Summary: Liposuction is one of the most commonly performed cosmetic procedures in the United States and worldwide. Since its development in the late 1970s, the procedure has seen a number of advances, including tumescent lipo), ultrasound-assisted liposuction (UAL), and laser liposuction.
History of Liposuction
In the earliest liposuction procedures, the surgeon manually moved the cannula (the medical suction wand) around to break up fat prior to aspiration. Tumescent lipo followed the same approach but introduced a solution of saline, local anesthetic and vasoconstrictive drugs, helping to make the fat easier to remove, reduce blood loss, and minimize the need for general anesthesia.
UAL was developed in the early 1990s, introducing an ultrasound-emitting probe to rupture fat cells. The most recent UAL devices use a solid cannula that is smaller in diameter than previous generations. The new generation cannulae emit frequencies that affect only low impedance tissue, giving surgeons more ability to minimize blood loss, postoperative edema and ecchymosis.
Standards of UAL
Two standard rules of UAL are as important today as when they were first put forth in 1992: never apply ultrasound to “dry” tissue, and never apply ultrasound without simultaneous movement of the probe. Each subsequent advance in UAL technology has improved patient safety and helped surgeons create improved patient outcomes. There are several safety standards that surgeons should follow:
- Patient Selection: Lipo patients should be thoroughly interviewed and a complete physical exam that often includes a lab analysis. Only patients who meet certain selection criteria should be treated. The procedure is not right for men and women with risk factors such as obesity (BMI >30), hernia at the operative site, skin laxity, internal metallic prosthesis, prior oncologic breast treatment, or evidence of lipoma or active inflammation/infection.
- Body Site Selection: The site of the body targeted for fat removal should be considered. The best results are often seen in the abdominal area, lower extremities, buttocks, back, upper extremities, and breast. Fat deposits should be well localized in the areas targeted for treatment. UAL should not be performed in the same area as another procedure that could potentially compromise tissue vascularity.
Surgical Approach in UAL
Treatment begins by breaking up deeper fat layers with slow, fan-shaped movements, gradually moving closer to the surface. Leaving 10 to 15 mm of adipose tissue protects the skin from heat injury and irregularities.
The length of treatment needs to be monitored carefully. Overuse of ultrasound energy provides no benefit but increases the risk of tissue damage and may cause excessive fat removal. In large areas such as the abdomen or buttock region, treatment with ultrasound generally should not exceed 8-10 minutes, with shorter times in narrower areas.
Note that ultrasound has a delayed fat reduction effect caused by fat cells continuing to die off for about 18 hours after treatment. Accordingly, some drainage may occur for a day or two after a UAL procedure.
Postoperative Dressing and Garments
The postoperative dressing is applied to allow for the expected movement of tissue during patient healing. Patients may need to wear a compression garment outside the dressing. The inner dressing is generally removed 5-10 days after surgery. UAL liposuction patients should immediately resume normal activity after surgery, but refrain from aerobic activity for about two weeks.