1. By Bob Kronemyer, Associate Editor
2 THE Aesthetic Guide May/June 2012 www.miinews.com
Physicians and patients interested
in a non-invasive aesthetic procedure
that is affordable, pain free and ef-
ficacious for body shaping and skin
tightening need look no further than
Exilis from BTL Industries, Inc. (Boston,
Mass.). This appealing monopolar,
focused radiofrequency (RF) device
provides for precise delivery of ther-
mal energy that can be uniquely tai-
lored to every individual body. Exilis
is also being used with complemen-
tary modalities and leading skincare
products to enhance outcomes in an
anti-aging program.
According to Robert Weiss, M.D.,
an associate professor of derma-
tology at Johns Hopkins University
School of Medicine in Hunt Valley,
Md., “the Dynamic MonoPolar fea-
ture of Exilis allows you to actually
target areas where you need more
tightening or more fat reduction.
Exilis can also target fat and then
tighten skin in the same area, all
with a few power and cooling-depth
adjustments. These capabilities dis-
tinguish Exilis from other monopolar,
bi-polar and multipolar RF devices.”
Dr. Weiss also noted that treatments
can get intense but are nearly pain
free for most patients. “They feel a
very tolerable, warm sensation and no
topical anesthetic is needed,” he said.
From a plastic surgery perspective,
“Exilis helps complete our armamen-
tarium,” said Marc Salzman, M.D.,
F.A.C.S., director of the Salzman
Institute of Cosmetic Surgery in
Louisville, Ky. “Patients come in who
are surgical candidates and want
surgery – be it a face-lift, an arm lift
or a tummy tuck, but there are quite
a few patients who either cannot,
for medical reasons, have surgery,
or don’t want a surgical approach,
Robert Weiss, M.D.
Associate Professor of Dermatology
Johns Hopkins University School of
Medicine
Hunt Valley, MD
Exilis Offers Tailored Treatments for
Body Shaping, Skin Tightening and Anti-Aging
clinical roundtable
Marc Salzman, M.D., F.A.C.S.
Director
Salzman Institute of Cosmetic Surgery
Louisville, KY
Abdomen before Tx
Abdomen after Exilis Tx
Photos courtesy of Marek Kacki, M.D.

2. THE Aesthetic Guide May/June 2012 www.miinews.com 3
Posterior bra area before Tx
Posterior bra area after four Exilis treatments
Photos courtesy of Jeanine Downie, M.D.
out of fear or due to downtime. In
the past, we held our hands up and
said there was not much to be done.
Now, with one device we can con-
tour the body – make the fat layer
thinner – and heat the skin to effect
healing with a tighter skin envelope.
There is no other device on the mar-
ket that does both well. We can
tighten the skin of the face and neck,
and remove fat around the hips – all
with a single modality, thanks to the
controlled depth of Exilis RF.”
The economics of offering Exilis
treatment also benefits both practi-
tioner and patient because the only
disposable is a $3.00 single-use
ground pad.
David Vasily, M.D., a derma-
tologist and director of Aesthetica
Cosmetic and Laser Surgery Center
in Bethlehem, Penn., is enthused
about Exilis’ crucial role as part of
an anti-aging program that does
not entail a costly consumable. A
monthly regimen should result in,
“ongoing reduction of coarse wrin-
kles, a further decrease in fine and
coarse lines and less laxity,” he con-
veyed. “I think the most remarkable
improvement has been in the texture
and tone of the skin. It becomes very
pretty, pores are reduced, color and
texture also gets better. The change
is striking.”
In addition, Exilis is ideal for some
older patients who cannot undergo
invasive or micro-invasive therapy, Dr.
Vasily noted. “We have used Exilis on
women in their late 70s and into their
80s, with very nice improvement.”
