| Since instant fat reduction holds great appeal, | | | | Love" a Cologne surgeon called Josef Schrudde |
| liposuction has become the most common cosmetic | | | | decided to try out the technique again of someones |
| procedure performed worldwide. According to the | | | | ankles. |
| American Society of Plastic Surgeons (ASPS), the | | | | The second attempt was much more successful and |
| number of liposuction procedures performed | | | | thankfully the patient lived to tell the tale. In 1974, an |
| increased by 386 percent from 1992 to 2000. More | | | | Italian gynaecologist called Giorgio Fischer further |
| than 450,000 liposuction pro- cedures were | | | | developed the technique with the invention of an |
| performed in 2005. Interestingly, 21% of these | | | | electrical, rotating scalpel encapsulated by a cannula |
| procedures were ultrasound-assisted lipoplasty (UAL). | | | | that suctioned out dislodged cells. In 1978 the |
| The American public spend an estimated $2 billion for | | | | technique was taken to Paris where it was refined |
| these operations. The basic technique involves | | | | and popularised by the French plastic surgeon |
| inserting a narrow tube (cannula) under the skin | | | | Yves-Gerard Illouz. In 1982, Illouz presented a new |
| through tiny incisions and manipulating the cannula to | | | | form of lipolysis using blunt cannulas and high-vacuum |
| break up and suction out fat cells. The procedure | | | | suction with reproducible good results and low |
| injures other local tissue, causing temporary bruising, | | | | morbidity and a new age of liposuction arrived. It was |
| swelling and blood loss. The areas most commonly | | | | the same year that American film actress Princess |
| treated are the outer thighs and abdomen in women | | | | Grace died on a mountain road in Monaco. |
| and the flanks or "love handles" in men. | | | | During the eighties other cannulae were developed |
| Liposuction can also remove unwanted fat from hips, | | | | by Kesselring and Meyer while the father of aesthetic |
| buttocks, knees, upper arms, chin, cheeks, neck and | | | | medicine Pierre Fournier developed another technique |
| other areas. The concept behind liposuction seems | | | | using a syringe. In this period lipo- suction reached the |
| almost too good to be true: However, it isn't an easy | | | | United States but quickly fell out of favour because |
| fix. The American Society of Plastic Surgeons (ASPS) | | | | of increased complications and several deaths. It now |
| warns that liposuction is a serious surgical procedure | | | | appears that many of the deaths related to Plastic |
| that involves a potentially painful recovery and risks | | | | Surgeons com- bining liposuction with abdominoplasty |
| of rare but serious complications. A decision as to | | | | "tummy tucks." In 1985 a Californian Dermatologist, |
| whether to undergo liposuction, according to the | | | | Jeffrey Klein, invented and pioneered a new |
| American Mayo Clinic, should be considered very | | | | tumescent method Technique, the safest method |
| carefully. Nevertheless, liposuction is a popular choice. | | | | known. He was helped in this development by a |
| However, now there may be a new ultrasonic | | | | Colorado dermatologist, Patrick Lillis. In 1987, an Italian |
| method of removing fat from the body that involves | | | | Plastic Surgeon from La Sapienza University in Rome |
| no risk to the patient. This new method called | | | | called Professor Nicolo Scuderi introduced the use of |
| UltraShape ® uses unique G-NIUS(TM) (Guided | | | | ultrasound as an emulsifying modality for fat tissue |
| Non-Invasive Focused Ultrasound Selective) | | | | during liposuction and a new age of 'fat busting' |
| technology to effectively and safely break down fat | | | | began. This technique was further modified when |
| cells. The use of external ultrasound means the | | | | Zocchi introduced titanium ultrasonic probes and |
| patient does not even have to undergo any invasive | | | | manual remodelling of the treated areas to eliminate |
| surgical procedure. The UltraShape procedure has the | | | | the fluid from the burst fat cells in 1992. It was the |
| potential to redefine aesthetic medicine by developing | | | | same year that Democratic Party candidate William J. |
| a non-invasive means for fat removal. | | | | Clinton was swept to power in the US presidential |
| Therapeutic ultrasound (in contrast to diagnostic and | | | | election and the world witnessed three days of |
| imaging modalities) has been used as a therapeutic | | | | rioting in Los Angeles after four white police officers |
| tool in medicine for more than fifty years. The first | | | | were acquitted of criminal charges despite video |
| ultrasonic machine (lithotripter) used to destroy | | | | evidence they had beaten black motorist Rodney |
| kidney stones was produced by the German Aircraft | | | | King. |
| manufacturer Dornier in Munich in 1980. It was the | | | | In 1998, Californian Plastic Surgeon, Barry Silberg |
| same year that the former Beatle, John Lennon, was | | | | elaborated on the technique using external |
| shot dead outside his New York apartment. In 1984, | | | | ultrasound-assisted liposuction (XUAL). This method |
| the company introduced the Dornier HM-3 (Human | | | | required traditional aspirative liposuction after the |
| Model-3) and in that same year the FDA approved | | | | application of high frequency ultrasonic fields delivered |
| the use of ESWL (extracorporeal shock wave | | | | through the skin into a wetted tissue. Silberg felt that |
| lithotripsy) in the United States for the treatment of | | | | this method led to less traumatic surgery with |
| renal calculi. Since that time, the HM-3 or the "Munich | | | | superior clinical outcome. There is little doubt as an |
| Stonebuster" as the press preferred to call it has | | | | invasive modality, like tumescent liposuction, the |
| treated over five million patients worldwide. By 1985, | | | | technique still had many of the drawbacks that |
| the technique was first applied successfully in a | | | | accompany invasive procedures. Moreover, many |
| patient with gallbladder stones. It was the same year | | | | doctors started to voice opinions that the magnitude |
