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| ULTRASOUND ASSISTED LIPOSUCTION By Ellen Wyatt |
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Abstract
A bioeffect of ultrasound is cavitation in tissue containing gas bodies. Cosmetic surgeons have found a way of using this to their advantage. Ultrasound is being used to assist the liposuction procedure. The liposuction cannula contains a piezoelectric crystal that converts an electrical signal into a mechanical sound wave. When the sound waves come in direct contact with the adipose tissue, they implode, releasing intracellular fat. This intracellular fat is then suctioned out of the body. This proves one’s adverse affect can work in favor of another.
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Key Words
Ultrasound assisted liposuction, Lipoplasty, UAL, Cosmetic surgery, Bioeffects
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As sonographers, we know that according to the AIUM standards we are to use the ALARA principal when it comes to the use of ultrasound. But, some fields of medicine are finding the adverse affect of ultrasound to weigh in their favor. In this instance, cosmetic surgeons have found a way to incorporate the bioeffects of ultrasound into removal of fat cells from the body. This procedure is called Ultrasound Assisted Liposuction or UAL. This literature review will outline and discuss this procedure. |
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Liposuction, or lipoplasty, is a technique where excess fat is suctioned from beneath the skin. Prior to suctioning, the skin is injected with a solution made up of saline, lidocane ( a local anesthetic), and epinephrine ( a drug that constricts the blood vessels). This helps reduce the amount of blood suctioned during surgery.6 After the injecting the tumescent solution, a small incision is made in the skin. In a procedure called tunneling, a hollow cannula is inserted and is pushed and pulled through the fatty tissue. The cannula is run back and forth in a criss cross direction, while applying suction to remove the subcutaneous fat. Along with the fat that is removed, some blood and nerves can be suctioned out.Due to blood loss and nerve damage, Physicians are looking for ways to perform a less aggressive procedure and still achieve the maximum amount of fat removal. This was the reasoning behind introducing ultrasound to liposuction. |
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As ultrasound travels through tissue it generates gas bubbles in the tissue. The expansion and collapse of these gas bubbles is called cavitation. As the sound travels the bubbles increase and decrease in size due to the compression and rarefaction in the sound wave. When higher acoustic energy is applied, the gas bubbles collapse during the compression phase of the vibration.5 |
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With ultrasound-assisted liposuction, ultrasonic energy is added to the traditional liposuction technique. Most surgeons still use the tumescent injection to better insure minimal blood loss. An ultrasonic generator transmits electrical energy to a hand piece containing a piezoelectric crystal that converts the incoming electrical signal to a mechanical vibration at a frequency of 20-30 kHZ.2 This probe may be a hollow cannula through which suction is applied, or it may be a solid probe, which will require the surgeon to aspirate the fat though a separate liposuction cannula. Since using a separate probe for ultrasound and suctioning is more time consuming, most prefer the cannula that transmits the ultrasound and suction at the same time. |
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When the ultrasound waves are applied to the adipose tissue from the cannula, the alternating waves cause compression and rarefaction resulting in bubbles and cellular implosion within the fat cells, which leads to the release of intracellular fat. This enables the emulsified fat to be suctioned with less trauma to the patient. The emulsified fat can be suctioned while reducing the amount of blood being suctioned. Some studies show that the use of ultrasound during liposuction increases the amount of skin shrinkage postoperativly. Ultrasound also enables the physician to suction more fat from the body.2 |
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The fact that ultrasound assisted liposuction allows more fat to be suctioned brings up the issue of determining the safe amount to be suctioned and should liposuction be used for fat removal instead of body contouring. Safety should be the surgeons main concern, but the amount of fat to be removed is usually the patient’s concern. There are ongoing studies about how much fat can be safely removed. Liposuction is one of the most common types of cosmetic operations that is performed in the United States according to the Journal of Anesthetic Surgery.1 Not only women are looking into to liposuction, but men are also looking into the procedure. As liposuction has evolved, the amount of fat that is suctioned has increased. The addition of ultrasound to the liposuction increases the amount of fat that can be suctioned during the procedure. This is one of the safety questions regarding UAL. The amount of fat that can be safely removed is controversial. Removal of fat greater than 5-6 Liters is considered large volume liposuction. |
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| The approval for the probes used for ultrasound assisted liposuction is still pending. There are several companies that have pending approval from the food and drug administration. The probes currently have a 510(k) premarket approval. This is approval from the FDA before the product actually goes on the market. Studies to approve this were performed in 2001. These studies showed that in comparison to suction assisted liposuction, after the use of ultrasound assisted liposuction the proportions of subjects reporting any adverse events were similar.4 |
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| The risks of ultrasound assisted liposuction coincide with the risks of traditional suction assisted liposuction. The skin can ripple or wave due to fat being suctioned next to the skin layers. Hematomas may form under the skin, the patient can form a bleed due to the cannula tearing through the tissue, infection, overworking of the heart due to the tumescent injection along with general anesthesia. In 1999 the death rate of liposuction patients was 20 out of every 100,000 people. One of the main concerns of ultrasound assisted liposuction is burning of the skin and underlying tissues. The ultrasound probe generates heat and if left in the same position for a prolonged period of time, the tissue will burn. The main area of concern is at the incision site where the cannula is constantly touching the skin. |
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| Long-term benefits of UAL vary depending on patient activity and diet post-operatively. The long terms affects of high level ultrasound on the subcutaneous tissues is also unknown.6 |
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| Price depends on area to be suctioned and the region of the country where you would be having the surgery done. Most cosmetic surgeons base the price of liposuction on the area to be operated on. Such as, upper abdomen, lower abdomen, upper thigh, back buttocks, etc.. An average price is 2,500-3,000 dollars per area. |
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Conclusion
In conclusion, the cavitation caused from ultrasound is being transmitted into fat cells to improve the results of liposuction. The procedure is still controversial as to the amounts of fat to be removed, and the safety and long term affects of ultrasound assisted liposuction. As long as there is a desire for perfection, there will be ongoing studies to meet that demand. |
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References
1. Zocchi, M. Ultrasonic Liposculpturing. Anesthetic Plastic Surgery, 1992. 16: 278- 298
2. Cooter, Rodney. Ultrasound-Assisted Lipoplasty. ANZ Journal of Surgery, 2001. 71: 309-317
3. Fowlkes, Brian J. Holland, Christy K. Mechanical Bieffects From Diagnostic Ultrasound. Journal of Ultrasound in Medicine, 2002. 19: 67-170
4. www.fda.gov
5. Rumack, Carol M. Wilson, Stephanie. Charboneau, William. Diagnostic Ultrasound
Second Edition, Volume 1. 1998. Mosby 11830 Westline Industrial p46-51
6. Greenley, Alexandra. Planning to Look Flabuless. FDA Consumer. November-
December 2000. p31.
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Copyright CVTC 2003. All Rights Reserved.