External Ultrasound-Assisted Liposuction of the Abdomen: A Report of our Experience

Introduction: Ultrasound-assisted liposuction (UAL) is currently an accepted and commonly used method, although the incidence of complications is noteworthy. In 1997, Silberg introduced the concept of external ultrasound-assisted liposuction (XUAL) to facilitate the standard technique with an expected decreased incidence of complications when compared with UAL. This article reports our experience with XUAL of the abdomen at a single cosmetic surgery center over a 1-year period. Methods: Two groups of 15 patients each underwent abdominal liposuction. Group 1 received the tumescent technique, and Group 2 received external ultrasound treatment, again using the tumescent technique. Ultrasonic energy was applied to the entire abdominal area in a standard fashion using the Intellect Legend Combo 2-C ultrasound unit set to 1.5 watts/cm2 continuous pulse for 10 minutes immediately following infusion of the tumescent solution. Patients were evaluated postoperatively for adverse events. Adverse events were defined as excessive edema, ecchymosis, seroma greater than 50 cc, hematoma, infection, and wound breakdown. Results: No cases of adverse events occurred in any patient in the immediate postoperative period. However, at the first postoperative appointment, it was notable that 2 of 15 patients in group 1 (13%) had developed a significant (>50 cc) lower abdominal seroma. Both patients were successfully treated with a single closed drainage procedure in the office via needle aspiration. In group 2 at the first postoperative visit, it was notable that 5 of the 15 patients (33%) presented with a significant (>50 cc) lower abdominal seroma. All patients in group 2 were successfully treated with drainage of the fluid via needle aspiration or by opening the midline lower port and placing a passive drain (in several cases). An average of 2.5 drainage procedures was required for resolution of the seromas in group 2. Discussion: The incidence of seroma formation was clearly linked to higher body mass index (BMI) and total fat volume removed. Consistent variables included tumescent volume infused, amount of ultrasound energy delivered, and cannula size used during the tumescent infusion and aspiration procedure. In most patients, the flanks and low back were also sculpted with the liposuction technique; however, the abdomen was the only area treated preoperatively with ultrasound. It is notable that the only area to develop a seroma was the abdomen, which suggests that the ul