eMedicine Specialties > Plastic Surgery > Body Contouring

Liposuction, External Ultrasound-Assisted: Follow-up

Author: Christian N Kirman, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Coauthor(s): Gaurav Bharti, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center; Joseph A Molnar, MD, PhD, FACS, Associate Director of Burn Unit, Associate Professor, Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine
Contributor Information and Disclosures

Updated: Oct 23, 2009

Outcome and Prognosis

In 2000, Mendes described less resistance to the cannula with a more rapid removal of fat; the aspirated tissue removed in this fashion revealed less blood content with intact viable fat cells.2 Patients reported less pain and discomfort on the areas treated with ultrasound; less swelling and bruising and superior skin shrinkage were also noted in the ultrasound-treated areas. No complications were reported, and Mendes concluded that clinical recovery was enhanced by external UAL. In 1999, Johnson and Cook also achieved excellent results with external UAL.17 They noted greater cannula maneuverability; an increase in the proportion of supernatant fat observed in the aspirate; and decreases in postoperative ecchymosis, swelling, and discomfort.

Overall, the outcomes and prognoses appear to be good with external UAL. Comparatively, the results of internal UAL in areas of fibrous-fatty tissue and for large-volume aspirations are well documented. The learning curve for the internal UAL technique is longer than that for the external technique.

Future and Controversies

In 2000, Lawrence and Cox reported that when corrected for the placebo effect, external ultrasound application prior to tumescent liposuction achieved no advantage for doctor or patient.12 In most cases, the surgeon could detect no difference in the rate of extraction, color of fat, or resistance to the cannula. Most patients reported greater discomfort on the side treated with high-intensity ultrasound compared to the side treated with very low-intensity ultrasound.

In 1999, Lawrence and Coleman reported that external UAL was helpful and effective.11 Ferraro's 2008 study reports that external UAL is a highly effective noninvasive modality that induces cell-to-cell contact, which leads to loosening of collagen fibers, allowing adipose cells to be removed mechanically with less effort and local tissue damage.4 At higher frequencies, external UAL causes complete cellular destruction of adipose cells.4

Currently, most authorities believe external UAL is ineffective. In their review of various liposuction techniques, Heymans et al found that vibroliposuction techniques provide the safest, most precise form of lipectomy without the complications associated with internal UAL.1 Future studies must define the exact settings to use with external UAL and which patients will benefit from external UAL. As with most techniques, the success of external UAL is likely operator-dependent; thus, this factor must be evaluated in future studies. External UAL has not yet achieved widespread acceptance or popularity.

For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article Liposuction.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Noah S Scheinfeld, MD, JD, FAAD, and Marc S Zimbler, MD, FACS, to the development and writing of this article.



More on Liposuction, External Ultrasound-Assisted

Overview: Liposuction, External Ultrasound-Assisted
Workup: Liposuction, External Ultrasound-Assisted
Treatment: Liposuction, External Ultrasound-Assisted
Follow-up: Liposuction, External Ultrasound-Assisted
References
Further Reading
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References

  1. Heymans O, Castus P, Grandjean FX, Van Zele D. Liposuction: review of the techniques, innovations and applications. Acta Chir Belg. Nov-Dec 2006;106(6):647-53. [Medline].

  2. Mendes FH. External ultrasound-assisted lipoplasty from our own experience. Aesthetic Plast Surg. Jul-Aug 2000;24(4):270-4. [Medline].

  3. Rosenberg GJ, Cabrera RC. External ultrasonic lipoplasty: an effective method of fat removal and skin shrinkage. Plast Reconstr Surg. Feb 2000;105(2):785-91. [Medline].

  4. Ferraro GA, De Francesco F, Nicoletti G, Rossano F, D'Andrea F. Histologic effects of external ultrasound-assisted lipectomy on adipose tissue. Aesthetic Plast Surg. Jan 2008;32(1):111-5. [Medline].

  5. D'Andrea F, Ferraro GA, Nicoletti GF, De Francesco F. External ultrasound-assisted lipectomy: effects on abdominal adipose tissue. Plast Reconstr Surg. May 2008;121(5):355e-356e. [Medline].

  6. Rohrich RJ, Ha RY, Kenkel JM, Adams WP Jr. Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction. Plast Reconstr Surg. Feb 2003;111(2):909-23; discussion 924-5. [Medline].

  7. Fischer A, Fischer GM. First surgical treatment for molding body's cellulite with three 5-mm incisions. Bull Int Acad Cosmet Surg. 1976;3:35.

