Liposuction and VASER

VASER is a fat pretreatment device based on the emission of pulsed or continuous ultrasound energy to emulsify fat before its aspiration by means of suction-assisted lipoplasty or power-assisted lipoplasty. If compared with previous generation UAL machines, it carries important technologic advances that focus on the safety and efficiency of the process. VASER is the result of improvements in surgical instrumentation and technique, proper use of wetting solutions, and knowledge about the best use of ultrasound for fat fragmentation. With its thinner cannulas and decreased use of ultrasonic energy, it allows greater emulsification of fat, creates more tunnels, diminishes the operative time, preserves vessels and nerves, and causes less pain and hematomas.     

Ultrasound-assisted lipoplasty: Is it really safe?

During the last decade liposuction has become the most common aesthetic procedure. It has also become the most common aesthetic procedure performed by physicians not trained in plastic surgery. New developments such as the tumescent technique, finer cannulas, and, finally, the technique of ultrasound-assisted lipoplasty (UAL) have been paralleled by reports of larger amounts of extracted fat. At the same time we see an increasing number of fatal complications. I have undertaken an investigation of 28 patients during 16 months, undergoing liposuction with UAL, to find out how the procedure affected them in terms of blood loss. I found that, while undergoing UAL, our patients lost up to 53% of their blood volume on postoperative day 1, and the average patient still had a loss of 20% of the blood volume 1 week postoperatively.     

Clinical application of VASER-assisted lipoplasty: A pilot clinical study

Background: Although lipoplasty is the most frequently performed aesthetic surgical procedure, ultrasound-assisted lipoplasty (UAL) has not been widely adopted because of its increased potential for complications, complex and bulky instrumentation, additional cost, and steep learning curve. Objective: We report on the use of the VASER ultrasound device in lipoplasty procedures and compare the clinical outcomes obtained by means of VASER-assisted lipoplasty with those of other UAL devices. Methods: A superwet technique was used, and the wetting solution was uniformly distributed in the intended treatment area. Skin protection measures included use of specially designed skin ports to protect the incision edges and wet towels adjacent to the port locations. Access incisions were 3 to 4 mm in length. The VASER device was used in VASER (pulsed ultrasound) mode by 2 investigators (P.B.F. and M.L.J.); the continuous ultrasound mode was used by these investigators only if tissue emulsification was not readily achieved by using the VASER mode. A third investigator (E.B.d.S.P.) primarily used the continuous mode. Effective fat fragmentation in either mode was achieved by a maximum of 1 minute of treatment time per 100 mL of infused wetting solution. Results: In a series of 77 patients treated by 3 different clinicians, satisfactory results were obtained with no major complications. This contrasts with an incidence of complications of 7.9% (median, 4.9%) for first- and second-generation UAL devices as determined by statistical analysis of the literature. Conclusions: The initial clinical experience with VASER-assisted lipoplasty indicates that it is a safe and efficient technique for body-contouring surgery. (Aesthetic Surg J 2002;22:131-146.)     

Ultrasound-assisted lipoplasty

Background : Ultrasound‐assisted lipoplasty (UAL) has been associated with particular types of complications and uncertain long‐term effects arising from interactions between ultrasonic energy and living tissue. The present review seeks to address these issues. Methods : Search strategy Three search strategies were devised to retrieve literature from Medline, Current Contents, Embase and Cochrane Library databases up until April 2000. Study selection Inclusion of papers was largely determined using a predetermined protocol. English language papers were selected. Acceptable study designs included randomized controlled trials, controlled clinical trials, case series or case reports. Data collection and analysis Thirty‐six papers met the inclusion criteria. They were tabulated and critically appraised in terms of methodology and design, outcomes, and the possible influence of bias, confounding and chance. Other papers were also included to provide background material. Results : There was little high‐level evidence available comparing UAL and suction‐assisted lipoplasty (SAL), with no conclusive evidence that UAL has a safety benefit, although low‐quality evidence suggests that UAL is associated with reduced surgeon fatigue as well as increased operating times, slower aspiration rates and an increased learning curve. There is inadequate evidence to determine whether the theoretical potential for DNA damage from ultrasound is realized in the clinical setting. Conclusions : The evidence base for UAL is inadequate to determine the procedure’s safety and efficacy. The potential for DNA damage must be investigated with appropriate in vivo animal models. Recommendations for the safe use of UAL are discussed.     

