reports of thinning in the postoperative period. From 2005 to 2010, thinning procedures were performed on 11 patients with 11 flaps. There were six males and five females in this series. Three flaps were deep inferior epigastric artery flaps, six flaps were anterolateral thigh flaps, and two were medial thigh flaps. After the initial microvascular reconstructive procedure, the patient underwent a second procedure where ultrasound-assisted lipoplasty, suction-assisted lipoplasty, flap advancement, and excision were performed. With aggressive, staged thinning procedures, there were no cases of partial or complete flap necrosis. Given the increasing number of perforator flaps being performed for upper- and lower-extremity reconstruction, a larger number of cutaneous flaps will need postoperative thinning. Ultrasound-assisted lipoplasty has been found to be a useful modality in revision of these flaps.

Use of the microdebrider for treatment of fibrous gynaecomastia

In the quest for reduced scars and better aesthetic outcomes in minimally invasive surgical techniques for gynaecomastia, suction-assisted lipoplasty and ultrasound-assisted lipoplasty are now considered accepted recent advancements. Nevertheless, the fibrous glandular breast disc encountered in young, thin patients requires a separate peri-areolar incision as the disc cannot be removed with suction lipoplasty. The use of a microdebrider (powered shaving rotary device) is a potential solution to this problem. We present a series of eight patients with fibrous gynaecomastia that was successfully treated in this way. The surgery is performed under general anaesthesia. The microdebrider cannula is used to remove the fibrous glandular breast tissue. Drains are inserted and fibrin glue is sprayed subcutaneously. Patients are discharged on the next day. Drains are removed on the 5th postoperative day. A compressive vest is worn for 6 weeks. (A video of the procedure can be seen on http://www.microflap.com/video3.asp). The eight patients were successfully treated. No bleeding, haematoma or seroma was encountered. All patients were satisfied with the results of the surgery. The microdebrider is a viable solution in the treatment of gynaecomastia with a fibrous breast disc. Excellent aesthetic results can be achieved with a single 3-mm incision.

A New Classification and Treatment Protocol for Gynecomastia

It is not uncommon to encounter patients who have undergone surgery for gynecomastia but who were not fully satisfied with the results. Although various approaches and techniques based on presurgical classification systems aimed at yielding the best possible surgical outcomes have been offered, standardized recommendation that is generally accepted by surgeons is lacking. The author reports on a new classification system and treatment protocol for the surgical treatment of gynecomastia. A system was developed that classifies patients into 3 types based on skin elasticity, presence of an inframammary fold (IMF), and mammary ptosis. Surgical excision of the breast mass was followed by a combination of destruction of the IMF, ultrasound-assisted lipoplasty (UAL) of the chest wall, ultrasound stimulation of the breast skin, and periareolar deepithelialization, depending on the gyneocomastia classification. This classification and the treatment protocol were applied to 30 patients, 13 to 60 years of age, between January 2005 and December 2007. Among these patients, 12 were classified as type 1, 6 as type 2, and 12 as type 3. Follow-up ranged from 3 to 18 months. Complications were common to all types of cases and techniques. They included 2 hematomas, 1 wound dehiscence, 5 cases of residual gynecomastia in those patients who underwent UAL alone, and 3 minor aesthetic problems near areolae. The proposed new classification and treatment protocol were found to help solve problems associated with surgical outcomes for all types of gynecomastia, although the issue of residual gynecomastia in patients undergoing UAL alone requires further study.

Comparative Analysis of Blood Loss in Suction-Assisted Lipoplasty and Third-Generation Internal Ultrasound-Assisted Lipoplasty

