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Monopolar radiofrequency

Monopolar radiofrequency

Ms Marie Duckett explains how she uses the Exilis Elite to treat fat, lax skin and cellulite

The Exilis Elite is a monopolar radio frequency machine which offers treatment of fat, of lax skin and of cellulite. It has little or no downtime—little because, similar to after a facial treatment, clients have difficulty applying makeup immediately because they’re red and hot.

How does it work?
It works very simply, by delivering heat without discomfort. We try and keep our patients somewhere between 8.5 and 9/10 on a comfort level. It seems to be the easiest way of establishing where they are on that score. The utilisation of the cooling tip gives a lot of flexibility when fat busting sufficient temperature is needed to bust fat cells. The constant monitoring of the temperature being achieved is very important for the treatment outcome. Clinically-proven neocollagenesis, tightens the skin and creates the contouring that we require. The treatment can be used on the face using the device’s small facial head and on the body – for example on the stomach, using the body head.

We found that the optimal number of treatments for the average under 50 for skin tightening and contouring is four. We will do six on someone over age 50. The device can be used for body contouring, or fat busting, using the large body head and using cooling to get to the right level to burn the fat away.

Ten degrees cooling is the coolest setting and this will penetrate down into the deep fat layers. With increases in the temperature you work more superficially, so at 25 degrees in much more superficial layers of fat.

With the cooling setting off, the treatment is to the dermis—so this is skin tightening as opposed to fat busting. The beauty of being able to switch between the two when treating patients is that very often, a reduction to fat content increases skin laxity in that area. So, a fat busting treatment can be immediately followed by a skin tightening treatment to make sure the skin is kept looking sufficiently taut.

There are two applicators: the body piece, which has an extremely useful inbuilt thermometer or temperature monitor. Your treatment opportunities lie between 40 degrees Celsius and 43.2, which is regarded as the mean temperature for the pain threshold. Below 40 degrees, apoptosis does not occur and nor does skin tightening. Maintaining a 40-degree temperature for at least five minutes is necessary—so to know what temperature your patient is at is really important.

The body piece is used predominantly for the larger area. The facial applicator doesn’t have a temperature monitor on it, so we now have a laser thermometer that we use. This has proved to be very interesting. You set up your machine to allow sufficient time to get the treatment area up to the optimum temperature. I now check the temperature with 5 minutes left on the clock. If they have not reached 40 degrees, I add more time in order to get the best results.

For the décolleté, we will often use the body piece for skin tightening because it’s a nice, large area, particularly large on some ladies. It gives it an ease of movement on a larger area.

Treatment areas
Exilis works by remodelling collagen. In the simplest terms, the heat causes the unravelling of the collagen fibres. The body recognises this unravelled collagen and is stimulated to produce new collagen. The device promotes neocollagenesis and then remodels that collagen, in order to create good, strong, young collagen again and give clients back the skin firmness and tone that’s been lost.

At 12 weeks post-the fourth or sixth session, depending on how many that they have, is when optimum results are visible. However, one of the first things that patients notice is an improvement in the quality of their skin before they notice the improvement in the tightness and the tone and the firmness of their skin. The larger the area, the more sessions needed. So doubled up sessions may be needed to cover the required area.

An absolute hate amongst so many women is the “fat back syndrome” and the overhanging bra lines and we can create really lovely results here. This is closely followed by bingo wings, where even on somebody with a high degree of laxity there is a distinct improvement following the treatments.

It’s also possible to treat excessive fat in the male breast, and although it wasn’t originally thought that it would treat cellulite it’s now proving to be extremely useful in its treatment. In fact, it is now FDA approved for this treatment and it makes a lot of sense – Exilis tightens the skin and improves the tone. Young people respond better, because they produce better collagen and more collagen than people who are significantly older.

It’s a great treatment around the eyes. It’s a quick treatment—just make sure you ensure patients remove all their eye makeup. I tighten above the brow, across the brow and then under the eye, so it’s three passes backwards and forwards under and three passes backwards and forwards over.

The Evidence
We have plenty of evidence to show that dermal remodelling and the neocollagenesis can make a significant difference. There is a thickening of the dermis, which is obvious and the evidence of the subcutaneous interstitial collagen, which is also improved greatly. The fat cell reduction is evident after just one treatment, and following the fourth treatment that’s even more obvious.

Anywhere there’s skin, you can tighten skin and you can improve the skin.

Lower jaw and neck can be treated together as one treatment area, so that you get the pull between the two areas and you get that beautiful re-establishment of the jawline. I treated one lady in her 60s who showed a distinct improved—you could actually start to see her jaw line and a reduction in her skin laxity and a great improvement in her neck. Very often they do double treatments in America rather than doing four single treatments—so one treatment and then a treatment immediately after. Our preference is to do a single treatment once a week. Two-week intervals just makes it a lot longer before they get their final result, which is always a pity.

Summary
Results with Exilis are dependent on two factors. One is the right choice of patient; if you feel you have a patient who is not going to be compliant and drink the amount of water that you want them to drink, then don’t even entertain it. You won’t get the results and you will just waste many hours of your time. Your own expertise is the other really crucial factor.

When you first start using this machine—or any machine—your first 20 patients, are probably going to be a big learning curve for you. The more competent you are and the greater the co-operation you insist on from your patient, the greater the likelihood that you will get the results that both you and your patient want.

Ms Marie Duckett is a Registered Nurse and has a wealth of experience in the area of medical aesthetics specialising in facial rejuvenation using dermal fillers and skin care.  She currently runs a successful clinic in London’s Harley Street.

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Author: bodylanguage

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