Doctor of Medicine

If I get a penny for every relative who asks me about cosmetic, non-surgical ways to get a smaller waistline, I will probably be $10 richer. Okay, that’s not much, but you get the picture: Everyone wants to know about non-invasive alternatives to liposuction, such as ultrasonic lipo-cavitation and external cryogenic treatment of fat.

Do they really work? After several sessions, will you see results that even your friends will notice? Or will availing of such treatments be a waste of money?

Liposuction Alternatives: Why People Want Them

I have a confession to make: My quest for evidence to support the effectiveness (and cost-effectiveness) of “non-invasive liposuction” is partly personal.

I used to be really skinny. I used to weigh 95 pounds – and my friends usually think I’m “lucky” while my parents usually think they’re not feeding me enough. I never gave it much thought; weight was never an issue to me because it posed no personal problem.

But things changed over time. Although I still seem lanky, I’m much heavier now. I love my weight now – I’m no longer “underweight”, hurray! – but it comes at a price: I can no longer wear the clothes in my closet.

Considering I’m of a very healthy weight that’s within the normal range, I can just imagine how difficult it must be for overweight and obese people. When I started working in clinics, not a week passed without at least one patient asking me about how to get rid of abdominal fat.

It was time to look for evidence (or the lack thereof).

Alternatives to Liposuction: The Evidence

One rather popular alternative to liposuction involves ultrasound waves. It has many names: cavitation liposuction, lipo-cavitation, and ultrasonic liposuction, to name just a few.

According to the illustration below, lipo-cavitation involves the delivery of ultrasonic waves that “separate” fat cells for removal. (Medical literature indicates that ultrasonic waves in effective cavitation treatments lead to “bursting” of fat cells.) infographic


The above procedure is not necessarily the same as hydrolipoclasy because of one important reason: hydrolipoclasy involves the introduction of a unique solution that causes cells to burst. (In plain lipo-cavitation, no such invasive technique is required.)

Another treatment that involves ultrasound waves is external ultrasound-assisted liposuction (external UAL). In this procedure, hydrolipoclasy is followed by actual invasive liposuction, thus its name.

In external UAL, 3-Watt ultrasound waves at a 3-MHz frequency are enough to destroy fat cells and collagenous networks, according to a study on the histologic effects of ultrasound lipectomy. However, machines that do not offer the same strength or frequency of ultrasound waves will not promise the same results.

Ultrasonic Cavitation: The Verdict

Unfortunately, not enough evidence is present to support the effectiveness of ultrasonic treatment without the introduction of a fluid into the target fat layer. I have yet to find peer-reviewed studies pointing to its effectiveness.

Although I can’t declare that ultrasonic cavitation doesn’t work, I can say with confidence that the evidence that exists is just not adequate. More studies, specifically peer-reviewed ones, need to be published before plain ultrasonic treatment alone (even that with adequate ultrasound frequency) can be deemed just as effective as its counterparts, namely hydrolipoclasy and external UAL.

Dr. Stef dela Cruz writes about cancer, weight loss, and other health issues. She uses both stethoscope and pen to help patients achieve optimum health. Follow her on Facebook or Twitter; she is perennially online.



Stef dela Cruz is a doctor-columnist who received the Dean Bacala Academic Excellence Award from the University of Santo Tomas and the Health Media Award from the Department of Health. She is the human of three cats and a dog. Stalk her on Facebook, Instagram, and Twitter – she won’t sue.

129 Responses to Effectiveness of Ultrasound Cavitation: Evidence-Based Approach

  1. I have been looking into this, and I am finding the same thing, no real proof, not even real people on youtube making much comments about it.

    What keeps going though my mind is this, If it obliterates these fat cells and even the video i seen of one that was pulverizing a piece of tin in the water, how can the real machine that and be release to the general public. people would be destroying their bodies because people do not have self control. They would not just use is 3 times a week for a few weeks and then 1 time a week after that for only 10 sessions. they would try to use it every day 3 times a day because they want to look pretty. There is no way you can expose your body to that (if it really works) and not have a negative impact.

    I find it hard to believe these machines could have any real success as they claim because they would have people overusing them and ruining their bodies. My guess is they can sell them to the private individual because they don’t do anything. For god’s sake you could not even by nexium (an antacid) over the counter into 1 year or so ago and its be on the market for at least 10 years or so. I just find it hard to believe a product that basically cause cells in your body to implode would be allowed to be basically sold to any one as they are now. Unless the product really does not do as claimed.

