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“ Body Sculpturing” Dr. P. Treacy Medical Director Ailesbury Clinics Dublin Ireland Olympia Conference 2006

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MEDICAL DISCLOSURE: <ul><li>Cosmetic Doctor presently registered in UK and Ireland </li></ul><ul><li>Previously worked in U.S., Australia, N. Z. and South Africa. </li></ul><ul><li>I purchased my own Velasmooth ® equipment. </li></ul><ul><li>I have no financial interest or stock in Syneron </li></ul><ul><li>I receive no additional remuneration for equipment bought by you after attendance at this lecture. </li></ul>

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Surgical operations for Body Sculpturing Liposuction or Ultrasonic Liposuction Abdomnioplasty Thigh and Buttock Lift Breast Augmentation

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Non-surgical procedures for Body Sculpturing Ultrashape ® Velasmooth ®

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“ Body Sculpturing with the Velasmooth®

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Focusing on treatment of cellulite with the Velasmooth®

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Focusing on treatment of cellulite with the Velasmooth®

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What is Cellulite? <ul><li>Cellulite is a term that is used to describe fat deposits under the skin that give the skin a dimpled like appearance. </li></ul><ul><li>It is estimated that up to 80% of women have a problem with cellulite. </li></ul>

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<ul><li>Cellulite is a term originally coined in European salons and spas in the 1970’s to describe deposits of dimpled fat found on the thighs and buttocks of many women </li></ul>The History of the term ‘Cellulite’

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<ul><li>P romotion of the concept in U.S. after publication of Cellulite: Those Lumps, Bumps and Bulges You Couldn't Lose by </li></ul><ul><li>Nicole Ronsard, the owner of a New York City beauty salon that specialized in skin and body care </li></ul>The Concept of Cellulite Grows

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Fat Layer of Skin <ul><li>The fat layer of the skin </li></ul><ul><li>is located in the subcutaneous layer of tissue known as the hypodermis. </li></ul>

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<ul><li>Strands of fibrous tissue connect the skin to deeper tissue layers and also separate compartments that contain fat cells. When fat cells increase in size, these compartments bulge and produce a dimpled appearance of the skin . </li></ul>The Physiology of Cellulite

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What happens during Cellulite? <ul><li>Cellulite is most often seen in women due to hormonal reasons. The fat is arranged in large chambers of macromolecules separated by columns of collagen fibres. </li></ul><ul><li>In people who are overweight excess fat is stuffed in these fibrotic compartments causing them to bulge out. </li></ul>

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What causes the skin ‘Dimpling’? <ul><li>The ‘ dimpling ’ is caused by modification of the texture of the subcutaneous tissue due to oedema and fibrosis secondary to impaired circulation and degradation of the tissue in this area. </li></ul>

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Skin ‘dimpling’ close up <ul><li>Cellulite is localised fat ‘ caught in a jail’ of interstitial connective tissue </li></ul><ul><li>Cellulite is a lack of drainage of fluid secondary to venous + lymphatic stasis because of genetic, hormonal and even environmental reasons </li></ul>

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1. HEREDITY 2. HORMONAL - premenstrual syndrome, 3. VENOUS and LYMPHATIC stasis 4. NUTRITION insufficient water intake - excess of sugars, fats What are the Causes of Cellulite?

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<ul><li>Stage 1 Problem seems to appear whenever you press skin </li></ul><ul><li>Stage 2 Dimpling of skin only appears as the patient stands up </li></ul>The Different Grades of Cellulite

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<ul><li>Stage 3 ‘ Peau de orange’ is present when the patient is lying down </li></ul><ul><li>Stage 4 You can actually feel knots in the tissue when you touch it </li></ul>The Different Grades of Cellulite

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The Physiology of Stages 1 & 2 <ul><li>Stage 1 and 2 </li></ul><ul><li>The problem only appears whenever you press skin or the patient stands up. This is caused by localised oedema secondary to vascular and capillary extravasation with dissociation of the adipocytes </li></ul>

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The Physiology of Stages 3 & 4 <ul><li>Stage 3 </li></ul><ul><li>‘ Orange skin’ is seen whenever the patient is lying down. This is caused by the formation of micronodules of both normal and larger adipocytes encapsulated by a network of collagen fibres </li></ul><ul><li>Stage 4 </li></ul><ul><li>The problem is present at all times because the micronodules fuse together to form painful subcutaneous macronodules . </li></ul>

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<ul><li>1996 Dr. Neil Solomon, conducted a double-blind study of 100 people to see whether cellulite differed from ordinary fat. </li></ul><ul><li>The pathologists found no difference between the two clinical types of fat </li></ul>The Medical Evaluation of Cellulite