Lipoplasty remains the most common cosmetic surgical procedure performed in the United States. In spite of its well documented clinical advantages, ultrasound-assisted lipoplasty (UAL) accounts for less than 20% of all lipoplasty procedures currently performed. The purpose of this study is to determine the blood content of third-generation internal UAL aspirate and compare it to traditional lipoplasty aspirate. The lipoplasty aspirate of 27 consecutive patients who underwent traditional suction-assisted lipoplasty (SAL) of their back and posterior flanks was compared to the aspirate of 30 consecutive patients who underwent third-generation internal UAL of their backs and posterior flanks using the VASER Internal Ultrasound Device (Sound Surgical Technologies; Louisville, CO). The volume and composition of the wetting solution used was the same for both groups. The aspirate analysis was performed by an independent laboratory on a Beckman Coulter LH 750 blood analyzer (Fullerton, CA) and consisted of complete blood counts after separation of the fat. The hemoglobin content of SAL aspirate was 7.5 times greater than in the aspirate. The hematocrit value of SAL aspirate was 6.5 times greater than in the VASER-assisted lipoplasty aspirate. Statistical analysis using an independent t test confirmed that the data was statistically significant with P values of < .0001 for both hemoglobin content and hematocrit values. We conclude that third-generation internal UAL should be considered for patients undergoing large-volume lipoplasty procedures or lipoplasty of tight, fibrous areas, such as the back and posterior flanks, where increased blood loss is expected.

Numerical analysis of a gas bubble near bio-materials in an ultrasound field

Ultrasonic cavitation bubble phenomena play a key role in numerous medical procedures such as ultrasound-assisted lipoplasty, phacoemulsification, lithotripsy, brain tumor surgery, muscle and bone therapies and intraocular or transdermal drug delivery. This study investigates numerically the interaction of a bubble with a bio-material (fat, skin, cornea, brain, muscle, cartilage or bone) involved in the treatments mentioned when subjected to an ultrasound field. A range of frequencies is used to study the bubble behavior in terms of its growth and collapse shapes, and the maximum jet velocity attained. Simulation results show complex dynamic behaviors of the bubble. In several cases a jet is formed directed away from the bio-material while in others, toward it. In certain cases, the bubble eventually breaks into two, with or without the formation of opposite penetrating jets. Very high maximum velocities of jets directing away or toward the bio-materials can be observed in some cases (700 to 900 ms −1). (E-mail: mpekbc@nus.edu.sg)

The L Brachioplasty: An Innovative Approach to Correct Excess Tissue of the Upper Arm, Axilla, and Lateral Chest

Brachioplasty is aesthetic reshaping of the upper arm after removal of excess medial skin and fat. Massive weight loss patients evolve a severe arm deformity that extends through the axilla and onto the chest. Prevalent operations are incomplete and leave conspicuous scars along the bicipital groove that end as Ts or Zs in the axilla. The L brachioplasty starts with a long ellipse centered over the lower half of the inner arm that sweeps up to the deltopectoral groove. A shorter ellipse is connected at right angles through the axilla onto the chest. The V flap formed between the ellipses is advanced across the axilla to raise the posterior axillary fold. An improved arm, axilla, and chest have an L-shaped zigzag crossing the axilla. L brachioplasty, along with upper body lifting, was applied to 24 female weight loss patients over the last 2 years. Ultrasound-assisted lipoplasty was also performed in five patients. All patients were interviewed. Follow-up ranged from 6 to 28 months. All 22 patients were improved and pleased. One patient requested and received a limited scar revision. Three patients had delayed healing at the tip of the triangular flap. Four seromas near the elbow responded to multiple aspirations. One hypertrophic scar was improved with intense pulsed light. The L-shaped brachioplasty is an innovative, effective, reliable, aesthetic, and safe technique. Integrating the brachioplasty into the upper body lift improves the contours of the axilla, breast, and upper lateral chest, contributing to improved harmonious body contour.

Effect of low-level laser therapy on abdominal adipocytes before lipoplasty procedures.

