Why ultrasound is indispensable in plastic surgery

Breast implants

Ultrasound technology has become integral to modern plastic surgery practice. We use it for noninvasive skin lifting (Ultherapy), screening silicone breast implants for silent rupture, and placement of TAP blocks to dramatically reduce discomfort after tummy tucks. Ultrasound is used to analyze problems with dermal fillers, measure skin thickness for evaluation of rejuvenation techniques, and enhance absorption of cosmeceutical products. It has been 10 years since my first post about ultrasound so it’s time for an update.

What ultrasound is and why it’s so useful

Ultrasound is simply acoustic waves at a frequency above the range of what the human ear hears. What makes ultrasound so versatile is the fact that it can be gentle enough to visualize a baby in utero or powerful enough to destroy fat cells. Ultrasound has been a special interest of mine since I became involved as an advisor many years ago to a startup company called Liposonix, which was developing a focused ultrasound system for localized fat reduction. Although the technology performed well and received FDA approval, it is unfortunately no longer available. I did learn a lot about ultrasound though, and the more I learned the more I came to see its potential.

One development I adopted early was the use of portable ultrasound scanner that runs on an app on a tablet computer. It was like going from a desktop PC to a smart phone! I started using it to place a type of nerve block called a TAP block on tummy tuck patients, using a long-acting local anesthetic called Exparel. Pain scores and recovery were dramatically improved.

Ultrasound for screening silicone breast implants

I was also among the first to use ultrasound imaging to screen silicone breast implants for silent rupture, which had previously required an expensive and inconvenient MRI exam. I developed a sizeable database of images to learn from, and now offer routine post-op screening for all of our silicone gel breast implant patients as a courtesy. This has since become routine in practices around the world.

Therapeutic uses of ultrasound employ higher intensity than for imaging. Another important factor is whether the acoustic waves are focused. Unfocused ultrasound for example is used for physical therapy to warm tissues and speed healing. Ultrasound energy can also be focused just like light through a lens, and can produce an intense effect at the focal point. This is called High-Intensity Focused Ultrasound or HIFU. Liposonix used HIFU to destroy fat cells with precision, but now the primary use of is Ultherapy. With this tried-and-true technology, the focal depth is just under the skin. (There are HIFU devices available for use in spas or at home, but be aware that these are much lower power.)

A note on ultrasound for breast implant capsular contracture: There is good theoretical reason to treat breast implant capsular contracture with ultrasound (nonfocused), but evidence for its effectiveness is lacking. Despite the fact that it has been in use for several years, it was only recently that a proper clinical trial was undertaken. Results of the trial have not been reported, which would certainly not be the case if it worked. This is one application of ultrasound that hasn’t panned out.