The New Ultrasonic Liposuction and Vibrating Cannulas — Improvements?

Since 1996, ultrasonic liposuction has been widely advertised. There are two types: internal and external ultrasonic liposuction. With internal ultrasonic liposuction, a cannula that is specially designed to transmit ultrasound waves is inserted into a person's fat and moved around, and the fat is broken up. Large holes need to be placed in the skin to use the large ultrasonic liposuction instrument. This machine makes the procedure somewhat easier for the physician. The physician does not have to use all the muscle power to push the cannula past resistance. Instead, the cannula glides into the tissues. The cannula holes in the skin are usually larger than with traditional liposuction.

External ultrasonic liposuction involves using a machine such as a chiropractor or physical therapist might use. A device is placed on the surface of the skin. This supposedly helps to break up the fat. This may make the cannulas go into the fat a little more easily, and some physicians have reported improved skin results in a shorter time interval. Our experience with external ultrasonic liposuction is that it doesn't work, providing unimpressive results, if any. Obviously, the amount of energy delivered through the skin has to be a small amount because the ultrasound machines can burn the skin surface if too much energy is used.

The medical journals have published many reports documenting the problems patients have after internal ultrasonic liposuction. It appears that sometimes complications occur in as many as 50 percent of patients who have this procedure. These complications, such as seromas (fluid collections underneath the skin) and prolonged time off work due to pain, are not generally life threatening but can be quite irritating. In addition, many physicians have reported skin burns.

A great number of physicians who were initially enthusiastic about this $20,000 machine have given it up. Lots of experience is necessary to safely use internal ultrasonic liposuction. Also, many of the benefits that were initially thought to occur due to the ultrasound seem to be actually a result of using the tumescent anesthetic. As you know, the most sophisticated surgeons have been using tumescent anesthetic since 1989, but there have been many surgeons who had not learned this technique until ultrasonic liposuction appeared.

This technology is not an improvement. Our small cannula liposuction is still superior. In the American Journal of Cosmetic Surgery, Dr. Gerard Boutboul remarked, "Ultrasound is being pushed by influential commercial advertising supported by very few clinical experiences showing no proof of the superiority of the ultrasound... As I reported during the American Academy of Cosmetic Surgery Congress in Palm Springs... ultrasonic lipoplasty is about to disappear... After treating more than 300 cases, we have stopped using this technique because of the many problems and no evidence of clinical superiority over a classic lipoplasty." He concluded, "Once again, I wish to tell American doctors using the ultrasound technique to be aware of its dangers as well as an absence of progress when compared to simple lipoplasty using micro cannulas, tumescent technique, and crossed planes."*

Also, the European Academy of Cosmetic Surgery Newsletter (winter 1997) reported, "The ultrasound liposuction which is mostly abandoned here in Europe because of its unsatisfactory results and high burns is now trying to sell in America. At the European Academy of Cosmetic Surgery, we want to continue to declare the traditional liposuction with small cannulas and the super wet technique as the most safe, effective, and affordable technique of body contouring until a scientific study proves that another technique is to be superior to the traditional liposuction."

Lastly there is a lot of marketing about the reciprocating or rotating cannula for liposuction. My experience with these instruments proved to me that they do seem to be pure hype, without any clinical benefit — useful only for advertising purposes.