Body
4D Liposuction (Hi-Definition Lipo)
ADR-C Breast Enhancement (Breast Fat Grafting)
ADR-C Buttock Enhancement (Buttock Fat Grafting)
Armpit Fat Lipo & Accessory Breast Removal
Corrective Liposuction (Lipo Revision)
Gynecomastia Surgery
Laserlipolysis (Laser Liposuction)
Lipoma Removal
Male Nipple Reduction Surgery
Modern Liposuction with MDC-Sculpt®️ Lipo technique
Profhilo® Body Skin Tightening
Pseudogynecomastia Surgery
Scar & Body Disfigurement Treatment
Scar Revision Surgery
Ultrasonic-Assisted Liposuction (UAL)

Ultrasonic-Assisted Liposuction (UAL)

If you want to remove stubborn fat deposits that refuse to budge, surgical body contouring in the form of Ultrasonic-Assisted Liposuction (UAL) can help you to achieve a more contoured body.

Established in 2004, Dr Ivan Puah, Medical Director of Amaris B. Clinic, has been performing various forms of liposuction, including Laserlipolysis (Laser Liposuction), Modern Liposuction with MDC-Sculpt®️ Lipo technique, Ultrasonic-Assisted Liposuction (UAL), VASER Liposuction and 4D Liposuction (Hi-Definition Lipo) for those who would like to trim down unwanted fat, correct disproportionate body shape and achieving a toned, well-balanced and defined physique.

VASER (an acronym for Vibration Amplification of Sound Energy at Resonance) liposuction - a liposuction technique with the assistance of ultrasound waves to break up and liquefy fat cells, making them easier for extraction.

WHAT IS ULTRASONIC ASSISTED LIPOSUCTION (UAL) & WHAT DOES IT DO?

Ultrasonic-Assisted Liposuction (UAL) is a liposuction technique that utilises ultrasonic energy to break down giant fat cells in the deep fat deposits, while preserving normal size fat cells in the superficial subdermal fat layer, producing a smoother body contouring result. UAL delivers ultrasonic energy internally and directly to the fat deposits via a probe, liquefying the unwanted fat into a “buttery” consistency. This allows the liposuction doctor to suction the fat out easily while leaving the important connective tissues relatively undisturbed.

VASER ^{[1,2,3,4,5,6,7]} (Vibration Amplification of Sound Energy at Resonance) Liposuction, developed by two plastic surgeons, Dr John Millard and Dr Alfredo Hoyos, has become another method of liposuction that utilises the assistance of ultrasound waves.

Dr Ivan Puah has been performing this form of liposuction technique for over 15 years in Singapore.

HOW Ultrasonic-assisted liposuction (UAL) WORKS

Dr Ivan Puah carries out UAL and all other forms of liposuction, such as Laserlipolysis (Laser Liposuction), *VASER Liposuction, Modern Liposuction with MDC-Sculpt®️ Lipo Technique and 4D Liposuction (Hi-Definition Lipo) for his patients in an accredited Day Surgery Center. Local anaesthesia with twilight sedation (not GA) will be administered during the procedure, meaning the patient has a shorter recovery period and lower post-operative discomfort.

Small incisions less than 4mm long are made strategically on the skin, followed by infiltration of anaesthetic solution into the areas to be treated. Afterwards, the doctor will insert the ultrasonic probe into the deep adipose tissue, moving it uniformly all over the fat tissues to emulsify the fat.

The probe is removed once the fat-melting process is achieved. Finally, using surgical cannulas of varied sizes, Dr Puah will debulk fat and carry out body sculpting for the patient.

IS Ultrasonic-assisted liposuction (UAL) SIMILAR TO TRADITIONAL LIPOSUCTION?

The objectives of UAL and traditional liposuction are the same: to remove unwanted fat and achieve a more contoured body. One major advantage of UAL [8,9,10] over traditional liposuction is that it is a gentler fat removal technique as fat is liquefied before it is removed, reducing the tugging, tearing and pulling that occurs with traditional liposuction.

UAL utilises ultrasound waves to selectively destruct fat cells by means of emulsification and enhances skin tightening which is not achievable by traditional liposuction. The degree of skin firming following UAL will depend on the patient's age and skin quality.

