Exilis NYC Precision Aesthetics MD

clinical roundtable

Exilis Offers Tailored Treatments for Body Shaping, Skin Tightening and Anti-Aging

By Bob Kronemyer, Associate Editor

Abdomen before Tx

Abdomen after Exilis Tx Photos courtesy of Marek Kacki, M.D.

Physicians and patients interested in a non-invasive aesthetic procedure that is affordable, pain free and efficacious for body shaping and skin tightening need look no further than Exilis from BTL Industries, Inc. (Boston, Mass.). This appealing monopolar, focused radiofrequency (RF) device provides for precise delivery of thermal energy that can be uniquely tailored to every individual body. Exilis is also being used with complementary modalities and leading skincare products to enhance outcomes in an anti-aging program.

According to Robert Weiss, M.D., an associate professor of dermatology at Johns Hopkins University School of Medicine in Hunt Valley, Md., “the Dynamic MonoPolar feature of Exilis allows you to actually target areas where you need more tightening or more fat reduction.

Exilis can also target fat and then Robert Weiss, M.D. Associate Professor of Dermatology Johns Hopkins University School of Medicine Hunt Valley, MD

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tighten skin in the same area, all with a few power and cooling-depth adjustments. These capabilities distinguish Exilis from other monopolar, bi-polar and multipolar RF devices.”

Dr. Weiss also noted that treatments can get intense but are nearly pain free for most patients. “They feel a very tolerable, warm sensation and no topical anesthetic is needed,” he said.

Marc Salzman, M.D., F.A.C.S. Director Salzman Institute of Cosmetic Surgery Louisville, KY

From a plastic surgery perspective, “Exilis helps complete our armamentarium,” said Marc Salzman, M.D., F.A.C.S., director of the Salzman Institute of Cosmetic Surgery in Louisville, Ky. “Patients come in who are surgical candidates and want surgery – be it a face-lift, an arm lift or a tummy tuck, but there are quite a few patients who either cannot, for medical reasons, have surgery, or don’t want a surgical approach,

out of fear or due to downtime. In the past, we held our hands up and said there was not much to be done.

Now, with one device we can contour the body – make the fat layer thinner – and heat the skin to effect healing with a tighter skin envelope.

There is no other device on the market that does both well. We can tighten the skin of the face and neck, and remove fat around the hips – all with a single modality, thanks to the controlled depth of Exilis RF.” The economics of offering Exilis treatment also benefits both practitioner and patient because the only disposable is a $3.00 single-use ground pad.

women in their late 70s and into their 80s, with very nice improvement.”

Furthermore, an infrared gun to gauge temperature, which is still needed with most competing devices, is now a thing of the past, thanks to Exilis’ built-in temperature sensor in the handpiece for easy reading and heat titration. “This keeps the temperature from becoming too hot, which adds to safety, comfort and David McDaniel, M.D., F.A.A.D.

Posterior bra area before Tx

Director McDaniel Institute of Anti-Aging Research Virginia Beach, VA

David Vasily, M.D., a dermatologist and director of Aesthetica consistent efficacy,” explained David Cosmetic and Laser Surgery Center McDaniel, M.D., F.A.A.D., director in Bethlehem, Penn., is enthused of the McDaniel Institute of AntiAging Research in Virginia Beach, Va. “One of my complaints about David Vasily, M.D. some of the older modalities was the Dermatologist Director lack of consistent results, which afAesthetica Cosmetic and Laser Surgery fects patient satisfaction.”

Center

Posterior bra area after four Exilis treatments Photos courtesy of Jeanine Downie, M.D.

Bethlehem, PA

For Bruce Katz, M.D., director of JUVA Skin & Laser Center in New about Exilis’ crucial role as part of an anti-aging program that does York City, N.Y., Exilis has become not entail a costly consumable. A Bruce Katz, M.D. monthly regimen should result in, Director “ongoing reduction of coarse wrinJUVA Skin & Laser Center kles, a further decrease in fine and New York City, NY coarse lines and less laxity,” he conveyed. “I think the most remarkable improvement has been in the texture and tone of the skin. It becomes very pretty, pores are reduced, color and his treatment of choice for non-invatexture also gets better. The change sive body shaping and skin tightening for the body and face. “Popular is striking.” areas to treat are the jowls, the In addition, Exilis is ideal for some neck, the arms, abdomen, thighs, older patients who cannot undergo and even around the knees a bit,” invasive or micro-invasive therapy, Dr. he said. “You can also use Exilis for Vasily noted. “We have used Exilis on eyebrow lifting.”

