Clinical Guide

BTL EXILIS SYSTEM™

Contents

1 CONTRAINDICATIONS ...........................................................................................................................5
2 LARGE APPLICATOR TREATMENT .......................................................................................................7
2.1 ABDOMEN.........................................................................................................................................8
2.2 BANANA ROLL –UPPER BACK OF THE THIGHS ...................................................................................9
2.3 UPPER BACK ...........................................................................................................................................10
2.4 BREASTS–MALE..........................................................................................................................................11
2.5 BUTTOCKS....................................................................................................................................................12
2.6 INNERTHIGHS.............................................................................................................................................13
2.7 KNEES............................................................................................................................................................14
2.8 LOVE HANDLES .......................................................................................................................................15
2.9 SADDLEBAGS............................................................................................................................................16
2.10 UPPER ARMS – FACE DOWN ...................................................................................................................17
2.11 UPPER ARMS – FACE UP ..........................................................................................................................18
3 SMALL APPLICATOR TREATMENT ......................................................................................................21
3.1 DÉCOLLETAGE.................................................................................................................................................22
3.2 EYELIDS.........................................................................................................................................................23
3.3 FOREARMS..................................................................................................................................................24
3.4 FOREHEAD...................................................................................................................................................25
3.5 HANDS..........................................................................................................................................................26
3.6 LIPS......................................................................................................................................................................27
3.7 LOWERCHEEKS........................................................................................................................................28
3.8 NECK............................................................................................................................................................29
3.9 PERIORALAREA.......................................................................................................................................30
3.10 SUBMENTUM..............................................................................................................................................31
3.11 UPPERARMS..............................................................................................................................................32
3.12 UPPERCHEEKS...........................................................................................................................................33
3.13 VULVA...........................................................................................................................................................34
4 CELLULITE TREATMENT – Support with BTL CELLUTONE™.......................................................36
NOTES.................................................................................................................................................38
 THIS CLINICAL GUIDE DOES NOT REPLACE THE OPERATOR’S MANUAL

1 Contraindications

Do not treat patients if the following conditions are present:

• Bacterial or viral infection, acute inflammations

• Impaired immune system
• Isotretinoin in the past 12 months
• Scleroderma
• Radiation therapy
• Burns in the treatment area
• Poor healing in the treatment area
• Metal implants
• Implantable pacemaker or automatic defibrillator / cardioverter
• Ablative / non-ablative cosmetic intervention (deep peeling)
in the past 3 months
• Cancer
• Active collagen diseases
• Cardiovascular diseases (such as vascular diseases, peripheral arterial disease,
thrombophlebitis and thrombosis)
• Pregnancy or IVF procedure
• Acute neuralgia and neuropathy
• Blood disorders, risk of bleeding, bleeding tissues, peptic ulcers
• Eczema
• Rosacea
• Febrile conditions
• Kidney or liver failure
• Patients undergoing radiological procedures
• Pronounced edemas, ascites, exudates
• Sensitivity disorders in the treatment area
• Tuberculosis
• Varicose veins

For the full range of contraindications, warnings and cautions, refer

to the Operator’s Manual.

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2 Large applicator treatment

Grounding electrode placement:

• We recommend that grounding electrode should be placed

on the buttock area.
• Prior to use of the grounding electrode, make sure the skin is clean and dry.
Do not use reference patch electrode on damaged, irritated or wet skin
to avoid burns under the electrode.
• Make sure the electrode adheres to the skin fully. If the electrode does not
adhere to the skin, clean the skin properly. Use a new electrode. Do not re-use
the original electrode.

Treatment technique

• Never stop moving the applicator during the therapy.

• It is important to use an adequate downward pressure to help ensure the
applicator tip is in full contact with the tissue at all times.
• Try to reach therapeutic temperature (40-43°C) within the first minute
or minute and a half.
• You can use two hands while treating as this will give you better control
of the applicator as well as help reduce strain on your arms, hands and wrists.

Remember, your patient should feel intense heat, but not pain. Instruct
the patient to say stop if any sensation of pain is felt. Remember to use
patient feedback as the first and skin temperature as the second indicator
to determine the appropriate power settings.

The most common mistakes:

• Poor applicator contact.

• Too much pressure.
• The motion is too fast.
• Only one circular motion.
• Lifting the applicator while it still emits the energy.
• Moving the applicator over the bones.

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2.1 Abdomen

Patient position:

Treatment technique:

• Slowly create large circular clockwise motion.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
100 - 120 10/20/30 10 – 30 4 7 - 14

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2.2 Banana Roll - upper back of the thighs

Patient position:

• You might need to use an alternative area to place the grounding electrode.
The most suitable alternative zone for the electrode is the inner or front thigh.

