Excerpt from Liposuction, Techniques: Internal Ultrasound-Assisted

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Michele Zocchi in Italy and Ralph Kloen in the United States are credited with developing and introducing internal ultrasound–assisted liposuction (UAL).^{1, 2} Industrial applications of high-energy ultrasound, as well as medical imaging applications of low-energy ultrasound, have been used for many years.

The use of ultrasound as an ablative tool in surgery has been well established in neurosurgery and general surgery applications. Zocchi's interest in ultrasound was originally for harvesting collagen from aspirated fat. The observations that adipose tissues were effectively emulsified while connective tissue structures were preserved in vitro led to the concept of using ultrasound adjunctively in vivo. This led to clinical use of first-generation devices (eg, SMEI, Casales), which used blunt solid probes 4-6 mm in diameter followed by aspiration with standard cannulas.

The promise of enhanced fat removal with minimal blood loss, claims of improved skin retraction, and safer large-volume procedures resulted in intense interest in UAL. However, enthusiasm was tempered by reports of skin burns, dysesthesias, and high seroma rates. Although considerable debate remains concerning the long-term effects and clinical use of UAL, it has become a well-established tool in the body-contouring armamentarium.

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