The best candidates for abdominoplasty

Ultrasound-assisted lipoplasty (UAL) is a method of liposuction that has been practiced in Europe and South America for a number of years, but has only recently begun to attract attention in the United States. It is similar to traditional liposuction techniques in that fatty tissue is removed from the body through small (less than one centimeter) incisions for the purpose of improving body contour. However, with UAL the fat is first fractionated by the application of ultrasonic energy. The ultrasonic energy is delivered to the fat via a long narrow probe which is inserted through the same small incisions used for traditional liposuction. The ultrasonic energy targets the fat cells, leaving the surrounding structures, such as blood vessels and connective tissues, apparently undamaged. The fractionated fat can then be removed using low-volume suction.

How does ultrasound fractionate fat?

Ultrasonic energy is transmitted to the fat via a long narrow probe which is connected to a handpiece, held by the surgeon. The handpiece is connected to an ultrasonic generator which converts electrical energy to ultrasonic energy. When the ultrasonic energy comes in contact with the fat, the high frequency vibration effectively bursts the fat cells allowing release of fractionated fat from the cell. This fractionated fat mixes with the body fluid and the wetting solution infused by the surgeon to form a stable fatty emulsion which is a creamy light yellow color. This can then be removed from the body with relatively low-volume suction. This results in less trauma to tissues, therefore less bleeding, bruising and discomfort leading to shorter periods of convalescence.

What are the advantages of UAL?

Early data indicates that, while UAL is not a substitute for traditional liposuction, there may be benefits, including decreased post-operative swelling and bruising. Some physicians believe UAL allows better control of contour or shape of the body in the areas treated with liposuction and early experience has shown minimal problems with post-operative contour irregularity. It allows relatively large volumes of fat removal per operation with relatively little blood loss and minimal post-operative bruising. UAL is also physically less demanding from a surgical standpoint. Certain anatomic regions, such as the hip, posterior back and central body regions, may respond preferentially to UAL. However, at present traditional liposuction remains the best method of removing fat from certain body areas such as the face, neck, knees and inner thighs. In fact, traditional liposuction my be required in addition to UAL in many cases.

Are there any possible complications associated with UAL?

As with any surgical procedure there are possible risks and complications. The risks and possible complications of UAL are essentially the same as with traditional liposuction techniques. Bleeding and infection are very rare with either technique (a good estimate would be less than 1% of cases have either of these problems.) Contour irregularity (or unevenness of the body contour) is possible with either technique. With any large amount of liposuction, there is the possibility of accumulation of fluid in an area which was suctioned. This is called a seroma and is easily treated by drawing off the fluid in an office setting. Overaggressive liposuction by any technique, especially when carried out very close to the skin, can compromise the blood supply to the overlying skin. This could lead to loss or scarring of the skin. There is also the potential for burns at the entry site or along the path of the probe. This problem should be extremely rare.

What kind of anesthesia is used for UAL?

UAL can be performed using a number of different kinds of anesthesia, just the same as with traditional liposuction techniques. It can be done under a general anesthetic in which the patient is completely asleep. It can also be done under an epidural anesthesia which is commonly used when a baby is delivered. Or it can be done under local anesthesia. With local and epidural anesthesia the patient is awake but is usually given some sort of sedative to keep him or her comfortable and relaxed. The question of what kind of anesthesia is appropriate for you should be discussed with Board certified plastic surgeon Dr. Zevon or anesthesiologist.

How much does this procedure cost?

The cost of the procedure will vary depending on the surgeon and in some cases the geographical area. In general, the more areas of your body that you have suctioned the more it costs. This question also must be discussed with Board certified plastic surgeon Dr. Zevon. Once you and Dr. Zevon have discussed which areas you might like addressed and which areas he/she feels are appropriate for this procedure, the cost can be accurately estimated.

What can I expect during the post-operative period?

The answer to this question depends largely on what areas and how much fat you have suctioned. In general, the more aggressive the removal and the more areas you have suctioned, the more “strict” the post-operative regimen. In general, you can expect some discomfort during the first week or so. Most people describe it as discomfort rather than actual pain. Many say it feels like a deep bruise. The skin over the areas suctioned is often numb for a variable length of time. Most surgeons require you to wear some kind of post-operative compression garment such as a girdle or an abdominal binder. This is used to compress the tissues to lessen swelling and bleeding. The type of garment you will wear will depend on Board certified plastic surgeon Dr. Zevon’s personal protocol and which areas you have suctioned. Most surgeons have you wear this for anywhere from two to six weeks after surgery.

Can I gain the weight back?

Yes, you can regain weight after any kind of liposuction. You have a set number of fat cells as an adult and liposuction simply removes a certain number of them. If you gain weight, the remaining fat cells can grow bigger, which is how we gain weight. The good news is that there are fewer fat cells remaining in the area of the body that was suctioned and the “weight” tends to distribute itself more evenly in harmony with your new body contour. All in all, liposuction is not the answer to weight control, rather it is a surgical method of contouring the body. It is always best to be at a stable and realistic weight when you undergo this procedure.

How do I select a plastic surgeon for UAL?

Since UAL is a new technique in this country, it is important to select a surgeon with appropriate training and experience with UAL.