Did the Exilis machine change? Why are old reviews pretty bad but recent ones report good results?

The initial Exilis was  delivering suboptimal power through its facial applicator - 50W. I had an opportunity to evaluate the next  prototype delivering 70W and eventually 90W. This power allows to treat much larger area with effective heating. The new device, Exilis Ultra, provides two sources of energy - radio-frequency as well as ultrasound. Interestingly, the Exilis machines in Europe had ultrasound module available long before this device became available in the US. Many initial units here had ultrasound module installed but disabled.
Overall, Exilis and Vanquish, both manufactured by BTL, can provide magnificent and consistent results but that requires rather strict technique and parameters that may go beyond the protocol. 

There have 3 Exilis machines. The first one did not have enough power on the face handpiece and had results that were less than favorable in many patients. In 2013 we had an upgrade to Exilis Elite and this machine worked quite a bit better. Some docs retained their old machine and therefore results even at that time may vary. In 2017 another upgrade came out, Exilis Ultra. This added ultrasound to the radiofrequency and it is the only machine that combines both of these modalities. The results we have been seeing are the best of any of the machines we have had yet. I expect the reviews to continue to improve as more physicians get familiar with the new machine. The most important thing with any of these machines is the "time on tissue." What I mean by this is that we have seen that the more time the tissue is heated for the better the result we are able to obtain. We have also seen that extending the time between treatments for facial skin tightening to 2 to 3 weeks rather than the 1 week recommended by the manufacturer will give better results. For the fat reduction capabilities of Exilis the time frame of 1 week seems adequate but in my practice we are seeing better fat reduction with ther other BTL machine called Vanquish...this too has an upgrade to Vanquish ME (Maximal Energy) so be sure to go to a practice that offers the newest technology.

For some time now, MGMD Dermatology has been offering Exilis Elite treatments, an exciting technology using radio frequency to deliver high energy in a controlled fashion to the dermis of the skin, causing collagen remodeling and a tightening effect. We have been obtaining fabulous results with the Exilis Elite and are excited that BTL, the maker of the Exilis system, has now introduced Exilis Ultra.
Exilis Ultra adds ultrasound to the radio frequency technology increasing efficacy.  With ultrasound the therapeutic treatment temperature is reached faster, increasing the skin tightening and fat burning effectiveness of Exilis Ultra treatments.  Exilis Ultra also enables easier treatment of difficult to treat areas, including slack upper arms.  

Yes, the Exilis device has evolved in order to become more effective. The Exilis Elite handpiece is able to deliver a higher level of power without increasing discomfort and pain for the patient. Exilis elite gives better results when 3-4 treatments are performed. It specifically stimulates collagen and elastin production resulting in firmer skin. With most nonsurgical procedures, a combination of procedures is recommended. It is not uncommon for fillers to be required to restore volume, Botox/Dysport for wrinkles, peels or laser for skin tone and texture and skin tightening.