Treatment technique:

• Slowly create large circular motion.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
80 - 100 20/25/30 5 – 10 4 7 - 14

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2.3 Upper Back

Patient position:

• Patient straddles a chair while hugging a pillow or a gymnastic ball or simply

have your patient sit on a treatment bed with their back facing you.

Treatment technique:

• When treating, move the applicator slowly creating large circular motion.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
80 - 100 20/25/30 5 – 15 4 7 - 14

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2.4 Breasts – Male

Patient position:

• Patient lies on their back.

• Arm bent at the elbow.

Treatment technique:

• Move the applicator slowly creating large circular motion.

• The treatment should be performed on soft breast tissue around the areola
zone.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
60 - 100 20/25/30 5 – 15 4 7 - 14

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2.5 Buttocks

Patient position:

• You must use an alternative area to place the grounding electrode. The most
suitable alternative zone for the electrode is the inner or front thigh.

Treatment technique:

• Move the applicator slowly creating large circular motion.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
80 - 120 15/20/30 10 – 15 4 7 - 14

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2.6 Inner Thighs

Patient position:

• Treated leg bent at the knee directly out to the side at the hip level.
• Place a rolled-up towel or a cushion under the patient’s knee to raise
the treatment area.

Treatment technique:

• Move the applicator slowly creating large circular motion.

• Find the optimal angle to hold the applicator in order to cover all the area
being treated.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
80 - 120 15/20/30 5 – 15 4 7 - 14

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2.7 Knees

Patient position:

• Use rolled-up towels to bolster the leg.

Treatment technique:

• Move the applicator slowly creating large circular motion.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
60 - 100 20/25/30 8 – 10 4 7 - 14

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2.8 Love Handles

Patient position:

• Place a rolled-up towel beneath the patient’s lower abdomen to better access
the treatment area.

Treatment technique:

• Slowly create large circular motion.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
100 - 120 10/20/30 8 – 15 4 7 - 14

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2.9 Saddle Bags

Patient position:

• Place a rolled-up towel beneath the treated lateral thigh to raise the treatment
area off the bed.

Treatment technique:

• Slowly create large circular motion.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
80 - 110 20/25/30 8 – 15 4 7 - 14

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2.10 Upper Arms – face down

Patient position:

• Treated arm bent in the elbow.

• You may want to use a small rolled-up towel or hand to elevate the treated
area.

Treatment technique:

• Slowly create large ELIPTICAL motion.

• Treated area should not reach the tip of the elbow (you should stay
approximately 3 cm away).
• To maintain patient comfort keep in mind the fact that you may need
to decrease the power by 10 to 20 units.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
60 - 80 20/25/30 8 – 15 4 7 - 14

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2.11 Upper Arms – face up

Patient position:

• Treated arm bent in the elbow.

• Place a rolled-up towel or a cushion under the patient’s elbow to elevate the
treated area.

Treatment technique:

• Slowly create large ELIPTICAL motion.

• Find the optimal angle to hold the applicator in order to cover all the area
being treated.
• The treated area should not reach the tip of the elbow (you should stay
approximately 3 cm away).
• To maintain patient comfort keep in mind the fact that you may need
to decrease the power by 10 to 20 units.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
60 - 80 20/25/30 8 – 15 4 7 - 14

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NOTES

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3 Small applicator treatment

Grounding electrode placement:

• Prior to use of a grounding electrode, make sure the skin is clean and dry.
Do not use reference patch electrode on damaged, irritated or wet skin
to avoid burns under the electrode.
• Make sure the electrode fully adheres to the skin. If the electrode does not
adhere to the skin, clean the skin properly. Use a new electrode. Do not re-use
the original electrode.
• We recommend that the electrode should be placed under the left or right
scapula or on the buttock area.

Treatment technique:

• You can use a mouth guard or folded gaze to protect teeth against heat
if teeth sensitivity is expected and if the area in close proximity to the mouth
is to be treated.
• It is necessary to apply a generous amount of gel to ensure proper contact
of the tip with the tissue. Always increase the treatment time by at least one
minute if you have to add more gel.
• For the face treatments, the number of sessions can be reduced from 4 to 2
if double injury protocol is used. In this protocol standard treatment times are
doubled by treating all zones of one side (of the area) first and performing
second pass over all zones of the same side again.
• Be sure to keep the applicator tip perpendicular to the treatment area.
• Always keep the applicator in motion when the energy is ON.

Your patient should feel intense heat, but not pain. Instruct the patient to say
stop if any sensation of pain is felt. When the patient says stop, reposition the gel.
If the patient says stop again you may need to decrease the power or duty factor.

The most common mistakes:

• Poor applicator contact.

• Too little gel used.
• The motion is too fast.
• Applicator tip not kept perpendicular to the treated area.
• Movement of the applicator stopped during therapy.
• Treating over the globe of the eye.
• Small circular motion used – tissue not allowed to cool down enough.