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<ul><li>1998 , researchers at the Rockefeller Institute used ultrasound, microscopic examinations, and some fat-metabolism studies to see whether “cellulitic&quot; skin and normal skin differed </li></ul>1998 The Rockerfeller Institute

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<ul><li>The researchers concluded </li></ul><ul><li>(a) certain characteristics of skin make women more prone than men to develop cellulite </li></ul><ul><li>(b) there were no differences in the appearance or function of the fatty tissue or the regional blood flow </li></ul>The Rockerfeller Conclusions

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<ul><li>Products include special creams </li></ul><ul><li>gels, supplements, herbs bath </li></ul><ul><li>liquids, massagers, rubberised pants; brushes, rollers, body wraps, and toning lotions . </li></ul>The Market for Cellulite products

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<ul><li>“ Anticellulite&quot; products include tablets that work while you are awake and others that reduce cellulite….. while you sleep! </li></ul>Growing Market for Cellulite Products 135 million Europeans are overweight 50 million Europeans suffer from obesity This is an increase of 25% in ten years

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Body Wrapping <ul><li>The wrapping causes temporary water loss by compression and by perspiration. The water is quickly replaced within 24 hours . </li></ul><ul><li>Body wrap claims this technique works because ‘cellulite’ is really water logged fatty tissue.. </li></ul>

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<ul><li>Herbal Product developed by Italian chemist called Gianfranco Merizzi. Ingredients include compounds clover extract, evening primrose oil, fucus vesiculosis, bioflavanoids, soya lecithin, ginko biloba, iron oxide and fish oil. </li></ul>Cellasene ®

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<ul><li>1998, FDA approved a French technique called Endomologie, for temporarily improving the appearance of cellulite </li></ul>Endermologie ®

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<ul><li>Endermologie ® ambiguous reports </li></ul><ul><li>from clinical studies. Usually takes </li></ul><ul><li>10-20 treatments to see any effect. Monthly maintenance is required to maintain these effects. </li></ul>Endermologie ®

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<ul><li>Recent procedure for fat melting that is limited in its ability to break down septae and dimpling effect although it can be used in combination therapy with Velasmooth ® </li></ul>Lipodissolve ®

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<ul><li>During 1990’s treatments for cellulite remained largely unsuccessful because they targeted skin appearance. It soon was apparent that dimpling on the surface of the skin would require a deeply acting treatment . </li></ul>The Treatment of Cellulite

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<ul><li>VelaSmooth™ is the first medical device for the treatment of cellulite. Using the combined energy technology — Bi-Polar Radio Frequency and Infrared Light — plus tissue mobilization and suction to safely and effectively re-contour the skin surface </li></ul>Velasmooth ® FDA approved

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Velasmooth ® <ul><li>RF increases oxygen intracellular diffusion by heating adipose tissue to a depth up to 10 mm </li></ul><ul><li>Infrared Light increases elasticity of skin and heats subcutaneous fat to a depth of up to 3 mm, while safeguarding the skin from damage </li></ul><ul><li>Suction manipulates and smoothes out the skin </li></ul>

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Large Applicator 4 mechanisms : IR, RF, Rollers, Skin Curving (Suction) 3 intensity levels

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Small Applicator No rollers

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Velasmooth® in Practice <ul><li>Ergonomic applicator </li></ul><ul><li>Intuitive, simple interface </li></ul><ul><li>Sophisticated software controlling treatment parameters </li></ul>

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How does Velasmooth ® work? Vacuum pinches the skin and attaches it to the rotating electrodes

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Anatomy of Cellulite Fat cells swell and push upwards as septa are rigid Blood and lymph vessels are compresses Accumulation of intracellular fluids and toxins

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Mechanism of Deep Hyperthermia <ul><li>Infrared light heats the tissue up to 5mm depth </li></ul><ul><li>RF heats tissue from 5 to 15mm depth </li></ul>IR Lamp Parabolic reflector Infrared filter RF electrodes

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Deep Hyperthermia by IR + RF <ul><li>Infrared (IR) light heats the tissue down to the deep dermis </li></ul><ul><li>RF heats tissue down to the subcutis </li></ul>Lamp Parabolic reflector Infrared filter RF electrodes

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Mechanism of Increasing Blood Supply <ul><li>90% of blood vessels are closed at normal atmospheric pressure. </li></ul><ul><li>Decreasing the atmospheric pressure vessel cause dilatation and increases blood flow. </li></ul>

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Accelerates metabolic process Fat deposits caught in chambers of connective tissue (septae) create phenomenon of cellulite Velasmooth ® treatment destroys the fat by acceleration of metabolic process

