Advantages and Limitations of Ultrasonic Liposuction


Ultrasonic liposuction or ultrasound-assisted liposuction is liposuction that is aided by the use of ultrasonic energy, that is, sound waves at frequencies higher than those able to be detected by the human ear. In ultrasonic liposuction, these high energy waves are used to break up and liquefy fat cells so that they can be more easily removed with a vacuum. The technique has been widely available in the United States since the early 1990s yet was being performed in Europe and South America prior to that.

Intuitively, ultrasonic liposuction makes good sense and its appeal over vacuum-only liposuction seems obvious; it is easier to suction a fluid rather than solid chunks of fat cells. However, the two current forms of ultrasonic liposuction may suffer from some technical limitations.

Ultrasonic liposuction: using an internal or external approach

Internal ultrasonic liposuction delivers ultrasound energy directly to fat tissue at the tip of the liposuction cannula or probe. The tip oscillates at a very high rate thus dislodging and liquefying the tissue that it touches. As the fat cells are broken apart and the contents are spilled, a powerful vacuum removes the fatty liquid from the body. Unfortunately, with internal ultrasonic liposuction, the end of the cannula can become extremely hot because of this intense vibrating energy. This hot probe has been reported to cause internal burns within the area that is being treated and has lead to internal scar tissue formation.

In order to address this potential harm to patients, newer internal ultrasonic cannula uses lower energy ultrasonic waves to disrupt the fat cells. As a result, they do not reach such high temperatures. Also, more recent versions of the device use smaller ultrasonic probes, which further reduce the chance for damage. Unfortunately, since these systems can cost tens of thousands of dollars, not every plastic surgeon will make that investment and it is not always clear what generation of ultrasonic liposuction system a given plastic surgeon will use.

The tumescent technique has provided an additional level of safety for patients as well. By filling the fatty area with saline, local anesthetic, and a medicine to reduce blood loss, ultrasonic liposuction cannulae heat the saline (saltwater solution) which has a very high heat capacity, especially compared to human tissue. Since it offers many different advantages over other liposuction methods, the tumescent technique is used in most liposuction procedures.

While internal ultrasonic liposuction possibly suffers from being too aggressive, external ultrasonic liposuction often fails to deliver enough added benefit to the procedure. External ultrasonic liposuction uses ultrasound in a fashion similar to the way diagnostic ultrasound is used to visualize a fetus in the womb or the valves of the heart as it is beating. The ultrasound probe is placed on the body’s surface and ultrasonic energy is applied through the skin to the layers of fat below. The difficulty in external ultrasonic liposuction is that the ultrasonic energy must be of sufficient intensity to penetrate the skin and disrupt fat cells but not be so intense that it burns the skin itself. Often the energy that is required to safely deliver the ultrasound energy externally is not enough to impact the fat cells within the body.

While ultrasonic liposuction can be an effective means of performing of fat removal, the internal approach with proper cannula selection and appropriate energy level needs to be assured in order for the approach to be considered safe. Ask your plastic surgeon about the specific ultrasonic liposuction system before consenting to the procedure.

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