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3.1 Décolletage

Patient position:

Treatment technique:

• Treat using very slow sweeping motion.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 8 – 10 4 7 - 10

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3.2 Eyelids

Patient position:

• You may use headdress to avoid hair falling into the treatment area.

Treatment technique:

• Use very slow sweeping motion.

• Move the applicator tip across the treated area in two rows.
• Use tongue depressor to prevent the gel from entering the eye.
• Never angle the applicator in the direction of the eye. Remember, you must
always treat over the orbital bone and never over the globe of the eye.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 60 6 4 7 - 10

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3.3 Forearms

Patient position:

• Arm stretched along the body.

Treatment technique:

• Move the applicator slowly creating large ELIPTICAL motion.

• Avoid treating too close to the tip of the elbow as this will cause discomfort.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 5 – 15 4 7 - 10

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3.4 Forehead

Patient position:

• You may use headdress to avoid hair falling into the treatment area.

Treatment technique:

• Treat using slow - overlapping circular motion.

• Start at the center part of the forehead and move to the temporal zone
(crows feet wrinkle area).
• Move back and start over from the center from when you finish
each set of moves.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 80 5–6 4 7 - 10

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3.5 Hands

Patient position:

• Your patient can sit on a chair with the hand on a treatment bed or they can
lie down with the hand on the side.
• The hand should be positioned so the fingers are tightly pressed together.

Treatment technique:

• Treat using slow sweeping motion.

• Start at the wrist and move all the way down the fingers.
• If the patient has laxity you can have the patient use their other hand
to gently pull the skin up towards the arm to create tension in the tissue.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 6 – 10 4 7 - 10

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3.6 Lips

Patient position:

• Instruct your patient to keep their lips closed tightly and make a pouty face
to lift the lips up enough above the teeth during the treatment.

Treatment technique:

• Since your patient is unable to speak during this treatment, it is important

to discuss hand signals such as stop and ok so you can communicate with
your patient during the treatment.
• Treat using slow sweeping motion around and over the lips.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 60 4-5 4 7 - 10

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3.7 Lower Cheeks

Patient position:

Treatment technique:

• Treat using very slow, large sweeping motion and some downward pressure.
• Move the applicator tip across the treated area forming one loop as this will
allow the skin to relax before the next round.
• Be sure to keep the applicator tip perpendicular to the treatment area.
• Remember, you must always treat the tissue above the mandible bone
and never directly over the bone in order to keep the treatment tolerable.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 6-7 4 7 - 10

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3.8 Neck

Patient position:

• Place a rolled-up towel beneath the patient’s neck to raise the treatment area
off the bed.

Treatment technique:

• If your patient has a moderate amount of laxity, you may want to use your
free gloved hand to cradle the neck while using your fingers to gently pull the
tissue.
• Treat using very slow sweeping motion.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 6 – 10 4 7 - 10

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3.9 Perioral Area

Patient position:

Treatment technique:

• Treat using very slow, circular motion surrounding the lips.

• Be sure to keep the applicator tip perpendicular to the treatment area.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 80 4-5 4 7 - 10

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3.10 Submentum

Patient position:

• Place a rolled-up towel beneath the patient’s neck.

Treatment technique:

• Begin the treatment on the lateral aspect of the chin strap moving towards
the past midline.
• Move the applicator tip across the treated area in two rows forming one loop
as this will allow the skin to relax before the next round.
• Use very slow, large sweeping motion and some downward pressure.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 4–5 4 7 - 10

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3.11 Upper Arms

Patient position:

• Arm is extended back towards the head.

Treatment technique:

• Move the applicator slowly creating large ELIPTICAL motion around the arm.
• Avoid treating too close to the tip of the elbow as this will cause discomfort.
• While using your gloved hand, grip the arm and push the tissue forward.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 8 – 15 4 7 – 10

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3.12 Upper Cheeks

Patient position:

Treatment technique:

• Use very slow, large sweeping motion and some downward pressure.
• Move the applicator tip across the treated area forming one loop as this will
allow the skin to relax before the next round.
• Remember, you must always treat over the bone and never over the globe
of the eye when treating lower eyelids.

Intended power Treatment Number of Frequency of

(units) Duty Factor (%) time per zone treatment treatments (days)
(min) s
90 100 6-7 4 7 - 10

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4 Cellulite treatment
support with BTL CELLUTONE™

Patient position:

• You must use an alternative area to place the grounding electrode.

The most suitable alternative zone for the electrode is the inner or front thigh.

Treatment technique:

• Move the applicator slowly creating large circular motion.

• For the front thighs use the same technique.

Use of BTL CELLUTONE™ can further enhance the treatment.

Intended power Treatment Number of Frequency of

(units) Cooling (°C) time per zone treatment treatments (days)
(min) s
100 - 120 30/off 4–5 4 7 – 14

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