Superficial subdermal liposuction (SSL) was presented by the authors as an
evolution in traditional liposuction in 1989, It allows one to treat the su
perficial fat to obtain better skin retraction during every liposuction pro
cedure. The use of ultrasound (US) in liposuction began 10 years ago as the
direct application of this energy to the adipose tissue using a probe to o
btain the selective destruction of fat, followed by its aspiration. This te
chnique gave rise to many complications and thus many concerns. The externa
l delivery of US has been proposed to overcome some of the drawbacks associ
ated with this procedure. The authors investigate the role of external ultr
asound (EU) used in conjunction with SSL. When comparing EU and SSL with SS
L alone, pretreatment with EU results in less bleeding during liposuction,
aspirated fat that is clearer and more oily, and less bruising and swelling
during the early postoperative period. EU is an ideal complementary proced
ure to SSL because the crumbling of the fat induced by US permits a more un
iform aspiration of the subdermal fat layer, making skin retraction more ev
en and effective.