Ultrasound-assisted Liposuction Research Articles

Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study.

In this study, the authors investigated the physiologic effects of the altered body composition that results from surgical removal of large amounts of subcutaneous adipose tissue. Fourteen women with body mass indexes of greater than > 27 kg/m2 underwent measurements of fasting plasma insulin, triglycerides, cholesterol, body composition by dual-energy x-ray absorptiometry (DXA), resting energy expenditure, and blood pressure before and after undergoing large-volume ultrasound-assisted liposuction. There were no significant intraoperative complications. Body weight had decreased by 5.1 kg (p < 0.0001) by 6 weeks after liposuction, with an additional 1.3-kg weight loss (p < 0.05) observed between 6 weeks and 4 months after surgery, for a total weight loss of 6.5 kg (p < 0.00006). Body mass index decreased from (mean +/- SEM) 28.8 +/- 2.3 to 26.8 +/- 1.5 kg/m2 (p < 0.0001). This change in body weight was primarily the result of decreases in body fat mass: as assessed by DXA, lean body mass did not change (43.8 +/- 3.1 kg to 43.4 +/- 3.6 kg, p = 0.80), whereas DXA total body fat mass decreased from 35.7 +/- 6.3 to 30.1 +/- 6.5 kg (p < 0.0001). There were significant decreases in fasting plasma insulin levels (14.9 +/- 6.5 mIU/ml before liposuction versus 7.2 +/- 3.2 mIU/ml 4 months after liposuction, p < 0.007), and systolic blood pressure (132.1 +/- 7.2 versus 120.5 +/- 7.8 mmHg, p < 0.0002). Total cholesterol, high-density lipoprotein cholesterol, plasma triglycerides, and resting energy expenditure values were not significantly altered after liposuction. In conclusion, over a 4-month period, large-volume liposuction decreased weight, body fat mass, systolic blood pressure, and fasting insulin levels without detrimental effects on lean body mass, bone mass, resting energy expenditure, or lipid profiles. Should these improvements be maintained over time, liposuction may prove to be a valuable tool for reducing the comorbid conditions associated with obesity.

Rhytidectomy assisted with ultrasound techniques: the ultra-lipo-lift technique.

Ultrasound-assisted liposuction has been practiced in Europe and South America for more than 10 years. This method was clinically introduced in 1989 for removal of fat by Dr. Zocchi, who developed the concept of applying ultrasound energy to adipose tissue [13,14]. Since 1992, we have been using ultrasound lipoplasty, first in body remodeling, then in face and neck surgery, after establishing working and safety rules in a study of 300 patients. In the beginning we were only looking to eliminate deposits of fat in oval faces with acne-scars, subdermal fibrosis, and thick skin, as these types of cases are not good candidates for rithidectomy. We found good skin retraction when we adjusted the superficial movements of the canula and had adequate machine power to avoid complications beneath the skin. Afterwards, we can break and release the adhesion zones of scarring and fibrosis, consequences of subdermic infiltrations or thread implants. Now we report our technique of rithidectomy assisted with ultrasound, which we have called ultra-lipo-lift (ULL). During the two last years we used this technique on 67 patients (48 females and 19 males) with good results and very few complications.

Effect of ultrasonic assisted lipectomy (UAL) on breast tissue: histological findings.

As the use of ultrasound-assisted liposuction (UAL) increases, the technique grows more popular in breast surgery, especially in reduction mammaplasty and treatment of gynecomastia. The aim of our study was to investigate the effect of UAL on breast tissue using histological examinations, and analyze the effect of this technique on a cellular level. Biopsies from 10 patients undergoing ultrasonically assisted lipectomy prior to classic reduction mammaplasty were taken from the treated areas of the breast. Biopsies were fixed in formalin and embedded in paraffin. Sections were stained with hematoxilin-eosin, and analyzed for defective adipocytes, and the effects of UAL on breast tissue. Untreated breast tissue and breast tissue that had been treated only with conventional aspiration lipectomy served as controls. Sections were analyzed using light microscopy. Compared to the breast tissue treated only with conventional lipectomy, a stronger destruction of the cellular structure of adipocytes could be detected. The destruction was visible even in areas more distant from the aspiration channel. In contrast, the breast tissue was mostly intact, no signs of ultrasonic-induced cellular destruction were visible. The glandular structure was kept intact. Beside the direct mechanical destruction by the probe and the canula, no further alterations of the cellular integrity of the glandular parts were visible. In conclusion our results indicates that UAL is also a safe technique for use in breast surgery. Besides easy handling and improved modelling, the destructive effect of the ultrasound does not include the glandular breast tissue.

Hearing and ultrasound-assisted liposuction: the effect on surgeon and patient.

