Ultrasound is very high frequency sound waves that transmit energy which causes controlled tissue destruction. Ultrasonic liposuction, also known as ultrasound-assisted lipoplasty (UAL), liquefies fat, which is then removed by low power suction. Dentists were the first healthcare professions to use ultrasound in the early 1960's. Ophthalmologists expanded the use to revolutionize cataract surgery. Ultrasonic aspirators now have numerous surgical applications for kidney surgery, liver resections and the removal of brain tumors.

UAL can be used internally as part of the suction cannula or externally to assist the dissolution of the fat. Internal ultrasound helps your surgeon to perform liposuction by using an ultrasonic probe attached to a generator. The probe vibrates and energy is delivered to the tip. This high frequency creates sound waves that collapse the fat cells by a process called cavitation. When the tip comes in contact with fat cells in your body, the outer cell membrane breaks and the fat is released, or "melts," making it easy to suction out. A tumescent solution (discussed in the previous chapter) helps the fat liquifaction process with UAL.

When your surgeon performs ultrasonic liposuction on you he will inject the tumescent solution, apply the ultrasonic energy and then evacuate (suck out) the fat with a hollow probe (a cannula) attached to a vacuum pump. UAL is common when large volume surgery (to be discussed later) is performed.

An external ultrasound machine also exists and the process is called external ultrasound assisted liposuction or XUAL. This machine delivers the sound wave and energy through your skin via a smooth plate. The plate is attached to a generator and is rubbed over your skin. The partially liquefied fat is then suctioned out. Less ultrasonic energy gets to the fat by this method since it must pass through the skin first. Many doctors do not think external ultrasound is necessary.

But the benefits external ultrasound include:

More fat removal during surgery; this results in more weight loss later. Improved body sculpting; the ultrasound "melts" the fat away just from the areas you and your surgeon choose and breaks down tough body folds to leave a smooth contour. Improved skin shrinkage (or contracture) following surgery; this means your skin may be tighter than after traditional liposuction. You may not need a "tummy-tuck" to remove baggy skin or a small "spare tire' around your abdomen.

UAL is also very helpful in correcting pre-existing contour irregularities or dents from another surgery. The ability to melt the fat and sculpt the body is particularly helpful around the buttocks, lower back, and lateral thighs where the fat is firmer. UAL is especially effective at removing the folds on the back and the lower abdomen. UAL, as with traditional suction-assisted liposuction, will not improve cellulite or stretch marks.

Complications resulting from UAL are the same as for traditional liposuction. But here are some additional ones. A unique risk is the possibility of blisters or burns. This can happen if the surgeon is inexperienced and lets the tip of the probe point up right under the skin. The energy from the ultrasound causes the burn.

Some surgeons have experienced a high rate of a problem called a seroma, which is a collection of a fluid that the body produces in an attempt to promote healing to heal. This can happen because a cavity is formed where the fat has been withdrawn and the body tries to fill the gap with a fluid from the blood called serum. The problem can be annoying, but is not dangerous. The unwanted liquid must be withdrawn repeatedly with a needle and syringe until the cavity collapses.

Ultrasonic Liposuction may also result in more numbness in the skin after surgery.

An experienced surgeon will avoid or treat these additional complications and your overall result will not be affected.