Lipoplasty: External Ultrasound-Assisted Lipoplasty (E-UAL)

The use of ultrasound-assisted lipoplasty (UAL) as an adjunct to conventional liposuction has led to the development of a new hybrid contender in the field of body contouring -- external UAL (E-UAL). Heralded by proponents as a less invasive technique than either conventional liposuction or UAL, E-UAL uses external ultrasound waves that may alter fat cells within the body. However, this technique is still in the early stages of scientific evaluation. There is not yet a complete scientific understanding of how E-UAL works or whether it will produce satisfactory long-term outcomes.

For many years, physical therapists have been using pulsed, low-power external ultrasound devices to relieve muscular pain. These devices elevate local tissues several degrees Centigrade but have had no reported effects on fat deposits beneath the skin. While the standard external ultrasound device used for physical therapy produces 1 to 1.5 watts per square centimeter, this ultrasound system delivers about 3 watts per square centimeter.

The area to be treated with E-UAL is first infiltrated with fluid containing local anesthetic to transmit the ultrasonic energy and allow for patient comfort. The transducer is placed on the surface of the skin over the area to be treated and kept in constant motion for 5 minutes. After completion of E-UAL, a small cannula is placed beneath the skin and traditional liposuction is used to remove the fluid and any fat that may have been liquefied.

With E-UAL, the surgeon must be careful not to apply the ultrasonic energy to one area for too long. Additionally, the effectiveness of the procedure may depend on whether the surgeon can predictably deliver a known quantity of energy to a targeted area, and this has not yet been adequately demonstrated. Finally, the internal effects of external ultrasound energy require further basic scientific study.


The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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