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eMatrix Product Launch

“Wrinkle Reduction & Fractional Skin Resurfacing Transformed”


Agenda • The Fractional Ablative Skin Resurfacing Market • Product Description • Technology Review • Clinical Protocol • Fractional Competitors • Sales Tools • Business Model


Skin Rejuvenation Market Size/Trends • Sales of light-based skin rejuvenation devices projected to grow by 10% per year, from $315 million (2005) to $501 million (2010) as physicians add new fractional and skin tightening technologies to their practices. • Unit sales expected to grow by 14% per year, to 9,420 units (2010).


Actual and Projected Procedure Volume for Fractional Skin Rejuvenation

Year

Installed Base

Tx/Year

Total Volume Growth over 2007

2007

4,710

150

706,500

2008

7,870

180

1,416,600

200%

2009

11,725

210

2,462,250

350%

2010

15,143

240

3,634,200

500%

(Medical Insight, May 2008)


eMatrix – Main Marketing Messages • New customers - the MOST economical and flexible stand-alone device to fractional ablative market • Fractional technology transformed – world’s first RF only fractional ablative technology • Elegant, sleek portable product • Customizable treatments - tunable fractional technology • Bi-polar radio frequency - newest technology for controlling fractional tissue ablation and coagulation


eMatrix – Main Marketing Messages (cont.) • SelectPulse for customizable fractional treatments • 3 applications in 1 applicator –

Program A - Mild ablation and skin resurfacing, shallow impact

Program B - Moderate ablation and skin resurfacing, mid-level impact

Program C - Intense ablation and skin resurfacing, deepest impact

• Minimal downtime • Disposable tip for patient safety and comfort • Intuitive interface


General Biological Effects Heating (Stimulation) •

Occurs at temperatures up to 50 ºC

Causes activation or reversible damage

The type of change is based on the intensity

Amount of affected tissue is based on time above 42.5ºC

Collagenesis leads to Skin Tightening

Coagulation (Necrosis = Tissue Destruction) •

Occurs at 70-80 ºC and related to exposure time

Causes irreversible damage

Leads to destruction of bonds and protein denaturalization

Ablation (Evaporation) •

Occurs at temperatures above100 ºC

Causes irreversible damage

Leads to Tissue Ablation (similar to Erbium/CO2 resurfacing)

Legend


What is the difference between Ablative and Non Ablative? • Ablative = Immediate Vaporization leading to resurfacing – Occurs at >100ºC : 2940nm, 2790nm,10,600nm • Non Ablative = Coagulation or Necrosis leading to resurfacing – Occurs at >70ºC: 1410nm,1440nm,1550/50nm • Combinations – 2790nm, 10,600nm


Matrix RF – The Technology -

+

-

+

-

Good ingredient

Chopping

Mixing

Bipolar RF

Sub-electrodes

Multiplication

+


Matrix RF – The Technology

+ Electrode-pins

The bipolar arrangement - RF current flows between the positive and negative electrodes. Control of this current allows varying degrees of tissue impact. In between areas through which RF current flow, intact tissue remains that serve as healing reservoirs


Matrix RF – Fractional Impact

-

+

Skin color

-

Gold-coated electrodes A

RF current field

A

-

+

-

Ablated tissue Coagulated tissue

Y

Z X

Top view

The RF current flow creates:

Side view

• Fractional impact on the surface • Tunable impact at different depths

Lightly heated tissue Intact skin


SelectPulse TM The Matrix RF Clinical Advantage • SelectPulse enables customization of the amount of heating, the depth of ablation and the amount of cellular destruction • Three different programs emulate the most common treatments found in most stand-alone fractional systems Program A Mild ablation and resurfacing with intensive cellular destruction and heating

Epidermis Dermis Fatty Tissue

Program B Moderate ablation and resurfacing with cellular destruction and heating

Program C Intensive (deepest) ablation and resurfacing with some cellular destruction and heating


SelectPulse™ Program

Matrix A

Matrix B

Matrix C

5 or 10

5 or 10

5 or 10

Coverage( %) Intensity (J) Fractional Tunable Balance

Heating (stimulation) Coagulation (necrosis) Ablation (evaporation)

