The desire for fat reduction is ubiquitous and a large number of methods exist from dieting to surgery to achieve it. While liposuction and bariatric surgery are all effective means of fat removal and weight reduction respectively, they are not equivalent and have very different outcomes. But they do share the similarity of being invasive surgery. And many people understandably want to avoid surgery for fat removal if possible. This has led to a large number of non-surgical devices that are currently available for use.

One of these devices is Exilis, coined as a body shaping and tissue tightening method. Exilis is an FDA-approved devices that employs radiofrequency (RF) energy for the reduction of targeted fatty deposits, skin tightening and sundamaged and wrinkled skin anywhere on the face and body. Radiofrequency energy is a safe form of radio waves that drives heat to fat cells that lie within one inch of the skin’s surface. This heat causes the metabolism of the fat cells to speed up and subsequently shrink. The heat also stimulates the skin to strengthen its collagen structure which provides some improvement in skin laxity.

Because it creates heat that passes into and through the skin, does it cause pain during a treatment? Generally it does not. While the RF energy is heating the skin, the system monitors the skin’s temperature  so it does not get too warm and the patient remains  both safe and comfortable. A grounding pad is also applied prior to treatment so there is no chance of arcing and causing a burn. Patients usually feel a deep heating sensation as the probe goes over a treatment area. Treatments last around 15 minutes per treatment area and are done in the office. Other than some mild redness of the treated areas for a few hours, there are no sequelae after treatments including any restriction of physical activities.

Which are the best areas for Exilis treatments? Regardless of body area, whether a man or a women, it is important that the amount of fat not be too excessive. While the definition of ‘excessive fat’ varies, a general rule is that if it is much bigger than one or two hand sizes, it will not be as effective as one would like. Most women are interested in face and jowl tightening and fat reduction of the abdomen, arms, flanks, bra rolls and thighs. Men have more restrictive needs involving the abdomen, flanks and chest.

Exilis always involves more than one treatment, it needs a series. The number of treatments will depend on the areas treated and whether fat reduction or skin tightening is the main objective. In most cases, four treatments will be needed spaced one or two weeks apart. The final outcome of the treatments may take two to four months to see the maximal benefits of the therapy.

Despite the appeal of Exilis and many satisfied patients, it is important to realize that no non-surgical fat reducing technology works for everyone. There is always the risk that no or limited results will be seen. For this reason, it is most ideal to go to facility or a plastic surgeon who performs all methods of fat removal and skin tightening. Their recommendation will be noteworthy because they are not captive to the monthly lease payment of an expensive device. They can offer the best treatment method, even if it is a surgical one that the patient is trying to avoid.

Dr. Barry Eppley

Indianapolis, Indiana

Liposuction provides the most effective method of body contouring that we currently know. Its invasive approach is the direct subcutaneous disruption of fatty deposits followed by their vacuum extraction. The final result is a combination of the fat removed and how the overlying skin shrinks and adapts to its reduced underlying support structure. While effective, it is fairly traumatic to the tissues and substantial recovery is required in most cases.

Because of the desire to avoid liposuction surgery, the field of non-invasive body contouring has emerged in the past decade as an alternative treatment option. These are device-driven technologies that direct and drive various types of energies into the underlying tissues in an effort to either shrink fat, tighten skin or both. One of these energy technologies is that of radiofrequency. Known by the acronym RF, radiofrequency is the oscillation of electrical currents at radio frequencies. In essence, it is another name for radio waves which is one form of electromagnetic energy. Radiofrequency energy has been used in medicine for well over fifty years in such applications as radiofrequency ablation of tumors and magnetic resonance imaging to create images of internal structures of the human body.

