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Ultrasonic Liposuction unsafe with any Doctor ?

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Ultrasonic Liposuction unsafe with any Doctor ?
« on: April 01, 2011, 10:41:08 PM »


There is a doctor who is recommended by this website, by its users, by people on other websites that rate doctors as being very good and skilled. However the 1 thing I don't like about him is that he still uses ultrasonic liposuction.

Is Ultrasonic Liposuction unsafe under any situation  and with any doctor no matter how skilled?

Dr. Lane Smith said " Initially ultrasonic liposuction was hoped to be superior to tumescent liposuction.   I was trained using mostly ultrasonic liposuction.  We hoped that the skin tightening would be better.  With time, this was not shown to be the case.   Instead, there appeared to be little to no advantage to ultrasonic liposuction, but the there did seem to be an increased rate of complications such as seromas (fluid collections) and numbness.    The biggest complication was a risk of burns, which does not happen with tumescent liposuction.    Because there was little or no advantage to ultrasonic liposuction and an increased risk of complications, surgeons slowly abandoned ultrasonic liposuction.   However, due to marketing, there appears to be a resurgence in the number of surgeons using ultrasonic liposuction."


I also read something that listed the following reasons



Safety of UAL is controversial. One study of 250 consecutive UAL patients concluded that internal UAL is "both safe and effective" despite three cases of dermal necrosis (1.2 percent), 28 postoperative seromas (11.2 percent), and 35 patients with Reston foam blisters. (Maxwell GP. Ultrasound-assisted lipoplasty: a clinical study of 250 consecutive patients. Plast Reconstr Surg 101:189-202,1998). Based on this report, most experienced liposuction surgeons have concluded that UAL is less safe than Tumescent Liposuction with microcannulas.

UAL causes blood clots in the small blood vessels. Internal UAL produces heat and elevates the temperature of targeted fatty tissue. However, it can also increase the temperature within the blood vessels that supply the overlying skin. Elevation of the temperature within blood vessels causes blood clots within the vessels. If the blood vessels that supply an area of skin with oxygen becomes blocked by clots, then the skin will die. Internal UAL may literally create a large area subcutaneous thermal injury.

Injury to peripheral nerves is possible with UAL. Patients who have had internal UAL appear to have an increased incidence of prolonged numbness consistent with injury to sensory nerves. The neurosurgery literature has documented the injurious effects of ultrasound on peripheral nerves. The potential for ultrasonic energy causing damage to peripheral nerves suggests that the risks of using UAL in arms, legs, neck and face may outweigh any potential benefits.

UAL Causes Seromas
A seroma is a fluid-filled cavity beneath the skin containing serum (clear yellow fluid) that can persistent for weeks or months. Internal UAL causes the formation of seromas in 15% to 70% of patients. Advancing the internal UAL cannula too slowly through fat or using too much ultrasonic energy, causes seromas by damaging surrounding tissues. In response one manufacturer has modified its recommendations and "solved the problem" by recommending that surgeons reduce the amount of internal ultrasonic energy that is delivered to subcutaneous fat. In other words, do less ultrasonic liposuction and reduce the incidence of problems.

External UAL and Manufacturer's Warnings
The external UAL device is the same ultrasound apparatus traditionally used by physical therapists. These ultrasound machines are associated with definite risks and dangers. The manufacturers of external ultrasound devices provide instructions that state external ultrasonic devices should not be used over the heart, the ovaries, or over a large artery such as the carotid artery. Manufacturers' warnings should prohibit the use of external UAL for liposuction of the male chest, the female abdomen, or on the neck or chin areas. If a surgeon uses external UAL on the female abdomen, then the manufacturer's warnings should be included in the information about UAL given to the patient.


After reading this, I have to wonder if UAL is safe even with the most skilled surgeon? It seem like the technological is fundamentally flawed not matter who is using it?

Should a doctor be discounted based on the fact that he insist on using ultrasonic liposuction? 

Thanks

Linkback: https://www.gynecomastia.org/smf/index.php?topic=22855.0

Re: Ultrasonic Liposuction unsafe with any Doctor ?
« Reply #1 on: April 02, 2011, 10:35:18 AM »
Sorry, I don't think I'm qualified to answer your question. However, do you have gyne?  If so, I would think you would be more concerned with the glandular excision.  Liposuction without excision won't take care of the problem. 

Anyhow, just thought I'd reply so this thread picks up some momentum.  Hopefully one of the doctors that contribute to this site weigh in soon.


