Liposuction Frequently Asked Questions
A Guide to the Constantly Changing Landscape of Liposuction Alternatives
(An article originally printed in Plastic Surgery News, April 2008)
The number and variety of devices purported to rid bodies of fat continue to grow. Some have been approved by the FDA, some are in the FDA pipeline and others are simply being reported as the "next big thing" in consumer magazines (perhaps in one of the titles in your waiting room right now). The following is a sampling of the more visible variations, and the stage of each in the process of government approval. The working mechanisms and claims of efficacy that accompany each device have been provided by the respective manufacturers.
Ultrasound
Ultrasonic energy fractionates or bursts the fat cells, which subsequently are removed with relatively low–volume suction—resulting in less trauma to tissues.
Liposonix (Liposonix) achieves targeted reduction of adipose tissue by precisely focusing high intensity ultrasound energy to cause disruption. Once adipocytes have been disrupted, hemotactic signals activate the body's inflammatory response mechanisms. Macrophage cells are attracted to the area to engulf and transport the lipids and cell debris. This results in an overall reduction in local adipose tissue volume.
Regulatory status: Liposonix Inc. has submitted a protocol to the FDA for clinical trials in the United States.
Ultracontour (Medixsysteme) is a dual ultrasound instrument that uses high intensity ultrasound and ultrasound-mediated vasodilation transducers to apply energy below the skin's surface in the subcutaneous tissue to treat the fat cells.
Regulatory status: Medixsysteme has completed the physician selection process necessary to begin trials.
Ultrashape Contour I delivers measurable circumference and fat—thickness reduction in a single treatment and incremental reduction with multiple treatments. Contour I produces mechanical, non–thermal, acoustic effects that target and selectively destroy fat cells, leaving surrounding critical structures such as skin, blood vessels, nerves and connective tissue intact. The procedure is guided by real–time tracking and guidance technology designed to deliver smooth, uniform body contouring results.
Regulatory status: Not approved.
VASERLipoSeledion (Sound Surgical Technologies) uses controlled ultrasound energy to selectively fragment fat—leaving nerves, blood vessels and connective tissue largely intact. The grooved probe transmits ultrasound energy around the entire grooved tip for greater emulsification with diminished risk of excess tissue trauma. A wetting solution infused prior to the procedure provides thermal protection and aids in the formation of the emulsion. Because fatty tissues are emulsified prior to removal, aspiration with a rounded cannula can be accomplished with suction and massage while leaving the tissue matrix relatively intact.
Regulatory status: FDA approved.
Mesotherapy
Mesotherapy involves the injection of various compounds into the skin to dissolve fat.
LipoDissolve is performed through a series of microinjections of phosphatidylcholine deoxycholate to permanently dissolve the fat. The hardened fat cells break down within a few weeks and are excreted through the body. Over the course of the treatment period, the fat cells in the targeted area are permanently eliminated.
Regulatory status: Not approved.
Laser-assisted lipolysis
A laser fiber inside a cannula delivers energy directly to fat cells, causing them to rupture and flush naturally from the system. Simultaneously, tissue around the area coagulates, resulting in overall tighter skin tissue.
CoolLipo (CoolTouch Inc.) The CoolLipo 1320 nm laser system is designed to ablate fat in areas such as the neck, chin and arms, and improve the outcome of conventional liposuction in larger areas such as the abdomen and thighs with percutaneous skin tightening.
Regulatory status: FDA approved.
ProLipo (Sciton) ProLipo ablates and liquifies fat deposits in treated areas. As a stand-alone procedure or in combination with liposuction, ProLipo can be performed under local anesthesia with less downtime and recovery than traditional lipolysis.
Regulatory status: FDA approved.
SmartLipo (Cynosure) uses a small laser to liquefy fat cells and an attached cannula to suction them away. Because the cannula is about 1–2 mm, SmartLipo is a less invasive procedure, reducing the risk of bruising and promoting a quicker recovery. In addition, the cannula's laser is designed to act as a visual guide to help the surgeon make more precise movements than possible with typical liposuction. The 1064–nm Nd:YAG laser has a 6–18 watt power range—the higher wattage allowing a faster procedure. As the laser liquifies fat cells, the laser simultaneously coagulates small blood vessels to prevent bleeding and swelling.
Regulatory status: FDA approved.
Radiofrequency
Radiofrequency uses electromagnetic energy with a wavelength slightly longer than microwave to heat the dermis and subcutaneous tissues in a controlled manner without inflicting any damage to the epidermis. The physical changes reportedly are the result of stretching and smoothing of fibrous bands that cause cellulite, and lymphic drainage of the byproducts of fat cells that have been reduced in size.
Vela (Syneron Medical Ltd.) uses light energy applied to tissue at a controlled infrared wavelength, radiofrequency energy and mechanical manipulations of the skin and fat layer to focus energies precisely on target treatment areas to reduce body circumference and cellulite.
Regulatory status: FDA approved.
(Source: Plastic Surgery News, April 28, 2008, p.45)
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