Continuing issues. Ultrasound-assisted lipoplasty

Ultrasound-assisted lipoplasty (UAL), the newest technological advancement in cosmetic surgery, has created significant discussion and controversy over the past few years. This article provides the reader with an update on the current status and continuing issues associated with UAL. The author discusses the role of the Task Force that was created to evaluate this new technology, reviews the regulatory issues and clinical studies concerning UAL and describes its benefits and limitations.     

Ultrasound-Assisted Lipoplasty (UAL) in Breast Surgery

Breast surgery has evolved significantly since the increased demand for reduced scars led to the development of minimal incision techniques. Ultrasound-assisted lipoplasty (UAL) presents important advantages when compared to traditional liposuction, such as preservation of connective structures and significant skin retraction capability. Other factors such as a favorable side-effect profile, satisfactory aesthetic results, and virtually inconspicuous scars have led us to utilize UAL in virtually all of the different breast surgery modalities carried out in our practice. Important aspects of patient selection, markings, surgical technique, and postoperative care are outlined. Ultrasonic energy is applied through superficial tunnels that lie radial to the mammary cone, with preservation of elements such as the areola, mammary ducts, and the central part of the breast's base which contains the perforators that supply the gland. Deep treatment should be applied onto adipose tissue regions and should preferably be performed in the peripheral and subcutaneous layers of the breast, with conservation of the central glandular cone to ensure maintenance of anterior projection. In selected cases, UAL is a valuable adjunct to procedures such as symmetrization, reduction mammaplasty, and breast reconstruction, permitting both volume reduction and shaping through three-dimensional retraction of connective tissue and skin. The excellent preliminary results support new indications and future developments of the technique.     

Vibroliposuction: a study of rate of aspiration

Challenges in suction-assisted lipoplasty (SAL) along with ultrasound-assisted lipoplasty (UAL) include physical effort by the surgeon, surface irregularities and undulations, risk of perforations (SAL), risk of burns (UAL), and lengthy operative time. In this study of 74 patients, vibro-assisted liposuction (VAL) was evaluated by rate of aspiration. In this group, variables included diameter of the cannula, number of openings, and pressure of compressed air. Our findings suggest that operative time is decreased with a greater number of openings into the cannula and a higher air pressure.     

Differences in wound healing between ultrasound-assisted lipoplasty and suction-assisted lipoplasty in inverted T-pattern breast reduction surgery and chest wall contouring

Background: Inverted T-pattern breast reduction does not directly address axillary or lateral chest wall fullness. Lipoplasty of this tissue has been advocated by some surgeons to reduce additional scarring. Objective: A prospective study was designed to examine the differences in wound healing of the breast reduction skin flaps when ultrasound-assisted lipoplasty (UAL) and suction-assisted lipoplasty (SAL) were each used as an adjunct to inverted T-pattern breast reduction surgery. Methods: The prospective study involved 15 consecutive nonsmoking female patients undergoing a standard inferior pedicle, central mound breast reduction and contouring of the lateral chest wall. Contouring of the left lateral chest wall and axilla was done with UAL and contouring of the right lateral chest wall with SAL. Lipoplasty was not used elsewhere in the breast tissue. The height and length of skin ischemia or necrosis at the inverted T incision was measured at postoperative day 2 or 3. Patients were placed on dressing changes and followed frequently until fully healed. Results: The amount of breast tissue removed and the amount of UAL/SAL axillary aspirate were not significantly different from side to side (for the mean UAL side, tissue 828 ± 190 g and aspirate 195 ± 102 mL; for the mean SAL side, tissue 780 ± 187 g and aspirate 194 ± 94 mL; P > .05). The mean area of lateral skin flap ischemia at the inverted T incision was significantly less on the UAL side than on the SAL side (UAL, 47 ± 128 mm²; SAL, 361 ± 500 mm²; P = 0.02). The time to complete skin wound healing of the lateral flap was significantly less in the UAL-treated flaps than in the SAL-treated flaps (UAL, 9.6 ± 8.6 days; SAL, 22.1 ± 22 days; P = .02). The study was terminated once these resounding differences in lateral skin flap necrosis and time of wound healing became obvious. Conclusions: UAL offers significant benefits in comparison with SAL as an adjunct to standard breast reduction surgery for contouring of lateral chest wall fullness.     