Compared to traditional liposuction, the recovery time from UAL is faster, and the patient can return to the daily routine within 2 to 3 days. Recovery from traditional liposuction may take 10 to 14 days and requires at least 24 hours of inpatient care (hospitalisation) post-op.

CAN Ultrasonic-assisted liposuction (UAL) REMOVE FAT FROM ALL PARTS OF THE BODY?

Yes. UAL can remove stubborn subcutaneous fat from almost any body part, such as the abdomen, back, waist, thighs, hips, male chest, buttocks, arms, armpits, neck, knees and calves.

The liquefied fat that has been removed can be further repurposed to parts of the face or body that requires enhancement. See ADR-C Breast Enhancement (Breast Fat Grafting), ADR-C Buttock Enhancement (Buttock Fat Grafting), ADR-C Facial Fat Grafting.

AM I A SUITABLE CANDIDATE FOR Ultrasonic-assisted liposuction (UAL)?

This procedure is suitable for men and women. Generally, you are a good candidate for UAL if you are in good health, with localised area of fat that does not respond well to diet and exercise and would like to correct disproportionate body shape.

IS Ultrasonic-assisted liposuction (UAL) FOR WEIGHT LOSS?

No. Ultrasonic-Assisted Liposuction and other liposuction techniques such as traditional liposuction, Laserlipolysis (Laser Liposuction) or *VASER Liposuction are meant to remove fat and contour specific body parts, not a weight loss tool or solution for obesity.

If your objective is to lose weight, you can consider our weight management programme.

Ultrasonic-assisted liposuction (UAL) versus fat freezing

Fat Freezing or cryolipolysis is a non-surgical fat reduction treatment whereby fat cells are destroyed by a controlled thermal reduction, which is then metabolised by the body via the liver.

On the other hand, Ultrasonic-Assisted Liposuction (UAL) utilises ultrasonic energy (delivered internally) to emulsify unwanted fat cells into liquefied form, which is then removed via suction.

Ultrasonic-Assisted Liposuction (UAL)

Fat Freezing

Type

Surgical fat loss and body contouring

Non-surgical fat reduction

Procedure

Involves local anaesthesia, infiltration of anaesthetic fluid via incision sites made on targeted areas followed by emulsifying of fat cells via a ultrasound probe (delivering ultrasonic energy internally) and subsequent removal of liquefied fat via suction

Involves vacuuming the targeted areas externally with a handheld device and applying subzero temperatures to freeze the fat. Your body will then metabolise the frozen fat cells and expel them naturally

Fat reduction claims

Remove over 90% of localised fat in one session, with body contouring

Reduce 20 to 25% of localised over multiple sessions, without body contouring

Skin Tightening

Has the capability to stimulate collagen production and tighten the skin

Not applicable

Results

Yields immediate visible results, but full results will show between 3 or 6 and 12 months when the post-procedural swelling subsides

It can take between 3 to 6 months or more to achieve subtle results if the patient responds to the treatment. For some, there may be no result at all

Areas

Treat all body parts with excess fat pockets and face successfully while contouring the body shape smoothly

Treat abdomen, waist, thighs, and arms but areas are limited by the size of the applicator head

WHO SHOULD NOT HAVE ULTRASONIC ASSISTED (UAL) LIPOSUCTION?

In general, the following group of patients will not be suitable for any form of liposuction, such as traditional liposuction, Laserlipolysis (Laser Liposuction), tumescent liposuction, VASER* Liposuction and UAL:
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• Pregnant women

• Patients with pre-existing medical conditions will be assessed during the consultation to ascertain their suitability for the procedure.

At Amaris B. Clinic, your health and safety are our priority. During the initial consultation, Dr Ivan Puah will assess your health status, including medical history, physical examination and a psychological evaluation.

Patients who present with serious underlying medical issues and who are psychologically unstable will not be suitable for the procedure.

IS Ultrasonic-assisted liposuction (UAL) SAFE?

Your safety is always our utmost priority. We carry out various liposuction techniques, such as UAL, *VASER Liposuction, Laserlipolysis (Laser Liposuction), 4D Liposuction (Hi-Definition Lipo) and Modern Liposuction with MDC-Sculpt®️ Lipo Technique in an accredited Day Surgery facility.

