Exilis Elite

The three go to procedures are Thermage, Ulthera and Exilis Elite. The Exilis Elite is newer, more affordable and most promising of the three and early data suggests it may be slightly more effective. Exilis is the most comfortable to have done. Ulthera tends to be the most painful and Thermage is the most expensive of all 3 treatments for a similar result.

Exilis is the only monopolar RF (Radiofrequency) system to incorporate ultrasonic energy in one hand piece. Exilis causes both shrinking of loose tissue immediately, as well as long term collagen production that lifts and tightens loose skin over time. It is very useful in many areas such as jowls, neck, brows and especially the abdomen.

The mechanical effect of ultrasound helps create separation of the fat cells clusters, allowing more efficient RF thermal delivery to adipose tissue. Exilis is the only monopolar RF (Radiofrequency) system to incorporate ultrasonic energy in one hand piece.

Exilis Elite features a dynamic monopolar RF delivery system with embedded Energy Flow Control (EFC) technology to uniformly heat tissue at therapeutic skin levels. It also offers built-in temperature sensors in an attempt to reduce the energy to levels that will effect therapeutic heating without causing excess pain. The Exilis is the most promising of the new RF devices and gives the best tightening results after five or six sessions.

The Exilis uses the same technology as Thermage, a powerful mono polar Radiofrequency. Exilis also includes ultra sound technology to maximize treatments.

There are currently two methods of radiofrequency delivery to skin: Dynamic (the Elite) and Static / Stamp (Thermage) delivery systems.

Dynamic Monopolar Delivery (Elite): At Skin & Body Renewal we have the Exilis Elite which uses a monopolar RF that is delivered dynamically in a continuous pulse with constant rotation and movement of the handpiece over a specified area of laxity or fatty adiposity. The problem area can be targeted in a few minutes to reach an optimal temperature. This optimal temperature is then kept for approx 6 to 8 minutes period of time to maximize results. The surface temperature measurements are continuously monitored due to Energy Flow Control (EFC) technology which uniformly heats tissue at therapeutic skin levels. This ensures that adverse side effects such as burns are eliminated. In addition a measurement tool is built into the Elite handpiece. Dynamic devices such as Exilis are quicker to reach optimal temperature (a few minutes) unlike stamped devices such as Thermage which can take hours.

Stamped / Static Monopolar Delivery (Thermage): Other Monopolar devices such as Thermage deliver radiofrequency in a stamped mode which consists of a short cycle of 1-2 seconds while the handpiece is held in place (Thermage Solta Medical) over a designated area. In the static stamped method, a single pulse is then delivered; the handpiece is then moved to an adjacent marked area and fired again. This is performed for hundreds of pulses until a premarked area is treated. Treatments with Thermage can take up to 3 hours as each pulse is measured for temperature while spray cooling is applied so the skin temperature does not exceed 45.

To summarise the differences between these two systems:

Exilis has Monopolar energy flow control combined with ultrasonic energy delivered in a dynamic method, a safety system, a built-in thermometer for total therapy control (no risk of overheating) with optimal temperatures been reached in minutes.

Thermage has Monopolar energy which is delivered in a stamp mode with single firing until hundreds of pulses are delivered which can take up to 3 hours for a treatment.

Thermage, with in it's most recent update, the CPT cooling tip probably works as well as the Exilis but the two treatments have the following similarities and differences:

Similarities:

• Exilis uses the same technology as Thermage, a powerful monopolar Radiofrequency for which it pays a 5% royalty to Solta, the company that produces Thermage, for its use.
• Exilis and Thermage both are used for skin tightening on the face, neck, decollete and body.
• Both cause immediate skin tightening together with long term collagen formation post treatment and further skin tightening in 3 to 6 months when new collagen remodels.
• Both improve deep lines and wrinkles.

Differences:

• Price Face / Neck / Eyes: Thermage is much more expensive per treatment for the consumer due to the expensive disposable tips that has to be used and the length of the treatment which has to be performed by a trained medical practitioner. An average Thermage treatment to treat jowls and upper neck and eyes will cost from R16 000 to R27 000 depending on the aesthetic clinic and more than one treatment may be needed. The average price of the Exilis on the face ranges from R1550 For eyes; R2450 for jowls and neck; up to R3650 for full face. The price depends on how many areas are treated in one session.
• ️Price Body: Thermage for skin tightening Stomach ranges corm R24 000 to R32 000. Treatment length varies between 90 mins to 3 hours. The average price for Exilis is charged per area body and is from R 2450 per area. The Exilis has no disposables thus making the treatment more affordable for patients.
• Results are seen instantly with Exilis. Patients schedule four sessions, two to four weeks apart. Noticeable results may be seen after one session versus other technologies where you have to wait. Major changes in body contouring and skin tightening occur after the first and second treatment session and are maintainable. With other technologies you have to wait anywhere from six weeks to three months before you see results. However, it is important to note optimal results will be achieved only after the third or fourth treatment.
• Number of treatments needed: with Thermage, one treatment may not be enough for skin tightening and one may require additional treatments 6 months down the line at an additional cost. For Exilis: 2 to 6 treatments may be needed depending on the extent of sagging.
• Pain factor: the original Thermage was not a comfortable treatment and thus the Solta company has introduced a cooling tip CPT (Comfort Pulse Technology) to make the treatment more bearable for the patient.
• Treatment depth: Exilis has EFC (Energy Flow control), a built in cooling tip combined with ultrasound and thus can heat very superficially which is perfect for skin tightening or it can go to depths of 25 mm (2.5 cm) which is great for fat reduction. Thermage can only go to a depth of 7 mm. Ulthera can only go to a depth of 1.5 mm, 3mm and a maximum of 4.5 mm.
• Treatment period: Exilis, a dynamic delivery treatment takes 12 to 20 minutes to do as opposed to Thermage, a stamp delivery which can take up to 3 hours to do.
• Exilis includes ultra sound technology which is combined with its powerful Mono polar Rafiofrequency technology to maximize the flow of energy, lipolysis of fat cells and tightening of collagen. Thermage only has monoploar Radiofrequency.
• Exilis has a built in cooling tip and heat sensor monitor which ensures that optimal heat is delivered as painlessly as possible and as safely as possible. This allows for maximal patient comfort, results and safety.
• Exilis has a built in saftery feature - it is one of the few RF devices where if you lose full contact with the skin, the machine will shut off, so there is no risk of any uneven contact with the skin which may result in burns as with other RF devices.
• Exilis has a built in temperature measurement system which Thermage has not had. This makes the process of achieving the clinically significant heat levels objective instead of subjective.
• Exilis has Energy Flow Control (EFC) technology which uniformly heats tissue at therapeutic skin levels.
• The Exilis Elite system has another fail-safe in that it automatically adjusts energy levels as it senses tissue density and depth changes, so more energy would automatically be employed in the cheek area where there is more tissue, and less around any bony structure so as to prevent any over heating.
• Exilis Elite is a two in one treatment which can be applied in the same treatment. It has a fat reducing and a skin tightening component thanks to its powerful monopolar radiofrequency combined with ultrasound and powerful epidermal cooling tip. Heating of the deeper tissues is accomplished by leaving the cooling on. You can then turn off the cooling to treat laxity. With RF alone, you can achieve both body contouring and skin tightening, which is something that is unique to Exilis. Normally, you would need to use two different systems.
• Exilis is a Quicker treatment. Compared to competing body shaping and skin tightening devices, Exilis “is quicker”. A 20 minute session with Exilis is equivalent to a session lasting 40 minutes to 2 hours with other technologies.

All three devices (Thermage, Ulthera and Exilis) work best on people ages 25-50-ish who have mild to moderate skin laxity. Ultherapy / Ulthera in it's most recent update, probably works as well as the Exilis but has the following differences:

• Price: Ulthera is much more expensive per treatment for the consumer due to the expensive disposable tips. Average price of treatment ranges from R10 000 to R18 000 per treatment depending on the aesthetic clinic and more than one treatment may be needed. The average price of Exilis is priced from R1 500 to R2 500 and 2 to 6 treatments may be needed. Ulthera – between R6 000 and R30 000 per ️Treatment depending on area chosen and aesthetic clinic.
• Treatment time: A typical treatment to treat the jowls and upper neck with Ulthera takes 60 min. An Exilis treatment takes between 12 and 20 minutes depending on how many areas are being treated. If one treats the full face including forehead, eyes, cheeks, jowls and neck, then the treatment will take 60 minutes.
• Pain factor: Ulthera is much more painful than the Exilis Elite as Ulthera has no epidermal cooling to block pain receptor transmission to the brain and pain medications and anti-anxiety medications are usually required to complete a treatment. The Ulthera treatment is extremely painful and In order to finish the treatment, it may be necessary to reduce parameters and/ or interrupt the treatment. In addition, for an Ulthera treatment, lots of time is necessary for the application of topical anesthetic and then for the anesthesia to work.
• Number of treatments needed: The promised result after Ulthera will be achieved within 3 months. The results after Exilis are seen immediately and further results can be seen 3 to 4 months down the line when new collagen remodels and tightens. One treatment of Ulthera may be all that is necessary, depending on the laxity of the skin; however, an evaluation after 3 months is suggested to see if an additional treatment is indicated. According to overseas experts who have used both Exilis and Ulthera technologies, Ulthera may require additional treatments to get a similar effect (one Ulthera treatment may not be sufficient for skin tightening) and a further treatment 6 months down the line an additional Ulthera treatment may be needed at an addititional cost. Exilis needs 4 to 6 treatments depending on the laxity of skin and the amount of adipose / fat tissue present.
• Exilis Elite is a two in one treatment; reducing fat and tightening skin thanks to it powerful monopolar Rafiofrequency technology (which it pays a royalty to the Thermage company for its use) combined with ultrasound technology for optimal flow of energy and heating. This fat reducing capability can treat resistant fat such as a double chin and skin tightening all in one treatment.
• Treatment Depth: Ulthera only reaches maximum 4 mm depth into the skin whereas the the Exilis with its EFC energy Flow control Technology and epidermal cooling allows heating to a depth of 25 mm or 2.5 cm.
• Ulthera does not have fat reduction capabilities as the heat produced is too superficial to cause fat lipolysis. This is particularly important for a fatty double chin and /or fatty jowls where one needs to reduce fat in addition to skin tightening in the same treatment for the same price.
• There is no true downtime with Ulthera; however, swelling and redness may be visible for several hours and some patients develop bruising and some have numbness that may last for several weeks post Ulthera treatment.
• Ulthera is not FDA approved for the body. It is only FDA approved for the face and neck.

The following areas can b done for both FAT reduction and SKIN tightening:

• Upper abdomen ● Lower Abdomen ● Love handles
• Anterior thighs ● Lateral thighs ● Posterior thighs. ● Inner thighs
• Inner knees ● Cankles
• Upper Arms (bat wings) ● Bra bulges ● Back fat ● Hands
• Arms with excess laxity can lose an inch or more within 3-4 treatments typically
• Vulva treatments (see below)

The medical use of RF is based on an oscillating electrical current that forces collisions between charged molecules and ions, which are then transformed into heat. Water is the main target for this process. As a result, RF heating occurs irrespective of skin type and is dependent on heating of water.

RF-generated tissue heating has different biological and clinical effects, depending on the depth of tissue targeted, the frequency used, and the specific cooling of the dermis and epidermis.

The depth of penetration of RF energy is inversely proportional to the frequency. Consequently, lower frequencies of RF, such as Exilis, are able to penetrate more deeply (up to 2.5 cm) and heat large volumes of subcutaneous adipose tissue, the dreaded resistant fat.

What happens when radiofrequency is applied to the skin?

1. RF- mediated thermal stimulation of the matrix in the skin results in an immediate change in the helical structure of collagen causing a tightening effect.
   
2. RF thermal stimulation results in a microinflammatory stimulation of fibroblasts, which produces new collagen (neocollagenesis) and new elastin (neoelastogenesis), as well as other substances to enhance dermal structure.
3. RF thermal stimulation of adipose tissue results in a thermal-mediated stimulation of adipocyte metabolism resulting in release of fat from cells, ie fat reduction.
4. RF thermal stimulation also causes apoptosis of fat cells ie permanent fat cell destruction.

RF devices tend to market themselves as monopolar, bipolar or multipolar RF devices. Monopolar energy (such as Exilis) travels from the handpiece to a distant pole and requires a grounding electrode that is applied to the body. It penetrates up to 25mm, affecting both skin and subcutaneous fat.

Bipolar energy only travels from one pole on a handpiece to another, penetrating only 2mm to 4mm into the skin.

“Both work by causing bulk heating of the deep dermis,” says James Muze, vice president of development at Syneron Candela. “Bipolar uses symmetrical electrodes that can control the distribution of energy between the two and, more specifically, confine it to dermal structures when appropriate.

Tripolar is a marketing term, not a scientific term. Devices with three or more poles use bipolar electrodes that switch between active pairs and inactive pairs.The tripolar system has three electrodes: one acts as a positive electrode while the other two act as negative electrodes creating two pairs of a bipolar system.

Dr. McDaniel recently completed one arm of a study on the Exilis Elite’s 90 Watt applicator, which involved 12 female volunteers with mild-to-moderate laxity of the skin around the submental region, mid and lower face. “All subjects showed at least mild improvement in skin laxity at the three-month point,” he noted. In a study done 3 months after Exilis treatments, skin biopsies taken from underneath the chin in subjects demonstrated new collagen formation in all biopsies. In addition, an increase in dermal elastin fibers was also observed in the biopsies.