Furthermore, an infrared gun to
gauge temperature, which is still
needed with most competing devic-
es, is now a thing of the past, thanks
to Exilis’ built-in temperature sensor
in the handpiece for easy reading
and heat titration. “This keeps the
temperature from becoming too hot,
which adds to safety, comfort and
consistent efficacy,” explained David
McDaniel, M.D., F.A.A.D., director
of the McDaniel Institute of Anti-
Aging Research in Virginia Beach,
Va. “One of my complaints about
some of the older modalities was the
lack of consistent results, which af-
fects patient satisfaction.”
For Bruce Katz, M.D., director of
JUVA Skin & Laser Center in New
York City, N.Y., Exilis has become
his treatment of choice for non-inva-
sive body shaping and skin tighten-
ing for the body and face. “Popular
areas to treat are the jowls, the
neck, the arms, abdomen, thighs,
and even around the knees a bit,”
he said. “You can also use Exilis for
eyebrow lifting.”
“I think the most
remarkable improvement
has been in the texture
and tone of the skin. It
becomes very pretty,
pores are reduced,
color and texture also
gets better. The change
is striking.”
David Vasily, M.D.
Dermatologist
Director
Aesthetica Cosmetic and Laser Surgery
Center
Bethlehem, PA
David McDaniel, M.D., F.A.A.D.
Director
McDaniel Institute of Anti-Aging Research
Virginia Beach, VA
Bruce Katz, M.D.
Director
JUVA Skin Laser Center
New York City, NY

3. 4 THE Aesthetic Guide May/June 2012 www.miinews.com
“Shortly after acquiring
my first Exilis in August
2010, I acquired a
second unit based
on the demand, its
diversity, and its ability
to be used year round.”
Angela Caponi, chief operating
officer at JUVA Skin Laser Center
added, “I absolutely believe that
Exilis is an important component of
our body shaping program. We have
over 55 lasers in the office, several
of which can probably treat the same
condition. However, Exilis is a win-
win situation. Treatment is very toler-
able; there is no pain at all. Other
RF devices have discomfort and
are not easy to delegate, whereas
patients feel comfortable with a
trained aesthetician or specialist per-
forming Exilis.”
Non-invasive technologies for
body shaping and skin tightening,
“are a reasonable alternative for
people who are concerned about
more invasive procedures like lipo-
suction,” said Miles Graivier, M.D.,
F.A.C.S., owner of Graivier Center
for Plastic Surgery and MedSpa in
Roswell, Ga. “Exilis is an additional
modality that can be used alone to
provide some body contouring, as
well as skin tightening. With the abil-
ity to focus the RF in the deeper fat
layers (up to 2.5 cm) and to tighten
the skin by heating the dermis, Exilis
allows for treatment of areas such
as the hips, arms, knees, abdomen,
back and bra fat.”
Moreover, Dr. Graivier uses Exilis
in conjunction with liposuction and
other body contouring procedures
to improve the results. “Using Exilis,
both pre- and post-liposuction, really
smoothes and tightens even further.
It also diminishes irregularities and
touches up slight bulges,” he said.
Editor’s Note: In the following clinical
roundtable, six aesthetic physicians
share their knowledge and clinical
expertise with Exilis. Together they
bring decades of experience with
Exilis and other body shaping de-
vices and procedures.
How does Exilis fit in your
overall practice?
Dr. Vasily – Increasingly, my office
is servicing a population of patients
who need skin rejuvenation, yet can-
not afford downtime, even for a few
days. In this economy, patients are
afraid of losing their jobs. Exilis fits
the bill. A person can return imme-
diately to their workplace, and we
have seen virtually no complications
from treatment. Young women with
postpartum “baby belly” have also
seen significant tightening with Exilis,
when committing to a series of six to
eight sessions.
Shortly after acquiring my first
Exilis in August 2010, I acquired a
second unit based on the demand,
its diversity, and its ability to be used
year round.
Ms. Caponi – Besides using Exilis
for skin tightening in the facial area
and abdomen, many patients want
their flabby arms treated. At our
practice, the device has taken over
a large portion of our aesthetician’s
clinical roundtable
Miles Graivier, M.D., F.A.C.S.