Re: Ultrasonic Liposuction unsafe with any Doctor ?
« Reply #2 on: April 02, 2011, 12:14:20 PM »
Sorry, I don't think I'm qualified to answer your question. However, do you have gyne?  If so, I would think you would be more concerned with the glandular excision.  Liposuction without excision won't take care of the problem. 

Anyhow, just thought I'd reply so this thread picks up some momentum.  Hopefully one of the doctors that contribute to this site weigh in soon.



Hi.

I know a lot of people go on here and say their doctors want to use this method to " lipo out the gland" claiming that the ultrasonic can be used for the gland.

This doctor seem to have experience with gyn surgeries and does not make that claim. He will remove the gland with an incision around the areola however for removing that fat, he uses the ultrasonic lipo.

My concerns is that from what I read, ultrasonic has little to no advantage however comes with a large amounts of complications and its not even FDA approved. Its something that seem to be pushed by manufacturers not doctors or patients.

peripheral nerves damage, blood clots, Seromas, damaging to the heart or supporting infrastructure,etc..

I was not even aware that doctors could use a medical device for surgery that was not FDA approved.

Every doctor I look at has ultrasonic lipo with general anesthesia. The ultrasonic concerns me and the general anesthesia concerns me( vs local anesthesia with heavy sedation) 

Just trying to find out if maybe the ultrasonic may be acceptable if the doctor is skilled with it or if its unsafe under any circumstance. 

Re: Ultrasonic Liposuction unsafe with any Doctor ?
« Reply #3 on: April 02, 2011, 12:18:11 PM »
The potential side effects and complications of ultrasonic lipo have been well described in the initial post of this thread -- no need to repeat them. 

Interestingly, when UAL (Ultrasonic Assisted Liposuction) was introduced, many docs specifically pushed it for doing gyne surgery, claiming that it did better than traditional liposuction and that it helped to tighten skin as well.  However, no significant improvement in skin tightening were noted.  And most important, UAL does nothing for gland tissue -- it is totally ineffective in removing it!!

In the US, most surgeons have abandoned it -- as can be seen by all the UAL machines that are for sale.

Dr Jacobs
Dr. Jacobs 
Certified: American Board of Plastic Surgery
Fellow: American College of Surgeons
Practice sub-specialty in Gynecomastia Surgery
815 Park Avenue
New York, New York 10021
Telephone:  (212) 570-6080
Email:  dr.j@elliotjacobsmd.com
Website:  http://www.gynecomastiasurgery.com
Website:  http://www.gynecomastianewyork.com/revi

Re: Ultrasonic Liposuction unsafe with any Doctor ?
« Reply #4 on: April 05, 2011, 06:28:38 AM »
The potential side effects and complications of ultrasonic lipo have been well described in the initial post of this thread -- no need to repeat them. 

Interestingly, when UAL (Ultrasonic Assisted Liposuction) was introduced, many docs specifically pushed it for doing gyne surgery, claiming that it did better than traditional liposuction and that it helped to tighten skin as well.  However, no significant improvement in skin tightening were noted.  And most important, UAL does nothing for gland tissue -- it is totally ineffective in removing it!!

In the US, most surgeons have abandoned it -- as can be seen by all the UAL machines that are for sale.

Dr Jacobs

From everything I have read on the internet and the machines being sold on ebay, I am inclined to agree. However, you would be surprised at how many doctors still are using ultrasonic. I think due to heavy marketing by the equipment manufacturers.

My question is if there is any agency or forces working to put a stop to these ultrasonic machines? Many people walk into a doctor's office and trust that the equipment they are using is relatively safe.

The FDA or maybe some other group ?

The US should have higher standards than Europe when it comes to this stuff and I think Europe has completely abandoned this method a long time ago.   

I mean we have such strict standards that they sterilize a arm before they administer a legal inject to a death row inmate, I can't believe the machine not even Europeans will use because of the dangers is still in use today in the US.
Thanks 

Re: Ultrasonic Liposuction unsafe with any Doctor ?
« Reply #5 on: April 05, 2011, 08:17:30 AM »
Unfortunately, in the US, once a machine is OK'd for marketing by a gov't agency, there is very little ability to re-call it.  Remember, many of the potential problems are not from the machine -- but errors in surgeon's technique.  Unfortunately, the technology of the machine makes it somewhat easier to make surgical errors.

Dr Jacobs


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