Monoploar Radiofrequency usually penetrated more than 3 mm but in the Exilis, up to 2.5 cm can be reached due to built in Energy Flow Control (EFC) technology and built in cooling. In fact, if one cools at 10 degrees C, the heating can go up to 2.5 cm due to advanced layered cooling. Layering simply means that energy is delivered to the various depths in the tissue. The applicator is designed so that you can make changes to the power and cooling right on the display. Changing the cooling during treatment allows you to treat deep tissue for fat reduction all the way up to the superficial layer for skin tightening and all in one treatment session.

For Thermage, the monopolar Radiofrequency only goes up to a depth of 7mm because it doesn't have Layering Advanced Cooling.

The Ulthera treatment only goes up to a maximum of 4.5mm.

The FDA approved the Exilis in 2013. While the primary focus of all of this devices is body contouring and fat reduction, the Exilis also has a skin-tightening component appropriate for the face, neck and body.

Exilis is a WINNER of three INTERNATIONAL AWARDS in 2013 for skin-tightening.

1. My Face My Body award for best skin tightening device November 2013. Thousands of NewBeauty Magazine readers and the industry's leading beauty experts.

2. Exilis won the award for Best Skin Tightening Product at The Aesthetic Show in Las Vegas in 2012.

3. IESG award in 2014 for best skincare equipment.

New Beauty editorial team cast their votes in the 2013 New Beauty Awards. In the category of “The Best Skin Tightener” Exilis Elite ranked higher than any other product. Reasons this procedure is loved by the masses include:

• Exilis is a non-invasive procedure,
• It can be used on any part of the body or face,
• Results can been seen after just a few treatments,
• It is a highly affordable treatment.

The Exilis has a Revolutionary built in cooling tip and heat sensor monitor which ensures that the optimal heat is delivered as painlessly as possible and as safely as possible. This ensures that the treatment switches off immediately should it be inadvertently lifted during the treatment session. This usually happens when treating uneven and curved surfaces such as the jawline area. The Cooling tip confuses the brain to not recognize pain signals as the epidermis is continually cooled.

No pain medication or anesthesia is needed during the session.

Neck and jowl fat can be treated at the same time as the skin tightening procedure. The fat reducing head is used on the double chin area for fat reduction as well as skin tightening.

It is very important to note: The number of Exilis Fat reducing and skin tightening treatments needed depends on the amount of resistant fat / cellulite / sagging present, and will be different for each individual patient.

• 2 to 3 cms of fat (+ FAT) needs 2 -4 sessions
• 3 to 5 cms of fat (++ FAT) needs 4 to 6 sessions
• 5 cms and above of fat (+++FAT) needs 6 to 8 sessions
• Body Fat reduction and Skin Tightening is charged per area. Exilis treatment is priced per area for 20 minutes per area.
• Upper abdomen ● Lower Abdomen ● Anterior thighs ● Lateral thighs ●Posterior thighs. ●Inner thighs ● Inner knees ● Cankles
• Upper Arms (bat wings) ● bra bulges ● back fat ● love handles ● Hands ● External Vagina
• PER AREA:
• Single session 20 mins R2450; Second area same session 40 mins R3650; Third area same session 60 minutes R4850.

What we are currently recommending is one treatment every two to three weeks with a minimum of four treatments, and then we’re waiting approximately three months and, if need be, we do a follow-up treatment. A further 2 to 4 treatments can be done and then a maintenance treatments every 6 months.

• At Skin, Body & Health Renewal, our team of trained doctors are not only passionate about healing your skin and treating your body problems but more importantly making sure that you have the best health possible! We achieve this by investigating underlying internal conditions that may be precipitating body and skin problems.
• At Body Renewal, our group of in house trainers have perfected the protocol of the Exilis for skin tightening and fat reduction procedures to ensure the best possible results in as few a treatments as possible.
• At Skin & Body Renewal, we incorporate a holistic approach into all our consultations. The initial consultation with your Skin & Body Renewal doctor will include a holistic / functional approach to your problem, be it loss of collagen and sagging, resistant fat pockets such as a double chin or excess abdominal fat. Medical problems/ conditions will be identified and medical recommendations given. If necessary, a consultation with one of our integrative doctors will be arranged.
• Ageing signs: Patients with menopausal ageing with loss of collagen etc will be advised on Bio identical hormone replacement or a replacement with alternative supplements.
• Excess fat deposits: Common and significant medical problems will be identified. Patients with a double chin or excess fat on the abdomen may have metabolic syndrome, diabetes, hypertension, hypothyroidism or sleep apnea amongst others. These will be identified and treated prescribed.
• For cellulite: A patient with cellulite will also be given advice and recommendations on how to improve possible underlying problem such as unopposed oestrogen, an over taxed liver or gut problems which are all associated with cellulite.