Ultrasound-assisted liposuction has become an important tool in body-contouring surgery. Although ultrasound frequency is by definition outside the range of normal human hearing, an audible sound is heard during ultrasound-assisted liposuction. This study measured sound intensity during ultrasound-assisted liposuction performed with two commercially available systems. Sound intensity was measured at the surgeon's ear, surgical site, and patient's glabella. All measurements obtained with both machines fell within acceptable standards as defined by the Occupational Safety and Health Administration. Use of ultrasound-assisted liposuction does not pose a risk to the patient, the surgeon, or operating room personnel.

Hearing and Ultrasound-Assisted Liposuction: The Effect on Surgeon and Patient

Kenkel, Jeffrey M. M.D.; Johns, Donnell F. Ph.D.; Rohrich, Rod J. M.D.; Adams, William P. Jr. M.D.; Roeser, Ross J. Ph.D. Author Information

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.

Current Status of Suction Lipectomy in Canada: A Cross-Sectional Survey of Plastic Surgeons

Background Suction lipectomy is the most common aesthetic surgery performed in North America. The safety of the procedure has recently been questioned, particularly with respect to large volume aspiration. Objective To delineate Canadian liposuction practice patterns and perceived complication rates. Subjects and Methods A survey was mailed to all plastic surgeons registered with the Canadian Society of Plastic Surgeons. The survey assessed surgeon demographics, hospital admission rates following liposuction, techniques used, wetting solutions, aspirate volumes and complications. Results A total of 322 surveys were mailed. The response rate was 44%. Of the 142 surgeons who responded, 119 regularly performed suction lipectomy. They reported that 70% of patients had suction lipectomy performed on an outpatient basis. Forty per cent of procedures were performed in private clinics. On average, surgeons performed 40 liposuctions/year without ancillary procedures and 27 liposuctions/year with ancillary procedures. Fifteen per cent of surgeons used ultrasound-assisted liposuction as an adjunct to traditional liposuction, although less than 1% used it exclusively. The ratio of aspirate to infiltrate was 0.25 to one in 45% of cases, 0.5 to one in 37%, one to one in 17% and one to one in fewer than 1%. In 69% of patients, 1 to 2 L was aspirated, while in fewer than 5% of patients, more than 3.5 L was aspirated. Early complication rates were as follows: hematoma and seroma 2.6%, infection 1.3% and skin loss 0.01%. Contour irregularity was the main late complication, occurring in 12% of patients. No cases of venous thrombosis, or pulmonary or fat emboli were reported. No deaths were reported. Conclusions Suction lipectomy is performed commonly by Canadian plastic surgeons, with the majority using a wet or superwet technique. In the vast majority of patients, fewer than 3500 cm3 are aspirated. The complication rate is perceived to be low.

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.

Endermologie versus Liposuction with External Ultrasound Assist

Background: Endermologie has been presented as a treatment to reduce cellulite and as a noninvasive method of body contouring. Objective: The purpose of this study was to (1) evaluate the effectiveness of Endermologie in cellulite reduction and body contouring, (2) compare the results of external ultrasound-assisted liposuction (EUAL) with those of Endermologie with regard to body contouring and cellulite reduction, and (3) determine whether EUAL is as effective in cellulite reduction as it is in body contouring. Methods: A prospective study comparing 2 closely matched, nonrandomized groups of 36 women each was conducted. Group 1 underwent a 20-week course of Endermologie, concentrating on the abdomen, flanks, hips, and thighs. Group 2 underwent EUAL to the superficial and deep subcutaneous areas of the flanks, hips, and thighs. Methods of evaluation included analysis of standardized 35-mm photography, standardized circumferential body measurements, and body composition. Photographic results were evaluated by objective blind grading from 4 physicians. Patient satisfaction was assessed through use of a questionnaire. Results: No significant complications were noted in either group. In the EUAL group, the average volume of aspirate was 1900 mL, with a subsequent contour revision required in 11% of cases. The standardized circumferential body measurements of the waist, hips, thighs, and right knees of the EUAL patients demonstrated a reduction greater than that noted in the Endermologie patients; this difference was statistically significant (P < .05). The body composition analysis of the EUAL patients demonstrated a greater reduction in the percentage of body fat, fat mass, body weight, lean body mass, and impedance than that seen in the Endermologie group; this difference was statistically significant (P < .05). The EUAL patients exhibited an increase in total body water greater than that noted in the Endermologie group; this difference was statistically significant (P < .05). In the Endermologie group, the results of objective blind photographic grading demonstrated a mean improvement of 25% in body contour, which was largely proportional to weight loss, and a mean cellulite reduction of 50%. In the EUAL group, a mean improvement of 87% in body contour, which represented a true alteration of body contour rather than a proportional reduction, and a mean cellulite reduction of 0% were noted. Mean patient satisfaction was 92% in the Endermologie group and 96% in the EUAL Group. Conclusions: EUAL has no role in reducing cellulite. Endermologie is the superior choice when cellulite reduction is the goal, but it is not an effective method of body contouring.

