Ultrasound-assisted Lipoplasty Research Articles

Ultrasound-assisted breast reduction and mastopexy

Background: The development of technology for ultrasound-assisted lipoplasty (UAL) offers the aesthetic surgeon a new tool for breast surgery procedures including breast reduction, breast lift, and the correction of mild- to medium-degree ptosis. Objective: The authors report on a series of 120 patients who underwent breast surgery with the use of UAL from 1995 through 2000. Methods: Preoperative screening, including mammography, was performed to evaluate breast tissue and determine whether patients were good candidates for surgery. Variants of Klein's tumescent solution were infiltrated, depending on the form of anesthesia administered. Stab incisions 2-cm long were made at the axillary line and 2 cm below the inframammary crease to allow entry of a 35-cm solid titanium probe. With use of a 50% power setting, ultrasound energy was applied from 10 to 15 minutes to up to 30 minutes to emulsify the fat. Ultrasound stimulation of the superficial layers of subcutaneous tissue was applied to promote retraction of the breast skin. Results: A mean of 500 mL of fat emulsion from each breast was obtained without major complications. Nipple elevation of up to 5 cm was possible if a large-volume reduction was performed in combination with ultrasound stimulation of the subcutaneous layer. Conclusions: The use of UAL to achieve breast reduction and mastopexy is both safe and effective for selected patients when performed by a surgeon experienced in the technique. ( Aesthetic Surg J 2001;21:493-506.)

Progressive lipodystropy in a patient with analbuminemia: laboratory investigation and treatment by ultrasound-assisted lipoplasty

We present a new case of analbuminemia accompanied by severe lipodystrophy in a young woman. Albumin concentration was below 200 mg/l serum (i.e., less than 0.5% of physiological) as measured by kinetic immunonephelometry, but this was partially compensated by increased circulating levels of both positive and negative acute-phase proteins and of secretory proteins such as cholinesterase. This appears to be the first report describing successful correction of analbuminemia-related lipodystrophy by ultrasound-assisted lipoplasty where, in the first session, around 7800 ml fat was aspirated. The possible relationships between the diagnosed disturbances in lipid metabolism (type IIa hyperlipoproteinemia, increased free fatty acids) and the severe dysregulation in lipid deposition are discussed.

EPR analysis of radicals generated in ultrasound-assisted lipoplasty simulated environment

The generation of various radicals by application of continuous wave (CW) high-intensity ultrasound energy (HIUE) to an aqueous biologic medium containing spin traps, under conditions simulating ultrasound-assisted lipoplasty (UAL), was demonstrated by EPR spectroscopy. The addition of water- soluble antioxidants, ascorbic acid and glutathione to the wetting solution substantially reduces the levels of hydroxyl radicals in the sonicated medium. These findings provide direct evidence for the generation of cavitation in the simulated intercellular environment, corroborating previous data, and pointing out that generation of transient cavitation in clinical UAL and other therapeutic and surgical applications of ultrasound is possible. The findings indicate that the effect of transient cavitation in aqueous biologic media may be similar to the effects of ionizing radiation, and raise the question of the long-term biosafety of the use of CW HIUE in UAL. The introduction of biocompatible water-soluble antioxidants to the sonicated medium may be utilized to suppress accumulation of radicals and reduce their possible adverse effects. (E-mail: topazmd@netvision.net.il)

Endermologie after external ultrasound-assisted lipoplasty (EUAL) versus EUAL alone

