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It is now impossible to criticize ultrasonic liposuction as a whole, since a third generation of instruments that do show some level of improvement has just arrived as of January 1999. At the time of publication of the first edition of Lipoinfo.com, the only data available applied to first- and second-generation ultrasonic liposuction instruments. The ultrasonic procedure, at that time, deserved to have its reputation tarnished, as there were serious consequences from which many patients will suffer forever. The original ultrasonic liposuction devices lacked adequate and controllable cooling along the entire length of the cannula. The web site author has used the newest third generation ultrasonic liposuction cannulas and does feel that they represent an improvement over the previous first and second generations. The third generation, as we will call it for practical purposes, is basically cooled along the length of the cannula shaft by an outer metal sleeve that goes almost all the way to the tip. Sterile cooling water passes between the hot inner vibrating shaft and the outer metal sleeve. Water is secreted near the cannula tip for cooling purposes. The metal cooling sleeve leaves only a tiny fraction of an inch of vibrating shaft (tip) exposed to the patient’s tissue. This design change is alleged to reduce the tendency for thermal burns. For the third generation of ultrasonic cannulas, there is some (but incomplete) suction of the sonicated (broken and foamy) fat out of the patient’s tissues and into the collecting container. The broken down fat remaining in the patient is pressed out with rollers, suctioned out with old-fashioned cannulas or left to be absorbed inside the patient’s body. Unfortunately, the third generation still suffers the possibility of causing end hits and other thermal burns, although chances of this occurring in an experienced surgeon's hands are minimal. The most concerning problem with ultrasonic liposuction has been that the tip can become red hot when impacting a dense bodily structure if the ultrasonic cannula is moving too slowly. In fact, the Italians (inventors of ultrasonic liposuction) are very convinced that the ideal ultrasonic liposuction cannula should not suction at all. They felt that the ideal vibrating ultrasonic cannula should just be put into the patient for the purpose of pulverizing and liquefying the fat so that the fat can later be sucked out with old-fashioned (traditional) liposuction device. Some of the disadvantages of ultrasonic liposuction, no matter what generation of cannula is used, would be surprising to many patients. Again surgeons have to use rolling pins to squish out of the patients the liquefied fat that was not suctioned through the liposuction cannula. This means that the current cannulas are inefficient, perhaps leaving up to one-half of the sonicated (shucked) fat behind. Third generation cannulas do not have holes large enough to suction up the fat that is sonicated and liquefied. Fatty acids are a source of much inflammation in the human body and do cause the body to lay down scar tissue and other unwanted reactions. It could be that the tunnels and liquefied oils and their byproducts contribute to the formation of seromas (fluid ball collections) so commonly seen with ultrasonic liposuction procedures. For generations I & II of ultrasonic liposuction cannulas, which are still currently in use in many offices throughout the United States, large skin "protectors" must be screwed into the patient’s skin to protect the liposuction cannula entrance wounds from burns. These "protectors" make for even larger scars at the entrance wounds. An unfortunate disadvantage of the third-generation liposuction cannula is that even though the manufacturer claims the longest cannula is 3mm wide, the manufacturer is just talking about the central portion of the cannula that only partially sucks some of the liquefied fat. The cooling sleeve portion adds another 2 mm at least to the thickness or diameter of the cannula, therefore, making a total thickness of over 5mm in the current third-generation ultrasonic liposuction cannulas. Larger entrance wounds cause larger scars following the procedure. The status of ultrasonic liposuction is improving. As was mentioned previously, reporting of the difficulties has been very poor among the doctors who have performed ultrasonic liposuction. Rather than making the data public to help all of the patients involved (and future patients), doctors feel that releasing such information may be "dirty laundry" or tarnishing to their reputations. In conclusion, current 3rd generation ultrasonic liposuction does have some advantages for the surgeon. It is most helpful in areas of the body that are very thick and fibrous, e. g., areas where liposuction is being done for a second or more time, the back region, and the male breast region where the fat can be thick and coursed by fibrous tissue. Reciprocating "power" cannulas vibrate more slowly but for greater distances offer an alternative to ultrasonic liposuction cannulas. Most remove fat in more larger globs much like traditional liposuction. Unfortunately, the instrumentation may cause repetitive stress syndrome in the surgeons who use them (i.e., diseases like tennis elbow and carpal tunnel syndrome). However, the future may hold many improvements for this type of liposuction or combinations of this type with others such as ultrasonic.
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