Our anesthesiologist is always present in the operating theatre during the surgery to monitor your vital stats and administer twilight sedation, ensuring you are comfortable and safe throughout the process.

How long will the treatment take?

Depending on the number of areas to be treated, Ultrasonic-Assisted Liposuction (UAL) may take between 1.5 and 3 hours.

HOW MUCH FAT CAN BE TAKEN IN ONE PROCEDURE?

Liposuction is a strictly regulated procedure in Singapore. According to MOH, a maximum cap is set on the total amount of fat that can be aspirated in one session. Based on your clinical condition, our doctor will advise you accordingly.

Ultrasonic-assisted liposuction (UAL) FOR PSEUDOGYNECOMASTIA

Pseudogynecomastia, like gynecomastia, is a real issue for men. This condition is caused by fat deposits on the male chest without glandular tissue proliferation. In pseudogynecomastia, the first line of treatment recommendation is weight management and exercise.

If the chest fat fails to reduce, the next recommended treatment will be through surgical means such as UAL, *VASER Liposuction, or Modern Liposuction with MDC-Sculpt®️ Lipo Technique.
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Ultrasonic-assisted liposuction (UAL) FOR OUTER THIGHS (SADDLEBAGS) & INNER THIGHS

The outer and inner thighs are areas where stubborn fat is known to accumulate and is hard to get rid of. For example, women with a particular genetic predisposition to have a pear body shape are susceptible to excess fat stored in these areas.

The pear body shape is characterised by large hips, which are wider than the bust and shoulders, making it difficult to fit into jeans, skirts or shorts. A sedentary lifestyle, poor dietary habits and estrogen dominance are also known causes.

UAL is recommended for volume reduction on the outer thighs, inner thighs and knees as it provides significant aesthetic improvement of the leg silhouette, creating an “elongating” effect, and improving the proportions of the lower extremities.

Ultrasonic-assisted liposuction (UAL) FOR PARADOXICAL ADIPOSE HYPERPLASIA (PAH)

A non-invasive fat reduction that has acquired popularity is cryolipolysis or Fat Freezing. It freezes fat, and the frozen fat cells will then be removed via the body's natural elimination process. Post-treatment, the patient can expect mild swelling and redness, which will subside over time.

A serious side effect is "Paradoxical Adipose Hyperplasia" (PAH). Although rare, it is not uncommon. Due to its appearance, it is also known as the "stick of butter" effect.

It happens when the treated areas increase in size instead of shrinking. They also become firmer compared to the surrounding tissues. Liposuction is the only remedial option.

Ultrasonic-assisted liposuction (UAL) FOR ABDOMEN (MUFFIN TOP)

The abdomen is one of the most common areas of concerns for both men and women. The accumulation of belly fat can also be the result of ageing. This accumulation usually results in the "muffin top" appearance.

Aside from ageing - for women, the accumulation of body fat also occurs after childbirth. Genetics also plays a part.

Ultrasonic-assisted liposuction (UAL) FOR ARMS (BINGO WINGS)

The 'bingo wings' is another that is dreaded by many. This wobbly and less-than-flattering loose flesh found on the upper arms is a common occurrence, and one of the causes is genetics. Some people are, therefore, more predisposed to them because they tend to store more fat in the affected area. UAL of arms produces the most visible cosmetic result of skin firming.

Ultrasonic-assisted liposuction (UAL) FOR ARMPIT FAT

Armpit fat or axillary fat is common among adults and often caused by excess weight, although hormones and genetics may also play a role. There are no spot reduction exercises to rescue its appearance. The most effective solution is to surgically remove the fat via liposuction.

Ultrasonic-assisted liposuction (UAL) FOR BACK FAT

Contrary to popular belief, this bulge can happen to any woman, even those with small or average breast size and those who are slim and fit. Depending on our DNA, each unique one of us has trouble spots in different areas where we accumulate more fat in specific body parts than others. For example, some people have more excess fat in their outer thighs, while some have more excess fat in their abdomen.

CAN Ultrasonic-assisted liposuction (UAL) TREAT MEDICAL CONDITIONS OTHER THAN FOR COSMETIC PURPOSES?