Low-level laser therapy is a new subspecialty for the medical application of lasers that provides therapeutic rather than surgical outcomes for many medical indications. Recently, low-level laser therapy was reported to "liquefy" or release stored fat in adipocytes by the opening of specialized yet not identified cell membrane-associated pores after a brief treatment. Currently, low-level laser therapy is a U.S. Food and Drug Administration-approved technology for improving pain alleviation. To explore these data further, a series of in vitro studies on human preadipocytes and institutional animal care and use committee-approved protocols in a porcine Yucatan model and an institutional review board-approved clinical study were performed. Using a 635-nm low-level laser of 1.0 J/cm supplied to the authors by the vendor, these studies were designed to determine whether alteration in adipocyte structure or function was modulated after low-level laser therapy. Cultured human preadipocytes after 60 minutes of laser therapy did not change appearance compared with nonirradiated control cells. In the porcine model, low-level laser therapy (30 minutes) was compared with traditional lipoplasty (suction-assisted lipoplasty) and ultrasound-assisted lipoplasty. From histologic and scanning electron microscopic evaluations of the lipoaspirates, no differences were observed between low-level laser therapy-derived and suction-assisted lipoplasty-derived specimens. Using exposure times of 0, 15, 30, and 60 minutes in the presence or absence of superwet wetting solution and in the absence of lipoplasty, total energy values of 0.9 mW were delivered to tissue samples at three increasing depths from each experimental site. No histologic tissue changes or specifically in adipocyte structure were observed at any depth with the longest low-level laser therapy (60 minutes with superwet fluid). Three subjects undergoing large-volume lipoplasty were exposed to superwet wetting fluid infiltration 14 minutes before and 12 minutes after, according to vendor instructions. Tissue samples from infiltrated areas were collected before suction-assisted lipoplasty and lipoaspirates from suction-assisted lipoplasty. No consistent observations of adipocyte disruptions were observed in the histologic or scanning electron microscopy photographs. These data do not support the belief that low-level laser therapy treatment before lipoplasty procedures disrupts tissue adipocyte structure.

Ultrasound-assisted lipoplasty

The author considers the circumstances in which it is more beneficial to use ultrasound-assisted lipoplasty (UAL) rather than traditional suction-assisted lipoplasty (SAL). He contends that the absolute benefit of UAL compared with SAL is the ability of the ultrasound to lyse fibrous tissue and fat.

Ultrasound-assisted lipoplasty treatment for axillary bromidrosis: clinical experience of 375 cases.

Bromidrosis is a condition of abnormal offensive body odor caused mostly by apocrine gland secretion from the axilla. Although no morbid sequelae are known, the odor can be disturbing enough to cause social impairment and psychological distress. Medical care is available but is temporary and yields limited clinical benefit. Surgical treatment may provide a more definite remedy through reduction of the apocrine gland. However, there are risks for complication following surgical treatment such as subdermal excision, subcutaneous shaving, en bloc excision, and liposuction. The search for a less invasive but still effective procedure has led the authors to use ultrasound-assisted liposuction, which has reduced the risk of complication and recurrence. The purpose of this article was to evaluate the long-term outcome of ultrasound-assisted liposuction for the treatment of bromidrosis. From August 1998 to September 2002, 375 consecutive patients underwent ultrasound-assisted liposuction for bromidrosis of the axilla. The average age of the patients was 25.7 years (range, 15 to 55 years) and the average follow-up period was 18.8 months (range, 7 to 56 months). Subjective complaints of recurrences were noted in 22 patients (5.9 percent) and secondary ultrasound-assisted liposuction was performed, resulting in no further complaints. Complications other than recurrences were mild skin sloughing (3.2 percent), hematoma (1.3 percent), subcutaneous band (0.3 percent), and hypesthesia of the hand (0.3 percent), all of which healed spontaneously. Through a questionnaire that was answered by 264 patients, a subjective satisfaction rate was measured. Among the completed questionnaires, 91.7 percent reported satisfactory reduction of odor. Ultrasound-assisted liposuction to treat bromidrosis of the axilla provides advantages such as rapid recovery, less restriction of movement, unnoticeable scars, and a low rate of recurrence. The long-term outcome supports the benefits of this procedure. The authors recommend the use of ultrasound-assisted liposuction as first-line treatment for bromidrosis of the axilla.