  8. Scuderi N, De Vita R, D'Andrea F. Nouve prospettive nella liposuzione: La lipoemulsificazione. G Chir. 1987;2:1-10.

  9. Zocchi M. Ultrasonic liposculpturing. Aesthetic Plast Surg. Fall 1992;16(4):287-98. [Medline].

  10. Silberg BN. The technique of external ultrasound-assisted lipoplasty. Plast Reconstr Surg. Feb 1998;101(2):552. [Medline].

  11. Lawrence N, Coleman WP 3rd. Ultrasonic-assisted liposuction. Internal and external. Dermatol Clin. Oct 1999;17(4):761-71. [Medline].

  12. Lawrence N, Cox SE. The efficacy of external ultrasound-assisted liposuction: a randomized controlled trial. Dermatol Surg. Apr 2000;26(4):329-32. [Medline].

  13. Cardenas-Camarena L, Cardenas A, Fajardo-Barajas D. Clinical and histopathological analysis of tissue retraction in tumescent liposuction assisted by external ultrasound. Ann Plast Surg. Mar 2001;46(3):287-92. [Medline].

  14. Hughes CE 3rd. Patient selection, planning, and marking in ultrasound-assisted lipoplasty. Clin Plast Surg. Apr 1999;26(2):279-82; ix. [Medline].

  15. Shi B, Li WZ, Li XY, Chen SZ. [500 cases of external ultrasound-assisted liposuction]. Zhonghua Zheng Xing Wai Ke Za Zhi. Mar 2004;20(2):86-9. [Medline].

  16. Zhang XH. [Application of external ultrasound-assisted tumescent liposuction in upper legs]. Di Yi Jun Yi Da Xue Xue Bao. Nov 2004;24(11):1331-2. [Medline].

  17. Johnson DS, Cook WR Jr. Advanced techniques in liposuction. Semin Cutan Med Surg. Jun 1999;18(2):139-48. [Medline].

  18. Mann MW, Palm MD, Sengelmann RD. New advances in liposuction technology. Semin Cutan Med Surg. Mar 2008;27(1):72-82. [Medline].

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Further Reading

Clinical guideline: Practice advisory on liposuction

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Keywords

external ultrasound-assisted liposuction, XUAL, ultrasound-assisted liposuction, body contouring, external UAL, ultrasonic liposuction, fat removal, cosmetic fat removal, fat suctioning, fat extraction, ultrasonic fat extraction, liposuction technique

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Contributor Information and Disclosures

Author

Christian N Kirman, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Christian N Kirman, MD is a member of the following medical societies: North Carolina Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Gaurav Bharti, MD, Resident Physician, Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center
Gaurav Bharti, MD is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, and Phi Kappa Phi
Disclosure: Nothing to disclose.

Joseph A Molnar, MD, PhD, FACS, Associate Director of Burn Unit, Associate Professor, Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine
Joseph A Molnar, MD, PhD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Parenteral and Enteral Nutrition, American Society of Plastic Surgeons, North Carolina Medical Society, Peripheral Nerve Society, and Wound Healing Society
Disclosure: KCI, Inc.  Honoraria Speaking and teaching; Integra Life Sciences Honoraria Speaking and teaching; Clincal Cell Culture Grant/research funds Co-investigator; KCI, Inc Wake Forest University receives royalties Other

Medical Editor

Gregory Caputy, MD, PhD, FICS, Chief Surgeon, Aesthetica Plastic and Laser Surgery Center, Inc
Gregory Caputy, MD, PhD, FICS is a member of the following medical societies: American Society for Laser Medicine and Surgery, Canadian Medical Association, International College of Surgeons, International College of Surgeons US Section, Pan-Pacific Surgical Association, and Wound Healing Society
Disclosure: Syneron Corporation Salary Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Alan Matarasso, MD, FACS, PC, Clinical Professor of Plastic Surgery, Albert Einstein College of Medicine; Immed Past President of New York Regional Society of Plastic and Reconstructive Surgery
Alan Matarasso, MD, FACS, PC is a member of the following medical societies: American Association of Plastic Surgeons, American College of Surgeons, American Medical Association, International College of Surgeons US Section, New York Academy of Medicine, New York County Medical Society, Pan American Medical Association, and Pan-Pacific Surgical Association
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None; Cellution Inc.  None Board membership; Angiotech  None

 
 
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