Ultrasonic-Assisted Liposuction (UAL) is commonly indicated for the removal of unwanted fat deposits and aesthetic body sculpting, pseudogynecomastia, correction of irregularities, "elongation" of thighs by reducing and reshaping fat around the hips, inner thighs and buttock area, and removing fat from sensitive spots such as armpits, knees and calves.

Interestingly, UAL and all other forms of liposuction, including *VASER Liposuction, are also effective beyond cosmetic needs and purposes. Generally, it may also treat certain medical conditions, such as:

• Adipose tissue diseases
• Multiple systemic lipomatosis
• Dercum's disease
• Subcutaneous lipomas
• Post-traumatic lipomas
• Chronic lymphedema
• Axillary hyperhidrosis

WHAT HAPPENS IF I GAIN WEIGHT AFTER Ultrasonic-assisted liposuction (UAL) ? WILL FAT RETURN AND MIGRATE TO OTHER BODY PARTS?

UAL removes fat permanently. A healthy lifestyle with a proper diet and exercise will help to maintain your new look. It is highly recommended that you do your best to keep your weight after treatment.

If any weight gain does occur, it will be proportionally distributed over the entire body. Changes to treated areas are usually more notable, with more than 3 to 4 kg of weight gain. You can also expect changes that are associated with the normal ageing process.

DOES Ultrasonic-assisted liposuction (UAL) HURT? HOW LONG IS THE RECOVERY?

Depending on the extent of the UAL, you can generally return to work in 2 to 3 days. In the first 48 hours post-surgery, you can usually manage the discomfort, soreness and pain (if any) with paracetamol. Bruising, if any, dissipates in a couple of days to weeks. Swelling will subside and improve with time. Our doctor will advise you when to resume strenuous or water-based activities during the follow-up review.

HOW MUCH DOES Ultrasonic-assisted liposuction (UAL) COST?

The liposuction doctor's fees are generally based on their experience, skills, and the body areas to be treated. A highly experienced doctor will have completed many procedures, including addressing complex conditions and procedures of the corrective kind. Other charges include the type of anaesthesia used, hospital or surgical facility costs, medical tests such as blood tests, post-surgery garments, pre and post-medication, etc.

Price is one of the many variables to consider. Choosing an accredited liposuction doctor from the Ministry of Health Singapore, who uses an accredited surgical facility and works with a well-trained surgical support team, is just as important, if not more. Make sure your health, safety and results are at the forefront besides considering the cost of liposuction.

WHAT ARE THE REALISTIC EXPECTATION FOR MY LIPOSUCTION SURGERY?

Results are visible even on the first-day post-surgery but will be more evident as your body contours improve over 3 to 6 and 12 months when the tissue swelling subsides. Skin firming from UAL goes on for over 6 months period.

Fat cells that are removed during the procedure are permanently lost. However, patients must maintain a proper balance between calorie intake and exercise. If you gain excessive weight, it will cause fat cells all around the body to enlarge.

CAN I EAT ANYTHING WITHOUT ACCUMULATING FAT IN THE TREATED BODY PART?

It is highly recommended that you do your part to maintain the results. This means adopting a healthy lifestyle that includes adequate physical activity. The procedure removes fat from the targeted body region. However, it does not prevent fat gain, especially if you do not take care of your body. It also does not prevent physical body changes due to the normal ageing process.

PRE-PROCEDURE

Before the procedure, a list of instructions will be handed to you, and you will need to follow them to minimise the risks of possible complications during surgery.

ON THE DAY OF THE PROCEDURE

Ensure that there is someone, preferably a family member or friend, to pick you up from the facility after the procedure. Arrive on the day of your scheduled procedure with an empty stomach, and do not consume anything by mouth for at least EIGHT hours. Our medical team personnel will advise you on how and what to prepare for the procedure.

WHAT HAPPENS DURING THE PROCEDURE?

The patient’s problem area and desired results will be discussed on the day of the surgery. The patient must fully understand the procedure, post-op care and predicted aesthetic results.

Next, the skin is marked to indicate the treatment areas. The patient will be brought into the surgery room, where the anaesthetist will take over and proceed with twilight sedation for the patient. The patient will be closely monitored throughout to maintain blood pressure, heart rate and oxygen level.