Histologic Effects of Ultrasound-assisted Lipoplasty

Background: In spite of the increasing popularity of ultrasound-assisted lipoplasty (UAL), questions remain about the effects of ultrasound energy on soft tissues, indications for the technique, and parameters for safe application and optimal results. Objective: This study was undertaken to evaluate the tissue effects of UAL and to correlate those effects with parameters based on clinical experience. Methods: Histologic evaluation with standard histologic staining was done on abdominoplasty specimens treated with UAL on one side and standard liposuction on the opposite side in patients undergoing both abdominoplasty and UAL. Additionally, 100 consecutive patients treated with UAL were reviewed. Results: It was found that optimal results correlated with submaximal amplitude settings, loss of tissue resistance to probe movement, and change in color of the aspirate from pale yellow to pink or tan as end points for the application of ultrasound. Histologic evaluation revealed that these parameters were associated with minimal effect on connective tissues and blood vessels. Longer application times were associated with disruption of collagen and elastin structures. Conclusions: This study confirms that UAL is an effective and safe technique in experienced hands when attention is given to easily observed end points for application of ultrasound energy.     

Ultrasound-assisted breast reduction and mastopexy

Background: The development of technology for ultrasound-assisted lipoplasty (UAL) offers the aesthetic surgeon a new tool for breast surgery procedures including breast reduction, breast lift, and the correction of mild- to medium-degree ptosis. Objective: The authors report on a series of 120 patients who underwent breast surgery with the use of UAL from 1995 through 2000. Methods: Preoperative screening, including mammography, was performed to evaluate breast tissue and determine whether patients were good candidates for surgery. Variants of Klein's tumescent solution were infiltrated, depending on the form of anesthesia administered. Stab incisions 2-cm long were made at the axillary line and 2 cm below the inframammary crease to allow entry of a 35-cm solid titanium probe. With use of a 50% power setting, ultrasound energy was applied from 10 to 15 minutes to up to 30 minutes to emulsify the fat. Ultrasound stimulation of the superficial layers of subcutaneous tissue was applied to promote retraction of the breast skin. Results: A mean of 500 mL of fat emulsion from each breast was obtained without major complications. Nipple elevation of up to 5 cm was possible if a large-volume reduction was performed in combination with ultrasound stimulation of the subcutaneous layer. Conclusions: The use of UAL to achieve breast reduction and mastopexy is both safe and effective for selected patients when performed by a surgeon experienced in the technique. (Aesthetic Surg J 2001;21:493-506.)     

Very Superficial Ultrasound-Assisted Lipoplasty for the Treatment of Axillary Osmidrosis

Treatment of axillary osmidrosis has been mainly concerned with surgical excision of glandular tissues and involved major surgical procedures with high morbidities and many complications. Search for a less invasive procedure for axillary osmidrosis resulted in the use of liposuction. However, there have been controversies over the efficacy of this method. The problem was that liposuction could not effectively remove the apocrine gland located in the dermis and dermosubcutaneous junction. A high rate of residual malodor and dissatisfaction were reported. The author used ultrasound-assisted lipoplasty (UAL) in the very superficial plane to remove the apocrine gland located in the dermis and dermosubcutaneous junction. The purpose of this study was to prove the efficacy of the very superficial UAL (VSUAL) for the treatment of axillary osmidrosis. From December 1998 to December 1999, 21 consecutive patients underwent UAL in their axilla for axillary osmidrosis. The follow-up period ranged from 2 to 12 months (mean: 8 months). UAL was performed in the very superficial plane with an amplitude of 40%. The very superficial UAL (VSUAL) was done mainly in a withdrawing manner with the tip of the cannula against the skin. The UAL (VSUAL) was done aggressively until the skin changed slightly erythematous. The results were assessed subjectively and objectively, and classified as excellent, good, fair, and poor. Nineteen patients were graded as excellent and one patient as good. The total satisfaction rate was 95.2%. One patient complained of residual malodor in her left axilla. There were no cases of skin necrosis, hematoma, or seroma. Histology showed partial removal of the subcutaneous layer and deep dermis, and degenerative epithelial changes in the apocrine glands in the residual deep dermis. These microscopic findings meant near-total functional ablation of the apocrine gland in the axilla comparable to ``flap-to-graft conversion' or surgical excision of axillary skin. The UAL (VSUAL) for axillary osmidrosis has the advantages of a high success rate with minimal complications. Rapid recovery, less restriction of movement, and tiny scars were other major benefits of this technique. Therefore, UAL (VSUAL) is a viable option for treatment of axillary osmidrosis.     

