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A new liposuction technology for adipocyte lipolysis and uniform three-dimensional tissue heating and contraction is presented. The technology is based on bipolar radiofrequency energy applied to the subcutaneous adipose tissue and subdermal skin surface. Preliminary clinical results, thermal monitoring, and histologic biopsies of the treated tissue demonstrate rapid preaspiration liquefaction of adipose tissue, coagulation of subcutaneous blood vessels, and uniform sustained heating of tissue.We live in a culture preoccupied with both weight and body contour. North America also is a society in which obesity is an epidemic. It is no surprise then that liposuction continues to be the most commonly performed aesthetic procedure in the world. In 2007, 450,000 liposuction procedures were performed in the United States alone by board-certified plastic surgeons, and another 150,000 by nonplastic surgeon physicians, for a total 600,000 lipocontouring procedures, accounting for approximately 5% of all elective surgeries in the United States. It is estimated that the number of liposuction procedures will more than double over the next 5 years.Coincident with the dramatic rise in liposuction procedures, the aging ''baby boomer'' population, with decreasing skin tone and advanced laxity, are seeking body contour procedures. A technology that effectively allows the physician to remove and contour adipose tissue with less bruising, swelling, and pain while simultaneously providing for significant soft tissue contraction would enjoy popular appeal.Traditional tumescent, small-cannula, suction-assisted liposuction (SAL) is based on mechanical disruption of adipose tissue by a suction cannula moved manually through the subcutaneous space aspirating small fat clusters of adipose tissue through the openings in the cannula [4,9,11,12,21]. This traditional liposuction procedure of avulsing fat through a mechanically induced negative pressure requires a degree of effort on the part of the physician and can be quite traumatic for the patient.Traditional SAL is less effective in secondary liposuction procedures and in fibrous areas, which do not enjoy significant skin contraction [13,14]. The evolution of smaller vented cannulas, wetting solutions, and syringe aspiration techniques has refined the art of liposuction [5-7, 13, 14, 16-18, 22]. In an attempt to improve the postoperative patient recovery profile of pain, swelling, and bruising, and to enhance skin contraction, physician effort, and effectiveness in secondary and fibrous cases, newer generations of energyassisted liposuction technologies have been developed.The technique of ultrasound-assisted liposuction, in which cavitational ultrasound energy is delivered through a probe to adipose tissue specifically cavitated and liquified, is shown to be less traumatic than SAL and may result in more skin contraction [2,15,20,23,24]. Power-assisted liposuction (PAL) is a commonly used technology that uses a variable-speed motor to provide reciprocating motion to

The use of radiofrequency energy to produce collagen matrix contraction is presented. Controlling the depth of energy delivery, the power applied, the target skin temperature, and the duration of application of energy at various soft tissue levels produces soft tissue contraction, which is measurable. This technology allows precise soft tissue modeling at multiple levels to enhance the result achieved over traditional suction-assisted lipectomy as well as other forms of energy such as ultrasonic and laser-generated lipolysis.

Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings.

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