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Rollers- Mechanical effect <ul><li>Rollers and Vacuum Suction (150 mbar or 750 mm of Hg) </li></ul><ul><li>Massaging effect facilitates drainage of trapped intercellular fluid to lymphatics </li></ul>

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Rollers- Mechanical effect <ul><li>Breaking connective tissue bonds also helps to reduce </li></ul><ul><li>volume of fat chambers in hypo-dermis </li></ul><ul><li>Brings target blood vessels closer to treatment heads </li></ul>

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Suction Mechanism increases blood supply <ul><li>90% of blood vessels are closed at normal atmospheric pressure </li></ul><ul><li>Decreasing the atmospheric pressure increases vessel dilation and blood flow </li></ul><ul><li>Thinning the cell membrane also helps in increased substance exchange between fat cells and vessels </li></ul>

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Suction helps Hyperthermia <ul><li>Suction brings the target closer to the IR and RF source </li></ul><ul><li>Target is the blood vessels in the deep dermis and in the subcutaneous fat layer and the tissue around </li></ul>

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Combined effect of energies shows effects after 10-12 sessions This leads to an improved skin appearance after about 10-12 sessions

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Vela Clinical Indications <ul><li>Temporary reduction in circumferences </li></ul><ul><li>Temporary reduction in the appearance of cellulite </li></ul><ul><li>Improvement in the local blood circulation </li></ul><ul><li>Improvement of skin texture </li></ul><ul><li>Relief of minor muscle aches and pain </li></ul>

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Vela Contra-indications <ul><li>Current or Hx of cancer </li></ul><ul><li>Pregnancy and nursing </li></ul><ul><li>Scarring , infection, or fragile skin at the tx. area </li></ul><ul><li>Hx keloid scarring </li></ul><ul><li>Patients with a pacemaker or internal defibrillator </li></ul>

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Contraindications <ul><li>Known photosensitivity to near infrared light </li></ul><ul><li>Use of medications known to induce photosensitivity, including Roaccutane, and anticoagulants </li></ul><ul><li>Diabetes (Type I or II), unless under control </li></ul><ul><li>Varicose veins in the treated area </li></ul>

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Vela Technical Specifications <ul><li>Infrared (IR) range 700-2000nm </li></ul><ul><li>RF power 30 W </li></ul><ul><li>IR power 30 W </li></ul><ul><li>Treated area </li></ul><ul><li>40x40 mm (for thighs, buttocks, and abdomen ) </li></ul><ul><li>25x30 mm (for arms, calf, under-chin, and face ) </li></ul>

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Vela Smooth Effect <ul><li>Re-contouring of skin surface by: </li></ul><ul><li>Increasing metabolic rate in adipose tissue due to: </li></ul><ul><ul><li>Increased blood supply </li></ul></ul><ul><ul><li>Increased oxygen diffusivity and exchange </li></ul></ul><ul><ul><li>Between blood vessels and fat cells </li></ul></ul><ul><li>Reduced fat chambers size due to: </li></ul><ul><ul><li>Reduced size of fat cells </li></ul></ul><ul><ul><li>Mechanical breakage of connective tissue bonds </li></ul></ul><ul><ul><li>Intercellular fluid drainage </li></ul></ul>

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Physiology of Velasmooth <ul><li>Increases substance exchange between fat cells and blood vessels </li></ul><ul><li>Increase rate of fat metabolic reaction </li></ul>

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O 2 Transport Coefficients in Water Hyperthermia increases diffusivity of oxygen and decreases skin viscosity delivering more oxygen from capillaries to mitochondrion 4.88x10 -5 0.467 60 3.99x10 -5 0.547 50 3.24x10 -5 0.653 40 1.97x10 -5 1.002 20 Diffusivity of O 2 [cm 2 /s] Viscosity of H 2 O [centipoises] Temperature O C

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Hyperthermia Effect on Rate of Metabolism <ul><li>Arrhenius law for yield of chemical reaction </li></ul><ul><li>Y=At e BT </li></ul><ul><li>Where A and B as constant, t is time and T is temperature </li></ul><ul><li>Rate of metabolic reaction is exponential function of tissue temperature. </li></ul>

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Treatment Schedule <ul><li>Number of treatments – 10-12 </li></ul><ul><li>Treatments frequency - twice a week </li></ul><ul><li>Supporting treatment - 1 to 3 months </li></ul><ul><li>Treatment duration 30-40min </li></ul>

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Typical improvement curve (based on C. Lee M.D. data) Strong effect Saturating effect Moderate effect

