Liposuction: Pulsed Ultrasonic Assisted
For both men and women, liposuction is one of the most commonly requested procedures for improving your appearance. In my experience, recent enhancements, like pulsed ultrasonic assisted liposuction, offer safer, more consistent results (including skin tightening) from treatment. Often, the improved skin effects of liposuction have reduced the need for tuck procedures, like tummy tuck and neck lift. Often, removed fat can be “recycled,” replacing volume lost to your aging process.
There are three techniques for liposuction: traditional liposuction, ultrasonic assisted liposuction (including pulsed ultrasonic liposuction), and external ultrasonic liposuction. In all three techniques, a medicated solution of IV fluids is injected into the treatment areas, making the fat easier to remove
Ultrasonic & Pulsed Ultrasonic Liposuction (UAL)
In my opinion, UAL gives the most consistent results for liposuction surgery. This is particularly true for areas that were previously difficult to treat, like “love handles”, abdomen, and your knees.
The ultrasonic assisted liposuction probe has 2 effects: destruction of some fat cells, and “loosening” of fat globules. Like a warm knife through soft butter, this means less force is needed to move the instruments through your fat, allowing more precision in treating sensitive areas (such as the fullness under your chin). Because your fat is loosened and liquefied, less vacuum pressure is needed to remove your unwanted fat, thereby decreasing the risk of “waviness” in your skin.
While effectively treating your fat, continuous UAL energy can burn your skin. By quickly cycling the ultrasound energy on and off, pulsed UAL offers the optimum fat treatment, while minimizing risk of injuring your skin. In my experience, this allows more aggressive treatment (and improved results) in sensitive areas, like under your chin, around your knees, and at your calves and ankles. Pulsed UAL also allows better definition of areas like your waist, rib cage, and arms.
Traditional Liposuction (SAL)
In traditional liposuction, fat is removed using a blunt tube with one or more holes near the end. High vacuum is applied to the tube, drawing fat into the tube. As the tube moves through your tissue, the fat "breaks" off, and is drawn out through the tube. If your body does not release the fat, bruised fat can be left behind.
External Ultrasonic Liposuction (XUAL)
This technique uses an ultrasound system similar to that used by physical therapists. Using a gel over the treatment site, ultrasound energy “heats” your fat (that has been infiltrated with the medicated solution discussed earlier). Fat is then removed using the instruments and high vacuum pressure of traditional liposuction. Vacuum trauma is the same as traditional liposuction, but the since less instrument force is required, mechanical trauma is reduced. As a very new technique, there are still differences of opinion regarding what treatment areas may benefit from XUAL.
Surgery
For most patients, liposuction is performed as an outpatient. If large volumes of fat are to be removed, your surgery may require overnight monitoring at the hospital. Small, confined areas may be treated in the office setting.
Anesthesia
Choice of anesthesia is based on your medical history, the areas to be treated, the anticipated volume of fat removed, and your personal preferences. Your safety is our first concern. Common anesthetic choices include regional anesthetics (such as spinal anesthesia), general anesthesia, or a local anesthesia.
Care After Surgery
Typically, you will be given a compressive garment to wear after surgery. There are differing opinions about the use of post-op compression. Opinions range from using some form of garment for up to 12 months to no garment at all. To control swelling, I feel compression is most helpful during the first 3 days after surgery. After that time, use of compression is recommended, but not required. Like using an ace wrap for a sprain, most patients find that compressive support adds to their comfort. You may use either the garment we give you, or any other support garment you find comfortable.
You may shower the day after surgery. Most patients prefer to shower in the morning.
At your pre-op visit, you will be given a prescription for pain medication. An "achy" muscular pain is the most common complaint after surgery. Patients often report that discomfort is most prominent when they change activity levels. This means that if they are resting, they are comfortable till they start moving. If they are active, they are comfortable till they rest.
Most patients resume progressive activity 7-10 days after surgery. Normal activity levels may take 4-6 weeks. While complete healing takes one year, the biggest changes occur over the first 3-6 months. Improvements in patients with larger volume resections can be expected to take longer to recover.
Results of Treatment
Your number of fat cells increases till you are 2-3 years old. After that time, your fat cells increase and decrease in size. How you body decides what cells will get bigger and when is not understood.
For this reason, there can be no guarantee of change in body contour. Some patients see remarkable changes in contour following relatively small fat resections, while other patients report no significant change in their clothing size following large volumes of fat.
Risks of Treatment
The results from liposuction surgery, both good and bad, are the result of surgical trauma. Liposuction trauma has three sources: mechanical trauma (from the instruments moving through your fat), vacuum trauma (from the vacuum used to remove your fat), and energy trauma (from ultrasound energy or the force needed to move the liposuction instruments through your fat). The goal is to apply "just enough" total trauma to achieve your desired result.
The risks are the same as for any other surgery, including bleeding, infection scaring, irregular skin contour, irregular body contour, and possible need for additional surgery.
Both ultrasonic techniques have a unique risk of causing a skin burn. Both can cause burns if the probe is kept in on position against the skin for a prolonged period. The risk is very small, so long as the probe remains in motion.