National report — Ultrasound-assisted lipoplasty (UAL), incorporating ultrasonic energy in liposuction, may seem like a one-hit surgical wonder. It made a dramatic debut in the United States in 1997, but enthusiasm for it quickly waned.
The procedure, which seemed to pose too many unknowns, fell out of favor, with surgeons falling back on the traditional suction-assisted lipoplasty (SAL).However, Jorge A. Perez, M.D., finds that UAL is perhaps more misunderstood than it is dangerous, according to a recent study he compiled with Dr. Joost P.B. van Tetering.
Results of the study, "Ultrasound-Assisted Lipoplasty: A Review of Over 350 Consecutive Cases Using a Two-Stage Technique," counter the previously set time limitations on ultrasonic usage that were meant to prevent burns. The study concluded that there is no correlation between application time and burns to the skin, with the caveat that two rules be followed without exception.
The two rules, formulated by Italian surgeon Dr. Michael Zocchi, stipulate that doctors should never apply ultrasonic energy to dry tissues, and they should keep the cannula moving at all times.
When the cannula stops moving, complications arise; in fact, tissue damage can happen within seconds, according to the study. While some surgeons claim that there is little or no difference between the results of UAL and SAL, Dr. Perez disagrees. "The problem with SAL is that the suction doesn't discriminate between the good tissue and the bad tissue. It suctions out everything. And within that subcutaneous tissue, in addition to the fat, are things like blood vessels and nerves and fibrous tissue — things that you want to protect and preserve," he says.
Just as with SAL, an entryway is made in the skin to introduce the cannula. But instead of suctioning out the tissue with the suction energy, the tip of the cannula gives off a sound wave that is specific in frequency to fat cells, which then turns the fat cells into an oil. The oil is then removed with a gentle suction.
But more specifically, Dr. Perez and Dr. van Tetering modified their process from a three-stage technique, which begins by infiltrating the body part with a tumescent fluid, then applying the energy, and finally, using traditional liposuction to suction out the fat. Their technique skips the traditional liposuction stage, or what's called "mopping up." They basically inject the tumescent fluid, then apply the energy and the suction simultaneously. As for time, Perez says that if, for example, an abdomen requires 45 minutes of UAL, doctors should spend 45 minutes on it, keeping the two main principles in mind.
On a clinical level, says Dr. Perez, that translates into less bruising, less pain and smoother results — not to mention a faster recovery. He says it's not unusual for his patients to take nothing stronger than Tylenol for pain.
"I did UAL on a gentleman recently," Dr. Perez says. "He owns and operates a very busy gourmet market; this guy works 80-hour weeks. He had liposuction on a Friday, and was back at the market on Saturday, running the store. That's the kind of recovery we get with this procedure."
While some claim that there is little or no difference between the results of ultrasound-assisted lipoplasty and traditional suction-assisted lipoplasty, Jorge A. Perez, M.D., disagrees.