How therapeutic ultrasound was used to remove fat

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Because instant fat reduction has wide appeal, liposuction has become the most common cosmetic procedure performed worldwide. According to the American Society of Plastic Surgeons (ASPS), the number of liposuction procedures performed increased by 386 percent between 1992 and 2000. More than 450,000 liposuction procedures were performed in 2005. Interestingly, 21% of these procedures were ultrasound assisted lipoplasty (UAL). The American public spends approximately $2 billion for these operations. The basic technique involves inserting a narrow tube (cannula) under the skin through small incisions and manipulating the cannula to break and suction out the fat cells. The procedure injures 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 tires” in men.

Liposuction can also remove unwanted fat from the hips, buttocks, knees, upper arms, chin, cheeks, neck, and other areas. The concept behind liposuction seems almost too good to be true: however, it is not an easy solution. The American Society of Plastic Surgeons (ASPS) advises 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 carry any risk to the patient. This new method called UltraShape ® uses the exclusive G-NIUS(TM) (Guided Non-Invasive Focused Ultrasound Selective) 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 procedures. The UltraShape procedure has the potential to redefine aesthetic medicine by developing a non-invasive means of fat removal.

Therapeutic ultrasound (in contrast to diagnostic and imaging modalities) has been used as a therapeutic tool in medicine for over fifty years. The first ultrasonic machine (lithotripter) used to destroy kidney stones was made by the German aircraft manufacturer Dornier in Munich in 1980. It was the same year that former Beatle John Lennon was shot dead outside his New York apartment. . In 1984, the company introduced the Dornier HM-3 (Human Model-3) and in the same year the FDA approved ESWL (extracorporeal shock wave lithotripsy) for use 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 successfully applied for the first time in a patient with gallbladder stones. It was the same year that energetic Dubliner Bob Geldof had the idea to organize Live Aid for the starving people of Africa.

In the following years, many conditions suitable for the ESWL 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 World War II, British eye surgeon Harold Ridley noticed that plexiglass pieces from the broken canopies of Spitfire fighter planes caused no reaction when embedded in the aircraft. pilot’s eyes. He used this theory to use the material to implant the world’s first intraocular lens, at St. Thomas’ Hospital in London on November 29, 1949. The following year, he faced widespread criticism from his colleagues at a conference in the United States. , who considered that the idea of ​​replacing the natural lens of the eye with an artificial one was too radical and unacceptable for the time.

Over the next twenty years, the idea of ​​cataract lens implants gradually became more acceptable. In 1968, American surgeon Charles Kelman adapted the new ESWL technology to remove cataracts. The procedure, later known as phacoemulsification, used a tiny probe with a vibrating tip to gently break up the cataract and wash it out. Phacoemulsification techniques and plastic lens implant technology were combined and revolutionized the science of cataract surgery. In 1981, a Ridley protégé named Choyce obtained the first FDA approval for intraocular lenses. It was the same year that hunger-striking Irish republican 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 on the arms and legs to treat localized chronic pain associated with chronic tendinitis. However, its main use may still turn out to be 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 in 1921, when a French surgeon named Dujarrier decided to practice the new art of liposuction in an attempt to create a better shape on a young ballerina’s knees. Unfortunately, his patient developed gangrene and required amputation. It was the same year that the new Irish Free State was established. After this initial fiasco, things remained quiet for many years, with the advent of antibiotics, World War II, and as the Beatles climbed the charts with “Can’t Buy Me Love,” a Cologne surgeon named Josef Schrudde decided to try the technique again on someone’s ankles.

The second attempt was much more successful and fortunately 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 electric scalpel encapsulated by a cannula that suctioned out detached cells. In 1978 the technique was brought to Paris where it was refined and popularized by the French plastic surgeon Yves-Gerard Illouz. In 1982, Illouz presented 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 the American film actress Princess Grace died on a mountain road in Monaco.

During the eighties, Kesselring and Meyer developed other cannulas, while the father of aesthetic medicine, Pierre Fournier, developed another technique using a syringe. In this period, liposuction made its way to the United States, but quickly fell out of favor due to increasing complications and several deaths. It now appears that many of the deaths are linked to plastic surgeons combining liposuction with a tummy tuck “tummy tuck.” 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 from La Sapienza University in Rome named Professor Nicolo Scuderi introduced the use of ultrasound as an emulsifying modality for adipose tissue during liposuction and began a new era of ‘fat removal’. This technique was further modified when Zocchi introduced ultrasonic titanium probes and manual reshaping of treated areas to remove fluid from burst fat cells in 1992. It was the same year that Democratic Party nominee William J. Clinton, came to power in the US The presidential election and the world witnessed three days of unrest in Los Angeles after four white police officers were cleared of criminal charges despite video evidence that they had beaten the black motorist Rodney King.

In 1998, California plastic surgeon Barry Silberg developed the technique using ultrasound-assisted external liposuction (XUAL). This method required traditional suction liposuction after the application of high-frequency ultrasonic fields through the skin into moistened tissue. Silberg felt that this method led to less traumatic surgery with a superior clinical outcome. There is no question that as an invasive modality, such as tumescent liposuction, the technique still had many of the drawbacks that accompany invasive procedures. In addition, many physicians began to believe that the magnitude of the ultrasonic energy used to destroy fat cells could also damage other tissue 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 fallout from 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 the lysis of fat was selective and left nearby tissues intact. Further macroscopic and microscopic analysis of the overlying skin found that it also remained intact. The researchers quickly moved from porcine models and tested the external ultrasound transducer to lyse human fat from ex vivo tissue removed from strips of skin excised in hospital abdominoplasty procedures. These experiments also showed that fat lysis only occurred in a specific region, leaving intact skin or fat outside of the focused beam. The temperature on the skin and within the focus was monitored and showed an increase of 1oC for a 1-2 second ultrasound treatment. Further human in vivo trials were initiated in Israel with participants treated with the ultrasonic device prior to the abdominoplasty in which the treated area was removed and analysed. 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 initiated 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 approximates to around 0.5 liters and the remainder can be removed with an additional procedure performed a month later. The device has now gained CE approval in Europe and more than 500 people have been commercially treated with the device in Ireland, the UK, Spain and Scandinavia, demonstrating the safety and efficacy of the treatment. FDA trials are currently underway with all expectations that they will soon approve the procedure.

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