Since instant fat reduction has great appeal, liposuction has become the most common cosmetic procedure performed around the world. According to the American Society of Plastic Surgeons (ASPS), the number of liposuction procedures performed increased by 386 percent from 1992 to 2000. In 2005, more than 450,000 liposuction procedures were performed. Interestingly, 21% of these procedures were ultrasound-assisted lipoplasty (UAL). The American public spends approximately $ 2 billion on these operations. The basic technique involves inserting a narrow tube (cannula) under the skin through small incisions and manipulating the cannula to break and suck out the fat cells. The procedure damages other local tissues, causing temporary bruising, swelling, and blood loss. The most commonly treated areas are the outer thighs and abdomen in women and the flanks or “love handles” in men.
Liposuction can also remove unwanted fat from the hips, buttocks, knees, arms, chin, cheeks, neck, and other areas. The concept behind liposuction seems too good to be true: however, it is not an easy solution. The American Society of Plastic Surgeons (ASPS) warns that liposuction is a serious surgical procedure that involves a potentially painful recovery and risks of rare but serious complications. The decision to undergo liposuction, according to the American Mayo Clinic, should be considered very carefully. However, liposuction is a popular option. However, now there may be a new ultrasonic method to remove fat from the body that does not pose any risk to the patient. This new method called UltraShape® uses exclusive G-NIUS (TM) (Selective Guided Non-Invasive Focused Ultrasound) technology to effectively and safely break down fat cells. The use of external ultrasound means that the patient does not even have to undergo any invasive surgical procedure. The UltraShape procedure has the potential to redefine aesthetic medicine by developing a non-invasive means of fat removal.
Therapeutic ultrasound (as opposed to diagnostic and imaging modalities) has been used as a therapeutic tool in medicine for more than fifty years. The first ultrasonic machine (lithotripter) used to destroy kidney stones was produced by the German aircraft manufacturer Dornier in Munich in 1980. It was the same year that former Beatle John Lennon was shot and killed in front of his New York apartment. . In 1984, the company introduced the Dornier HM-3 (Human Model-3) and that same year the FDA approved the use of ESWL (Extracorporeal Shock Wave Lithotripsy) in the United States for the treatment of kidney stones. Since then, the HM-3 or “Munich Stonebuster” as the press preferred to call it, has treated more than five million patients worldwide. In 1985, the technique was first applied successfully in a patient with gallbladder stones. It was the same year that energetic Dubliner Bob Geldof had the idea to host Live Aid for the starving people of Africa.
In the following years, many conditions suitable for the SWL technique were investigated. But the history of the use of therapeutic ultrasound in medicine didn’t really start there. In fact, it may have inadvertently started with another aircraft manufacturer because during WWII British ophthalmic surgeon Harold Ridley noticed that pieces of Plexiglas from shattered awnings from Spitfire fighter jets caused no reaction when embedded in the pilot’s eyes. He used this theory to use the material to implant the world’s first intraocular lens, at London’s St. Thomas Hospital on November 29, 1949. The following year, he encountered widespread criticism from his peers at a conference in the United States that considered the idea of replacing the natural lens of the eye with an artificial one that was too radical and unacceptable for the time.
Over the next twenty years, the idea of lens implants for cataracts slowly became more palatable. In 1968, the American surgeon Charles Kelman adapted the new ESWL technology to remove cataracts. The procedure, later known as phacoemulsification, used a small probe with a vibrating tip to gently break open the cataract and wash it off. Phacoemulsification techniques and plastic lens implant technology were combined and the science of cataract surgery was revolutionized. In 1981, a Ridley protégé named Choyce obtained the first FDA approval for intraocular lenses. It was the same year that the Irish Republican on hunger strike, Bobby Sands, died in Maze Prison. Today, after decades of development, modern phacoemulsification is considered one of the safest surgeries performed with millions of successful procedures completed each year around the world.
Today, the use of therapeutic ultrasound in the form of extracorporeal shock wave therapy has found its way into many other facets of medicine with recent advances in machines specifically designed for use in the arms and legs to treat associated localized chronic pain. with chronic diseases. tendinitis. However, its main use can be even the most interesting as the “Tel Aviv Fatbuster”. In fact, the association of ultrasound with the destruction of fat cells begins many years earlier. It may have started as early as 1921, when a French surgeon named Dujarrier decided to practice the new art of liposuction in an attempt to create a better shape for a young dancer’s knees. Unfortunately, his patient developed gangrene and required an amputation. It was the same year that the new Irish Free State was established. After this initial fiasco, things remained quiet for many years, through the advent of antibiotics, World War II, and as the Beatles climbed the charts with “Can’t Buy Me Love,” a surgeon from Cologne named Josef Schrudde decided to try the technique again on someone’s ankles.