Exilis is an great solution for men and women who desire to tighten their skin on the body and the face, and rejuvenate their appearance. Exilis is actually one of the most successful non invasive treatments to traditional liposuction as the Exilis not only tightens skin but also reduces fat in the treatment area. Our doctors will ensure that you are a good candidate which means and that your weight is stable and that you are generally healthy. You should be able to maintain the results of an Exilis program if you eat healthily from that point on and also exercise regularly.

Exilis relies on the body’s own regenerative process to stimulate the natural renewal of existing collagen and creation of new collagen. This results in an actual lift of skin overtime – and just better-fitting skin.

Many people notice an immediate effect following the treatment, but the ultimate lifting and toning takes place over 2-3 months, as tired collagen is renewed and replaced with new, stronger collagen. And, as collagen-building process continues, further improvements can even appear up to 6 months following a procedure!

Common and significant medical problems that patients with a double chin or excess fat on the abdomen present with are metabolic syndrome, diabetes, hypertension, hypothyroidism or sleep apnea, amongst others. We have numerous solutions to treat the aesthetic problem of excess fat but more importantly we have to exclude these medical conditions which are common in overweight or obese patients. A consultation with one of our experienced doctors at Skin, Body & Health Renewal will identify underlying medical problems and recommend aesthetic and medical solutions.

"It can be eloquently summed up that in my practice with 45 devices the only device that we required a duplicate to meet demand has been Exilis. Most of our patients (90%) have been thrilled with the results. Not getting this device in your practice would be the worst mistake anyone could make. What more can I say?" Dr. Robert Weiss. Associate Professor of Dermatology, Johns Hopkins University School of Medicine Hunt Valley.

"Treatment is extremely affordable for most patients, given the results. Overall, my patients and staff alike are excited about the device's technology and the results." Dr. Patricia Wexler, Associate Clinical Professor of Dermatology, Mount Sinai School of Medicine New York City, NY.

"My patients are very happy with the consistent, reproducible results. Fortunately, they are not keeping this a secret and have been sending me new patients, or adding more areas of treatment for themselves." Jeanine B. Downie, MD.

"The Exilis device has been an impresive tool in collagen recontouring in my opinion. I have noted positive changes in the patients I have treated. My patients have tolerated their procedures well and are pleased with the results." Neal B Schultz, MD

"Exilis delivers visible results, with no downtime and no side effects, in a truly predictable fashion. The advanced Peltier Cooling allows for much deeper penetration, without damaging the epidermis. In my opinion, BTL invested in a very wonderful and simple application of cooling. By manipulating the cooling system, you can predictably sculpt the body." Marek Kacki, MD, Visage MedArt, Nashville, TN.

"Our practice focuses primarily on non-surgical therapies and we have found Exilis Elite to be safe for skin of all colors, effective and easy-to-use." David McDaniel, MD, F.A.A.D. Director McDaniel Institute of Anti-Aging Research, Virginia Beach, VA.

"All things considered: cost, efficacy, patient satisfaction, reliability of hardware, Exilis has surpassed my expectations. The vast majority of our patients are happy with their results and will likely do a second and sometimes third area." Marc J. Salzman, MD, FACS, Luisville.

"I am convinced of the safety of the procedure and the reliability of the device after working with it for several months and several hundred treatment sessions. The clinical support and training we received was excellent and personalized and we are thrilled with our decision to offer this treatment option to our patients." John B. Turk, MD, Facial Plastic Surgeon, New York City, NY.

"I have never had any technology in my office that has been as popular. For me, this is RF redefined." Mary Lupo, MD, Dermatologist, New Orleans, LA.

"Most important, the patients are happy with the results and are booking other areas of treatment. They love that there is no downtime and they can return to work, home, or exercise immediately after each procedure." Lori G. Polacek, MD, Plastic and Reconstructive Surgery.

"My experience with skin tightening dates back to the use of IPL with long wave filters and YAG lasers. Since then, we have used a variety of devices to help improve skin elasticity. In the last three or four years, the Exilis and Exilis Elite have been the most popular skin tightening procedures in my practice, with the greatest patient satisfaction." Amir Moradi, MD, Facial Plastic and Reconstructive Surgeon, San Diego, CA.