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The development of suction-assisted lipoplasty (SAL) revolutionized body contouring as it allows the plastic surgeon to reshape the body using small incisions and with minimal morbidity. However, SAL has limitations, especially in certain fibrous areas such as the back and male breast and in secondary liposuction cases. Ultrasound-assisted lipoplasty (UAL) has extended the use of liposuction to these difficult areas. Although UAL offers several advantages compared with conventional liposuction (e.g., treatment of difficult fibrous areas and ease of contouring), it also has drawbacks, including increased equipment costs, risk of thermal injury, and the need for larger incisions. External ultrasound-assisted lipoplasty (E-UAL) is a new, hybrid technology in the field of body contouring. Ultrasonic energy has three possible effects on biologic tissues: micromechanical, thermal, and cavitation. Although the primary means through which E-UAL produces effects is unknown, it is likely to be a combination of all three mechanisms.1

Physical therapists have used pulsed, low-power external ultrasound devices safely for many years to relieve muscular pain and induce local thermal effects. These devices elevate local tissues several degrees centigrade but have had no reported effects on subcutaneous fat deposits. Intrigued by the ability of internal UAL devices to induce cavitation and extend the range of minimally invasive body contouring, Barry Silberg, MD, developed a single transducer system for external UAL. This idea was modified by Steven Hoefflin, MD, for use with two simultaneous transducers.1

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