Dr. Darm Aesthetic Medicine: Exilis Platform Offers Array of Options for Aesthetic Practices

1. Exilis Platform Offers Array of Options
for Aesthetic Practices
By Bob Kronemyer, Associate Editor
Radiofrequency for body contouring, experiencing some sagging of the skin
Robert Weiss, M.D. skin laxity and skin tightening has tak- around the jowls, or wrinkles around
Associate Professor of Dermatology en a major leap forward with Exilis the eyes. The system has also shown
Johns Hopkins University School of from BTL Aesthetics, Inc. (Columbia, S.C.). “very nice results” for the abdomen in
Medicine
Hunt Valley, MD
This radiofrequency (RF) device has the patients with lax skin (e.g., post-lipo-
unique ability to safely deliver controlled suction, post-pregnancy),” Dr. Weiss
thermal energy to many different targets noted. Thighs have also responded fa-
in the skin and body for effective and vorably, “with improvement in saggy
David B. Vasily, M.D. safe treatment with minimal patient dis- skin.” A third area with noticeable re-
Dermatologist comfort and no downtime. sults is the upper arm and shoulder –
Director
Aesthetica Cosmetic and Laser Surgery
particularly women in their 40s and
Center Treatment time is also reduced be- 50s. “These women start to notice that
Bethlehem, PA cause the Energy Flow Control (EFC) they don’t like the way their arms look
component delivers the maximum ther- in short sleeves because of some sag-
mal effect to tissue while allowing the ging skin,” Dr. Weiss said.
operator unparalleled visual control and
Patricia Wexler, M.D. flexibility due to real-time monitoring of For full-face treatment, most patients
Associate Clinical Professor of
Dermatology skin temperature. Moreover, the ad- require three to four sessions of about
Mount Sinai School of Medicine vanced cooling system allows the der- 15 to 30 minutes each, spaced two to
New York, NY mis, deep dermis, subdermis and deep three weeks apart. Following a series
tissue to all be targeted. Skin burns are of treatments, patients should “see a no-
also prevented by a unique feature ticeable improvement in skin tone, tex-
that immediately turns the power off if ture and laxity,” Dr. Weiss conveyed.
the handpiece loses contact with skin. The number of sessions for off-the-face
When you consider its versatility and areas is basically the same, depending
lack of costly consumables, Exilis be- on the patient’s needs. “Again, there is
comes an affordable treatment option a noticeable improvement in contour,
appealing to a wide-range of patients. skin texture and folds.”
“For those practices that have used Dr. Weiss, who is director of the
RF, Exilis is different,” said Robert Weiss, Maryland Laser, Skin and Vein Institute
M.D., an associate professor of derma- in Hunt Valley, Md., appreciates that
tology at Johns Hopkins School of “Exilis is unique in delivering monopo-
Medicine (Hunt Valley, Md.). “The treat- lar RF with a grounding pad, so we
Submental region before Tx
ment tip is constantly moving and the know it is penetrating deeply.” The built-
treatment itself is actually pleasant and in temperature sensor also allows for
relatively quick. Patient satisfaction is the skin temperature to be maintained
also high and you can offer treatments between 40° and 42° C. “This permits
to patients that are unable to afford delivery of enough energy to cause skin
some of the pricier devices with expen- tightening and contour changes, with-
sive consumables. Exilis is an excellent out causing pain,” Dr. Weiss explained.
alternative. You have more control. “People feel a heat sensation – similar
You’re not confined to a fixed pattern.” to a very warm massage.” No local or
topical anesthesia is needed.
Patients achieve skin smoothing and
Submental region after four Exilis treatments skin tightening, according to Dr. Weiss. Exilis is extremely user-friendly and
Photos courtesy of Robert Weiss, M.D. Candidates for facial treatment are has preset parameters according to the
typically those in their 40s through 60s area being treated. “Besides suggested
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2. starting energy, the device itself has a and they have more control over the
“Within one small database program for entering treatment,” Dr. Weiss advised. “I person-
patient information and keeping track ally like using it myself because I am not
month after the of their energy levels and dates of limited to a predefined treatment pat-
treatment,” Dr. Weiss said. A touch tern. It’s nice to have the same kind of
last treatment, the screen also provides instructions on us- control as sculpting a face with dermal
age and proposed energy levels for fillers. We have the ability to direct the
most significant various treatments. treatment to problem areas, which is a
significant advantage of Exilis. The staff
improvement typically “Usually by the second treatment, also prefers Exilis because typically it
we begin to notice results,” Dr. Weiss does not cause the patient any pain.”
