The first internal ultrasonic liposuction patents were issued around 1987. Following the development of external ultrasonic liposuction, ultrasonic liposuction was divided into two varieties. There are now two main types of ultrasonic liposuction: INTERNAL (with the vibrating cannula) and EXTERNAL (performed with a vibrating machine applied to the outside of the skin just prior to the liposuction procedure). Please see the section entitled "External Ultrasonic Liposuction" for more details on that procedure.

Ultrasonic liposuction can be performed with either the traditional, wet, or tumescent methods. "Ultrasonic" means high-pitched sound. This property has many uses outside of the operating room; for example, in "shaking things loose," as is the case with the new ultrasonic toothbrushes. The ultrasonic principle is to loosen the fat so that fat or oil can be vacuumed out of the body faster than it might with other methods. Equipment concerns caused years of delay in the roll-out of machinery necessary to perform internal ultrasonic liposuction. The industry is currently on its third generation of devices. Unfortunately, older generation INTERNAL ultrasonic equipment is still in use (referred to as cannulae, or tubes) may kill tissue and burn patients. First- and second-generation ultrasonic cannulae have perforated patients' kidneys and gallbladders. Additionally, internal ultrasonic liposuction may cause "end hits," a burning-through of the surface skin. "End hits" occur when the ultrasonic cannula pushes on the deeper leather layer of the skin from the inside out, resulting in blister formation and, sometimes, in visible scarring of the outside layer of the skin. Another downside is that internal ultrasonic liposuction results in more seroma formation than does regular liposuction. Seromas are ball-like collections of fluid. These fluid balls are produced in the tissue following injury. Seromas may be long-lasting and unsightly knobs and bumps in patients' skin. However, they can be treated. Seroma formation may also be operator dependent since the author has done many internal ultrasonic liposuctions with third-generation equipment and has never had a seroma form in a patient to this date.

INTERNAL ultrasonic liposuction instrumentation is very expensive  (retail US$40,000 for third generation equipment), and doctors have to pass these costs along to patients. Many plastic surgeons still use first- and second-generation ultrasonic liposuction equipment. After all, many paid tens of thousands of dollars for the then-popular older (1st & 2nd generation) equipment back then when it was new and some doctors now can pick up the older, earlier generation equipment at a great discount.

Why were/are first- and second-generation internal ultrasonic liposuction cannulae a problem? The cannulae may overheat as a result of less-than-adequate cooling. If the first- and second-generation cannulae tips are moved too slowly and they can become burning hot and boil any tissue they touch! This may result in tissue burns and long-lasting nerve damage. In the current third-generation model, water cools most of the cannula shaft through a metal jacket to reduce overheating and the chances of burning of the patient. Unfortunately, fat has to pass through inside the newer ultrasonic cannula, and space is taken up by the outer metal jacket of these cannulae. Therefore, ultrasonic cannulae presently available are large-at least 5mm in diameter. Third-generation cannulae are less likely but still can develop red hot tips if not operated properly and can cause "end hits." Surgeons who claim protection from tissue burning for 1st & 2nd generation instruments with placement of large amounts of fluids either via the "wet technique" or the tumescent technique in the area to be suctioned may be ill-informed. Some tissue burning protection is always gained by the presence of water but it is by no means complete and may vanish as the fluid disperses from the tissue either while waiting for the suctioning portion of the liposuction surgery to begin or during a lengthy procedure.

The high-frequency ultrasonic vibrations will weaken all generations of internal ultrasonic cannulae. Thus it is not unexpected that reports exist of ultrasonic cannulae breaking into pieces inside of patients and requiring exploratory surgery to remove. Third-generation titanium cannulae may cost hundreds of dollars each and may be rated for, say, 20 uses. Very few surgeons or their staff keep accurate records of the number of uses and amount of time of use of each specific ultrasonic cannula in their sets/kits.

INTERNAL ULTRASONIC LIPOSUCTION

The practice of internal ultrasonic liposuction on humans did not originate in United States. It was first used in Europe and Latin America. Unfortunately, in the early 1990's, the experience with internal ultrasonic liposuction caused concern. There were many serious problems that caused harm to patients, and the procedure suffered in popularity. Then how did internal ultrasonic liposuction come to the USA? Back in the early 1990's, American Board-Certified plastic surgeons realized that they were losing a significant portion of the liposuction market to other specialists. Board-certified plastic surgeons had neither invented the procedure of liposuction nor had they perfected it, when compared with other specialties. In order to recapture the lucrative market, U.S. Board-certified plastic surgeons decided to adopt and foster U.S. ultrasonic liposuction as their own. Technology from Europe was modified with the hope that it would be safer, yet effective. Unfortunately, many of the results of the first- and second-generation internal ultrasonic liposuction have been disastrous.

The third generation was just starting in 1999, and it is too soon to tell how many problems will arise. The Food and Drug Administration (FDA) usually oversees the state of medicine in the USA with fairly good results. Board-certified plastic surgeons allegedly gave their word that they would monitor ultrasonic liposuction problems. Was there really true monitoring? Unfortunately, the status of ultrasonic liposuction monitoring in the United States as of 1999 was/is as follows: First, as of January 1, 1999, ultrasonic liposuction was not FDA approved. Although the FDA may seem like a large government bureaucracy, many times, FDA slowness in approval does prove beneficial to the American public, whether by accident or on purpose. (Consider the case of thalidomide, a sedative, used in Europe, that caused birth defects in children of mothers who took it.) In the future, it is possible that new and better forms of ultrasonic liposuction will be developed that will help patients more than harm them. Second, as of January 1, 1999, no one was truly monitoring ultrasonic liposuction-not a government agency, not even the manufacturers of the ultrasonic liposuction equipment. In the next paragraph, the misuse of the term "monitoring" will be evident in the use of "definitions" that are not in the public's interest. It has been alleged that the board-certified plastic surgeons' own task force (designed to oversee ultrasonic liposuction) failed to perform with accuracy and honesty in reporting the true number of complications, even among its own board members.