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End point of Cellulite Treatment <ul><li>Number of passes and levels of energy should be adjusted to obtain stable erythema over the treated area </li></ul><ul><li>Slow replacement of applicator or staying on one place not longer then 5 pulses </li></ul>

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Velasmooth ® Cellulite treatment

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Before and After 10 Velasmooth Treatments Before After

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Before and After 10 Cellulite Treatments

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Before After 12 treatments Velasmooth

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Velasmooth ® Cellulite

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Treatment areas <ul><li>Non-proportional Fat Distribution </li></ul><ul><li>Some parts of the body accumulate more fat and have to be treated more aggressively to improve body contour </li></ul>

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Treatment of Anchor Zones <ul><li>Even small reduction of fat in anchor zones significantly improves the body contouring </li></ul>

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Treatment of Anchor Zones <ul><li>The anchor zones should be treated at maximal settings </li></ul><ul><li>Average number of passes applied to the anchor zones should be higher that for rest of the body at least by 2 passes </li></ul>

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Dr. Christopher Ho, Vela

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Dr. Shah, Vela

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Dr. Shah, Vela

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Dr. Shah, Vela

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Tina Alster M.D. , Vela

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Dr. Shah, Vela

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Before After Body Contouring H. Akai, M.D. Tokyo, Japan

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Treatment of Post Liposuction Patients <ul><li>Improves the results </li></ul><ul><ul><li>Allows homogenization of adipose tissue </li></ul></ul><ul><ul><li>Improve healing process </li></ul></ul><ul><ul><li>Reduce loose skin </li></ul></ul><ul><li>Treatment technique </li></ul><ul><ul><li>Two passes with slow replacement of applicator or with staying on one place during 4-6 pulses </li></ul></ul><ul><ul><li>Two passes with fast moving the applicator with stronger pressing the skin </li></ul></ul>

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Dr. A. Del Giglio, Italy , Post Liposuction Treatment

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Hyperthermia Effect on Metabolism <ul><li>Heat produced by IR increases oxygen dissociation from oxy-hemoglobin in heated dermal blood vessels </li></ul><ul><li>Heat produced by RF increases rate of oxygen intracellular diffusion by deep hypodermal heating </li></ul><ul><li>Fat metabolic reaction in adipocytes mitochondria is increased </li></ul><ul><li>Use of stored energy from fat cells (lipolysis) results in shrinkage of cells themselves </li></ul>

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Treatment Protocol <ul><li>Treat thighs, buttock and abdomen with large applicator, and arms, calf, under-chin, and face with small applicator </li></ul><ul><li>~ 10 Treatments performed twice a week </li></ul><ul><li>( Patients with lymphatic drainage problems need more sessions) </li></ul><ul><li>Maintenance treatments done monthly, then bi-monthly </li></ul><ul><li>Average treatment time 30-45 min </li></ul><ul><ul><li>~10 mins per area (thigh, buttock, abdomen, arms, chin) </li></ul></ul><ul><ul><li>No more than 5 sec dwell on one site </li></ul></ul>

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Treatment Parameters <ul><li>Best results with maximal (3 rd ) level </li></ul><ul><li>Reduce IR for dark skin or over dark tattoo </li></ul><ul><li>Reduce RF on curved areas with bad coupling </li></ul><ul><li>Reduce suction on sensitive areas (abdomen, inner-thigh) and on loose skin </li></ul>

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Treatment Parameters <ul><li>Use lower levels for muscle aches, poor circulation and skin texture </li></ul><ul><li>Increase levels in subsequent sessions </li></ul><ul><li>Repeat passes until persistent endpoints are apparent </li></ul><ul><li>Endpoints are general erythema, edema and warmth </li></ul>

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Treatment Tips <ul><li>Pretreatment - exfoliation and trimming of long hair </li></ul><ul><li>Avoid anticoagulants (if medically permitted), as they increase the chance of bruising </li></ul><ul><li>Use conductive water spray – not gel! </li></ul><ul><li>Replenish spray only when movement of roller is affected – not when the spray appears dry </li></ul>

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Treatment Tips <ul><li>Treating without spray – keep skin very clean </li></ul><ul><li>Work in general direction of the lymphatics – </li></ul><ul><li>ONE WAY </li></ul><ul><li>Change direction to achieve best contact . </li></ul><ul><li>Keep ONE WAY </li></ul>

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Facilitate Lymphatic Drainage

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Fat Anchor Zones <ul><li>Evidence of body contouring by fluids redistribution in anchor zones </li></ul><ul><li>Result = reduction in circumference </li></ul>

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THANK YOU!

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QUESTIONS?