“ I think the most remarkable improvement has been in the texture and tone of the skin. It becomes very pretty, pores are reduced, color and texture also gets better. The change is striking.”

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clinical roundtable

Angela Caponi, chief operating officer at JUVA Skin & Laser Center added, “I absolutely believe that Exilis is an important component of our body shaping program. We have over 55 lasers in the office, several Angela Caponi Chief Operating Officer JUVA Skin & Laser Center New York City, NY Arm before Tx

Arm after Exilis Tx Photos courtesy of Bruce Katz, M.D.

“ Shortly after acquiring my first Exilis in August 2010, I acquired a second unit based on the demand, its diversity, and its ability to be used year round.”

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of which can probably treat the same condition. However, Exilis is a winwin situation. Treatment is very tolerable; there is no pain at all. Other RF devices have discomfort and are not easy to delegate, whereas patients feel comfortable with a trained aesthetician or specialist performing Exilis.”

Non-invasive technologies for body shaping and skin tightening, “are a reasonable alternative for people who are concerned about more invasive procedures like liposuction,” said Miles Graivier, M.D., F.A.C.S., owner of Graivier Center for Plastic Surgery and MedSpa in Roswell, Ga. “Exilis is an additional Miles Graivier, M.D., F.A.C.S. Owner Graivier Center for Plastic Surgery and MedSpa Roswell, GA

Moreover, Dr. Graivier uses Exilis in conjunction with liposuction and other body contouring procedures to improve the results. “Using Exilis, both pre- and post-liposuction, really smoothes and tightens even further.

It also diminishes irregularities and touches up slight bulges,” he said.

Editor’s Note: In the following clinical roundtable, six aesthetic physicians share their knowledge and clinical expertise with Exilis. Together they bring decades of experience with Exilis and other body shaping devices and procedures.

How does Exilis fit in your overall practice?

Dr. Vasily – Increasingly, my office is servicing a population of patients who need skin rejuvenation, yet cannot afford downtime, even for a few days. In this economy, patients are afraid of losing their jobs. Exilis fits the bill. A person can return immediately to their workplace, and we have seen virtually no complications from treatment. Young women with postpartum “baby belly” have also seen significant tightening with Exilis, when committing to a series of six to eight sessions.

Shortly after acquiring my first Exilis in August 2010, I acquired a second unit based on the demand, modality that can be used alone to its diversity, and its ability to be used provide some body contouring, as year round. well as skin tightening. With the ability to focus the RF in the deeper fat Ms. Caponi – Besides using Exilis layers (up to 2.5 cm) and to tighten for skin tightening in the facial area the skin by heating the dermis, Exilis and abdomen, many patients want allows for treatment of areas such their flabby arms treated. At our as the hips, arms, knees, abdomen, practice, the device has taken over back and bra fat.” a large portion of our aesthetician’s

clientele. Since it is so easy and safe to use, I am comfortable with my staff doing all the treatments.

Overall, Exilis was very easy to add into the practice.

What is your treatment protocol and what kind of results are you seeing with Exilis?

Dr. Katz – Patients often need four treatments at one week intervals. A lower-face session takes about 20 minutes and patients are very happy with the results. We achieve significant tightening and some nice sculpting. At times I also use Exilis after liposuction for additional fat melting and further tightening.

Ms. Caponi – Generally, patients commit to approximately four to six sessions, spaced one week apart.

We have observed results after the third session such as circumferential reduction in the abdomen area. For skin tightening, a significant difference will likely be noticeable after the second or third treatment. I have not seen anyone come back after their initial series of treatments because quite honestly they have been very happy.

