Liposonix - 140 Joules Total Enough?

I have definitely seen more consistent results with total fluence (dose) of about 180 Joules. My personal preference is to deliver it in fewer pulses, say 60 x 3, but lower setting are more comfortable for some patients so we use what is called "pulse stacking".

As a dermatologic surgeon with background in electrical engineering and significant experience with application of ultrasound technology in aesthetic medicine including Liposonix, Vaser Shape, and Ultherapy, I must state that anything less than the maximum dose of 180 Joules total per area may be suboptimal for Liposonix. Pain management can be achieved with mild sedation protocol that is offered to every patient undergoing Liposonix in our clinic. In addition, all of our Liposonix will get two additional Vaser Shape which I have found to augment clinical benefit of fat pad reduction and to facilitate resolution of post-treatment inflammation that sometimes occurs after Liposonix treatment.

The company recommends a total of 180 Joules of energy to each marked area. This can be divided into 60 x 3 pulses, 45 x 4 pulses, or rarely, 30 x 6 pulses. The total number of pulses delivered to each square must be given consecutively before moving to the next square. To be honest, 140 J would be less than ideal. The treatment with 180 J is promised to provide a 1 inch reduction in waist circumference. 

As for pain medication, in our office we provide demerol, valium, and an anti-nausea medication. In my experience, however, these and other pain medications do not seem to provide much alleviation of the pain involved with the procedure.