    I can go online right now and order a professional one like used in a spa for about $1000, no questions asked, shipped to my door, no wavers to sign, nothing. A device that can really obliterate tissue in the body would not be so easily purchased. Its that simple.

    There is a saying that I REALLY REALLY HATE, but it seems to be true ‘If its sounds to good to be true, then it probably is’. If anyone is considering buying one of these machines, just think about what I am saying and logically work it out for yourself. I was considering it. but I an now leaning toward not.

    And if my comment offends anyone that wants to defend the product, go on youtube and make a real video showing your before and afters. I don’t want to see a video of some doctor or some spa or from someone that makes money from the product. I want to see real reviews by real people with real before and after. If you look up gopro on youtube, if you look up, gastric sleeve on youtube. if you look up pretty much any product out there you will find people that have used and and will tell there good and bad. the fact that all I am finding is videos made only be people that befit from the sale of this product puts me off. Make a real review on youtube if you think its great, with before and after, show me your a real person, other wise your comment here of how great you think it is, has no value to me. You could realy just be someone on a marketing team somewhere.

    on November 7, 2014 at 4:18 am idontbelieveit
  2. I just thought I would add to this thread from my experiences as a Naturopath with these machines. I have been using this equipment in my clinic for over 4 years now. Some people don’t get much result but many people do. ..even without dietary changes. I lady lost a lot of cms even though she ate chocolate and drank alcohol (against my advice). The extra water is to flush the body faster and the exercise is to move the lymphatic system as the lymph valves are in the muscles. I have seen on average 1-5 cms lost per session and in some cases 8 or 9 in one measurement within the hour. Sometimes they have increased cms straight after a session, probably due to fat leakage causing swelling in the area until it is moved. There are a few people that seem to have very little result. These people are very bloated so I suspect food allergies or a need to detox. Hormonal cycles also play a role in the results as does medication I find. Everybody is unique and individual with their own metabolic rate. Of course a good diet is suggested to prevent further weight gain. Some people will swear they are careful with their food intake and choices, yet they really don’t monitor. It is an individual experience and can get awesome results …..or very little which is when I detox the person as well. Sometimes I include essential oils into the treatments to add to their water to help move the fat along as well to help with these issues,. I also use RF to tighten and tone as well as Biomesosculpture which helps clean the extracellular matrix (where the fat leaks to). drain the lymphatic system and to contour the body.I hope this helps some of you with questions, doubts or skepticism.

    on April 27, 2015 at 8:07 am Judy
  3. Thank you Dr Stef. I almost wasted my money.

    on August 3, 2015 at 7:41 am Amy
  4. The effects of nonfocused external ultrasound on tissue temperature and adipocyte morphology.
    Garcia O Jr1, Schafer M.
    Author information
    Nonfocused externally applied ultrasound energy has been used extensively in the clinical setting for noninvasive body contouring on the premise that ultrasonic diathermy may have a reducing effect on adipose tissue.
    The authors document both the time/temperature relationships and cellular changes following nonfocused and weakly focused ultrasound treatments in an animal model.
    Nonfocused ultrasound treatments were administered to 3 Yorkshire pigs, at clinically recommended settings, for two 12-minute intervals. Tissue temperatures were recorded. Lymph fluid samples were taken pretreatment from the control side and posttreatment from the treated side. Biopsies were taken of the skin, adipose tissue, muscle, and lymph nodes on both the control side (pretreatment) and the ultrasound-treated side (posttreatment) for histological examination.
    Lymph fluid analysis revealed highly elevated triglyceride values on the treated side versus the control. Analysis of lymph node biopsies revealed free vacuoles of fat within the lymph node tissue on the treated side compared with normal controls. In situ temperature measurements indicated that the device produced uniform heating throughout the adipose tissue layer. Electron microscopy of the treated adipose tissue revealed alterations in the cellular architecture without necrosis and free lipids within the extracellular space.
    On the basis of the increase of free lipids in the lymph system posttreatment, the increase in free lipids within the lymph nodes on the treated side, and the free lipids in the extracellular space without cell necrosis, we conclude that treatment with this device reduces adipose tissue by altering the permeability of the adipocytes.
    PMID: 23220874 [PubMed – indexed for MEDLINE]