The second attempt was much more successful and luckily the patient lived to tell about it. In 1974, an Italian gynecologist named Giorgio Fischer further developed the technique with the invention of a rotating electrosurgical knife encapsulated by a cannula that sucked out the detached cells. In 1978 the technique was brought to Paris where it was perfected and popularized by French plastic surgeon Yves-Gerard Illouz. In 1982, Illouz introduced a new form of lipolysis using blunt cannulas and high vacuum suction with good reproducible results and low morbidity and a new era of liposuction arrived. It was the same year that American film actress Princess Grace died on a mountain road in Monaco.
During the 1980s, Kesselring and Meyer developed other cannulas, while the father of aesthetic medicine, Pierre Fournier, developed another technique using a syringe. In this period, liposuction came to the United States, but it quickly fell out of favor due to increased complications and several deaths. It now appears that many of the deaths associated with plastic surgeons combining liposuction with tummy tucks are “tummy tucks.” In 1985, a Californian dermatologist, Jeffrey Klein, invented and pioneered a new tumescent method technique, the safest method known. He was aided in this development by a Colorado dermatologist, Patrick Lillis. In 1987, an Italian plastic surgeon at the University of La Sapienza in Rome named Professor Nicolo Scuderi introduced the use of ultrasound as an emulsifying modality for fatty tissue during liposuction and began a new era of ‘fat removal’. This technique was further modified when Zocchi introduced titanium ultrasonic probes and manual reshaping of treated areas to remove fluid from burst fat cells in 1992. It was the same year that Democratic Party candidate William J. Clinton arrived. to power in the US presidential elections and the world witnessed three days of rioting in Los Angeles after four white police officers were acquitted of criminal charges despite video evidence that they had beaten black motorist Rodney King .
In 1998, Californian plastic surgeon Barry Silberg developed the technique using ultrasound-assisted external liposuction (XUAL). This method required a traditional suction liposuction after the application of high frequency ultrasonic fields delivered through the skin to a moistened tissue. Silberg felt that this method led to less traumatic surgery with a superior clinical outcome. There is little doubt that, as an invasive modality, like tumescent liposuction, the technique still had many of the drawbacks that accompany invasive procedures. In addition, many doctors began to express opinions that the magnitude of the ultrasonic energy used to destroy fat cells can also damage other tissues in contact with the cannula. Many felt that one of the technical drawbacks of the ultrasonic liposuction technique was that the cannula had to be inside the body. It was at this stage that a Tel Aviv plastic surgeon named Ami Glicksman considered using external ultrasonic waves to selectively break down fat cells without the patient having to undergo a surgical procedure.
In 2001, as the rest of the world grappled with the aftermath of an Al Qaeda terrorist attack on the World Trade Center in New York, Dr. Glicksman was in Tel Aviv investigating the feasibility of using external ultrasound to break down fat cells. in pigs. His experiments were successful and he noted that fat lysis was selective and left nearby tissues intact. Other macroscopic and microscopic analyzes of the overlying skin indicated that it also remained intact. The researchers quickly moved from the pig models and tested the external ultrasound transducer to lyse human fat from ex vivo tissue removed from skin flaps excised in hospital abdominoplasty procedures. These experiments also showed that fat lysis only occurred in a specific region, leaving the skin or fat intact outside the focused beam. The temperature on the skin and within the focus was controlled and showed an increase of 1oC for an ultrasound treatment of 1-2 seconds. Further in vivo human trials were started in Israel and participants were treated with the ultrasonic device prior to abdominoplasty in which the treated area was removed and analyzed. The first study of twenty patients began in 2002 monitoring the safety and effectiveness of the treatment. Histological evaluation of all tissues removed during surgery clearly showed that external ultrasound treatment only destroyed fat cells, leaving blood vessels, connective tissue, nerves and epidermis intact.
In 2003, a US-organized coalition invaded Iraq with the stated reason that it had not abandoned its nuclear and chemical weapons development program in accordance with UN resolutions. Also in that year, a large multicenter clinical trial with the external ultrasound device was started at five sites in the US, UK and Japan, in which 137 patients underwent a single treatment. The results showed that, on average, a 2 cm reduction in circumference was observed after treatment. This is close to about 0.5 liters and the rest can be removed with an additional procedure performed a month later. The device has obtained CE approval in Europe and more than 500 people have been commercially treated with the device in Ireland, the United Kingdom, Spain and Scandinavia, demonstrating the safety and efficacy of the treatment. FDA trials are currently underway with all expectations that they will approve the procedure shortly.