Circumferential approach to contouring of the trunk

Background: Body contouring usually involves the lower and upper abdomen, flanks, hips, and back. Several techniques are available with which to achieve suitable simultaneous correction of all these aesthetic units. Objective: We review the techniques available for contouring of the trunk. Excisional procedures are abdominoplasty, abdominohemiflankplasty or extended abdominoplasty, abdominoflankplasty, and flankplasty. Indications for excisional surgery and its combination with ultrasound-assisted lipoplasty and conventional lipoplasty with excisional surgery are discussed. Methods: A series of 102 consecutive patients underwent contouring surgery of the trunk between 1998 and 2003. Detailed preoperative evaluation of the entire trunk area was performed to determine the most appropriate surgical procedure for each patient. The key surgical principles defining the technique used included high lateral tension with minimal central tension, direct limited undermining to a central triangle, discontinuous cannula undermining, and anchoring of the scar so as to avoid migration. Results: A circumferential approach to contouring of the trunk area offered excellent outcomes and a high level of patient satisfaction. Significant improvement in body contour was achieved, with a low rate of complications. Conclusions: Excisional techniques for body contouring involve major surgery that results in a relatively large scar. Carried out with maximal preoperative, intraoperative, and postoperative care, it offers a safe way to achieve significant improvement in body contour with minimal risk to the patient.

Breast reduction with ultrasound-assisted lipoplasty.

Ultrasound-assisted lipoplasty for reduction of fatty breasts and fixation has been found to be a safe technique with promising aesthetic results when it is applied in selected patients and performed by a surgeon with expertise with ultrasound-assisted body contouring. From 1995 to 2000, 120 patients were treated with ultrasound energy to decrease the fatty component of the breast tissue and at the same time to lift the breast mound. Each patient was evaluated preoperatively with mammograms for correct assessment of the nature and consistency of the breast tissue. Only patients with fibrofatty and fatty breast parenchyma were selected for breast reduction and fixation with ultrasound-assisted lipoplasty. Patients with suspect mammograms (calcification) and a strong family history of breast cancer were not considered. All the prescreening and the postoperative long-term mammographic evaluations were conducted by a radiologist with high competence in breast tissue resonance. Patients' age ranged from 17 to 53 years. Total aspirate ranged from 300 to 1200 ml for size, of which 65 percent was supranatant (fat) and 35 percent was infranatant (tumescence solution and blood). Patients were operated on while they were under general anesthesia; more recently, pure tumescent anesthesia was tried with success in minor cases. Breast dimensions were assessed with breast sizers (before and after the operation), and breast measurements were assessed using a classic breast drawing. Minimum follow-up of patients was 4 years. Particular care was given to evaluating long-term breast tissue appearance through mammographic studies and to looking for suspected calcifications. No evidence of a suspect mass or calcifications was found during the 4-year follow-up. The main advantages of the technique are a significant reduction in breast volume (up to three cup sizes), significant breast lift (up to 5 cm), and nearly invisible scars (1.5 cm in length at the inframammary sulcus and at the axilla).

Ultrasound-assisted lipoplasty: a review of over 350 consecutive cases using a two-stage technique.

Ultrasound-assisted lipoplasty (UAL) was developed in Europe and South America. Its introduction into the mainstream of United States surgery in 1997 was initially received with great enthusiasm. Soon, however, anecdotal reports surfaced describing limitations and complications related to the emerging technology. Among the concerns expressed were burns and postoperative seroma formation. The etiology of these complications was speculated to be a result of prolonged ultrasonic energy time. Consequently, some authors recommended limiting the amount of ultrasonic energy time per site and even complete avoidance of UAL in certain body areas. Our review includes over 350 consecutive cases of internal UAL performed by two surgeons utilizing a similar technique. The basic rules of UAL as described by Zocchi were followed without regard to other limitations such as ultrasonic energy site times, body areas, and level of tissue planes. The mechanism of action of UAL and the surgical technique are described. The procedure is a two-stage technique, including tumescent infiltration followed by energy application and simultaneous hollow titanium cannula aspiration. Suction-assisted lipoplasty was not a component of the procedure. The results, including complications, are outlined. Complications were few and not severe. There was no correlation between length of ultrasonic energy time and rate of postoperative complications. The advantages and disadvantages of UAL are discussed. UAL alone is the authors' preferred technique for body contouring to all body areas, except in the female breast.

Ultrasound-assisted lipoplasty.

The use of ultrasound-assisted lipoplasty (UAL) to assist in the removal of subcutaneous fat has been practiced in Europe for nearly 15 years and over the last 7 years has gained popularity in the United States. Liposuction is now one of the most commonly performed cosmetic procedures by board-certified plastic surgeons. This article will review the UAL procedure, its history, regulatory issues, instrumentation and equipment needed. It will also review changes and recent updates, clinical protocol, complications, and future considerations.