occurs. Based on our reported. “Within one month after the
last treatment, the most significant im- Moreover, patient feedback is en-
knowledge of similar provement typically occurs. Based on couraging. “I would say the rate of pa-
our knowledge of similar technologies tient satisfaction is very high,” Dr. Weiss
technologies using using RF, we anticipate results will last stated. “Often, patients will see some
one to two years.” tightening and some smoothing imme-
RF, we anticipate Furthermore, since the only consum-
diately after treatment. They are gener-
ally very pleased, especially in relation
able is an inexpensive single-use, dis-
results will last one posable grounding pad, coupled with
to the cost and the time involved.”
the rapid delivery of energy, treatment One of the first patients Dr. Weiss
to two years.” prices “are very reasonable,” Dr. Weiss treated with Exilis was a thin-skinned
commented. “This allows for a signifi- female in her early 50s. “I noticed af-
cant cost savings compared to other ter treating one half of her face, there
tightening devices.” was a real difference. The jowl was
lifted,” he recalled. “With a total of
Dr. Weiss has used Exilis in combi- three treatments on both sides of her
nation with fractional devices to help face, the patient achieved outstanding
with scarring or more superficial wrin- results, and it truly complemented the
kles, along with a reduction of saggy dermal filler that I had placed in the
skin. Typically, these patients will nasolabial folds and in the cheeks.
schedule three fractional sessions, one She looked ten years younger.”
month apart, followed by three Exilis
sessions. Results are evaluated at six Exilis also has “an excellent safety
57 year old patient before Tx months. Likewise, patients who have profile,” Dr. Weiss noted. “We’ve had
undergone laser lipolysis with liposuc- no skin burns, which is theoretically
tion on the abdomen – but are left possible with an RF device and a
with some fat or weight gain – will grounded device. However, since the
benefit from two subsequent sessions patient is providing constant feedback
of Exilis about three weeks apart for about what they are feeling, this great-
even smoother and tighter results, ly reduces the risk of injury to the skin.”
without needing to schedule a second
session of liposuction. Patricia Wexler, M.D., an associate
clinical professor of dermatology at
Both the nurse practitioner and physi- Mount Sinai School of Medicine in
cian assistant at Dr. Weiss’s practice en- New York City, N.Y., concurs with Dr.
57 year old patient one month after four Exilis treatments joy using Exilis more than other, similar Weiss about his overall impressions of
Photos courtesy of David B. Vasily, M.D. devices because “it is a little less tedious Exilis. “Treatment is quick and relatively
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3. painless, with results seen in as early Furthermore, treatment is “extremely
“Exilis may be as two sessions and improvements affordable for most patients, given the
continuing throughout treatment and results,” Dr. Wexler said. Patients also
used in lieu of time,” she said. “Exilis can also be appreciate the small amount of office
used on virtually any area with fat or time required for treatment. Similarly,
liposuction, after laxity of the skin. You do not need a Exilis “may be used in lieu of liposuc-
minimum amount of skin or fat to be tion, after liposuction or even tried
liposuction or treated. Exilis not only treats the deep- before liposuction as an alternative
est layers, but rejuvenates the skin therapy,” she said. “Overall, my pa-
even tried before when treating the upper levels of the tients and staff alike are excited about
dermis, for less wrinkles and better the device’s technology and the results.”
liposuction as an skin tone.”
David B. Vasily, M.D., a dermatolo-
alternative therapy. Dr. Wexler has used Exilis for fat gist and director of Aesthetica Cosmetic
reduction and skin tightening, as well and Laser Surgery Center in Bethlehem,
Overall, my patients as in patients who are not candidates Penn., was hesitant to embrace RF tech-
for liposuction because of skin laxity. nology. “I’ve never really been that
and staff alike are Post-liposuction patients are also can- excited about RF systems, preferring
didates for treatment due to laxity or lasers instead. My experience with RF
excited about the irregularity. “Patients with small areas and the feedback I had received from
that would be high risk for surgery many of my colleagues who also used
device’s technology and patients afraid of surgery can RF was that it had delivered some re-
also benefit,” Dr. Wexler said. sults, for some people, some of the
and the results.” time. Therefore, RF was not a predict-
Before treatment, Dr. Wexler ar- able, consistent type of device.”
ranges a patient consultation, takes
photographs, measurements and weight, However, Dr. Vasily was attracted to
and discusses patient expectations of Exilis because he felt the device ful-
the procedure. Patients are also in- filled a missing niche in aesthetics.