2-8

2-10

Tissue impact via coagulation and subnecrotic tissue heating. No or minimal ablation

6-12

8-16

Tissue impact via some ablation, coagulation and heating

10-16

14-20

Tissue impact via ablation and some coagulation. Only residual heating


Matrix RF – Close up of Impact

• Samples of the Matrix RF imprint on the skin • 144 electrode-pins

• Parameters affecting impact • Energy, electrode density, pulse mode, inter-pulse delay

• Parameters are grouped in programs


Histological Evidence 1

1. Ablation crater with rim of coagulation below, thin rim of precoagulated tissue 2. Beginning of scab formation

2


Histological Evidence 1

2

1. Scab before shedding off, bronze appearance 2. Scab formation, thickening of epidermis, infiltration of leucocytes, heating and shrinkage of dermal collagen


Clinical Studies • 4 Clinical Sites – Dr. George Hruza, 22 patients – Dr. Amy Taub, 20 patients – Dr. Sharyn Laughlin, 20 patients, Canada – Dr. Stephen Mulholland, Canada, histologies • Marketing sites, in development


Opinion: Dr. Amy Taub • Treatment is quick and easy to administer, 20 minutes is more than adequate • The hand piece is so light and easy to use • I was very surprised regarding the results that have been quite good • We have found that most patients find this procedure to be easily tolerated • I think this is a winning technology that can compete favorably with fractional CO2 • We are seeing some impressive tightening • Patient satisfaction is high


Opinion: Dr. George Hruza • Impressed with the periorbital wrinkle improvement • Nice cheek improvement was also noticeable • Matrix RF has more efficacy than standard skin rejuvenation; has nice textural improvement • His conclusion was that the Matrix RF was best seen as an applicator to add to a treatment like Triniti for localized rhytids around the eyes


Demographics • 3 subjects received rejuvenation treatment in the past (Botox, Titan by Thermage, Photorejuvenation by Restylane)

n=34; 2 sites; Average age: 52 Skin types

Patient distribution by age groups 40% 30%

29%

35%

40% 9%

10%

) (% g ta n rc e P

60%

26%

20%

III, 72%

80%

II, 19%

20%

IV, 8%

0%

0%

II

35-45

46-55 56-65 Age range

66-71

II

III

III

IV

IV


Clinical Protocol: Pain Management • Patient dependent • Program dependent • Topical anesthetic – At the discretion of the physician – If used, will most likely require compounding substance – Optimal Compounding Formula – Study initiated with Dr. Afsahi • Synercool or cold compress should not be used pretreatment or pre-pulse.


Basic Clinical Protocol • Apply topical anesthesia as needed • Remove topical anesthesia with water and water soluble cleanser, allowing skin to dry thoroughly – If an oily residue remains clean with alcohol • Choose your Program (refer to QRG) • Complete 1 pass on entire face – Clean treatment tip when advised (every 25 pulses) – Clean with alcohol and allow to completely dry prior to treatment • Cooling immediate post tx may be necessary – Cold packs (not ice) or Synercool • Protect skin with high level sunblock


Pick a Program Traditional - Pick your Laser (Emulation) – Program A – Low downtime (1 Day) • Texture and Scarring*

– Program B – Medium downtime (2-3 Days) • Pigmented Lesions* • Hypertrophic texture regularities/scarring*

– Program C – High downtime (3-5 Days) • Pigmented Lesions* • Hypertrophic texture regularities/scarring* • Atrophic texture regularities/scarring/wrinkles* *Fractional lasers would be used to treat these indications.


Demonstration Starting Points Step 1   choose skin type

Step 2   choose wrinkle score*

Step 3   choose program

Step 4 choose coverage %

Step 5 choose energy**

I, II, III IV-VI

II I or II

B A

5% 5%

6-12 Joules 2-10 Joules skin types above III use 20% less energy skin types V and VI use lowest possible setting

To classify by targets for pigmented lesions you will use 10% and scarring or texture(wrinkles) you will use 5% *Class I wrinkles – Fine wrinkles, class II wrinkles – fine to moderate depth wrinkles, moderate number of lines **If you do not reach the desired reaction within 10-15 minutes you can increase energy level, if the response is excessive decrease the parameters.


