James J. Romano, MD
Over the years the technique of liposuction to remove excess fat tissue has steadily improved. Suction-assisted lipectomy (SAL) has undergone many modifications and improvements to become one of the most important tools in the collection of cosmetic surgery techniques. Ultrasound-assisted lipectomy (UAL) has been practiced in Europe since the mid 1980s and has recently gained much interest and popularity in the United States. There are numerous reported advantages of this technique over traditional liposuction.
Ultrasonic systems are not new and not experimental. They have been used for military and industrial applications since the 1940s. Dentists were first to use this technology medically in the 1960s for the purpose of scaling and cleaning the teeth.
UAL is the surgical technique that allows for very efficient, smooth, and exacting body contouring by the liquefaction of fat, which is then removed by low-power suction (SAL).
UAL involves the transformation of electrical energy into high-frequency sound waves that are transmitted into the tissues by a probe on a handpiece to create a mechanical vibration. It is similar to the energy produced by a vibrating tuning fork, just that it is a higher frequency, and not audible. It is called “ultrasonic” because these sound waves are just above the upper limit of human hearing. The effect of these sound waves, when applied to low-density tissues like fat or water, is to cause microcavities or bubbles that eventually burst and cause “cavitation” and then disrupt the fat cells. Once the cells are disrupted, the contents flow out and mix with the surrounding fluid and form a stale fatty emulsion that can be easily suctioned out. This is when the conventional SAL is used to finish and “fine-tune” the procedure. Because of this mechanism of action, the surrounding denser and stabler structures like the skin, vessels, nerves, muscles, and ligaments are preserved and unharmed.
The procedure is performed very similarly to conventional SAL. A light general anesthetic is used and a dilute local anesthetic solution is infused into the tissues. This is called a “wetting solution” and is for the purpose of providing additional excellent anesthesia, less blood loss, more comfort, and less bruising, and it also cools the tissue and makes it less dense and better for performing the UAL technique.
Surgery is performed in the outpatient surgery center and usually lasts about two to three hours. There are no drains. The incisions are very small and are closed under the skin in a plastic surgery fashion with dissolving stitches. Foam pads and a compression garment are placed after surgery. The dressings are changed in three days. The garment is worn all of the time for three weeks, then only during the day for another three weeks.
Recovery is surprisingly fast. Most bruising is gone in about three to five days. There is some edema and swelling that rapidly subsides. Most patients can return to work in less than a week.
The result is wonderfully natural and lasts the rest of your life as long as you maintain your weight in a stable range.