structed to drink three liters of water “Exilis allows us to achieve some skin
the day before treatment, the day of tightening, non-invasive wrinkle reduc-
treatment and the day after. Four tion and body contouring,” he said.
treatment sessions are scheduled sev- Exilis offers a new approach to RF. “I
en to ten days apart, with light physi- liked some of the safety controls – the
cal activity in-between. “As early as advanced cooling and temperature
Arm before Tx the second treatment, patients can feedback. If you lose contact with the
see one inch of improvement, skin skin, the RF energy shuts off, so you do
tightening and textural change,” Dr. not risk any burning,” Dr. Vasily point-
Wexler related. ed out. The temperature feedback is
particularly advantageous “for deeper
If the patient perceives pain during applications.”
treatment, the power is adjusted, “but
the temperature is maintained within Dr. Vasily was also impressed by
the therapeutic range at all times,” Dr. the engineering of the device, “allow-
Wexler said. “Exilis is very user-friend- ing for flat-top, smooth delivery of the
ly because there is one temperature thermal energy, as opposed to spiky
range that is desired, and the screen heating and delivery with most other
Arm after four Exilis treatments
is easy to use. The variables are few RF devices. This delivery method, com-
Photos courtesy of Peter Hajduk, M.D.
and there are minimal disposables.” bined with the cooling and feedback,
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4. allows for optimized delivery of energy of four to six sessions, but more optimized
and enhances safety. As a result, Exilis results often occur one to three months
is able to address all compartments of after the treatments are completed.”
the skin: superficial to deep.”
When the peak temperature of around
“I was amazed at At Aesthetica, the primary usage of
Exilis to date has been facial applica-
41° C is attained, patients “feel a little
transient heat,” Dr. Vasily said. “Some
the reduction in some tions. “Results are amazing. In fact,
Exilis is probably the most pleasant-
people absolutely love the feeling and
actually fall asleep during treatment. It
very coarse elastotic surprise device I’ve ever had,” Dr.
Vasily noted. “I started evaluating the
seems to be very well tolerated and no
anesthesia is used.”
rhytides on the device in older individuals because
traditional wisdom established that it Besides being user-friendly, the ergo-
nomics and handpiece of Exilis “are
face and tightening would be useful in people up to age
70. However, many women over age very nice,” Dr. Vasily pointed out. “The
handpiece is not too heavy and the
of neck skin.” 70 desire to look as good as they can,
but we are really limited in treatment workload on the joints and body is
options for this older age group. Results much less than with older endermolo-
in this group – including a number of gie type units, for example. Our Exilis
ladies in their mid to late 80s – have is on from morning until evening, every
been just remarkable. It’s been very, day of the week. It is incredibly popu-
very rewarding. Many patients had se- lar.” Dr. Vasily’s staff also enjoys Exilis.
vere solar damage, also known as “It is a fairly easy treatment for them to
elastotic wrinkling. Patients have been perform and the device is fun to use,”
thrilled with the outcomes.” he continued. “More importantly they
like the patient feedback. Standard
Initially, patients scheduled a treat- feedback from patients is that skin
ment session about once every seven looks very pretty, with nice texture and
to ten days, for a total of four sessions. tone. Patients then want other body ar-
61 year old patient before Tx
As early as one month after starting eas to be treated, and they refer
treatment, “I was amazed at the reduc- friends. Exilis markets itself through
tion in some very coarse elastotic rhyt- word-of-mouth.” Dr. Vasily has also
ides on the face and tightening of neck successfully treated post-partum skin
skin,” Dr Vasily said. One woman laxity of the belly with Exilis, as well as
close to age 90 began treatment one the abdomen.
month before attending her grand-
daughter’s wedding. “She looked fab- Since there are no expensive dis-
ulous for the wedding.” posables, “you have a lot of latitude
61 year old patient three months after four Exilis treatments in pricing,” Dr. Vasily advised. “This
Photos courtesy of David B. Vasily, M.D. “Some people see results after just is very affordable treatment.” The pro-
one or two sessions, while others need cedure can also be performed year
to wait a few months after completing round. “During the summer, it is typi-
a series. For facial wrinkling, results cally much harder to schedule photo-
are noticeable after two treatment ses- facials and laser hair removal because
sions and certainly within one month patients are tan, so revenues drop off,”
after completion. However, tightening Dr. Vasily said. “However, Exilis can
of facial laxity typically takes slightly be safely used on tanned patients.”
longer. You may see results by the com-
pletion of a treatment series consisting
6 THE Aesthetic Guide January/February 2011 www.miinews.com