Comparative evaluation of traditional, ultrasonic, and pneumatic assisted lipoplasty: Analysis of local and systemic effects, efficacy, and costs of these methods

Recently ultrasound assisted liposuction (UAL) and pneumatic assisted lipos uction (PAL) have been introduced as an attempt to improve the results and reduce the pitfalls of standard liposuction (SAL). Until now no studies com paring, at the same time, UAL, PAL, and SAL have been published. The aim of this study was to analyze these methods from the surgeon's point of view, focusing not only on aesthetic results but also on local and systemic traum a, efficacy, handling, and cost. Forty-five cosmetic patients affected by l ocal lipodystrophy, divided into three equal groups, have undergone liposuc tion with the three above-mentioned techniques. Quantitative and qualitativ e analysis of lipoaspirates, together with blood chemistry, local and syste mic complications, time to aspirate 100 cm(3), distress, fatigue, and costs of the procedures, has been recorded. Our results showed bloodier lipoaspi rates in SAL and a higher percentage of triglycerides in UAL lipoaspirates. Blood tests revealed a slight decrease in the postoperative Hb in SAL only . Early complications observed were four erythemas in PAL, three ecchymoses in SAL, and one long-lasting edema in UAL. Aesthetic results rated by inde pendent viewers were similar for all methods. Efficacy was higher in the PA L group (4 min x 100 cm(3) fat aspirated) than in SAL (7 min x 100 cm(3) fa t) and UAL (10 min x 100 cm3 fat). Surgeon's distress was higher in PAL tha n in SAL and UAL. Surgeon's fatigue was much lower in the PAL group than in the others. Costs expressed as multiples of 1 unit (1 unit = $500 U.S.) we re highest for UAL, low for PAL, and lowest for SAL. In conclusion, PAL and UAL caused reduced vascular injury, UAL being more selective for adipocyte removal. Complications of UAL and PRL were mostly related to the longer le arning curve of these methods. The UAL procedure was much more expensive th an PAL and, especially, SAL. PAL proved to be a handytechnique, with the mo st favorable cost/benefit ratio, and seems to be the best option for busy l iposuction practices or fast office procedures, even though the choice of t he ideal technique always depends on the surgeon's preference.