At the same time, the targeted area will be thoroughly cleansed, followed by Dr Ivan Puah making small incisions on the skin. Infiltration of anaesthetic fluid is done uniformly across the area. Once this is completed, the doctor will insert the ultrasonic probe into the deep fat tissues, manoeuvre and melt the fat cells.

After which, using cannulas of varied sizes, Dr Puah will remove the melted fat and sculpt the targeted areas. Incisions will be closed with stitches, and heavy dressings will be applied.

POST-PROCEDURE CARE

Antibiotics, anti-swelling and pain relief medications will be prescribed. You will need to apply an elastic post-liposuction compression garment 24/7 for 6 to 8 weeks to prevent seromas, minimise bruising and decrease soreness.

You may expect some post-operative leakage of anaesthetic fluid from the incision sites for a couple of days, and we will provide you with the post-op care pack to manage this.

Our medical team personnel will schedule your post-op reviews and treatments. You will be advised what to expect at each stage to help alleviate any concerns and worries.

Does Amaris B. provide aftercare treatments?

At Amaris B. Clinic, aftercare significantly assists you with faster recovery and ensures optimum results. We have curated a bespoke aftercare program designed to help you with the healing process, such as manual lymphatic drainage massages, skin firming and many others.

HOW TO FIND THE RIGHT DOCTOR IN SINGAPORE FOR Ultrasonic-assisted liposuction (UAL), LASERLIPOLYSIS OR *VASER LIPOSUCTION

DO:

• Ensure that the doctor is accredited and licensed by the Ministry of Health (MOH) Singapore to perform the procedure. Doctors are not allowed to offer liposuction if they do not receive accreditation from MOH.

• Make an effort to find out the doctor's experience in the treatment you seek. Experience usually comes with years of practice in such procedures as body sculpting and liposuction.

• Ask the doctor for examples of the results of his work. These should be a good indication of what you can expect and a reflection of the doctor's capabilities. The doctor should be able to show you various body regions they have treated.

• Do understand the benefits as well as potential side effects of the procedure. Clear your misconceptions and ask the doctor any questions you find relevant and necessary.
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• Note that post-treatment follow-up and care are equally important, as they can help to improve your recovery and final results. Adhere to the pre and post-procedure advice given. You have to do your part as much as the doctor will. This will go a long way in ensuring a smooth procedure and, equally important, in recovery.

DON'T:
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• Opt for a procedure just because it is cheap or the cheapest option. The intent is to get the most appropriate one done to best suit your needs without incurring unnecessary risks to your health and wellbeing.

• Be afraid or shy to ask the doctor any questions. These include in regards to treatment options that may be available. Your doctor should be able to alleviate your concerns and worries.

• Have unrealistic expectations. Everyone is unique, and each need must be addressed and met as realistically as possible. Discuss your goals and keep an open mind regarding what can and cannot be achieved.

• A key point that can never be reiterated enough is to discuss matters in regards to your goals and needs with the doctor. Also, raise any concerns, including the risks involved, cost and benefits. You should feel assured because comfort and safety matter.

• Do not forget to provide essential information such as any pre-existing and prevailing medical conditions, including past medical history, allergies and medications that you are taking.

CAN I USE MEDISAVE/INSURANCE FOR ULTRASONIC ASSISTEDLIPOSUCTION (UAL), TRADITIONAL LIPOSUCTION, VASER* LIPOSUCTION OR LASERLIPOLYSIS?

No. Liposuction in any form is considered an elective cosmetic surgery to improve one's body contours; hence is not covered by Medisave or insurance.

LIPOSUCTION DOCTOR IN SINGAPORE, DR IVAN PUAH

Dr Ivan Puah is an accredited liposuction doctor in Singapore with over 17 years of body sculpting experience. He has completed fundamental and advanced body sculpting surgical training conducted by Dr John Millard and Dr Alfredo Hoyos. These two plastic surgeons were the ones who developed *VASER (an acronym for Vibration Amplification of Sound Energy at Resonance) Liposuction, a liposuction technique with the assistance of ultrasound waves, to break up and liquefy fat cells, making them for easier extraction.