    Somebody wanted medical articles re Lipo Cavitation and was told no one had done any?? These are just two I have found there are more?

    on August 3, 2015 at 1:06 pm Dottydonut
  5. Biological effects of low frequency high intensity ultrasound application on ex vivo human adipose tissue.
    Palumbo P1, Cinque B, Miconi G, La Torre C, Zoccali G, Vrentzos N, Vitale AR, Leocata P, Lombardi D, Lorenzo C, D’Angelo B, Macchiarelli G, Cimini A, Cifone MG, Giuliani M.
    Author information
    In the present work the effects of a new low frequency, high intensity ultrasound technology on human adipose tissue ex vivo were studied. In particular, we investigated the effects of both external and surgical ultrasound-irradiation (10 min) by evaluating, other than sample weight loss and fat release, also histological architecture alteration as well apoptosis induction. The influence of saline buffer tissue-infiltration on the effects of ultrasound irradiation was also examined. The results suggest that, in our experimental conditions, both transcutaneous and surgical ultrasound exposure caused a significant weight loss and fat release. This effect was more relevant when the ultrasound intensity was set at 100 % (~2.5 W/cm², for external device; ~19-21 W/cm2, for surgical device) compared to 70 % (~1.8 W/cm² for external device; ~13-14 W/cm2 for surgical device). Of note, the effectiveness of ultrasound was much higher when the tissue samples were previously infiltrated with saline buffer, in accordance with the knowledge that ultrasonic waves in aqueous solution better propagate with a consequently more efficient cavitation process. Moreover, the overall effects of ultrasound irradiation did not appear immediately after treatment but persisted over time, being significantly more relevant at 18 h from the end of ultrasound irradiation. Evaluation of histological characteristics of ultrasound-irradiated samples showed a clear alteration of adipose tissue architecture as well a prominent destruction of collagen fibers which were dependent on ultrasound intensity and most relevant in saline buffer-infiltrated samples. The structural changes of collagen bundles present between the lobules of fat cells were confirmed through scanning electron microscopy (SEM) which clearly demonstrated how ultrasound exposure induced a drastic reduction in the compactness of the adipose connective tissue and an irregular arrangement of the fibers with a consequent alteration in the spatial architecture. The analysis of the composition of lipids in the fat released from adipose tissue after ultrasound treatment with surgical device showed, in agreement with the level of adipocyte damage, a significant increase mainly of triglycerides and cholesterol. Finally, ultrasound exposure had been shown to induce apoptosis as shown by the appearance DNA fragmentation. Accordingly, ultrasound treatment led to down-modulation of procaspase-9 expression and an increased level of caspase-3 active form.
    PMID: 21658315 [PubMed – indexed for MEDLINE]
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    on August 3, 2015 at 1:07 pm Dottydonut
  6. Pingback: Ultrasonic Cavitation Newsopeningday | openingday

  7. So it says in this article that there is NOT ‘enough evidence’ which means that there are people who will not see results and people who will.Been reading everyone’s comments and I see mixed reviews on the effectiveness of ultrasonic cavitation.
    I don’t like these studies being in medical science and a nurse myself I say this. Reason being there are too many factors. It is like surgery– for instance if someone has issues with their kidneys — it all depends which stage they are in to see if they will need a transplant or they will even survive. Same goes for weight loss. Too many factors are involved such as gender, thyroid issues, hormonal issues, amount of fat and their weight loss history, including the medications they are taking. It could be that certain antidepressants or medications are causing weight loss or weight gain or making you keep water weight. You cannot just take any group of people and start performing studies. Sometimes people do work out and eat right and hit a plateau and still need to take certain meds or workout even more–there is a theory that sometimes when we eat very little our body goes into starvation mode and holds onto the weight we have –so maybe that can be another reason people are not losing weight. If this treatment is HELPING you along diet and exercise do it! Because you will see countless studies on people losing weight with diet or just protein and low carb and countless studies that without exercise you wont get a definite shape. Do what works for you but try to eat healthy because no matter what you do you want to keep your arteries clean and healthier food in general helps our organs and body function better in the long run.

    on February 25, 2018 at 11:13 pm sara
  8. Your place is valuable for me. Thanks!

    on April 29, 2018 at 8:00 pm Bauchmuskeltrainer

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