Before Tx 1

Immediately after 1 Tx

1 day after 1 Tx

2 days after 1 Tx


Matrix RF Treatment

Baseline Photos Courtesy of George Hruza, MD

weeks FU 4 # of electrode pins: 64 Pulses: 1,2 Energy: 8-20J Treatment area: Peri-orbital, Peri-oral


Matrix RF Treatment

Baseline Photos Courtesy of George Hruza, MD

weeks FU 4 # of electrode pins: 64 Pulses: 1,2 Energy: 8-20J Treatment area: Peri-orbital, Peri-oral


Matrix RF Treatment

Baseline Photos Courtesy of George Hruza, MD

weeks FU 4 # of electrode pins: 64 Pulses: 1,2 Energy: 10-16J Treatment area: Peri-orbital, Peri-oral


Matrix RF Treatment

Before

After 2 treatment Photos Courtesy of Amy Taub, M.D.


Matrix RF Treatment

Before

After 2 Treatments Photos Courtesy of Amy Taub, M.D.


Matrix RF Treatment

Before

After 3 Treatments

Photos Courtesy of Amy Taub, M.D.


Matrix RF Treatment

Before

After 3 Treatments

Photos Courtesy of Amy Taub, M.D.


Matrix RF Treatment

Before

After 3 Treatments

Photos Courtesy of Amy Taub, M.D.


Matrix RF Treatment

Before

After 3 Treatments

Photos Courtesy of Amy Taub, M.D.


Matrix RF Treatment

Before

After 3 Treatments Photos Courtesy of Amy Taub, M.D.


eMatrix Hardware Diagram Collapsible Screen

Holster for Applicator

On/Off button

Applicator Connector


Log In Screen


Welcome Screen


Area Selection Screen


Program Selection Screen


Treatment Screen


eMatrix Specifications Applicator Weight

0.6 Ibs (0.3 Kg.) including cable

System Dimensions

Tabletop: 20.87”x15.35”x11.42”

System Weight

15.4 lbs./ 7 kg.

Disposable tip

Treatment area – 12 x 12mm Tip types: 64 pins Distance between pins: 64 pin tip – 1.5mm

Program Selection

A , B or C

Total RF energy

2 - 20 Joules (Depends on Program Selection)

Coverage

(5%, 10%)

Number of pulses per tip

Maximum 125 pulses Every 25 pulses – message to clean tip


What comes with the eMatrix?

• Matrix RF applicator • Set of 10 treatment tips • Set of 10 test tips • User Manual • QRG


Matrix RF – Treatment Tip • Treatment tips – Treatment area: 12mm x 12mm – No. of matrix dots: 64 – Distance between matrix dots: 1.5mm

• Disposable tip – Hygienic purposes for patient – Recurring revenue stream for company


Matrix RF – Treatment Tip • Tip controlled by tip ID – SW mechanism recognizes new tip and begins counting down pulses – Every 25 pulses, user will be instructed to clean tip – After 125 pulses, tip will STOP functioning and user will be instructed to replace tip – Once tip is taken out OR system is restarted, tip is no longer usable


Features and Benefits Feature

Benefit

Small, lightweight applicator

Most ergonomic

Disposable tips

Hygienic, increased patient safety

Bipolar radio frequency Controlled thermal effects. Customizable clinical impact based on energy density and tissue resistance SelectPulse energy delivery

Ability to customize depth of ablation and degree of skin resurfacing based on patient needs. Customizable patient results


Features and Benefits Feature

Benefit

Time efficiency

Quick treatments – full face (20 minutes), neck, chest and hands (10 minutes)

Treatment protocol

Short treatment protocol, up to 3 treatments, 4 weeks apart

Clinical efficacy

Proven in clinical trials conducted by leading physicians

Treatment protocols

Short treatment protocol with minimal downtime and tolerable discomfort levels which can be easily managed with topical anesthetics

Sterility

Single use tips prevent cross contamination between patients


Features and Benefits Feature

Benefit

Program A

Resembles the skin improvements achieved with fractional Er:Glass devices which rely on coagulative resurfacing for improvements in overall tone and texture.