Background: Endermologie, despite its moderate success in the temporary reduction of the appearance of cellulite, has proven unsuccessful compared with lipoplasty for body contouring. Objective: The purpose of this study was to determine whether a body contouring program combining Endermologie with lipoplasty would produce better long-term body contouring results than lipoplasty alone. Methods: A prospective study comparing 2 closely matched, nonrandomized groups of 25 women each was conducted. Those in group 1 underwent external ultrasound-assisted lipoplasty (EUAL) to the superficial and deep subcutaneous areas of the flanks, hips, and thighs, followed in 10 days by a 20-week Endermologie course. Those in group 2 underwent only EUAL to the superficial and deep subcutaneous areas of the flanks, hips, and thighs. Patient evaluation preoperatively and 9 months postoperatively included standardized 35-mm photography; standardized circumferential body measurements of the waist, hips, thighs, knees, and calves; and body composition analysis. Patient satisfaction was assessed through the use of a questionnaire. Results: No significant complications were noted in either group. The average volume of aspirate in the 2 groups was not significantly different (group 1, 2000 mL; group 2, 2100 mL), nor were the results of standard circumferential body measurements and body composition analysis. There was, however, a reduction in the rates of subsequent revisional surgery in the 2 groups (revision rates: group 1, 4%; group 2, 12%). The results of objective blind grading demonstrated no statistically significant difference (P [equals] .30) in body contouring between the 2 groups (group 1, 92% improvement; group 2, 87% improvement). However, a statistically significant (P [lt ] .005) difference was noted for reduction in the appearance of cellulite between the 2 groups (group 1, 50% improvement; group 2, 0% improvement). Patient satisfaction was 96% in group 1 and 92% in group 2. Conclusions: Endermologie after EUAL improves postoperative results with respect to reduction in the appearance of cellulite and reduces the rate of subsequent revision but demonstrates no significant improvement over EUAL alone with respect to body contour improvement.

Differences in wound healing between ultrasound-assisted lipoplasty and suction-assisted lipoplasty in inverted T-pattern breast reduction surgery and chest wall contouring

Background: Inverted T-pattern breast reduction does not directly address axillary or lateral chest wall fullness. Lipoplasty of this tissue has been advocated by some surgeons to reduce additional scarring. Objective: A prospective study was designed to examine the differences in wound healing of the breast reduction skin flaps when ultrasound-assisted lipoplasty (UAL) and suction-assisted lipoplasty (SAL) were each used as an adjunct to inverted T-pattern breast reduction surgery. Methods: The prospective study involved 15 consecutive nonsmoking female patients undergoing a standard inferior pedicle, central mound breast reduction and contouring of the lateral chest wall. Contouring of the left lateral chest wall and axilla was done with UAL and contouring of the right lateral chest wall with SAL. Lipoplasty was not used elsewhere in the breast tissue. The height and length of skin ischemia or necrosis at the inverted T incision was measured at postoperative day 2 or 3. Patients were placed on dressing changes and followed frequently until fully healed. Results: The amount of breast tissue removed and the amount of UAL/SAL axillary aspirate were not significantly different from side to side (for the mean UAL side, tissue 828 ± 190 g and aspirate 195 ± 102 mL; for the mean SAL side, tissue 780 ± 187 g and aspirate 194 ± 94 mL; P > .05). The mean area of lateral skin flap ischemia at the inverted T incision was significantly less on the UAL side than on the SAL side (UAL, 47 ± 128 mm 2; SAL, 361 ± 500 mm 2; P = 0.02). The time to complete skin wound healing of the lateral flap was significantly less in the UAL-treated flaps than in the SAL-treated flaps (UAL, 9.6 ± 8.6 days; SAL, 22.1 ± 22 days; P = .02). The study was terminated once these resounding differences in lateral skin flap necrosis and time of wound healing became obvious. Conclusions: UAL offers significant benefits in comparison with SAL as an adjunct to standard breast reduction surgery for contouring of lateral chest wall fullness.

Microwave-assisted lipoplasty: A new treatment for body contouring

Louis P. Bucky, MD, Philadelphia, PA , is a board-certified plastic surgeon. Lipoplasty is the most popular technique for body contouring in aesthetic surgery today. Advances and innovations in lipoplasty have focused on cannula design, suction techniques, and wetting solutions. Traditional lipoplasty depended on the mechanical disruption of subcutaneous adipose tissue by means of a vacuum-assisted cannula. Advances in cannula design and, more important, the infusion of low-dose epinephrine and lidocaine anesthesia, have allowed removal of greater volumes of fat and have reduced bruising and patient discomfort. The first attempt to use ultrasonic energy to enhance liposuction was in the 1980s. In more recent years, the introduction of ultrasound-assisted lipoplasty (UAL) in this country by Zocchi1 has led to its increasing popularity. Despite careful evaluation, however, the exact mechasisms of UAL are not clearly understood. Although other mechanisms may be at work, there are 3 major tissue effects that probably play a role in UAL: thermal, mechanical, and cavitational. The relative contributions of each of these mechanisms and their side effects on the tissues are …

Very superficial ultrasound-assisted lipoplasty for the treatment of axillary osmidrosis.

Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was that liposuction could not effectively remove the apocrine gland located in the dermis and dermosubcutaneous junction. A high rate of residual malodor and dissatisfaction were reported. The author used ultrasound-assisted lipoplasty (UAL) in the very superficial plane to remove the apocrine gland located in the dermis and dermosubcutaneous junction. The purpose of this study was to prove the efficacy of the very superficial UAL (VSUAL) for the treatment of axillary osmidrosis. From December 1998 to December 1999, 21 consecutive patients underwent UAL in their axilla for axillary osmidrosis. The follow-up period ranged from 2 to 12 months (mean: 8 months). UAL was performed in the very superficial plane with an amplitude of 40%. The very superficial UAL (VSUAL) was done mainly in a withdrawing manner with the tip of the cannula against the skin. The UAL (VSUAL) was done aggressively until the skin changed slightly erythematous. The results were assessed subjectively and objectively, and classified as excellent, good, fair, and poor. Nineteen patients were graded as excellent and one patient as good. The total satisfaction rate was 95.2%. One patient complained of residual malodor in her left axilla. There were no cases of skin necrosis, hematoma, or seroma. Histology showed partial removal of the subcutaneous layer and deep dermis, and degenerative epithelial changes in the apocrine glands in the residual deep dermis. These microscopic findings meant near-total functional ablation of the apocrine gland in the axilla comparable to "flap-to-graft conversion" or surgical excision of axillary skin. The UAL (VSUAL) for axillary osmidrosis has the advantages of a high success rate with minimal complications. Rapid recovery, less restriction of movement, and tiny scars were other major benefits of this technique. Therefore, UAL (VSUAL) is a viable option for treatment of axillary osmidrosis.

External ultrasound-assisted lipoplasty from our own experience.

External ultrasound-assisted liposuction (XUAL) is a new technique that requires traditional aspirative liposuction after the application of high frequency ultrasonic fields delivered through the skin into a wetted tissue. Initial data suggest that it has some advantages over the traditional procedure, especially regarding the achievement of less traumatic surgery with superior clinical outcome. This preliminary report describes a comparative study between conventional liposuction and the external ultrasound-assisted technique as the modality of treatment for fat deposits in 65 bilateral anatomical areas. The results showed considerable superiority of the ultrasound-assisted series. We found less resistance to the canulla with more rapid removal of fat and the aspirated tissue showed less blood content with intact viable fat cells. Patients report less pain and discomfort on the ultrasound-treated sides and we found less swelling and bruising, with superior skin shrinkage. Clinical recovery was also enhanced by the external ultrasound and no complications were reported with the technique.