The Web site author has seen many patients, in consultation for attorneys and regarding expert witness work, related to ultrasonic liposuction claims. Patients presented with long-standing (likely permanent) nerve damage, which had been documented by other medical specialists (such as neurologists and orthopedists) prior to the patients' visits with the Web site author. Amazingly, some patients had things in common. Some were operated on by the same surgeon, and each was told the same thing. The doctor told the ultrasonic liposuction patients he had never heard of a problem like this before. How could a doctor who has two patients with the same problem tell one that he has never seen the problem before? If specialists do not report problems, quality will not improve. When it comes to medical procedures, in order to maintain high-quality standards, doctors must always look for trouble, find the sources of problems, and try to create remedies, so that patients will not be harmed and care can improve. It appears that proper reporting of the number of complications of ultrasonic liposuction in the United States will require the patients to report the complications themselves to either the Government or to public watchdog groups.

As of January 1, 1999, only one major ultrasonic liposuction manufacturer "records" complications. Amazingly enough, the ONLY complication that this manufacturer records is "death." Many obviously serious complications have occurred that are short of death. Sadly, if a manufacturer decides to make a definition of complications or problems that is so narrow and restrictive (death), the manufacturer will never know what the true complications associated with their machinery may be. Many of these manufacturers are traded on the stock market. Could the recording of patient complications be suffering in order to benefit company management and major shareholders of these companies? Have the values of patients' lives, health, and well-being been placed below the value of money in ultrasonic liposuction companies?

The ultrasonic liposuction manufacturers were fortunate to have eager board-certified plastic surgeons as surrogate spokesmen. This means that the ultrasonic liposuction machine manufacturers did not have to speak directly to the public in order to advertise their product. The plastic surgeons spoke for them, using their access to the common media (television, newspaper, and radio) in America. Rapidly, a tremendous amount of business was generated without the direct involvement of the ultrasonic liposuction companies themselves. Although the surgeons became surrogate spokesmen, they were relatively insulated from the information necessary to be good spokesmen. For example, doctors had limited contact with each other and with their stories of problems, except for their contact at annual meetings and their reading of medical journal articles, which are usually one year old by the time they hit the press. Surgeons who operate unaware of recent or current complications related to their methods may act to the detriment of the public's safety. Referring back to our earlier case, it is interesting that a surgeon with two of the same "rare" bad results (of nerve damage due to ultrasonic liposuction) has patients to whom he has declared that he has "never heard or seen of anything like this before." It may also be interesting to see what happens to the future of ultrasonic complication reporting now that patent lawsuits have narrowed the number of manufacturers to one (Mentor), who has licensed the patent from a French company.

EXTERNAL ULTRASONIC LIPOSUCTION & "EXTERNAL" LASER-ASSISTED LIPOSUCTION

Currently, the newest (remember newest does not always mean best) type of ultrasonic liposuction is external. In external ultrasonic liposuction, a vibrating handpiece is held on the outside skin of the areas that are soon to be suctioned. Before the external ultrasound is applied, the areas are first pumped with fluid and are then shaken by the sound/shock waves of the external ultrasonic liposuction device. The external ultrasonic liposuction device is similar to the hand-held devices used to treat deeper tissues such as muscle and fibrous tissues in physical therapy. However, to achieve any significant (breaking-up or liquifaction, not just soothing) effect on the fat, excessive energy levels must be transferred through the delicate upper skin into the deeper fat. When appropriately used the devices have not proven to be effective. When inappropriately used, external ultrasonic liposuction devices have caused serious burns and scarring to the visible surface skin of patients. In short, it probably does not work any if your doctor tries to make it "work" your doctor may harm you.

The Web site author has talked with doctors who have performed the tumescent method with and without ultrasonic external liposuction. Many doctors noted no difference. In the case of external ultrasonic liposuction, additional time is involved in performing that procedure. Some surgeons would likely not do the external ultrasonic procedure unless they could charge extra money. Additionally, the gels and creams used to allow the external ultrasonic device to pass over the skin smoothly could possible cause an allergy and can be introduced internally through the entrance wounds (in small amounts) when cannulae pass through the wounds into the patient. Although the introduction of these gels into the human body has not yet been reported to cause serious problems, there is always the possibility of allergy related to anything that is applied to the human body.

In summary, taking the above thoughts into consideration, at the very least, "properly performed" external ultrasonic liposuction is probably of little danger, might add a little time to the procedure, and has a value that is in doubt among reputable doctors. The decision of which doctor to have perform your liposuction surgery should be based upon viewing the doctor's previous results and on interviews with several previous patients. In medicine, the Web site author's advice is usually that if a modification to a procedure is not necessary, don't include it. Sometimes bad things come from unnecessary actions. So why use it? Marketing, money, etc. If your doctor insists on using it on you ask him/her for the double-blinded, paired comparison data published in a peer reviewed medical journal that supports it. If he/she cannot produce the data decline the procedure. If the present some data to you, fax it to the website author for an opinion or a rebuttal.

Regarding external laser assisted liposuction. The thoughts are identical to my thoughts on external ultrasonic liposuction for virtually the same reasons. Ditto. So why use it? Marketing, money, etc.