Mild ablation and skin resurfacing, shallow impact Program B Moderate ablation and skin resurfacing, mid-level impact Program C Intense ablation and skin resurfacing, deepest impact

Resembles the impact of fractional Er:YAG ablative devices that are sued for color correction and texture irregularities Resembles the impact of fractional CO2 devices that provide high levels of ablation and partial resurfacing for treatment of rhytids.


Fractional Competitors


Alma Lasers Pixel CO2 Omnifit

Pixel CO2

• Pixilated hand piece for

• Fractional CO2 system

CO2 systems • 10,600nm • Spot size = 8 x 8mm (81 pixels)

• 10,600nm • Pulse repetition rate = 25-500Hz • Spot size = 8 x 8mm (81 pixels), 10 x 10mm (49 pixels)


Cynosure,Inc. Affirm with Multiplex • Combined Apex Pulses (CAP) Technology • Wavelength = 1440nm & 1320nm • Rep rate = Up to 2.0Hz • Pulse width = 3-35ms • Fluency range = up to 14 J/cm² • Spot size = 10x10mm, 14x14mm, 11x55mm


Cutera Pearl • YSGG 2790nm • Pulse repetition rate = Up to 20Hz • Fluency range =1.5 - 3.5 J/cm² • Spot size = 12 x 14mm


Eclipsemed / Deka SmartXide DOT • CO2 Laser with DOT Therapy • Wavelength = 10,600nm • Energy/matrix point = Up to 60mJ/dot • Rep rate = 5-100Hz • Spot size = 15 x 15mm (max)


Ellipse, Inc. Juvia • Fractional CO2 Laser • Wavelength = 10,600nm • Rep rate: 0.5 - 50Hz • Spot size = 7x7mm; 9x9mm; 11x11mm


Lumenis UltraPulse Active FX/Deep FX • Fractional CO2 Laser • Wavelength = 10,600nm • Rep rate = 1 to 1000 pulses/sec. • Energy/matrix point = Up to 225mJ • Fluency range = up to 7.5 J/cm² • Spot size = 0.12 or 1.25mm


Lutronic Mosaic • Er:Glass • Wavelength = 1540nm • Energy/Matrix Point = 70mJ • Spot Sizes 10x10mm, 8x8mm, 6x6mm, 5x10mm


Palomar Lux2940 fractional laser handpiece

Lux1540 fractional laser handpiece

Lux1440 fractional laser handpiece

Technology

Er:YAG

Er Glass

Nd:YAG

Wavelength

2940nm

1540nm

1440nm

Energy/Matrix point

??

Up to 70mJ

Up to 10mJ

Spot size

10 x 10mm, 6 x 6mm

10 x 10mm, 15 x 15mm

15mm

Pain

“Significantly less than trad. CO2�*

*according to their marketing pieces


Reliant Fraxel re:store

Fraxel re:fine

Fraxel re:pair

Technology

Er: Glass

Nd:YAG

Fractional CO2 Laser

Wavelength

1550nm

1410nm

10,600nm

Energy/Matrix point

4-70 mJ/MTZ

1-10 mJ/MTZ

Pain Management

Compound topical anesthetics

Topical anesthetics, or forced air cooling

Compound topical anesthetics

Price

$120,000 Tip: $400-500 good for 5-8 treatments

$75,000 Disposable tips

$130,000 Tip: $400 per treatment


Sciton Contour TRL

ProFractional XC

• Er:YAG (2940nm)

• Er:YAG (2940nm)

• 30 x 30mm

• 20 x 20mm

• Applicator and

• Applicator

system • $90,000

• Pain Level: “No Discomfort* • $95,000 *according to their marketing pieces


Product Brochure


Email Signature and E-Blast


Ad and Rollup


Practice Marketing Materials Patient Pamphlet

Postcard

Poster Countertop


Web Site


Business Model


Business Potential • How does eMatrix fit into Syneron’s product mix? • eMatrix is the perfect fit for non-core physicians. The key targeted specialties would be: – General practice, family practice, internal medicine – OB/GYN – Cosmetic Surgeons • eMatrix and Matrix RF have the same technology and for that reason the suggested target market for Matrix RF is existing eSeries customers. • The target market for eMatrix is: – VelaShape customers – New customers from our targeted specialties for eMatrix (see above) – Core physicians, as they might be intrigued by the innovative technology.

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