Dr. Weiss – Results far exceeded our expectations in an initial 30 patient study for treating the jowls and neck for rhytides, laxity and submental fat pad reduction. Patients underwent four sessions, spaced seven to ten days apart. We were particularly impressed with the tightening of the jowls and improvement of the contour of the neck. Significantly less laxity was observed in 14 of 15 patients, and most showed a reduction in the submandibular fat pad. Arm Dr. McDaniel – Anti-aging patients contour patients also achieved an average circumferential reduction of with skin laxity and contour irregularities undergo four sessions at 10 2.1 cm on each limb. to 14 day intervals. Patients begin Dr. Salzman – Four to six treat- to see some improvement early on, ments, performed weekly, are usual- but we think the full result takes up ly necessary to achieve measurable to four to six months from the last amounts of non-surgical fat reduc- treatment. You notice improvement in skin texture and smoothing, not tion and skin tightening. just tightening and lifting. The colDr. Graivier – The treatment pro- lagen synthesis likely improves for tocol for Exilis has evolved as I’ve three or four months. performed more and more procedures with this technology. Initially, we started with about four treatments, usually separated by seven days to two weeks. However, now I’m recommending four to eight sessions, again separated by 7 to 14 days, for body contouring and skin tightening. The procedure itself only takes about 20 to 30 minutes per area, so it is not labor intensive and it is quite comfortable for the patient.

Dr. Vasily – I was hugely surprised early on when I noticed that Exilis not only helped with the obvious, but there was significant improvement in the texture, tone and color of photodamage and aging skin.

We honestly were not anticipating that. As a result, my colleagues and I began using Exilis exclusively for wrinkles, lines, dyschromia, etc., on patients who could not afford downtime. Over the past 18 months, Exilis

“ We have observed results after the third session such as circumferential reduction in the abdomen area.

For skin tightening, a significant difference will likely be noticeable after the second or third treatment.”

Before Tx

After Exilis Tx Photos courtesy of David Vasily, M.D.

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clinical roundtable

has evolved into a go-to, non-invaMs. Caponi – At JUVA Skin & Laser Center, we charge $400 per treatsive device for skin rejuvenation. ment, per area. For instance, treating An initial series of six sessions of the abdomen, arms and cheeks would Exilis, seven to ten days apart, is be $1,200 per session. It takes about scheduled, depending on the indi- two hours for all three areas. vidual patient and the amount of skin Dr. Weiss – Since there are no laxity. A full facial takes about 45 mincostly consumables or expensive utes. Lately, we are doing more in the tips that need replacing, treatment malar area of the cheek since we find is more affordable.

The tip itself is that by lifting and tightening that area, metal so it can be easily disinfected we can achieve a nice, youthful look. between patients.

Neck before Tx

Neck after Exilis Tx Photos courtesy of Marek Kacki, M.D.

“ O ver the past 18 months, Exilis has evolved into a go-to, non-invasive device for skin rejuvenation.”

Dr. Salzman – You’re talking $3.00 for a disposable ground pad. So if I have to give it away, for whatever reason, I’ll let my nurse do follow-up treatDr. Katz – As with other RF de- ment for the price of the disposable. vices, Exilis produces heat in the Competing modalities may cost $300 tissues, which stimulates collagen to $400 in just disposables per session. production and leads to skin tightening. In essence, RF increases rotaDr. Vasily – By offering a series of tion of water molecules in the tissue. treatments, package pricing is availRF is also colorblind, so you can use able, so patients receive a discount. it on all skin types.

Plus, you don’t have to factor in an expensive disposable, whether it be Dr. Graivier – In order to achieve a tip or a handpiece. Physicians have body contouring, the deeper lay- been “disposabled to death” over the ers of fat must be addressed. Using last few years. It is so refreshing that Exilis’ cooling system allows focused with Exilis you don’t have this so you RF energy to reach the deeper lay- don’t have to work disposables into ers of fat. This has been validated by your pricing structure.

What makes Exilis so effective?

animal studies monitoring heat of the Dr. McDaniel – For many of our padermis and the deeper levels of heat tients, it is really difficult in this economy generated, along with clinical studies for them to afford the cost of some of using three-dimensional circumferenthe competing treatments. We charge tial measurements. $400 a session for a region of the face. A package of four sessions totaling $1,600 is still significantly less than In your opinion what are some of our other treatment options.

the cost benefits of Exilis treatment?