Owner
Graivier Center for Plastic Surgery and
MedSpa
Roswell, GA
Angela Caponi
Chief Operating Officer
JUVA Skin Laser Center
New York City, NY
Arm before Tx
Arm after Exilis Tx
Photos courtesy of Bruce Katz, M.D.

4. THE Aesthetic Guide May/June 2012 www.miinews.com 5
“We have observed
results after the third
session such as
circumferential reduction
in the abdomen area.
For skin tightening, a
significant difference
will likely be noticeable
after the second or third
treatment.”
clientele. Since it is so easy and
safe to use, I am comfortable with
my staff doing all the treatments.
Overall, Exilis was very easy to add
into the practice.
What is your treatment pro-
tocol and what kind of results
are you seeing with Exilis?
Dr. Weiss – Results far exceeded
our expectations in an initial 30 pa-
tient study for treating the jowls and
neck for rhytides, laxity and submen-
tal fat pad reduction. Patients under-
went four sessions, spaced seven to
ten days apart. We were particularly
impressed with the tightening of the
jowls and improvement of the con-
tour of the neck. Significantly less
laxity was observed in 14 of 15 pa-
tients, and most showed a reduction
in the submandibular fat pad. Arm
contour patients also achieved an
average circumferential reduction of
2.1 cm on each limb.
Dr. Salzman – Four to six treat-
ments, performed weekly, are usual-
ly necessary to achieve measurable
amounts of non-surgical fat reduc-
tion and skin tightening.
Dr. Graivier – The treatment pro-
tocol for Exilis has evolved as I’ve
performed more and more proce-
dures with this technology. Initially,
we started with about four treat-
ments, usually separated by seven
days to two weeks. However, now
I’m recommending four to eight
sessions, again separated by 7 to
14 days, for body contouring and
skin tightening. The procedure it-
self only takes about 20 to 30
minutes per area, so it is not labor
intensive and it is quite comfort-
able for the patient.
Dr. Katz – Patients often need four
treatments at one week intervals. A
lower-face session takes about 20
minutes and patients are very hap-
py with the results. We achieve sig-
nificant tightening and some nice
sculpting. At times I also use Exilis
after liposuction for additional fat
melting and further tightening.
Ms. Caponi – Generally, patients
commit to approximately four to six
sessions, spaced one week apart.
We have observed results after the
third session such as circumferential
reduction in the abdomen area. For
skin tightening, a significant differ-
ence will likely be noticeable after
the second or third treatment. I have
not seen anyone come back after
their initial series of treatments be-
cause quite honestly they have been
very happy.
Dr. McDaniel – Anti-aging patients
with skin laxity and contour irregu-
larities undergo four sessions at 10
to 14 day intervals. Patients begin
to see some improvement early on,
but we think the full result takes up
to four to six months from the last
treatment. You notice improvement
in skin texture and smoothing, not
just tightening and lifting. The col-
lagen synthesis likely improves for
three or four months.
Dr. Vasily – I was hugely surprised
early on when I noticed that Exilis
not only helped with the obvious,
but there was significant improve-
ment in the texture, tone and color
of photodamage and aging skin.
We honestly were not anticipating
that. As a result, my colleagues and
I began using Exilis exclusively for
wrinkles, lines, dyschromia, etc., on
patients who could not afford down-
time. Over the past 18 months, Exilis
Before Tx
After Exilis Tx
Photos courtesy of David Vasily, M.D.

5. 6 THE Aesthetic Guide May/June 2012 www.miinews.com
“Over the past 18
months, Exilis has
evolved into a go-to,
non-invasive device for
skin rejuvenation.”
has evolved into a go-to, non-inva-
sive device for skin rejuvenation.
An initial series of six sessions of
Exilis, seven to ten days apart, is
scheduled, depending on the indi-
vidual patient and the amount of skin
laxity. A full facial takes about 45 min-
utes. Lately, we are doing more in the
malar area of the cheek since we find
that by lifting and tightening that area,
we can achieve a nice, youthful look.