Dr Ivan Puah is certified to perform *VASER liposuction, having completed his liposuction training in the United States and Argentina. He is the Chairman of Lipo Peer Review Committee in Singapore and has received dedicated surgical training in gynecomastia surgery in the United States of America.
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Having trained to perform liposuction is only the beginning. Dr Ivan Puah believes it is crucial to understand and master the technicalities of the procedure, including the potential complications that may arise. To be meticulous in approach, with a detailed overview and foresight capabilities, are essential must-haves for a doctor.

An advocate of liposuction as not just a bulk fat removal procedure but also a delicate procedure involving 30% Science and 70% Art drives Dr Ivan Puah to develop his unique and proprietary fat removal and body sculpting approach known as the MDC-Sculpt® Lipo technique. It is a multi-dimensional contouring approach customised to an individual's body shape and clinical condition. This allows bulk fat removal and precise sculpting of the treated area, while care is taken to ensure that incision sites and scarring are kept to the bare minimum.

Finding the right doctor with an aesthetic sense is essential in achieving the desired outcome in terms of silhouette and true results. A body sculpting procedure is akin to a work of Art in progress. The artist's skill, experience, appreciation and understanding of the body aesthetic separate a masterpiece from an average piece of work.

IS Ultrasonic-assisted liposuction (UAL) WORTH IT?

Wanting to proceed with UAL is personal. It is a practical, permanent, and clinically proven solution to remove fat in bulk and achieve skin tightening, compared to non-surgical fat treatments such as Fat Freezing.

Fat Freezing requires multiple sessions done over more extended periods. The applicator's size also limits the area that can be treated non-surgically.

If you have tried various methods of losing fat in a specific area but are not achieving the result that you yearn for, we recommend that you come for a consultation and assessment to understand whether or not you are suited to the procedure.

We welcome you to call us and schedule a consultation with Dr Ivan Puah to understand how we can help you achieve a more defined physique.

References

[1] Garcia O Jr. Ultrasound-assisted liposuction: Current concepts and techniques. Cham, Switzerland: Springer Nature Switzerland; 2020.

[2] Hoyos, A. E., & Millard, J. A. (2007). VASER-assisted high-definition liposculpture. Aesthetic surgery journal, 27(6), 594-604.

[3] Di Giuseppe A, Shiffman MA. Aesthetic plastic surgery of the abdomen. Springer International Publishing Switzerland; 2016.

[4] Hoyos AE. High Definition Liposculpting. In: Body Contouring: Art, Science, and Clinical Practice. Springer-Verlag Berlin Heidelberg; 2010: p. 419-424.

[5] Serdev, N. P., & Serdev, N. (2011). Ultrasound Assisted Liposculpture–UAL: A Simplified Safe Body Sculpturing and Aesthetic Beautification Technique. Advanced Techniques in Liposuction and Fat Transfer, N. Serdev, ed., InTech, Rijeka, Croatia, 135-150.

[6] Nagy MW, Vanek PF Jr. Plast Reconstr Surg. 2012;129(4):681e-689e.

[7] Prendergast PM, et al. Aesthetic medicine: Art and techniques. Springer-Verlag Berlin Heidelberg; 2012.

[8] ZocchiM.2006Ultrasonic liposculpturing. Aesthetic Plast Surg 1992; 16287298Mark Laurence Jewell. Lipoplasty. In: M. Eisenmann-Klein, Constance Neuhann-Lorenz, eds. Innovations in Plastic and Aesthetic Surgery. Springer, Berlin Germany;:439-444

[9] 29.HaeckP. C.SwansonJ. A.IversonR. E.SchechterL. S.SingerR.BobBasu. C.DamitzL. A.GlasbergS. B.GlassmanL. S.Mc GuireM. F.theA. S. P. S.PatientSafety.Committee2009Evidence-Based Patient Safety Advisory: Patient Selection and Procedures in Ambulatory Surgery. Plastic and Reconstructive Surgery, 1244SOctober), 6S27S

[10] Gingrass MK, Kenkel JM.Comparing ultrasound-assisted lipoplasty with suction-assisted lipoplasty. Institute for Aesthetic and Reconstructive Surgery, Nashville, Tennessee, USA