The power of RF and its ability to penetrate tissues is a function of its wavelength (distance covered by one cycle of the wave) and its frequency. (the number of waves passing a given point in a second) The wavelength multipled by the frequency equals the speed of light. The frequency of RF energy is expressed in Hertz Units. (one Hz = one wave/second)  One thousand waves equals one kilohertz (KHz), one million waves equals one megahertz (MHz) and one billion waves equals one gigahertz. (GHz) Most RF waves are in the range of about 3 KHz to 300 GHz. As a common comparison, microwaves have radiowaves in the frequencies of 300 MHZ to 3 GHz. Exilis has RF energies in the 2 MHz range which can be seen to be just a fraction of the energy emitted by a standard kitchen microwave. Such wave oscillations affect underlying tissues by causing their molecules to vibrate creating a heating effect. The depth of wave penetration is ultimately controlled by the amount of power (watts), wavelength and the heat generated by the treated tissues. The Exilis device has been shown to penetrate up to 2.5 cms (one inch) below the skin. 

Exilis treatments are delivered through a handheld wand device known as a transducer. It is a monopolar RF device that will rapidly heat up tissues, known as the therapeutic thermal temperature. The safety of the device is the real time monitoring of the skin’s temperature so it does not become too hot/burned. This allows the maximum of power to be delivered with reasonable comfort. A liquid gel interface between the skin and transducer is critical as well as the technician keeping the transducer head in motion based on the skin’s temperature.  The software of the Exlis device has a unique energy flow control feature so that it eliminates energy peaks to ensure more uniform energy distribution. It is these energy peaks, which if uncontrolled, that can lead to intermittent patient discomfort.

RF wave stimulation breaks down the well known triple-helix structure of collagen in the dermis of the skin. This unraveling by the focused energy is followed by healing of the dermis through the creation of new collagen by fibroblast production. This accounts for the skin thickening and skin tightening effect. It is not yet known whether thinner or thicker skin is more influenced by this RF-induced collagen remodeling. Fat within an inch of the undersurface of the skin is affected by cell breakdown of the adipocyte walls. The RF waves cause weakening of the fat cell walls which results in extrusion of their fatty acid content. The released lipids are naturally absorbed and eliminated by the lymphatic system which is why high daily water intake is recommended during the treatment period. With loss of some of their content, the fat cells shrink reducing the overlying skin contour. With this penetration distance limitation, areas of thinner fat will respond more rapidly and effectvely than thicker areas to Exilis treatments.

The key to getting skin tightening and far reduction effects with RF energy is the periodic ‘re-injury’  of the target tissues. This means that multiple treatment sessions are needed that are not spaced too far apart. (one to two weeks) For both skin and fat it is important to not give them adequate time to completely heal their structures. The fat cell walls need to be repeatedly weakened for maximal content release. The fibroblasts of the skin dermis benefit by repeated heat stimulation for collagen production. Exilis effects are continuous meaning that their full benefits can take several months to see. Although many patients report see benfits as early as after the first treatment.

Dr. Barry Eppley

Indianapolis, Indiana

As the latest statistics published by the American Society of Plastic Surgery show in 2010, the fastest growing procedures in cosmetic surgery are not surgery at all. Rather it is such non-invasive procedures as Botox, injectable fillers and focused and high-intensity light face and body treatments. This is a trend that has been ongoing now for the past decade and shows no sign of slowing down anytime soon. Recent studies also show that up to 25% of people would have some form of cosmetic surgery if cost and recovery were not an issue.

Whether it is to avoid the costs and recovery of more expensive surgery or to treat cosmetic problems for which there is no good surgical solution, non-surgical treatments continue to expand. One such area of expansion is the use of light-based and energy therapies. From skin tightening, fat reduction or the the improvement of cellulite, treatment options appear as often as new devices become clinically available. While light-based treatments were once thought of as just laser devices, used largely for skin resurfacing and hair reduction, this is no longer the case. Energy-based devices are now available that uses infrared light, ultrasound, and radiofrequency waves, technologies that long have had FDA-approved uses in diagnostic and therapeutic traditional medicine.

One such recent device is that of Exilis. This is a monopolar radiofrequency device that has recently received FDA clearance for localized fat reduction and skin tightening. With penetration depths that past the skin level by a few centimeters, stubborn fat deposits can be treated even over large areas. The radiofrequency waves disrupt the membranes of the fat cells by the generation of heat causing them to spill their lipid contents. As the liquid fat is absorbed over time, the size of the fat deposit becomes less. Exilis treatments are done in the office as walk in and walk out therapies requiring no downtime or recovery. It takes a series of 4 to 6 treatments spaced a week apart to see the best results.

