First Exilis treatment. Just 4 min. Enough?

Question

I had my first Exilis treatment today. Areas treated/m: lower abdomen for skin laxity and arms for stubborn fat. Each area took only 4 min. On my tummy the power was set to 100 and for my arms 70-80. Are these parameters ok?And are 4 min sufficient? I read so much and almost everybody sais the treatment lasts 30-45 min?

J. Jason Wendel, MD, FACS · Answer

Thank you for your question in regards to Exilis. The settings on the Exilis machine will vary depending on the area that is being treated. Although it doesn't seem like 4 minutes is an adequate amount of time for that specific area. To be sure what is best for you, see two or more board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have treatment. I hope this helps.

Marek Kacki, MD · Answer

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.

Manish Khanna, MD, FRCP(C) · Answer

Hi Alighnt,As far the parameters, they seem to be within the range of what is typically done. We start a little higher and then lower the energies as per the patient's comfort level. However, 4 minutes is not a sufficient treatment time. We have treated very small areas for 10 minutes (around the knee cap for example) but typically arms are treated for 15 minutes each and a lower abdomen for approximately 20 minutes. If the area requiring treatment on the lower abdomen is very small then we could possibly treat for 15 minutes but 4 minutes is insufficient. I would indeed discuss this with your provider if you are certain that you were treated for only 4 minutes as it is not enough time to stimulate collagen (for skin tightening) or to destroy fat cells (for fat reduction).Best of luck, Manish Khanna, MD

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