Ultrasonic liposuction: Using ultrasound technology to achieve precise weight loss and body shaping.

Ultrasonic Liposuction:

Ultrasonic liposuction, also known as ultrasonic liposculpting, was pioneered by Italian physician Michele Zocchi in 1992. Its principle involves converting electrical energy into high-frequency energy using an ultrasound generator, producing ultrasound waves exceeding 16 kHz. The operating range of the ultrasound device is between 20 and 40 kHz.

(I) Mechanism of Action
Because adipose tissue is relatively loose and has poor adhesion, ultrasound waves exert physicochemical and biological effects on it, including:

1. Microscopic Mechanical Movement
Ultrasound waves can directly damage intracellular organic macromolecules, causing violent movement and displacement of these molecules, as well as breakage of chromosomes and macromolecules, loss of DNA replication, and structural shearing, ultimately leading to cell death.

2. Cavitation Effect
The cavitation effect is the effect of tiny cavities created by the negative pressure generated by the expansion and circulation of ultrasound waves. The effect of ultrasound on liquids is mainly due to the implosion effect caused by the expansion and compression of waves, resulting in numerous micropores containing gas or vapor within the liquid. In low-density adipose tissue, the molecular cohesion is weak, and the relatively low negative pressure caused by ultrasound can create these pores. The implosion of these intracellular and extracellular micropores leads to enhanced molecular motion, ultimately causing cell rupture. Ultrasonic emulsification primarily utilizes the "cavitation effect" of ultrasound.

3. Thermal Effect
A thermal effect is generated during ultrasound treatment, but due to the infiltration of a large amount of swelling fluid at the surgical site, this thermal effect will not damage the cellular tissue. The titanium probe used to transmit ultrasound is a good acoustic conductor, and the heat generated by the ultrasound probe due to energy absorption causes minimal tissue damage and can be disregarded in liposuction.

(II) Indications
Ultrasonic liposuction is particularly suitable for mild to moderate obesity with localized fat accumulation or predominantly localized fat accumulation. It can also improve diffuse obesity accompanied by difficulties in bending, squatting, and walking. (III) Preoperative Examination
Routine examinations are performed before treatment, including measuring height, weight, and various circumferences of the treatment area, and taking anteroposterior, lateral, and oblique radiographs. The amount of fat to be removed is designed in a standing position, and contour lines are drawn. The probe dwell time at these contour lines is determined based on their density.

(IV) Anesthesia Management
General anesthesia or epidural anesthesia may be chosen depending on the scope of the surgery.

(V) Incision Design
The incision is located in a concealed area that facilitates surgical manipulation and natural drainage, approximately 1 cm in length.

(VI) Surgical Procedure
Regardless of whether general or epidural anesthesia is used, a tumescent solution must be injected (preparation method described above). This solution reduces postoperative pain, lowers the density of adipose tissue, enhances the "cavitation effect" of ultrasound, reduces biological damage, and lowers the concentration of extracellular fluid.

After infiltration injection, ultrasound treatment is performed on the treatment area. Through a micro-incision in the skin, a peptide metal probe is inserted into the subcutaneous fat to transmit ultrasound waves to the surrounding adipose tissue. During the procedure, a crisscrossing technique is used, proceeding from deep to shallow along the designed line. For patients with loose skin, the inner surface of the skin can be intentionally stimulated with an ultrasound probe. Due to the response of the skin's blood vessels and lymphatic vessels to the ultrasound stimulation, the loose and inelastic skin will contract strongly.

After the ultrasound treatment, the fat fragments, fatty acids, interstitial fluid, and emulsion formed by the ultrasound-induced damage are aspirated using a suction tube, preserving cell membranes, intercellular substances, and connective tissue containing autologous collagen in their appropriate positions.

Finally, the incision is sutured, and negative pressure or rubber band drainage is applied for 48–72 hours. Antibiotic treatment is administered for seven days, and elastic bandages or compression garments are used for shaping for three months.

The anesthesia method for ultrasound finger suction requires a hypotonic tumescent solution. The tumescent solution used for ultrasound differs from Klein's solution in that 1000ml of normal saline is replaced with 500ml of normal saline plus 500ml of distilled water. When fat cells are extremely swollen, the energy of ultrasound selectively liquefies (breaks up) them, reducing their number. This method has many advantages: ① It selectively destroys unwanted fat tissue while preserving surrounding normal structures. ② It only removes the liquid component (fatty acids) of the fat tissue, while cell membranes and intercellular substances containing higher densities of autologous collagen remain in situ. Post-operative unevenness is greatly reduced, resulting in a smooth and even feel, meeting aesthetic requirements for body shaping. ③ Stimulating the inner surface of the skin with ultrasound energy can cause loose skin to contract, making it particularly suitable for patients with loose skin due to obesity. ④ It preserves all tubular structures such as arteries, veins, lymphatic vessels, and nerve tissue, preventing fat embolism and deep vein thrombosis. Post-operative recovery is rapid, allowing patients to quickly return to normal work and life.