What makes Exilis so
effective?
Dr. Katz – As with other RF de-
vices, Exilis produces heat in the
tissues, which stimulates collagen
production and leads to skin tighten-
ing. In essence, RF increases rota-
tion of water molecules in the tissue.
RF is also colorblind, so you can use
it on all skin types.
Dr. Graivier – In order to achieve
body contouring, the deeper lay-
ers of fat must be addressed. Using
Exilis’ cooling system allows focused
RF energy to reach the deeper lay-
ers of fat. This has been validated by
animal studies monitoring heat of the
dermis and the deeper levels of heat
generated, along with clinical studies
using three-dimensional circumferen-
tial measurements.
In your opinion what are
the cost benefits of Exilis
treatment?
Dr. Katz – For physicians, having
virtually no consumables is a big
plus. Our patients are very happy
with the return on investment.
Ms. Caponi – At JUVA Skin Laser
Center, we charge $400 per treat-
ment, per area. For instance, treating
the abdomen, arms and cheeks would
be $1,200 per session. It takes about
two hours for all three areas.
Dr. Weiss – Since there are no
costly consumables or expensive
tips that need replacing, treatment
is more affordable. The tip itself is
metal so it can be easily disinfected
between patients.
Dr. Salzman – You’re talking $3.00
for a disposable ground pad. So if I
have to give it away, for whatever rea-
son, I’ll let my nurse do follow-up treat-
ment for the price of the disposable.
Competing modalities may cost $300
to $400 in just disposables per session.
Dr. Vasily – By offering a series of
treatments, package pricing is avail-
able, so patients receive a discount.
Plus, you don’t have to factor in an
expensive disposable, whether it be
a tip or a handpiece. Physicians have
been “disposabled to death” over the
last few years. It is so refreshing that
with Exilis you don’t have this so you
don’t have to work disposables into
your pricing structure.
Dr. McDaniel – For many of our pa-
tients, it is really difficult in this economy
for them to afford the cost of some of
the competing treatments. We charge
$400 a session for a region of the
face. A package of four sessions total-
ing $1,600 is still significantly less than
some of our other treatment options.
Can you comment on the
safety profile of Exilis?
Dr. Weiss – Energy Flow Control
(EFC) is a safety feature stemming
clinical roundtable
Neck before Tx
Neck after Exilis Tx
Photos courtesy of Marek Kacki, M.D.

6. THE Aesthetic Guide May/June 2012 www.miinews.com 7
“The device is 100%
safe. We have had
zero safety incidents –
no burns, no arcing, no
discoloration of skin.
Exilis is 100% benign.”
from the proprietary grounding pad,
which allows the device to check the
resistance of the skin. For example,
if there is a sudden spike in energy,
due to encountering a different area
of skin or improper contact, EFC will
shut off the energy. It also reduces
the risk of temperature reaching
too high, which can cause burning
or blistering. Compared to other RF
devices, Exilis allows you to safely
use higher power settings for deeper
heating without serious discomfort.
Due to the cooling system, we find
that Exilis patients are able to toler-
ate the higher temperature for a bet-
ter result.
Dr. McDaniel – I tell patients that
Exilis treatment feels a bit like a hot
stone massage. Although it can feel
hot, the heat is very transient and
moves around, avoiding the inten-
sity of some other treatment modali-
ties. The cooling system of Exilis is
also quite good compared to some
of the older devices.
Dr. Salzman – The device is 100%
safe. We have had zero safety inci-
dents – no burns, no arcing, no discol-
oration of skin. Exilis is 100% benign.
How do you incorporate Exilis
into an anti-aging program?
Dr. Vasily – Near the beginning of
the cycle, patients start using topi-
cal anti-aging skincare products.
Sometimes, Exilis is coupled or al-
ternated with other non-invasive, no
downtime treatments. We also discuss
with patients the possibility of a peri-
odic Exilis session to maintain results.
