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About face

Article-About face

Key iconKey Points

  • According to experts, ultrasound-assisted liposuction (UAL) is safe and effective for treating the face and neck because of recent innovations
  • Further, one surgeon indicates that UAL results may include less tissue trauma and bleeding than with conventional techniques, regardless of body area

Marlene J. Mash, M.D.
Recent innovations, including smaller cannulas and a protective pad for the Vaser System (Sound Surgical Technologies, LLC; Lafayette, Colo.), have helped to make ultrasound-assisted liposuction (UAL) safe and effective for facial and neck liposuction, experts tell Cosmetic Surgery Times . "I use Vaser LipoSelection because I've found it creates less tissue trauma and bleeding than conventional techniques, regardless of body area," says Marlene J. Mash, M.D., a Plymouth Meeting, Penn.-based dermatologist and dermasurgeon in private practice. In addition, she says that Vaser LipoSelection helps tighten loose skin, which proves particularly helpful in conjunction with a traditional lower face and neck lift. Instead of using a cold knife and undermining scissors in these areas, she says, "I use the titanium rod of the LipoSelection device to undermine the tissues and break up any fat or fibers." The ultrasonic wand is especially effective in the postauricular area, which tends to be very difficult to undermine, she adds. "Vaser LipoSelection cuts the undermining time at least in half" versus traditional undermining techniques and provides similar benefits for areas difficult to access with traditional liposuction, she estimates. Whatever location she's treating, Dr. Mash says she begins with oral and tumescent anesthesia, the latter of which swells the tissue and creates an area into which one can safely insert the Vaser wand without damaging nerves or blood vessels.

PATIENT PROTECTION After anesthesia application, Dr. Mash uses 3- to 4-mm incisions — one under the chin and one behind each ear — to introduce the Vaser probe under the skin. "This allows a port to be placed first, and then the wand goes through the port," she explains. The wand comes with three different tips, but for head and neck liposuction, she recommends using the three-ringed tip, which delivers the least energy.

Some physicians avoid ultrasonic devices for liposuction and liposculpturing because they believe ultrasonic energy burns the tissues, she says. As a result, she says, relatively few physicians use Vaser LipoSelection for the face and jowls. "We must protect the skin surrounding the aperture where the rod enters," Dr. Mash notes. Traditionally, cosmetic surgeons have placed wet towels over the area. "But that becomes very messy and cumbersome," she says. Instead, Dr. Mash says that she has "developed a way to prevent tissue burning."

"My device [the Mashpad, patent pending] is a silicon sheet measuring approximately 3-cm square that prevents the rod from having any contact with the skin," she explains. "It also has a 3-mm opening directly in its center to accommodate the port and wand." The sheet is autoclavable and withstands the heat generated by the wand. Using crisscrossing strokes, she says, "The wand acts as a dissection device and simultaneously emulsifies fibers and fat. The Vaser probe undermines the superficial planes above the platysma, the mandibular border and the preauricular area." With this technique, she adds, "The heat from the device creates tissue retraction and further tightening of the skin. This is one of the unique properties of the ultrasonic device." Overall, Dr. Mash says that when properly performed, the procedure is gentle and less traumatic than conventional liposuction or lower facelift surgery. Vaser LipoSelection also cuts downtime from one week with traditional liposuction to three or four days, she adds.

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