Comparative Lipoplasty Analysis of in Vivo-Treated Adipose Tissue

A comparative histologic and chemical analysis was undertaken of adipose tissue treated in vivo with traditional, ultrasound-assisted, and external ultrasound-assisted lipoplasty. A series of six healthy women undergoing elective liposuction according to the superwet technique using a 1:1 infiltration ratio with the estimated quantity of fat to be removed was included in the study. Four separate regions on each patient were treated independently in vivo with traditional liposuction, internal ultrasound-assisted liposuction, or external ultrasound-assisted liposuction for 7 minutes. External massage was used as a control. Four separate specimens of adipose tissue from each patient were assessed for cellular disruption using blinded histologic evaluation. The remainder of tissue was centrifuged to separate the aqueous phase from the cellular components and then spectrophotometrically analyzed for creatinine kinase and glycerol 3-phosphate dehydrogenase activity as markers of cellular disruption. Histologic analysis confirmed 70 to 90 percent cellular disruption with internal ultrasound-assisted liposuction. Suction-assisted and external ultrasound-assisted liposuction showed 5 to 25 percent disruption, whereas massage controls showed only 5 percent. Only internal ultrasound-assisted liposuction showed 5 to 20 percent thermal liquefaction. Absorbance analysis showed creatine kinase activity (sigma units) greatest in ultrasound-exposed tissue. Both external and internal ultrasound-assisted liposuction gave creatine kinase levels 28 to 33 percent greater than suction-assisted liposuction, which varied only 10 percent from controls. Glycerol 3-phosphate dehydrogenase activity was 44 percent greater for internal ultrasound-assisted liposuction than that detected with suction-assisted liposuction. Glycerol 3-phosphate dehydrogenase activity with external ultrasound-assisted liposuction and massage did not vary much from each other, at only 14 percent and 11 percent activity compared with internal ultrasound-assisted liposuction, respectively. Histologic and enzyme analysis of the different types of liposuction and their effect on adipocyte cellular disruption revealed no significant effect of external ultrasound or massage on the adipocytes. Further experimental studies are necessary to evaluate the role and efficacy of alternative techniques for body contouring.

Body Contouring with Ultrasound-assisted Lipoplasty

Body Contouring with Ultrasound-assisted Lipoplasty

Body Contouring with Ultrasound-assisted Lipoplasty

Lipoplasty (i.e., liposuction) is the most commonly performed cosmetic surgical procedure in the United States. During the past 20 years, there have been dramatic technological advancements in both surgical technique and equipment used to improve postoperative outcomes. As a result, perioperative nurses are faced with the challenge of providing quality care for this patient population in a variety of ambulatory surgical settings with highly specialized equipment. Perioperative team members play significant roles in the coordination of individualized patient-focused care, which includes detailed instructions and education, appropriate use and care of equipment, and postoperative follow-up. The efforts of the team members contribute to positive surgical outcomes, as well as to overall patient satisfaction.

The Superficial Subciliary Cheek Lift, A Technique for Rejuvenating the Infraorbital Region and Nasojugal Groove: A Clinical Series of 71 Patients

Two embryologically and histologically distinct layers of the subcutaneous adipose tissue were treated individually by different modalities. The authors performed ultrasound-assisted lipoplasty at the superficial layer and traditional suction-assisted lipectomy in the deep subcutaneous tissue. The ultrasound procedure allowed tissue-specific destruction of the superficial layer supported by dense fibrous networks without disrupting them. Skin retractions caused by this procedure could diminish the necessity of surgical dermolipectomy such as an abdominoplasty in moderately deformed cases. On the other hand, the traditional liposuction was performed to remove the excessive deep fat contained in the loose fibrous network in a limited area. Although the advancement of ultrasound devices and regimens has now reduced their operating times significantly, the ultrasonic lipoplasty was slower than traditional liposuction at the beginning of our procedure. In the abdominal wall, the procedure was performed only in a confined area, because the skin retractions made over the locally managed areas created a circumferential tightness around the trunk, using the nontreated area as a bridge. Confinement on the managed area prevented unnecessary blood loss and tissue destruction. It was less a matter of fat volume to remove in the superficial layer; rather, a precise application to the exact target area was required to get a more natural result. Dual-plane lipoplasty was performed for 2 years in 35 patients, mostly for the abdomen. No serious complication such as seromas or skin loss was observed in our series of patients.