Laboratory and Histopathologic Comparative Study of Internal Ultrasound-Assisted Lipoplasty and Tumescent Lipoplasty

Despite the advantages of using internal ultrasoundassisted lipoplasty instead of the classic tumescent lipoplasty, such as reduced bleeding and tissue damage, the authors found no objective or comparative study of these techniques in humans. For this reason, they conducted a clinical study to determine the amount of bleeding and tissue damage caused by each of the techniques. A simple clinical assay was accomplished at the Jalisco Plastic Surgery Institute on seven female patients scheduled for abdominal lipectomy. Two similar sections of the surgical area were marked for lipoplasty techniques: classic tumescent lipoplasty on one side and internal ultrasound-assisted lipoplasty on the other. Both areas were treated simultaneously by surgeons experienced in each technique. Laboratory tests and histologic studies were performed on the aspirated material and the manipulated tissue, respectively. The fluids sent to the laboratory were analyzed to determine the amount of bleeding and tissue damage. In the laboratory, the degree of lesion and tissue damage was evaluated in the dermis, nerves, blood vessels, and adipose cells. With internal ultrasound-assisted lipoplasty, indicators of tissue damage such as glutamic oxalacetic transaminase, pyruvic oxalacetic transaminase, cholinesterase, and myoglobin showed higher values than with tumescent lipoplasty. The same was found for hemoglobin levels and in the histologic data indicative of tissue damage; both values were statistically significant at p < 0.001. Internal ultrasound-assisted lipoplasty was not demonstrated to be more innocuous or to have a selective effect in adipose cells, and it generally resulted in more tissue damage and bleeding than the classic tumescent technique. (Plast. Reconstr. Surg. 110: 1158, 2002.)

Ldquo ]Terrorists[rdquo ] of the courtroom

To the Editor: In their Commentary on breast reduction with ultrasound-assisted lipoplasty (UAL) in the November/December issue of Aesthetic Surgery Journal (2001;21:507-508), Drs. Grotting and Buck summarize the evidence well. They confirm that current evidence shows no ill effects from the use of UAL. They also make it clear that there is no evidence to indicate that this procedure entails greater problems than any other technique of breast reduction surgery. Nevertheless, they suggest that it may not be possible to use UAL in breast reduction surgery in the United States because of the risk of possible litigation. Drs. Grotting and Buck note that no long-term carcinogenic effects of UAL …

Is ultrasound-assisted lipoplasty advisable in breast reduction surgery?

To the Editor: Doctors Giuseppe and Santoli reported on their series of approximately 120 patients that underwent an ultrasound-assisted lipoplasty (UAL) breast reduction technique in the November/December issue of Aesthetic Surgery Journal (2001;21:493-506). In reading the article, I noted several areas of concern and would like to comment on them, as follows. 1. The amount of ultrasound (power) utilized by the authors appears to be quite high in relation to the amount of fat emulsion produced. The authors reported the application 10 to 15 minutes of ultrasound energy in the fat tissue of the breast, which produced approximately 250 to 300 mL of emulsion. In my experience with the VASER device, 1 minute of ultrasound energy application generally would result in approximately 100 …

Vibroliposuction: a study of rate of aspiration.

Challenges in suction-assisted lipoplasty (SAL) along with ultrasound-assisted lipoplasty (UAL) include physical effort by the surgeon, surface irregularities and undulations, risk of perforations (SAL), risk of burns (UAL), and lengthy operative time. In this study of 74 patients, vibro-assisted liposuction (VAL) was evaluated by rate of aspiration. In this group, variables included diameter of the cannula, number of openings, and pressure of compressed air. Our findings suggest that operative time is decreased with a greater number of openings into the cannula and a higher air pressure.

Lipoplasty: From body contouring to tissue engineering

Learning Objectives: The reader is presumed to have a broad understanding of plastic surgical procedures and concepts. After studying this article, the participant should be able to: Physicians may earn 1 hour of Category 1 CME credit by successfully completing the examination based on material covered in this article. The examination begins on page •••. Background: The rapid development of disciplines such as cell therapy and tissue engineering has focused attention on stem cells as the ideal cellular substrate for new tissues. Human adipose tissue is a potential source of such stem cells. Objective: We review the role of human adipose tissue in stem cell research and describe the procurement of stem cells from the stromal vascular fraction of human adipose tissue obtained through suction-assisted lipoplasty. Methods: Raw lipoaspirate obtained through suction-assisted lipoplasty was washed in phosphate-buffered saline and digested with collagenase. The collagenase was then inactivated by fetal bovine serum and the cells were centrifuged for 10 minutes at 1200 × g. The resulting cell pellet was resuspended, plated, and maintained in nondifferentiating control media. Results: Processing of 250 to 500 mL of suctioned tissue routinely yielded 2 to 6 × 10 8 processed lipoaspirate cells. Cell viability was typically >95%. These cells have been shown to differentiate in vitro into at least the adipogenic, chondrogenic, myogenic, neurogenic, and osteogenic lineages in the presence of specific induction factors. Conclusions: Adipose tissue may be an ideal source of stem cells, because it is abundant, easy to obtain in large quantities, and safe to procure. Such a development could place the plastic surgeon at the epicenter of medical research. Issues that require further research include elucidation of site-specific differences in fat cells, the use of vacuum-assisted lipoplasty and ultrasound-assisted lipoplasty in procuring stem cells, and the development of more efficient and convenient tissue processing techniques. (Aesthetic Surg J 2002;22:121-127.)

Clinical application of VASER-assisted lipoplasty: A pilot clinical study

Background: Although lipoplasty is the most frequently performed aesthetic surgical procedure, ultrasound-assisted lipoplasty (UAL) has not been widely adopted because of its increased potential for complications, complex and bulky instrumentation, additional cost, and steep learning curve. Objective: We report on the use of the VASER ultrasound device in lipoplasty procedures and compare the clinical outcomes obtained by means of VASER-assisted lipoplasty with those of other UAL devices. Methods: A superwet technique was used, and the wetting solution was uniformly distributed in the intended treatment area. Skin protection measures included use of specially designed skin ports to protect the incision edges and wet towels adjacent to the port locations. Access incisions were 3 to 4 mm in length. The VASER device was used in VASER (pulsed ultrasound) mode by 2 investigators (P.B.F. and M.L.J.); the continuous ultrasound mode was used by these investigators only if tissue emulsification was not readily achieved by using the VASER mode. A third investigator (E.B.d.S.P.) primarily used the continuous mode. Effective fat fragmentation in either mode was achieved by a maximum of 1 minute of treatment time per 100 mL of infused wetting solution. Results: In a series of 77 patients treated by 3 different clinicians, satisfactory results were obtained with no major complications. This contrasts with an incidence of complications of 7.9% (median, 4.9%) for first- and second-generation UAL devices as determined by statistical analysis of the literature. Conclusions: The initial clinical experience with VASER-assisted lipoplasty indicates that it is a safe and efficient technique for body-contouring surgery. (Aesthetic Surg J 2002;22:131-146.)

Ultrasound-assisted lipoplasty (UAL) in breast surgery.

Breast surgery has evolved significantly since the increased demand for reduced scars led to the development of minimal incision techniques. Ultrasound-assisted lipoplasty (UAL) presents important advantages when compared to traditional liposuction, such as preservation of connective structures and significant skin retraction capability. Other factors such as a favorable side-effect profile, satisfactory aesthetic results, and virtually inconspicuous scars have led us to utilize UAL in virtually all of the different breast surgery modalities carried out in our practice. Important aspects of patient selection, markings, surgical technique, and postoperative care are outlined. Ultrasonic energy is applied through superficial tunnels that lie radial to the mammary cone, with preservation of elements such as the areola, mammary ducts, and the central part of the breast's base which contains the perforators that supply the gland. Deep treatment should be applied onto adipose tissue regions and should preferably be performed in the peripheral and subcutaneous layers of the breast, with conservation of the central glandular cone to ensure maintenance of anterior projection. In selected cases, UAL is a valuable adjunct to procedures such as symmetrization, reduction mammaplasty, and breast reconstruction, permitting both volume reduction and shaping through three-dimensional retraction of connective tissue and skin. The excellent preliminary results support new indications and future developments of the technique.