Non-surgical ultrasonic lipoplasty

Published on 22/05/2015 by admin

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Last modified 22/05/2015

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CHAPTER 64 Non-surgical ultrasonic lipoplasty

Peter Fodor

History

High-intensity focused ultrasound (HIFU) has been used in a variety of research and medical applications dating back to 1942. This technology is useful in targeting specific sites surrounded by non-target tissue because of its unique ability to precisely focus energy. In the 1960s, Kelman introduced the idea of using ultrasound energy for surgery with his use of phacoemulsification during cataract surgery. A device called the Cavitron ultrasonic surgical aspirator (CUSA) has been successfully applied to the fields of neurosurgery, gynecology, general surgery and other specialties for purposes such as tumor ablation and tissue resection since the 1970s.

More recently, researchers realized the potential of HIFU in aesthetic medicine. Historically it began with Dr Nicolo Scuderi of Italy who in 1987 introduced the technique of using ultrasound energy in conjunction with lipoplasty. This technique involves inserting thin ultrasound transducers through small incisions to emulsify adipose tissue before removing it with suction. Ultrasound assisted lipoplasty (UAL) has since evolved into a useful, practical tool in body sculpting surgery. In the past few years, studies have proven that with a transducer placed on the skin surface, energy can be precisely directed into the subcutaneous adipose layer to disrupt adipose cells non-invasively without damaging the skin, intervening tissues, or underlying tissues and organs. This principle led to the development of the LipoSonix® (Bothell, WA) device for non-invasive ultrasonic body sculpting.

Physical evaluation

• The safety profile for the procedure is excellent, with no abnormal findings in blood analyses and with very few side effects/complications, none of which are significant.

• The procedure is extremely precise. The product is designed so that energy is delivered only to the target tissue, with no effect to the skin or to the non treated surrounding tissues or organs.

• The procedure is non-surgical and ultimately results in reduction of the targeted fat layer with minimal, if any, risk of infection.

• Speed and efficiency for the procedure are impressive. The learning curve for product operation is short. The treatments take well under an hour to complete.

• The procedure is well-tolerated by patients. There is no general anesthesia required. There is minimal post-treatment discomfort and essentially no patient down-time.

• Clinical efficacy is quite promising as the early results are visibly evident upon viewing before and after clinical photographs.

• Patient satisfaction is high, as most patients experience a noticeable difference in fit of their clothes and indicate that they would recommend the procedure to others.

Anatomy

The anatomy of the skin and underlying adipose tissue is straightforward. The epidermal layer is approximately 1 mm thick with the dermis directly underneath and of variable thickness depending on the body area. The subcutaneous adipose tissue varies in depth between a few millimeters to several centimeters depending on the subject and the area of the body. As a general rule, a fascia covering the muscle layer underlies the adipose tissue.

The primary role of adipose tissue is to efficiently store energy. Adipose tissue is a type of connective tissue that is made up of loose associations of fat cells (adipocytes) surrounded by thin fibrous septae. The collagen matrix comprises approximately 20% of the adipose tissue which provides structure. Different areas of the body have more extensive collagen networks. This results in more fibrous areas of subcutaneous fat. Adipose tissue also contains stromal-vascular cells, macrophages, leukocytes, and non-differentiated pre-adipocytes.

Each adipocyte has a thin rim of cytoplasm which contains a flat nucleus, a small amount of cytoplasm, and in general, one large lipid droplet. Up to 75% of the cell volume is made up of lipids or triglycerides. The remaining weight of the adipocyte is protein and water. Each triglyceride droplet is comprised of one glycerol and three fatty acid molecules. The fatty acid composition changes depending on factors such as age, diet and exercise.

Lean adipose tissue is highly vascular, however, the adipocytes are in general so greatly expanded by their stored lipids, that the ratio of capillary to total cell mass is small. Each adipocyte is in contact with at least one capillary. Nerve fibers also run sparsely through adipose tissue and the number of nerves varies greatly in different parts of the body. In general, adipose tissue is less innervated that most other tissue types.

Size of adipose deposits in the human body is a function of fat cell number and mass. There are rare examples of hyperplastic growth – increasing the number of cells – occurring in adulthood. Most growth of adipose deposits however comes from hypertrophic growth – increase in adipocyte cell size. In general, once these cells are destroyed, they are permanently removed from a given area of the body.

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