As for efficacy, on a molecular
level, the monopolar RF of Exilis
induces factors that create new
collagen and elastin. We also see
epidermal improvement, which is ex-
tremely interesting and surprising. A
lot of patients have shown a signifi-
cant reduction in actinic bronzing
and solar lentigines.
Dr. McDaniel – Our office uses a
variety of topical skincare products
from the start. Maintenance therapy
for Exilis ranges from once every
three to six months to once every
other year. The most common ad-
junct therapies for maintenance with
Exilis are dermal fillers and neuro-
modulators, which are particularly
in demand by middle-aged and
older patients. I typically arrange to
inject dermal fillers / modulators a
few weeks earlier than Exilis.
It’s like a tug of war. The fat loss is
pulling you down to look older and
saggy, whereas Exilis is pulling you
upward to look younger and firmer.
Hence, the rate of that fat loss and
continued extra laxity of your skin,
to some extent, determines the fre-
quency of maintenance.
Dr. Weiss – For anti-aging treat-
ment, I like the fact that we can fo-
cus on areas of the face and neck
that need the most improvement,
such as jowls and “turkey neck”, not
only for skin tightening but for some
smoothing as well.
Before treating patients for reju-
venation with Exilis, my staff and I
assess a patient for surface texture
and saggy skin. The treatment plan
typically consists of an initial series
of three to four sessions, spaced
about two weeks apart. After an
initial series, patients can expect
a clinically significant reduction in
tightening of the jowls and smooth-
ing of the neck. The results-to-price
ratio is very favorable. In addition,
Neck before Tx
Neck three months after Exilis Tx
Photos courtesy of Hartsough Dermatology Clinic

7. 8 THE Aesthetic Guide May/June 2012 www.miinews.com
if patients have numerous superfi-
cial wrinkles or pigmentation issues,
Exilis may be combined with other
treatment modalities, such as frac-
tional laser resurfacing or intense
pulsed light (IPL). Since there is only
a slight bit of redness that occurs
from Exilis, other treatments can be
performed on the same day, imme-
diately after.
A single maintenance treatment
of Exilis is scheduled on average
once every 12 to 18 months, often
in conjunction with injection of a
neuromodulator, hyaluronic acid
or other dermal fillers; again, with
Exilis first. We try to avoid using
any form of energy over the neuro-
modulator once it is injected in the
skin because we do not want any-
thing to interfere with the effect of
the injection.
A topical growth factor product
is also recommended for ongoing,
daily home-use, starting the first day
of the initial series of Exilis. These
products enhance collagen produc-
tion by helping to activate fibro-
blasts. With Exilis, you are drawing
more fibroblasts into the areas that
you treated, so these topicals boost
that effect. Combining a growth fac-
tor with Exilis causes a significant
improvement in skin smoothing.
Besides a growth factor product,
patients are also encouraged to use
a topical containing vitamin C.
With nearly two years of experi-
ence with Exilis, I have actually seen
excellent clinical results for its anti-
aging effects. We know treatment is
delivered deep enough to affect sub-
cutaneous tissue and cause skin tight-
ening. Overlap of Exilis treatment for
anti-aging and self-improvement is
common. People come in and say, “ I
see that I am aging. What can I do to
improve the way I look?” A woman
may comment that she is starting to
look like her mother. Exilis is part of
our program to reverse aging or the
effects of gravity over time.
Compared to other energy-
based body shaping treat-
ment modalities, what unique
advantages does Exilis offer?
Dr. Salzman – With Exilis, you are
not limited to an area that fits in an
applicator, as with cryolipolysis. You
can treat as many 7 inch by 5 inch
areas as you desire, and the areas
can overlap. In contrast, with cryo-
lipolysis, every one of those areas
take one hour. Low-level laser light is
another option, but it typically scans
the entire body, whereas Exilis is
more discriminating in targeting the
hills and valleys of fat distribution.
