Ultrasonic assisted liposuction: techniques and applications

Ultrasonic Assisted Liposuction

Where is Ultrasonic Liposuction Performed:

Ultrasonic assisted liposuction (UAL) is performed in all areas where traditional liposuction is used. These areas include the abdomen, hips, thighs, and upper arms (Liposuction," 2008). However, UAL is especially useful in areas that require increased precision. Areas including male breast tissue, stomach, 'love handles' or midsection, chin, and neck all are common areas where UAL is performed. In addition, it is popularly used in areas that have been previously treated with traditional liposuction that are in need of increased contouring ("Ultrasonic," 2008). The ultrasonic cannulas "allow easier penetration through the firmer fat found in these locations (...and) decrease the manual force required by the surgeon in areas of firmer fat quality" ( "Statement," 1998, p. 1035).

Risk Factors Associated with Ultrasonic Liposuction:

There are several risk factors associated with UAL. In one study, it was found that several UAL patients had an onset of induration at approximately the third week postoperatively. Hyperesthesia and 'spongy edema', in which a rubbery-like feel to the edematous tissue, can be temporarily experienced. In addition, there is a slightly increased chance of seromas, persistent numbness, fascitis, and panniculitis with UAL (Lack, 1998). Aggressive use of UAL has also been noted to lead to burns and skin necrosis ("Statement," 1998).

Instrumentations Used in the Procedure and How the Procedure Performed:

UAL utilizes ultrasonic energy through a cannula, which is then applied to subcutaneous fat, in order to emulsify the fat combined with suction for extraction. Electrical energy is applied to a piezoelectric crystal in a hand piece. The crystal is distorted by the electrical energy and produces mechanical energy, which is transmitted to a cannula that has been attached to the handpiece. The mechanical energy is transmitted down the cannula as a sine wave and is exhibited as a minute to-and-fro motion of the cannula, most prominent at its tip. It is the to-and-fro motion that is transmitted to the tissue environment, which is in contact with the probe (Lack, 1998). Originally developed in Italy, UAL was first introduced in the United States in 1996. Because of the primary drawback of this technology -- heat production -- UAL is performed in a wet environment, like that produced by the tumescent liposuction technique ("Statement," 1998).

For the destructive ultrasound to be used successfully in UAL, it must be selective. Due to the physics of sound transmission, ultrasound is tissue selective. Because of the denseness of tissues with a higher collagen and/or elastin content, they fragment poorly. These types of tissue include ligaments, vessels, skin, tendons, and organ capsules. However, ultrasound can be easily transmitted through soft parenchymal tissues, including adipose. The infusion of tumescent fluid decreases the organization, structure and cohesion of the tissue, making it even more susceptible to ultrasound (Lawrence & Coleman, 1997).

The first step in UAL is the injection of tumescent fluid. This mixture of anesthetic, salt water solution, and epinephrine is injected into the area that is to be treated. Not only does the fluid help act as a heat sink but also helps prevent fluid loss during the process, while also making the fat deposits easier to remove. Sound waves are then produced by a generator and transmitted through via the thin. Vacuum-like cannula. When the instrument makes contact with the fat cells, they liquefy and are vacuumed out ("Ultrasonic," 2008).

Indications and Clinical Application for UAL:

Scheinfeld and Zimbler (2006) noted that patients with lipodystrophy, localized increased adipose tissue, benefit from liposuction. These patients may be at or below their ideal weight, yet there is fatty tissue present in excess in certain areas. Generalized obesity is not an indication for liposuction. Candidates should be in good health, have realistic expectations and not be obese. UAL is specifically indicated in areas where enhanced contouring is needed, very large areas, or very fibrous areas. Other indications for UAL, and liposuction in general, include treatment of: solitary and multiple lipomas, lipodystrophy, gynecomastia or psydogynecomastia, axillary hyperhidrosis, and axillary bromidrosis. UAL may also be used in reconstructive procedures, including fat debulking during scar revision ("Guidelines," 2006).

Role of Sonographer in UAL:

The role of sonographer is primarily diagnostic. In regards to the UAL procedure, a sonographer may be called on prior to the procedure to determine the density of the fatty areas being considered for liposuction. In this way, the cosmetic surgeon can determine if UAL or tumescent liposuction is the most appropriate course of treatment.