| that the energetic Dubliner, Bob Geldof, had the idea | | | | of ultrasonic energy used to destroy the fat cells |
| of organising Live Aid for the starving people of | | | | may also damage other tissue in contact with the |
| Africa. | | | | cannula. Many felt one of the technical drawbacks of |
| In the following years, many conditions suitable for | | | | the ultrasonic liposuction technique was that the |
| the technique of ESWL were investigated. But the | | | | cannula had to be inside the body. It was at this |
| story of using therapeutic ultrasound in medicine did | | | | stage a Tel Aviv plastic surgeon called Ami Glicksman |
| not really start there. In fact it may have | | | | considered the possibility of using external ultrasonic |
| inadvertently started with another aircraft | | | | waves to selectively break down fat cells without |
| manufacturer because during World War 2, British | | | | the patient having to undergo a surgical procedure. |
| ophthalmic surgeon Harold Ridley, noticed pieces of | | | | In 2001, while the rest of the world was getting to |
| Plexiglas from the shattered canopies of Spitfire | | | | grips with the aftermath of an Al Qaeda terrorist |
| fighter planes did not cause any reaction when they | | | | attack on the World Trade Centre in New York, Dr. |
| became embedded in pilot's eyes. He used this | | | | Glicksman was in Tel Aviv researching the feasibility |
| theory to use the material to implant the world's first | | | | of using external ultrasound to break down fat cells |
| intraocular lens, at St. Thomas Hospital in London on | | | | in pigs. His experiments were successful and he noted |
| Nov. 29, 1949. The next year he encountered | | | | that fat lysis was selective leaving nearby tissues |
| widespread criticism from his peers at a conference | | | | intact. Further macroscopic and microscopic analyses |
| in the United States who considered the idea of | | | | of overlying skin noted that it also remained |
| replacing the eye's natural lens with an artificial one | | | | untouched. The researchers quickly moved from the |
| too radical and unacceptable for the period. | | | | pig models and tried the external ultrasound |
| Over the next twenty years the idea of lens | | | | transducer to lyse human fat from ex vivo tissue |
| implants for cataracts slowly became more | | | | harvested from skin fiaps excised in hospital |
| acceptable. In 1968, American surgeon, Charles | | | | abdominoplasty procedures. These experiments also |
| Kelman adapted the new technology of ESWL to | | | | showed fat lysis only occurred in a specific region, |
| remove cataracts. The procedure, later known as | | | | leaving skin or fat outside of the focused beam |
| phacoemulsification, used a tiny probe with a vibrating | | | | intact. The temperature on the skin and within the |
| tip to gently break up the cataract and wash it away. | | | | focus was monitored and showed an increase of 1oC |
| The techniques of phacoemulsification and plastic lens | | | | for an ultrasound treatment of 1-2 seconds. Further |
| implant technology were combined and the science | | | | human in-vivo trials were commenced in Israel with |
| of cataract surgery was revolutionised. In 1981, a | | | | participants being treated with the ultrasonic device |
| protégé of Ridley called Choyce | | | | prior to abdominoplasty in which the treated area |
| gained the first FDA approval of intraocular lenses. It | | | | was removed and analysed. The first study of |
| was the same year that Irish Republican hunger | | | | twenty patients commenced in 2002 monitoring the |
| striker, Bobby Sands died in the Maze prison. Today, | | | | safety and effectiveness of the treatment. |
| after decades of development, modern | | | | Histological evaluation of all tissues excised during |
| phacoemulsification is considered one of the safest | | | | surgery clearly showed that the external ultrasound |
| surgeries performed with millions of successful | | | | treatment only destroyed adipose cells, leaving blood |
| procedures completed every year around the world. | | | | vessels, connective tissue, nerves, and epidermis |
| Today the use of therapeutic ultrasound in the form | | | | intact. |
| of extracor-poreal shock wave therapy has found its | | | | In 2003, a US-organised coalition invaded Iraq with |
| way into many other facets of medicine with recent | | | | the stated reason that it had not abandoned its |
| advances in machines designed specifically for use on | | | | nuclear and chemical weapons development program |
| arms and legs to treat the chronic localised pain that | | | | according to UN resolutions. In that year also, a large |
| is associated with chronic tendonitis. However, its | | | | multi-centre clinical trial with the external ultrasound |
| main use may yet prove to be the most interesting | | | | device started in five sites in the USA, UK, and |
| as the "Tel Aviv Fat- buster". In fact the association | | | | Japan, in which 137 patients underwent a single |
| of ultrasound with the destruction of fat cells starts | | | | treatment. The results showed that on average a 2 |
| many years before. It may have started as far back | | | | cm reduction in circumference was observed |
| as 1921, when a French surgeon called Dujarrier, | | | | post-treatment. This approximates to about 0.5 litres |
| decided to practice the new art of liposuction in an | | | | and the rest may be removed with a further |
| attempt to create a better shape on a young | | | | procedure performed one month later. The device |
| ballerina's knees. Unfortunately his patient developed | | | | has now obtained CE approval in Europe and more |
| gangrene and required an amputation. It was the | | | | than 500 individuals have been commercially treated |
| same year that the new Irish Free State was | | | | with the device in the Ireland, UK, Spain and |
| established. After this initial fiasco, things remained | | | | Scandinavia, demonstrating the safety and |
| quiet for many years, through the advent of | | | | effectiveness of the treatment. FDA trials are |
| antibiotics, the Second World War and while the | | | | presently underway with all expectations that they |
| Beatles were racing up the charts with "Can't Buy Me | | | | will shortly approve the procedure. |