Surgical lipectomy

Until 20 years ago, surgical lipectomy was accomplished exclusively through an open surgical approach. It was then largely replaced with the less invasive suction technique. More recently, the field has expanded again with the advent of liposhaving, ultrasound-assisted liposuction, and laser-assisted liposuction, making surgical lipectomy one of the most commonly performed cosmetic surgical procedures today. The techniques of lipectomy are discussed along with their applications to facial plastic surgery. Until 20 years ago, surgical lipectomy was accomplished exclusively through an open surgical approach. It was then largely replaced with the less invasive suction technique. More recently, the field has expanded again with the advent of liposhaving, ultrasound-assisted liposuction, and laser-assisted liposuction, making surgical lipectomy one of the most commonly performed cosmetic surgical procedures today. The techniques of lipectomy are discussed along with their applications to facial plastic surgery.

Report From The Conference On Ultrasound-Assisted Liposuction Safety And Effects

The authors report on the Ultrasound-Assisted Liposuction (UAL) Safety and Effects conference held in St. Louis, Missouri, in November 1998. The meeting was convened to discuss how internal UAL works (its physics and mechanisms of action), gain a basic knowledge of the interaction between acoustic energy and tissue, identify safety concerns potentially related to thermal effects and free radical production, and define future research questions. Those attending represented multiple scientific disciplines: plastic surgery, physics, lipid chemistry, cancer biology, and medical biophysics. Participants agreed that scientists do not yet understand the mechanisms of UAL action, although multiple mechanisms are probably involved, such as mechanical forces, cavitation, and thermal effects. Additional research has revealed that long-term complications or negative bioeffects--including DNA damage and oxidation-free radical attack--are probably not serious safety concerns with UAL. Several areas deserving future investigation were proposed.

Sensory changes after traditional and ultrasound-assisted liposuction using computer-assisted analysis.

Postoperative sensory changes (i.e., hypesthesias) that occur after suction-assisted lipoplasty (SAL) are expected clinical sequelae. These disturbances usually return to normal within several weeks to months postoperatively. The presumed mechanism of injury is direct trauma to the peripheral nerves from the suction cannula. In addition, the potential for demyelination of peripheral nerves secondary to cavitation during ultrasound-assisted liposuction (UAL) is well known. Quantitative data describing hypesthesia after both procedures are limited. The purpose of this study was to objectively evaluate the severity and duration of postoperative hypesthesia after liposuction to better educate patients preoperatively. Furthermore, the authors use the three-stage UAL technique and wanted to determine whether a clinical difference in sensory return existed between suction- and ultrasound-treated areas. A total of 21 patients underwent liposuction performed by the senior author (RJ.R.). The abdomen, flanks, thighs, and medial knees were tested for objective sensation with the Pressure Specified Sensory Device preoperatively and at 2, 6, and 10 weeks postoperatively. A total of 102 sites were tested. On average, the SAL-treated areas improved to normal sensation by 6 weeks, whereas the UAL-treated areas took, on average, 10 weeks to recover. The severity of the hypesthesia was not correlated with larger aspiration volumes or longer UAL exposure time per site. At 10 weeks, 90 percent of UAL-treated patients and 89 percent of liposuction patients overall had recovered normal sensation. This study provides the body-contouring surgeon with good, objective data with which to educate patients regarding sensory return after liposuction.

Sensory Changes after Traditional and Ultrasound-Assisted Liposuction Using Computer-Assisted Analysis

Trott, Suzanne A. M.D.; Rohrich, Rod J. M.D.; Beran, Samuel J. M.D.; Kenkel, Jeffrey M. M.D.; Adams, William P. Jr. M.D.; Robinson, Jack B. Jr. Ph.D. Author Information

Sensory Changes after Traditional and Ultrasound-Assisted Liposuction Using Computer-Assisted Analysis

Sensory Changes after Traditional and Ultrasound-Assisted Liposuction Using Computer-Assisted Analysis

Book Review: Ultrasound-Assisted Liposuction

Book Review: Ultrasound-Assisted Liposuction

The effects of ultrasonic energy on peripheral nerves: implications for ultrasound-assisted liposuction.