Can you comment on the Dr. Katz – For physicians, having safety profile of Exilis?

virtually no consumables is a big plus. Our patients are very happy Dr. Weiss – Energy Flow Control (EFC) is a safety feature stemming with the return on investment.

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from the proprietary grounding pad, which allows the device to check the resistance of the skin. For example, if there is a sudden spike in energy, due to encountering a different area of skin or improper contact, EFC will shut off the energy. It also reduces the risk of temperature reaching too high, which can cause burning or blistering. Compared to other RF devices, Exilis allows you to safely use higher power settings for deeper heating without serious discomfort.

Due to the cooling system, we find that Exilis patients are able to tolerate the higher temperature for a better result.

collagen and elastin. We also see epidermal improvement, which is extremely interesting and surprising. A lot of patients have shown a significant reduction in actinic bronzing and solar lentigines.

Dr. McDaniel – Our office uses a variety of topical skincare products from the start. Maintenance therapy for Exilis ranges from once every three to six months to once every other year. The most common adjunct therapies for maintenance with Exilis are dermal fillers and neuromodulators, which are particularly in demand by middle-aged and older patients. I typically arrange to Dr. McDaniel – I tell patients that inject dermal fillers / modulators a Exilis treatment feels a bit like a hot few weeks earlier than Exilis. stone massage. Although it can feel It’s like a tug of war. The fat loss is hot, the heat is very transient and pulling you down to look older and moves around, avoiding the intensaggy, whereas Exilis is pulling you sity of some other treatment modaliupward to look younger and firmer. ties. The cooling system of Exilis is Hence, the rate of that fat loss and also quite good compared to some continued extra laxity of your skin, of the older devices. to some extent, determines the frequency of maintenance.

Dr. Salzman – The device is 100% safe. We have had zero safety inciDr. Weiss – For anti-aging treatdents – no burns, no arcing, no discolment, I like the fact that we can fooration of skin. Exilis is 100% benign. cus on areas of the face and neck that need the most improvement, How do you incorporate Exilis such as jowls and “turkey neck”, not only for skin tightening but for some into an anti-aging program? smoothing as well.

Dr. Vasily – Near the beginning of the cycle, patients start using topical anti-aging skincare products.

Sometimes, Exilis is coupled or alternated with other non-invasive, no downtime treatments. We also discuss with patients the possibility of a periodic Exilis session to maintain results.

Before treating patients for rejuvenation with Exilis, my staff and I assess a patient for surface texture and saggy skin. The treatment plan typically consists of an initial series of three to four sessions, spaced about two weeks apart. After an initial series, patients can expect a clinically significant reduction in As for efficacy, on a molecular tightening of the jowls and smoothlevel, the monopolar RF of Exilis ing of the neck. The results-to-price induces factors that create new ratio is very favorable. In addition,

“ The device is 100% safe. We have had zero safety incidents – no burns, no arcing, no discoloration of skin.

Exilis is 100% benign.”

Neck before Tx

Neck three months after Exilis Tx Photos courtesy of Hartsough Dermatology Clinic

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“ With nearly two years of experience with Exilis, I have actually seen excellent clinical results for its anti-aging effects.”

Before Tx

After Exilis Tx Photos courtesy of Marek Kacki, M.D.

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if patients have numerous superficial wrinkles or pigmentation issues, Exilis may be combined with other treatment modalities, such as fractional laser resurfacing or intense pulsed light (IPL). Since there is only a slight bit of redness that occurs from Exilis, other treatments can be performed on the same day, immediately after.

improve the way I look?” A woman may comment that she is starting to look like her mother. Exilis is part of our program to reverse aging or the effects of gravity over time.

Compared to other energybased body shaping treatment modalities, what unique A single maintenance treatment advantages does Exilis offer?

of Exilis is scheduled on average once every 12 to 18 months, often in conjunction with injection of a neuromodulator, hyaluronic acid or other dermal fillers; again, with Exilis first. We try to avoid using any form of energy over the neuromodulator once it is injected in the skin because we do not want anything to interfere with the effect of the injection.

