Treating skin laxity requires little different parameters then fat reduction. The initial protocol for treatment of face and neck called for 4 min. treatment of each area. This, however, was far from being adequate so treatment parameters have changed. There are many individual protocols used in order to provide the best possible results. In general, I begin treatment with maximum power and avoid any interruption of the procedure for any reason including adjustments . This is of key importance in fat reduction. There is really no reason to adjust power during Exilis treatment; once area heats up to the edge of patient's tolerance the applicator is moved for a brief moment outside of the treated area (without losing contact with skin) then immediately returned to the same area. By doing so one can extend the field maintaining maximum tolerated heating. Although skin surface temperature is displayed in real-time there is no mathematical correlation between temperature of skin and adipose tissue. Moreover, in the same patient different areas of the abdomen may have different temperatures of the targeted fat. I have done multiple treatments with thermocouples inserted into the fat layer at different depths in order to measure temperatures and compare it to skin surface temperature as measured by the device. The difference I found ranged from 1.3 C up to 5.3 C. Therefore, we do most of the fat reduction treatments assuming that the increase in fat temperature is only 1.3 C - 1.5 C above the surface's. Based on this assumption, our treatments are much longer than protocol suggests, we use maximum energy throughout the session and the only limitation we observe is patient's tolerance of discomfort. As many have pointed out, an adequate hydration is a must in order to optimize this tolerance.