External Ultrasound-assisted Lipoplasty

Background: The role of internal ultrasound in liposuction has been debated for approximately 15 years since the preliminary work by Zocchi and colleagues. Objections to the use of internal ultrasound include the added cost, the risk of injury to dermal or nerve elements, the increased incidence of seromas, the increase in operating room time and personnel required by the new technology, and uncertainty regarding ultrasound-assisted lipoplasty (UAL) application times. Anecdotal reports of skin slough, especially when UAL was used in conjunction with abdominoplasty, have caused the introduction of external UAL (XUAL) to be greeted with caution and concern. Objective: At the request of the Innovative Procedures Committee of the American Society for Aesthetic Plastic Surgery, I undertook a study of the effectiveness of XUAL on the extremities and face, as well as in conjunction with abdominoplasty. Methods: Fifty-nine consecutive patients presenting for liposuction or liposuction with abdominoplasty during a 4-month time frame (September 1997 to January 1998) were treated with XUAL, external ultrasound, or XUAL on one side and standard liposuction on the opposite side. Results: Recovery from XUAL was uniformly rapid, with resolution of edema at an average of 3 to 4 weeks compared with 3 to 6 months in comparable non-XUAL patients. Skin shrinkage was most noticeably advantageous in the face, abdomen, and inner thighs, as well as the arms in both small and large upper arm fat deposits. There was no permanent discoloration or dysesthesia noted. Seromas and postoperative hemorrhages observed during the series were directly related to postoperative trauma in three patients. Conclusions: It was apparent in this study that external ultrasound is a valuable adjunct in body and facial sculpture.     

Endermologie after external ultrasound-assisted lipoplasty (EUAL) versus EUAL alone

Background: Endermologie, despite its moderate success in the temporary reduction of the appearance of cellulite, has proven unsuccessful compared with lipoplasty for body contouring. Objective: The purpose of this study was to determine whether a body contouring program combining Endermologie with lipoplasty would produce better long-term body contouring results than lipoplasty alone. Methods: A prospective study comparing 2 closely matched, nonrandomized groups of 25 women each was conducted. Those in group 1 underwent external ultrasound-assisted lipoplasty (EUAL) to the superficial and deep subcutaneous areas of the flanks, hips, and thighs, followed in 10 days by a 20-week Endermologie course. Those in group 2 underwent only EUAL to the superficial and deep subcutaneous areas of the flanks, hips, and thighs. Patient evaluation preoperatively and 9 months postoperatively included standardized 35-mm photography; standardized circumferential body measurements of the waist, hips, thighs, knees, and calves; and body composition analysis. Patient satisfaction was assessed through the use of a questionnaire. Results: No significant complications were noted in either group. The average volume of aspirate in the 2 groups was not significantly different (group 1, 2000 mL; group 2, 2100 mL), nor were the results of standard circumferential body measurements and body composition analysis. There was, however, a reduction in the rates of subsequent revisional surgery in the 2 groups (revision rates: group 1, 4%; group 2, 12%). The results of objective blind grading demonstrated no statistically significant difference (P [equals] .30) in body contouring between the 2 groups (group 1, 92% improvement; group 2, 87% improvement). However, a statistically significant (P [lt ] .005) difference was noted for reduction in the appearance of cellulite between the 2 groups (group 1, 50% improvement; group 2, 0% improvement). Patient satisfaction was 96% in group 1 and 92% in group 2. Conclusions: Endermologie after EUAL improves postoperative results with respect to reduction in the appearance of cellulite and reduces the rate of subsequent revision but demonstrates no significant improvement over EUAL alone with respect to body contour improvement.     

Comparative Evaluation of Traditional, Ultrasonic, and Pneumatic Assisted Lipoplasty: Analysis of Local and Systemic Effects, Efficacy, and Costs of These Methods

Recently ultrasound assisted liposuction (UAL) and pneumatic assisted liposuction (PAL) have been introduced as an attempt to improve the results and reduce the pitfalls of standard liposuction (SAL). Until now no studies comparing, at the same time, UAL, PAL, and SAL have been published. The aim of this study was to analyze these methods from the surgeon's point of view, focusing not only on aesthetic results but also on local and systemic trauma, efficacy, handling, and cost. Forty-five cosmetic patients affected by local lipodystrophy, divided into three equal groups, have undergone liposuction with the three above-mentioned techniques. Quantitative and qualitative analysis of lipoaspirates, together with blood chemistry, local and systemic complications, time to aspirate 100 cm³, distress, fatigue, and costs of the procedures, has been recorded. Our results showed bloodier lipoaspirates in SAL and a higher percentage of triglycerides in UAL lipoaspirates. Blood tests revealed a slight decrease in the postoperative Hb in SAL only. Early complications observed were four erythemas in PAL, three ecchymoses in SAL, and one long-lasting edema in UAL. Aesthetic results rated by independent viewers were similar for all methods. Efficacy was higher in the PAL group (4 min × 100 cm³ fat aspirated) than in SAL (7 min × 100 cm³ fat) and UAL (10 min × 100 cm³ fat). Surgeon's distress was higher in PAL than in SAL and UAL. Surgeon's fatigue was much lower in the PAL group than in the others. Costs expressed as multiples of 1 unit (1 unit = $500 U.S.) were highest for UAL, low for PAL, and lowest for SAL. In conclusion, PAL and UAL caused reduced vascular injury, UAL being more selective for adipocyte removal. Complications of UAL and PAL were mostly related to the longer learning curve of these methods. The UAL procedure was much more expensive than PAL and, especially, SAL. PAL proved to be a handy technique, with the most favorable cost/benefit ratio, and seems to be the best option for busy liposuction practices or fast office procedures, even though the choice of the ideal technique always depends on the surgeon's preference.     

Ultrasonic Liposuction Versus Surgical Lipectomy

Obesity is a serious problem in our century. Nowadays, the incidence of obesity has been increased to 35%. Two common methods for surgical treatment of obesity are surgical lipectomy and ultrasound-assisted liposuction (UAL). This study included 40 patients in two groups, 20 patients in the surgical lipectomy group and 20 patients in the UAL group. Abdominal surgical lipectomy was done in 20 patients (12 female, 8 male), with ages ranging 28–60 years. Abdominal UAL was done in 20 patients (11 females, 9 male), with ages ranging 20–55 years. General anesthesia was used for surgical lipectomy. Tumescent anesthesia was used for 13 UAL patients and general anesthesia was used for the remaining 7. The average time for surgical lipectomy was shorter than that for UAL. The average hospital stay for the surgical lipectomy group was almost five times longer than for UAL. The UAL group also recovered four times faster and required analgesics half as long. The average amount of fat removed in each case was 2.22 kg with UAL and 1.97 kg with surgical lipectomy. The UAL group received analgesic drugs for five days, whereas the surgical lipectomy group received analgesic drugs for 10 days because they sustained more pain. In this study, I do not discuss or compare the major complications of each method because the groups were not large enough. However, there were some minor UAL complications, echymosis in 80%, orthostatic hypotension for three or four days in 75%, infection in one patient, postoperative epidermal loss in small area of the abdomen in two patients, and cellulitis in 75%. All were resolved after one month. UAL is a special method with fewer major complications and shorter hospital stays than surgical lipectomy. The incisions in UAL are smaller, but the operation lasts much longer than surgical lipectomy.     

肿胀麻醉下外超声与非超声吸脂术的比较研究

目的：比较肿胀麻醉法下的外超声吸脂与单纯负压吸脂术的差别，以探讨外超声吸脂术的优点，方法：将10－例吸脂者的腹部均分为左右两侧，在肿胀麻醉下一侧行外超声吸脂，另一侧行单纯负压吸脂，比较吸脂效果并分析吸出物，结果：临床吸脂患者中，外超声作用侧所吸出的上层脂肪占总吸出量的百分比大于非超声吸脂侧（P＜0．001），吸出物中外超声吸脂侧血红蛋白浓度低于非超声吸脂侧（P＜0．001），三酰甘油浓度高于非超声吸脂侧（P＜0．001），血红蛋白与三酰甘油的比值低于非超声侧（P＜0．001），提示外超声吸脂明显较非超声吸脂术脂肪乳化好，出血亦少，且操作省力，术后并发症轻，皮肤收缩效果好，结论：外超声吸脂术是一种去除局部堆积脂肪的更为安全，有效的方法。     

超声技术治疗腰腹部肥胖效果观察

目的:观察超声技术体外治疗腰腹部肥胖的临床疗效。方法:采用超声特定声波强度对60例腰腹部轻中度单纯性肥胖的就医者进行治疗,针对每例就医者治疗前后腰围测量及治疗前后的对比照片,进行临床疗效的评估。结果:显效3例,占5%;有效39例,占65%;无效18例,占30%。结论:使用超声波皮肤治疗仪治疗腰腹部肥胖,操作简单,安全可靠,就医者无痛苦易于接受,是目前值得推广的局部减肥的方法。     

Refinements in the lipoplasty technique

Careful attention to the proper indications, technique, and the traps of lipoplasty will decrease the incidence of complications and reward the surgeon with better results. The aesthetic complications of lipoplasty are multiple and varied and they may at times be disastrous. A thorough understanding of all the steps is the best way to avoid problems.