The integration of ultrasound-assisted liposuction with traditional suction-assisted lipoplasty has extended the role of liposuction in body contouring. Although there are ample data regarding the effects of ultrasound on peripheral nerves from studies with the Cavitron ultrasound surgical aspirator, there is little information concerning the effects of modern ultrasound body contouring equipment on neural tissue. This study was designed to evaluate the functional and histologic effects of ultrasound energy on rat peripheral nerves (sciatic nerves) using a commonly-used ultrasound-assisted liposuction generator. After the application of ultrasound to exposed rat sciatic nerves, operative magnification was used to assess any visible injury. The sciatic function index was serially measured to quantify immediate and long-term functional effects on the nerves. Our results showed immediate visible injury using low amplitude settings (level 6), but no functional evidence of injury until much higher settings were used (level 9). All animals in the groups with initial functional impairment had returned to normal or near-normal function at completion of the study (51 days). Histologic examination revealed no evidence of damage in the low amplitude groups. Histologic analysis of the high amplitude groups displayed diffuse infiltration of the nerve, with foamy histiocytes and an increased number of mast cells, consistent with remote neural injury followed by myelin breakdown and repair.

Extending the role of liposuction in body contouring with ultrasound-assisted liposuction.

The initial experience with ultrasound-assisted liposuction in treating difficult fibrous areas, such as gynecomastia, hitherto not uniformly responsive to traditional suction-assisted lipoplasty, has led to the evolution and improvement of ultrasound-assisted liposuction techniques. This prospective study examined 114 consecutive patients treated with ultrasound-assisted liposuction over a 13-month period, from September of 1996 to September of 1997. The means by which this procedure helps achieve fat contouring differs from that of suction-assisted lipoplasty. Ultrasound-assisted liposuction removes fat through a fat emulsification process termed "cavitation," whereas suction-assisted lipoplasty achieves contouring through the mechanical avulsion of fat. The technique for the use of ultrasound-assisted liposuction has changed significantly from our initial series of patients to our current technique. To optimize the benefits of both ultrasound-assisted and traditional suction-assisted lipoplasty, we use a three-stage technique consisting of infiltration, ultrasound-assisted sculpturing, and suction-assisted lipoplasty for evacuation and final contouring. This has decreased our operative time, minimized complications, and optimized our body contouring results. Data were collected intraoperatively, including treatment times, treatment volumes, and treatment areas for both suction-assisted and ultrasound-assisted lipoplasty. A total of 114 patients were treated with ultrasound-assisted liposuction between September of 1996 and September of 1997. There were 23 male patients and 91 female patients. In general, the average total volume removed with this procedure decreased by about 50 percent throughout the series, whereas the suction-assisted lipoplasty volume increased correspondingly by 50 percent. Overall, suction-assisted lipoplasty volume was approximately two times ultrasound-assisted liposuction volume in the same area. Exceptions to this include the dense fibrous areas such as the back and male breast, where aspiration volumes were approximately equal. The total ultrasound-assisted liposuction treatment times were reduced after our initial 30 patients, and suction-assisted lipoplasty times increased. Total aspiration rates in our later patients averaged 36.2 cc/per minute for ultrasound-assisted and 58.4 cc/per minute for suction-assisted lipoplasty, whose rates were approximately 1.5 to 2 times faster than for ultrasound-assisted liposuction in most areas. After using this technology in our initial series of 30 patients, it became apparent that ultrasound was not a substitute for suction-assisted lipoplasty but rather a natural complement. We have found that the marriage of the techniques enhances results and minimizes complications, such as seromas, which have been reported to be 11.4 percent with ultrasound-assisted liposuction alone and are 2.6 percent in our series.

Ultrasound-Assisted Liposuction

Ultrasound-assisted liposuction (UAL) has been practiced in Europe and South America for almost 10 years. Concern about UAL's safety has delayed its

Breast reduction with ultrasound-assisted liposuction

The trend in breast reduction, as in other types of surgeries, has been a reduction in the length and number of scars. The use of liposuction in the breast has also been gaining in acceptance, although it can be difficult to perform because of the fibrous nature of breast tissue. Ultrasound-assisted liposuction (UAL) makes liposuction of the breast easy and effective and can be used by itself in selected cases or as an adjunct to shorter scar techniques, expanding their applicability to a larger range of breast sizes. Two representative cases are shown: one showing breast reduction with UAL alone and the other showing resolution of a difficult gynecomastia problem using only the ultrasound device. Preliminary studies show no adverse effect on postoperative mammograms. We have found UAL to also be very useful as an adjunct to other types of breast surgery, such as transverse rectus abdominis musculo-cutaneous (TRAM) flap revisions. Although further investigation is very much needed, we believe that UAL will become a valuable asset not only in surgery of the breast, but in liposuction in general.