Dr. Weiss – One unique feature of
Exilis is that there are two applica-
tors that allow us to better treat the
face, neck and body. At our office,
the larger applicator has been suc-
cessfully used for body shaping of
the abdomen, arms and thighs. We
have also seen excellent results for
skin tightening, overall body shap-
ing and wrinkle reduction.
Dr. Katz – I like that you can vary
the depth of the energy with Exilis.
Not only can you tighten the skin, but
also attain some fat sculpting as well.
Any pearls of wisdom to en-
hance the efficacy of Exilis?
Dr. Weiss – Clinicians should be
aware of the temperature of the skin
and have a good idea of whether
they are targeting fat or skin laxity
clinical roundtable
“With nearly two
years of experience
with Exilis, I have
actually seen excellent
clinical results for its
anti-aging effects.”
Before Tx
After Exilis Tx
Photos courtesy of Marek Kacki, M.D.

8. THE Aesthetic Guide May/June 2012 www.miinews.com 9
or both. Exilis also allows you to
dwell over an area that you want to
focus on; meaning it can be applied
over those areas that require more
contouring for a longer period.
Dr. Salzman – A post-operative
upkeep regimen for incisional face-
lift patients consists of dermal fillers
three to six months after and the con-
tinuation of Exilis so that the elastic-
ity stays and does not regress and
recur. Exilis is a way of keeping that
patient in your practice. However,
you need an operator who is pas-
sionate about doing treatment cor-
rectly and achieving the best results.
Dr. Graivier – I think the two
pearls I have learned with Exilis
are that we can cause improved
contour by focusing the RF gener-
ated heat deeper in the fat layers
and we can tighten skin by focus-
ing on the dermis. For example, we
usually start by treating the deeper
fat because with Exilis technology
we are able to cool the skin and
drive the heat to these deeper lay-
ers. Cooling the surface to varying
degrees allows for more precise tai-
loring of the depth of heat penetra-
tion. Then, after driving the heat
deeper, we remove the cooling and
heat the dermis to stimulate col-
lagen synthesis in the skin. These
steps allow for a combination of fat
contouring and skin tightening.
Additionally, doing more treat-
ments, approximately four to eight,
in shorter time frames – one to two
weeks apart – appears to yield bet-
ter results.
Dr. Katz – Training is crucial for
efficacy. The people at BTL are
great at training staff to use Exilis
properly. Not only do they train
staff well, but they are in touch
with them on a regular basis about
updates for even better outcomes.
A lot of other companies don’t do
that. Once you buy a device, you
don’t hear back. With Exilis, our
staff stays motivated because they
feel BTL is interested in their pro-
grams and how patients are re-
sponding to treatment.
Exilis is truly a user-friendly and pa-
tient-friendly technology for achieving
really nice results for skin tightening
and body shaping.
How do you predict Exilis
will evolve in the future?
Dr. Graivier – In the future, I expect
Exilis will increase its penetration
depth and strength, so heating can
occur somewhat faster as tempera-
ture is the endpoint we are trying to
achieve. This will make for quicker
treatment times and decreased op-
erator fatigue.
Dr. Vasily – I anticipate that at our
center, and likely in others as well,
Exilis will play an ever-increasing
role as a cornerstone of anti-aging
because of favorable pricing, the
lack of complications and down-
time, and the fact that it is a painless
procedure with very nice results. The
staff can also perform the procedure
with a minimal learning curve.
Dr. McDaniel – A new indication
for Exilis is the hands, which I will
soon begin treating based on the
impressive findings of a European
dermatologist. In a beach resort
area like Virginia Beach, people’s
hands have really taken a beating.
If your face looks out of sync with
your hands, your hands betray
your age.
“Training is crucial for
efficacy. The people
at BTL are great at
training staff to use Exilis
properly. Not only do
they train staff well, but
they are in touch with
them on a regular basis
about updates for even
better outcomes.”
Gynecomastia before Tx
Gynecomastia after Exilis Tx
Photos courtesy of Marek Kacki, M.D.