Dr. Salzman – With Exilis, you are not limited to an area that fits in an applicator, as with cryolipolysis. You can treat as many 7 inch by 5 inch areas as you desire, and the areas can overlap. In contrast, with cryolipolysis, every one of those areas take one hour. Low-level laser light is another option, but it typically scans the entire body, whereas Exilis is more discriminating in targeting the A topical growth factor product hills and valleys of fat distribution. is also recommended for ongoing, Dr. Weiss – One unique feature of daily home-use, starting the first day Exilis is that there are two applicaof the initial series of Exilis. These tors that allow us to better treat the products enhance collagen producface, neck and body. At our office, tion by helping to activate fibrothe larger applicator has been sucblasts. With Exilis, you are drawing cessfully used for body shaping of more fibroblasts into the areas that the abdomen, arms and thighs. We you treated, so these topicals boost have also seen excellent results for that effect. Combining a growth facskin tightening, overall body shaptor with Exilis causes a significant ing and wrinkle reduction. improvement in skin smoothing.

Besides a growth factor product, Dr. Katz – I like that you can vary patients are also encouraged to use the depth of the energy with Exilis. a topical containing vitamin C. Not only can you tighten the skin, but With nearly two years of experi- also attain some fat sculpting as well.

ence with Exilis, I have actually seen excellent clinical results for its antiAny pearls of wisdom to enaging effects. We know treatment is delivered deep enough to affect sub- hance the efficacy of Exilis? cutaneous tissue and cause skin tightening. Overlap of Exilis treatment for Dr. Weiss – Clinicians should be anti-aging and self-improvement is aware of the temperature of the skin common. People come in and say, “ I and have a good idea of whether see that I am aging. What can I do to they are targeting fat or skin laxity

with them on a regular basis about updates for even better outcomes.

A lot of other companies don’t do that. Once you buy a device, you don’t hear back. With Exilis, our staff stays motivated because they Dr. Salzman – A post-operative feel BTL is interested in their proupkeep regimen for incisional face- grams and how patients are relift patients consists of dermal fillers sponding to treatment. three to six months after and the continuation of Exilis so that the elasticExilis is truly a user-friendly and paity stays and does not regress and tient-friendly technology for achieving recur. Exilis is a way of keeping that really nice results for skin tightening patient in your practice. However, and body shaping. you need an operator who is passionate about doing treatment correctly and achieving the best results. How do you predict Exilis or both. Exilis also allows you to dwell over an area that you want to focus on; meaning it can be applied over those areas that require more contouring for a longer period.

Dr. Graivier – I think the two pearls I have learned with Exilis are that we can cause improved contour by focusing the RF generated heat deeper in the fat layers and we can tighten skin by focusing on the dermis. For example, we usually start by treating the deeper fat because with Exilis technology we are able to cool the skin and drive the heat to these deeper layers. Cooling the surface to varying degrees allows for more precise tailoring of the depth of heat penetration. Then, after driving the heat deeper, we remove the cooling and heat the dermis to stimulate collagen synthesis in the skin. These steps allow for a combination of fat contouring and skin tightening.

Gynecomastia before Tx

will evolve in the future?

Dr. Graivier – In the future, I expect Exilis will increase its penetration depth and strength, so heating can occur somewhat faster as temperature is the endpoint we are trying to achieve. This will make for quicker treatment times and decreased operator fatigue.

Dr. Vasily – I anticipate that at our center, and likely in others as well, Exilis will play an ever-increasing role as a cornerstone of anti-aging because of favorable pricing, the lack of complications and downtime, and the fact that it is a painless procedure with very nice results. The staff can also perform the procedure with a minimal learning curve.

Additionally, doing more treatDr. McDaniel – A new indication ments, approximately four to eight, in shorter time frames – one to two for Exilis is the hands, which I will weeks apart – appears to yield bet- soon begin treating based on the ter results. impressive findings of a European dermatologist. In a beach resort Dr. Katz – Training is crucial for area like Virginia Beach, people’s efficacy. The people at BTL are hands have really taken a beating. great at training staff to use Exilis If your face looks out of sync with properly. Not only do they train your hands, your hands betray staff well, but they are in touch your age.

Gynecomastia after Exilis Tx Photos courtesy of Marek Kacki, M.D.

“ Training is crucial for efficacy. The people at BTL are great at training staff to use Exilis properly. Not only do they train staff well, but they are in touch with them on a regular basis about updates for even better outcomes.”

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