eMedicine Specialties > Plastic Surgery > Body Contouring
Liposuction, External Ultrasound-Assisted: Treatment
Updated: Oct 23, 2009
Treatment
Medical Therapy
Antibiotics (eg, cefazolin) are usually administered 1 hour before the liposuction procedure.
Surgical Therapy
Several companies make ultrasound machines that can be used to break up adipose tissue externally with ultrasonic energy. Examples are the Silberg EUA (Wells Johnson; Tucson, Ariz) and the Rich-Mar 510 (Bernsco; Seattle, Wash). Johnson and Cook used a Rich-Mar XUAL (Rich-Mar; Inola, Okla) with a continuous-wave setting at 1 MHz.
Liposuction is the suctioning of adipose tissue using thin tubes, or cannulas, inserted through tiny incisions in the adipose tissue. The cannula is attached to a flexible tube that leads to a suction machine, and the fat is vacuumed out through these tubes and collected in a large receptacle for measurement of the volume removed.
Prior to the surgery, the patient reviews the informed consent with his or her surgeon, when any questions may be answered and the details of the procedure discussed. The body areas to be addressed are marked, ensuring that both the patient and the surgeon understand which areas will be addressed. Then, the patient is taken to the operating room, where he or she is prepared with povidone-iodine solution (eg, Betadine) or other sterilizing solution.
Next, local anesthesia and epinephrine is injected for the tumescent technique. The two solutions used contain 0.05% or 0.1% lidocaine. The 0.05% solution has 500 mg of lidocaine. The 0.1% has 1000 mg of lidocaine. The tumescent liposuction technique uses local anesthesia along with epinephrine to minimize blood loss and postoperative discomfort. The surgeon can infiltrate anesthetic solution with either a pressure cuff around the bag of tumescent solution or a peristaltic pump and infiltrators. The tumescent local anesthesia technique allows a patient to move intraoperatively into the exact position needed to remove the fat. If many areas are treated, intraoperative sedation or general anesthesia is often used in conjunction with the tumescent anesthetic; this may be safely administered by an anesthesiologist or certified anesthetist.
Lidocaine toxicity must be considered. Patients should be monitored with a pulse oximeter and ECG during the procedure. Oral diazepam or a similar medication is useful to enhance anesthesia. Oral clonidine, given before the procedure, is helpful in patients with high blood pressure. Some clinicians also use small amounts of meperidine (Demerol), promethazine (Phenergan), or midazolam (Versed) to enhance anesthesia.
Preoperative Details
Routine preoperative screening is performed. Marking must be diligently performed prior to tumescence because many contours are lost or altered following its injection.
Intraoperative Details
The external ultrasound-assisted liposuction (UAL) machine is used to break up adipose tissue before liposuction begins. These machines produce 1 MHz of ultrasound energy in a continuous or pulsed cycle. The maximum power is 30 W or 3 W/cm2. The sound heads provided are 5 or 10 cm. The continuous cycle induces more tissue destruction than the pulsed cycle. Note that that a 1-MHz beam is reduced to half intensity at 48 mm of fat. In 2000, Lawrence and Cox applied external ultrasound at 2-3 W/cm2 in a continuous-wave cycle for 10 minutes to the treatment side.12
A coupling gel is used to prevent air interference at the skin-transducer interface. Before the ultrasonic energy is applied, the areas to be treated are infused with tumescent anesthesia. Ultrasound is applied to the treatment areas using circular strokes continuously, usually for 10 minutes on each side. The recommended duration of treatment is 1-2 minutes for each area 1.5 times the size of the transducer face. For most areas, this is 10-15 minutes per treatment area. The transducer must be moved continuously to prevent overheating. After the ultrasound application, standard tumescent liposuction is performed. Note that newer machines have been developed that deliver higher intensity ultrasonic forces of 2-3 MHz, which are associated with greater destruction of adipose cells.
Postoperative Details
Postoperatively, pain control needs should be minimal. Usually, extra-strength acetaminophen is sufficient. Some practitioners continue to administer antibiotics with gram-positive coverage for 7-10 days. Most practitioners apply elastic (eg, Ace) bandages, compression garments, or French tape compression to areas that have been treated to prevent seromas and bruising and to decrease soreness in these areas. Patients are often concerned about postoperative leakage of tumescent fluid from incision sites for up to several hours. Patients should be reassured that such leakage is common.
Follow-up
Patients can engage in noncontact sports immediately as tolerated. They cannot engage in contact sports or high-impact sports for approximately 2 weeks. Compression garments can and should be used postoperatively. Optimally, patients should wear these 12-24 h/d for approximately 2-4 weeks (as tolerated).
Complications
Rarely, external UAL can cause bruising, skin burn, and seromas. Skin necrosis, fibrosis, pigmentation alteration, and sensory alteration are also possible. Rarely, skin ulceration and a rubbery feel to edematous tissue have been described. The complications of tumescent liposuction are well described. In rare cases, cardiac problems can occur. Sometimes, surface irregularities and skin laxity can develop after these procedures.
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 |
| « Previous Page | Next Page » |
References
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].
Mendes FH. External ultrasound-assisted lipoplasty from our own experience. Aesthetic Plast Surg. Jul-Aug 2000;24(4):270-4. [Medline].
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].
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].
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].
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].
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.
Scuderi N, De Vita R, D'Andrea F. Nouve prospettive nella liposuzione: La lipoemulsificazione. G Chir. 1987;2:1-10.
Zocchi M. Ultrasonic liposculpturing. Aesthetic Plast Surg. Fall 1992;16(4):287-98. [Medline].
Silberg BN. The technique of external ultrasound-assisted lipoplasty. Plast Reconstr Surg. Feb 1998;101(2):552. [Medline].
Lawrence N, Coleman WP 3rd. Ultrasonic-assisted liposuction. Internal and external. Dermatol Clin. Oct 1999;17(4):761-71. [Medline].
Lawrence N, Cox SE. The efficacy of external ultrasound-assisted liposuction: a randomized controlled trial. Dermatol Surg. Apr 2000;26(4):329-32. [Medline].
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].
Hughes CE 3rd. Patient selection, planning, and marking in ultrasound-assisted lipoplasty. Clin Plast Surg. Apr 1999;26(2):279-82; ix. [Medline].
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].
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].
Johnson DS, Cook WR Jr. Advanced techniques in liposuction. Semin Cutan Med Surg. Jun 1999;18(2):139-48. [Medline].
Mann MW, Palm MD, Sengelmann RD. New advances in liposuction technology. Semin Cutan Med Surg. Mar 2008;27(1):72-82. [Medline].
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