Dual-Plane Lipoplasty for the Superficial and Deep Layers

Two embryologically and histologically distinct layers of the subcutaneous adipose tissue were treated individually by different modalities. The authors performed ultrasound-assisted lipoplasty at the superficial layer and traditional suction-assisted lipectomy in the deep subcutaneous tissue. The ultrasound procedure allowed tissue-specific destruction of the superficial layer supported by dense fibrous networks without disrupting them. Skin retractions caused by this procedure could diminish the necessity of surgical dermolipectomy such as an abdominoplasty in moderately deformed cases. On the other hand, the traditional liposuction was performed to remove the excessive deep fat contained in the loose fibrous network in a limited area. Although the advancement of ultrasound devices and regimens has now reduced their operating times significantly, the ultrasonic lipoplasty was slower than traditional liposuction at the beginning of our procedure. In the abdominal wall, the procedure was performed only in a confined area, because the skin retractions made over the locally managed areas created a circumferential tightness around the trunk, using the nontreated area as a bridge. Confinement on the managed area prevented unnecessary blood loss and tissue destruction. It was less a matter of fat volume to remove in the superficial layer; rather, a precise application to the exact target area was required to get a more natural result. Dual-plane lipoplasty was performed for 2 years in 35 patients, mostly for the abdomen. No serious complication such as seromas or skin loss was observed in our series of patients.

Continuing Issues: Ultrasound-Assisted Lipoplasty

Continuing Issues: Ultrasound-Assisted Lipoplasty

Physical Acoustics Of Ultrasound-Assisted Lipoplasty

The acoustic fields generated by probes and cannulas used for ultrasound-assisted lipoplasty (UAL) are sources of cavitation and sonoluminescence. The localized stress fields and heating caused by cavitation are strong enough to lyse cells and, in the authors' opinion, constitute the means of therapeutic action of UAL. The spectrum of sonoluminescence extends into the ultraviolet. Various devices have been calibrated and various issues relating to health risks are discussed.

Lipoplasty Complications And Their Prevention

Liposuction is a very popular plastic surgical procedure with acceptably low risks; however, any surgical procedure has some inherent risks. It is imperative that the surgeon has a clear understanding of possible complications associated with liposuction, as well as their prevention and treatment. This article addresses a comprehensive list of complications associated with liposuction in general and, where applicable, addresses differences in risk between ultrasound-assisted lipoplasty and suction-assisted lipoplasty.

Liability In Suction-Assisted Lipoplasty: A Different Perspective

In this article, the author discusses liability issues for suction-assisted lipoplasty (SAL) and ultrasound-assisted lipoplasty (UAL) that every plastic surgeon should consider. The article reviews factors affecting SAL insurance, discusses the outlook for the new UAL procedure based on experiences with previous breakthrough procedures, and closes with a call for all plastic surgeons to exercise great care in patient selection.

A Practical Guide To Ultrasound-Assisted Lipoplasty

This article provides practical guidelines for plastic surgeons to incorporate ultrasound-assisted lipoplasty into their practice. Tips for improved results are provided and methods to avoid complications are discussed. The author also weighs the advantages and disadvantages of ultrasound-assisted lipoplasty and suction-assisted lipoplasty.

An Endomicroscopic Comparison Of Various Techniques And Technologies Of Lipoplasty

Using video images of lipoplasty, this article focuses not only on how to extract fat, but also on how to preserve all the systems surrounding it, thereby improving the quality of the results obtained by the surgeon. The study reviewed in this article has two objectives. First, it determines the limitations of all lipoplasty techniques and finds methods of combining these techniques to optimize their strengths and minimize their weaknesses. Secondly, it searches for alternatives to open surgery, which was previously unavoidable. Endomicroscopic exploration of the subcutaneous fat while practicing different techniques of ultrasound-assisted lipoplasty demonstrates the safety and efficacy of the physical principles (cavitation and microstreaming) of ultrasound energy. The use of the adapted probe (solid or hollow) on subcutaneous fat can preserve the surrounding structures, allowing the surgeon to remove a large volume of blood-free fat and maintain tightened skin on the surface.

Ultrasound-Assisted Lipoplasty: Is This New Technology For You?

Adopting a new technique is a decision often made based on limited information and is a serious undertaking with potentially profound implications. Each surgeon has a professional and ethical obligation to scrutinize a new technology personally before embracing it. This article reviews certain factors that every surgeon should consider before adopting a new technique and specifically, provides basic information on starting ultrasound-assisted lipoplasty. The author takes into account the learning curve in acquiring new skills as well as certain economic factors.