The radiofrequency of Exilis also has a skin tightening effect. By heating the underside of the skin (deep dermis) through the radiofrequency energy, collagen is produced which causes the skin to tighten. This is particularly effective in the face, the jowls and neck, where the skin and underlying tissues are thinner. Because lower energy levels are used, it feels very much like getting a hot stone massage. Since the production of collagen is more gradual, treatments need only to be done every two weeks for two to three months. Some may call this a RF (RadioFrequency) Facelift as it can tighten the face without surgery.

Another energy device example is that of Sciton’s SkinTyte device. As part of their multimodality laser platform, Skin Tyte is high intensity pulsed light known as BBL. (broad band light) By stacking pulses of light over a treatment area, the underside of the skin is heated. This also produces collagen and a skin tightening effect very similar to that of Exilis. Unlike Exilis, however, its energy does not penetrate deep and no fat reduction effect is achieved. As the name implies, it is a non-surgical method of skin tightening.

While Exilis can do fat reduction and Skin Tyte can not, this begs the question as to whether Exilis or SkinTyte is better for skin tightening. It s unknown at this time as to how these technologies compare for their effectiveness. Since my practice has both technologies, I will be able to answer this question better in the future as greater numbers of patients are treated.

Dr. Barry Eppley

Indianapolis, Indiana   

Device-based energy therapies for skin tightening and fat reduction have been around now for about a decade. Like computer and all electronic devices, their effectiveness improves with technologic advances. One of the recent device advances in heating fat and tightening skin is Exilis technology. This uses a well known energy technology, radiofrequency, to create its effect. But its advantages are based on modifications to radiofrequency in how it is delivered.

Exilis uses radiofrequency which is basically sound waves that are delivered into and through the skin. Traditionally radiofrequency is delivered in a bipolar fashion which penetrates little further than the thickness of the skin. But Exilis’s uniqueness is that it is monopolar radiofrequency which allows the waves to penetrate deeper and deliver more energy to dissolve fat cells. By using a grounding pad on the patient, the radiofrequency is applied deeply and it does a return circuit back to the machine. The skin temperature is also monitored to make sure it never gets too hot (above 45 degrees C) to prevent skin damage and make it comfortable for the patient. In addition, Exilis has a proprietary technology called Energy Flow Control (EFC) which monitors the energy level to prevent burns and any energy arching if skin contact is not ideal.

While many non-invasive energy therapies have left physicians skeptical, Exilis is FDA-approved for tightening skin and reducing wrinkles. The heat generated in the dermis of the skin causes collagen production, generation of collagen networks and tightening of skin. Fat reduction has also been reported by both doctors and patients alike. The deeper penetrating heat can cause fat cells to break down (lipolysis), release their free lipids and shrink in size. This results in an external change in the size of the body part.

The application head of Exilis and its built-in cooling device make it possible and safe to treat loose skin and excess fat anywhere on the body. This could be as diverse as the neck and jowls, back of the arms, bra rolls, stomach and all the way down to the knees. The ability to ‘spot treat’ is a major advantage over other more cumbersome devices. Each treatment is not only safe but is not painful. Most patients equate an Exilis treatment similar to a hot stone massage due to precise temperature monitoring. It can be used to treat all skin types which is another advantage of the device.

Because the temperature and the duration of generated heat to any part body is controlled for safety, multiple treatments are needed and results gradually achieved. Exilis treatments are done in a series of 4 to 6 treatments spaced one to two weeks apart to get the best result. Treatments are done in 30 to 45 minute sessions with no pain during and no downtime afterwards. One can go right back to their regular activities without any change in routinue.

For those patients receiving treatments for fat reduction, we advise drinking lots of water after the treatments to flush out fat through enhanced lymphatic flow. Combined with regular exercise and a niacin-based supplement known as Curva, optimal fat reduction can be achieved.

Results from Exilis are gradual although most see some immediate results. But maximum results takes months to see, up to three months after the last treatment. Studies have shown that the results are long-lasting.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana