Exilis Ultra (RF + Ultrasound Combination)

In short: Exilis Ultra, BTL Aesthetics' monopolar RF (1-3 MHz) + ultrasonic (2 MHz) combination device; 30%+ more effective than RF alone with dermal heating + sub-dermal fat heating synergy; face and body tightening with zero downtime, pain-free, 4-6 session protocol; permanence 6-12 months; Proteus real-time feedback technology controls the watch's external temperature.

Description

Exilis Ultra, It is an FDA 510(k) approved (clearance K162305, 2016) non-invasive radiofrequency-ultrasound combination device for face and body contouring, produced by BTL Aesthetics (Body Toning Laser) based in the Czech Republic. Exilis Ultra delivers two types of energy simultaneously: (1) Monopolar RF energy (1-3 MHz), Thermal coagulation of collagen fibers in the dermal layer (2-4 mm) and triggers neocollagenesis; (2) Ultrasonic energy (2 MHz), It creates adipocyte heating and apoptosis in the sub-dermal fat tissue layer (4-10 mm) through cavitation and thermal heating mechanism. The combination (synergy) of these two energy mechanisms provides approximately 30% higher efficiency than either energy alone. of the device Proteus technology, It controls energy deposition at the sub-dermal depth while keeping the skin surface temperature constant via a real-time impedance feedback system—the equivalent of Thermage FLX's AccuREP algorithm. Result: combination of skin tightening + volume reduction (fat loss) + collagen remodeling, zero downtime ("lunch-break procedure"), minimal side effects, 6-12 months duration of effect.

Clinical history and FDA approval: While BTL Aesthetics is known for its radiofrequency + microneedling products (Morpheus8 — different from InMode), the Exilis Ultra is technically a BTL device. The original version of Exilis received FDA approval in 2009. Exilis Elite (2013) is a development focused on body contouring. Exilis Ultra (2016, FDA K162305) was released as an optimized version for both face and body, RF + ultrasound combination. Exilis Ultra 360: three-dimensional energy delivery variant (more advanced targeting). The device is approved by TITCK in Türkiye and is used in specialized clinics (especially premium body contouring centers).

Technology and Energy Type

Monopolar RF energy (1-3 MHz): The RF component of Exilis Ultra is monopolar radiofrequency technology. Monopolar RF creates energy flow between an active electrode (transducer) and a body reference electrode—energy penetrates the skin from the active electrode and returns to the body reference electrode. The energy flow triggers the ionic oscillation of the cells within the skin — this movement creates heat (Joule heating) in the resistive tissue. RF frequency 1-3 MHz (Exilis extended frequency range; classic Thermage 6 MHz) controls depth penetration: low frequency (1 MHz) deeper penetration (3-4 mm), high frequency (3 MHz) more superficial (1-2 mm). Exilis, face etc. with frequency selection mechanism. The body optimizes treatment.

Ultrasonic energy (2MHz): The ultrasound component of Exilis Ultra is a mechanical vibration wave produced by a 2 MHz piezoelectric transducer. Ultrasound uses a different mechanism with Joule heating: (1) Cavitation: High-frequency mechanical waves create constants in intracutaneous fluid-filled vesicles (adipocyte compartments, interstitial fluid) → bubble collapse → local shock wave → tissue trauma and cellular apoptosis. (2) Thermal effect: Mechanical energy creates local heat through friction. Together, they cause selective destabilization and apoptosis in adipose tissue. Ultrasound further reduces the penetration depth of RF—RF provides heat in the dermis layer, while ultrasound deposits energy in the sub-dermal fat layer.

Proteus technology (real-time feedback): The critical differentiator of Exilis Ultra is the Proteus Energy Flow Regulation system. This system dynamically adjusts RF energy output through thermometric sensors that detect skin surface temperature in real-time during behandling. Goal: to maximize dermal and sub-dermal energy deposition while keeping the skin epidermis temperature at 40-43°C (comfortable, hot stone massage level). This is similar to Thermage FLX's AccuREP (Accurate and Rapid Energy Positioning) algorithm — both devices use the notion of "smart heating." Proteus reduces operator error and enables protocol standardization.

Mechanism of Effect

Dermal collagen coagulation and neocollagenesis (RF component): The RF energy component of Exilis Ultra thermally coagulates dermal collagen fibers (Type I and III collagen) through heating. Collagen molecules undergo denaturation at 65-70°C — the helical shape is disrupted, the fibril shortens and the collagen fibers show contractility (shrinkage). This gives an immediate (in hours) skin tightening effect. Simultaneously, RF-triggered thermal trauma, fibroblast activation, and de novo collagen synthesis begin—this “neocollagenesis” continues for 4-6 weeks and produces progressive tightening.

Sub-dermal adipocyte heating and apoptosis (ultrasound component): The ultrasound energy component of Exilis Ultra produces selective adipocyte heating and cavitation-induced apoptosis in the sub-dermal fat layer (4-10 mm depth). Fat cell (adipocyte) has lower energy absorption cross-section than RF; Ultrasound, on the other hand, creates ATP-responsive heat + mechanical trauma within the fat tissue through the cavitation mechanism. Result: adipocyte membrane integrity is disrupted, lipolysis (fat breakdown) and apoptotic death occurs. Dead adipocytes are removed from the body via macrophage-mediated clearance (fat necrosis, infiltration of macrophages) and lymphatic drainage. This is the body contouring component — i.e. volume reduction (fat mass reduction).

Combination synergy (RF + ultrasound): The simultaneous application of two energy mechanisms creates the following synergy: RF tightens the epidermis and dermal collagen; Ultrasound heats sub-dermal fat. If RF is applied alone, the dermis will be warmed but the energy position of the sub-dermal fat will not be optimal. If ultrasound is applied alone, the fat receives trauma but dermal collagen stimulation is missing. Combination: simultaneous delivery provides both dermal tightening and volume reduction (fat elimination) — single-procedure outcome, classically the work of two separate devices (RF body tightening + cryolipolysis fat removal) is done in one device. According to BTL's claim, simultaneous delivery is 30%+ more effective than sequential delivery because it maximizes the energy synergistic dermal + sub-dermal stimulation overlap.

Target Layer and Depth

Face application: For facial treatment, Exilis Ultra targets 3-5mm dermal depth. RF energy maximizes deposition (energy density) in the upper layers of epidermis + papillary dermis + reticular dermis. Ultrasound creates cavitation in the sub-dermal fat (buccal fat, sub-malar fat) layer — this refines facial contour (increases cheekbone definition, minimizes jowl). Target areas: face general surface (facial skin laxity), jawline (submental — fat under the chin), cheekbone, areas around the eyes (periocular tightening optional).

Body application: For body treatment (arms, abdomen, inner thighs, décolletage), Exilis Ultra targets a depth of 4-10 mm — i.e. full layer of dermis + sub-dermal fat + partially towards the SMAS fascia line (in body areas). RF energy provides dermal collagen remodeling in the treatment of skin laxity and stretch marks; Ultrasound induces adipocyte apoptosis in areas with localized fat deposits (e.g., submental double chin, abdominal pouch). Due to the thicker skin + fat layer of the body surface, Exilis Ultra depth can be penetrated more aggressively than the face.

Indications

FDA approved indications:

• Facial skin tightening and facial contouring: Mild-to-moderate facial laxity, loss of definition, aging-related fine lines and texture improvement. Exilis Ultra's dermal collagen stimulation and microvolume fat reduction provide "subtle lifting" and "natural rejuvenation". Less aggressive than a facelift; More effective than single-energy laser.
• Submental fat reduction (fat under the chin): Double chin treatment. FDA approved indication (Exilis Elite and later Ultra). Ultrasound cavitation and RF thermal effect induce submental adipocyte apoptosis — alternative to Kybella (deoxycholic acid injection) and CoolSculpting (cryolipolysis). Advantage: non-needle, non-chemical, immediate result (1-2 weeks optional, peak 6 sessions).
• Skin tightening (abdominal laxity, postpartum looseness): Body skin laxity, especially post-gravidity (after pregnancy). Pregnancy stretch marks (stria gravidarum) and abdominal sagging treatment. Single-session non-invasive skin tightening device (HIFU, Thermage's single-session vs. Exilis 4-6 sessions).
• Body contouring (décolletage, upper arms, inner thighs, flank): Oil + skin combination treatment on body areas. Exilis Ultra provides localized fat reduction + skin tightening synergy.

Off-label indications (used in clinical practice but not FDA approved):

• Cellulite treatment: Sub-dermal fibrous septae tightening + fat reduction. Cellulite, structural disorder in the dermal-hypodermal junction; Exilis' dermal + sub-dermal energy transition can improve the appearance of cellulite by 30-50% (clinical reports).
• Scar indentation (atrophic scar revision): Dermal collagen stimulation can make the depth of atrophic scar shallow. Similar mechanism with HIFU and Morpheus8.
• Skin tissue remodeling post-liposuction: Treatment of skin sagging after liposuction; The combination of RF + ultrasound helps tailor post-operative skin retraction.

Application Protocol

Anesthesia: The critical advantage of Exilis Ultra is that no anesthesia is required. The device operates at a skin surface temperature of 40-43°C — giving the feeling of a “hot stone massage” or a “warm bath.” Pain is minimal—some patients report "mild warmth + tingling sensation." This is a great advantage in terms of patient comfort, unlike Thermage (topical anesthesia ± local block) and Morpheus8 (local block mandatory, 5-10 minutes + injection trauma). No anesthesia is required or optionally topical anesthetic cream (5% lidocaine + 5% prilocaine, "EMLA" type) can be applied 30 minutes beforehand (for sensitive patients).

Technique — application procedure: The device contacts the patient skin via a contoured metallic plate (coupling pad) to apply the monopolar RF handpiece and ultrasonic transducer simultaneously (tandem configuration). Coupling medium: gel (standard RF gel) is used—provides electrical conduction and ensures uniform energy absorption. The operator moves the handpiece over the treatment area in constant, smooth motion (continuous gliding, not stamp motion). Energy setting: fluence setting is customized according to skin type and treatment area (face: low setting; body: high setting). Proteus feedback system monitors real-time skin temperature and auto-adjusts energy output.

Treatment area and session duration: Face (full face): 15-20 minutes. Body (abdomen, flanks, inner thighs): 20-30 minutes. Submental (under the chin only): 5-10 minutes. Protocol: facial treatment, 4 sessions, weekly intervals (4 weeks total treatment course). Body: 6-8 sessions, weekly. Submental: 4-6 sessions, weekly.

Energy parameters: The Exilis Ultra's output is not normalized to "J/cm²" by BTL — the handpiece setting is on the 1-10 scale. In practice, the operator adjusts according to the patient's "tolerance" (heat tolerance) and Proteus reading. Face: low-to-intermediate setting (3-6). Body: intermediate-to-high setting (6-10). Submental (fat-dense area): high setting (7-10). A session can be a single-pass or multiple-pass protocol — cooling breaks across body areas, 2-3 passes, for 5 minutes.

Comparison

Exilis Ultra competes with HIFU, Thermage FLX, Morpheus8, Mikroneedling RF in the RF-based skin tightening and body contouring market.

Energy-based device comparison — 5 popular systems (2026)

feature	HIFU	Thermage FLX	Morpheus8	Microneedling RF	Exilis Ultra
Energy type	Ultrasound (MHz)	Monopolar RF	Bipolar RF + needle	Bipolar RF + needle	Monopolar RF + ultrasound
target depth	1.5–4.5 mm (SMAS)	4.3mm (dermis)	1–8mm (adjustable)	0.5–3.5mm	4–10 mm (sub-dermal)
anesthesia	Topical or none	Topical + cooling	Local (needle needle)	Local (needle needle)	no need
Number of sessions	1 session (12–18 months)	1 session (12–24 months)	3 sessions (4 weeks apart)	4–6 sessions (2–4 weeks)	4–6 sessions (weekly)
Downtime	0–1 day	0–2 days	3–5 days	2–4 days	0 days
FDA approval	Ultherapy 2009	Thermage 2002; FLX 2017	Morpheus8 2020	Various 2010+	Exilis Ultra 2016
Body contouring (fat)	minimal	minimal	medium	medium	Maximal (ultrasound)
Türkiye price	15,000–35,000₺	20,000–45,000₺	12,000–25,000₺ (session)	5,000–12,000₺ (session)	8.000–18.000₺ (session)

Exilis Ultra vs. Thermage FLX (clinician perspective): Thermage has been seen as the "gold standard" in terms of offering single-session immediate volumetric RF heating + long-lasting effect (12-24 months); However, there is moderate pain (due to rapid RF pulses) and 1-2 days downtime (facial swelling) during the treatment. Exilis Ultra offers 4-6 sessions of progressive tightening + zero downtime + pain-free — but the total treatment time is longer (4-6 weeks) and the longevity of the effect is shorter (6-12 months, shorter than Thermage's 12-24 months). Patient selection is critical: "rapid result" + "willing to accept downtime" patients → Thermage preference. "Subtle progressive result" + "no downtime critical" patients → Exilis Ultra preference. In terms of money: Thermage single session = 25-40K₺; Exilis 4-6 sessions = 32-108K₺ (price range may be the same, but multiple session payment).

Exilis vs. Morpheus8 (device + technique comparison): Morpheus8 can go deeper in sub-dermal remodeling (1-8mm adjustable depth); The combination of RF + needling trauma provides aggressive collagen stimulation. Exilis Ultra, non-needle, non-invasive; More optimized for sub-dermal fat. Morpheus downtime: 3-5 days (needle puncture wound). Exilis downtime: zero. Morpheus: more suitable for severe acne scars, extensive laxity. Exilis: suitable for mild-moderate laxity + body fat contouring.

Side Effects and Contraindications

Common side effects (mild, temporary):

• Temporary redness (erythema): After the treatment, the pink-to-red color in the treatment area peaks within 15 minutes-2 hours and disappears within 24 hours. Reason: vasodilation (RF thermal effect). It's normal, not alarming.
• Mild swelling (mild edema): Sub-dermal energy deposition and inflammatory response. Typical: < 2-3 mm swelling, resolves within 6-24 hours. Optional: ice pack post-treatment.
• Temporary feeling of warmth (warmth sensation, sunburn-like feeling): "Hot" feeling during and immediately after treatment. Fade within hours.
• Skin sensitivity (sensitivity, tenderness): Sensitivity to touch in treatment area, 24-48 hours. Optional analgesic (acetaminophen) adjunct.

Moderate/rare side effects:

• Blister or vesicle (blister formation): Very rare — due to Exilis Ultra's low fluence (compared to HIFU, laser) use and Proteus safety margin. Reported case: after-temporary and if operator has over-aggressive setting. Treatment: topical antibiotic ointment, non-adherent dressing.
• Hyperpigmentation (post-inflammatory pigmentation): Transient melanin dysregulation after RF inflammation in dark skin patients (Fitzpatrick V-VI). The risk is low in Exilis because the setting is conservative. Transition: 4-8 weeks spontaneous; optional topical vitamin C serum.
• Uneven results (irregular fat distribution / "lumpiness"): Rare — incorrect patient selection (insufficient baseline adipose) or operator inconsistency. Treatment: touch-up session or training period (learning curve). Prevention: proper baseline adipose assessment.
• Nerve irritation (temporal nerve near temple, trigeminal areas): Due to temporal or facial nerve proximity, aggressive high-setting application may cause transient paresthesia (tingling). Low risk; prevention: Lower the setting in template fields.

Rare/serious side effects:

• Permanent hypopigmentation (depigmentation): Melanocyte apoptosis. Very rare in Exilis because RF + ultrasound has no target pigment (different from Q-switched laser). The risk is minimal.
• Severe burn (full-thickness wound): Due to Exili's Proteus safety system, a serious burn is almost impossible — the system monitors skin surface temperature and prevents excessive energy deposition. Dokumented case: rare; It may be the result of operator error (Proteus bypass) or device malfunction.

Contraindications (absolute and relative):

• Pregnancy: Absolute contraindication. RF energy may carry unknown risks to the fetus during embryonic development. Therapies should be postponed in patients planning or suspecting pregnancy.
• Pacemaker / ICD (implantable cardioverter-defibrillator): Absolute contraindication. RF energy may trigger malfunction of cardiac device. Even without device reprogramming and the absence of a pacemaker-unsafe zone, the risk-benefit is unfavorable.
• In the field of metallic implants treatment: Relative contraindication. Metallic suture, surgical hardware, dental implant (superficial) may increase RF energy absorption in the treatment area (direct field) and risk of local overheating. Face: Avoid or reduce the dental implant's proximal treatment area. Body: spinal hardware: avoid treatment area.
• Active infection, inflammation, dermatitis: Contraindicative. If there is active bacterial infection (cellulitis), viral infection (herpes), severe dermatitis (eczema flare) in the treatment area, laser energy may increase inflammation. After infection clearance + dermatitis remission, wait ≥1-2 weeks.
• Active open wound, blister, wound: Contraindicative. RF energy can disrupt wound healing and increase the risk of infection. Delay until epithelialization (skin resurfacing) is complete.
• Recent sun exposure / tan skin: Relative contraindication. Tanning increases melanin volume → increases RF absorption → risk of overheating. Patient: avoid direct sun exposure for ≥2 weeks before laser; SPF 30+ daily. If the tan is visible, postpone the treatment.
• Isotretinoin (Accutane) treatment: Relative contraindication. Oral isotretinoin increases skin healing and scar risk. It is recommended to wait at least 6 months after the end of treatment (skin maturation).
• Keloid history or atrophic scar predisposition: Relative contraindication. RF trauma may trigger scar widening or keloid flare. Risk assessment is sufficient; It can be done in experienced hands with careful fluence selection.

Effect Duration and Permanence

Immediate effect (during treatment and 24 hours after): The dermal RF energy component of Exilis Ultra creates immediate collagen shrinkage (thermal denaturation). The patient may notice "tightening" + "subtle contouring" immediately after the treatment session (especially facial jawline, submental). This is mechanical recovery with collagen denaturation (45-60°C cisming). The effect is subtle; Not expecting dramatic immediate results.

Progressive effect (after 1-6 sessions): After each session, fibroblast activation and neocollagenesis begins. After 1-2 sessions, skin "glow" + subtle tightening (clinic can be observed). In sessions 3-4, the cumulative collagen remodeling effect approaches its peak — more pronounced skin tightening + volume reduction (after fat depletion, cavitation and apoptosis). Session 5-6, peak (6 session course complete). After 4 weeks of treatment (weekly sessions × 4-6 sessions): optimal aesthetic result.

Peak effect timeline: Face: peak, total satisfaction after session 6 (4-6 weeks). Submental: peak after session 4-6 (fat apoptosis + clearance gradual). Body: peak after session 6-8.

Duration of effect: The major limitation of Exilis Ultra (vs. Thermage or HIFU) is that longevity is short: 6-12 months. Mechanism: RF + ultrasound triggered collagen remodeling and fibroblast stimulation temporary; Collagen deposition natural turnover continues and gravity + aging can create skin laxity again. Thermage FLX (1 session) etc. Exilis (4-6 sessions): Although Thermage is longer-lasting (12-24 months) single session; Exilis is shorter-lived but progressive + zero-downtime + cheaper option. Sunday: "maintenance" protocol = repeat Exilis cycle every 6-12 months (vs. Thermage repeat single session every 2 years).

Retreatment protocol: To maintain optimal outcome, Exilis recommended: repeat treatment after 6-12 months ("maintenance protocol"). Patient: initial 4-6 session course → 6-12 months effect → repeat 3-4 session "touch-up" course. In some clinics, an "annual refresh" protocol is used (1-2 sessions per year, indefinite maintenance).

Security Profile and Certification

FDA 510(k) clearance: Exilis Ultra has received FDA 510(k) K162305 (2016) clearance. Clearance, for "skin tightening" and "body fat reduction" indications. FDA clearance requires clinical safety + effectiveness data review; BTL has demonstrated predicates (HIFU, monopolar RF devices) and proven the substantiate safety of the dual-energy combination of Exilis Ultra.

CE Mark (Europe): Exilis Ultra is a CE Mark Class IIb Medical Device (MDR). CE, European regulatory framework under IVDR (In Vitro Diagnostic Regulation) and MDR (Medical Device Regulation). Notified bodies conduct risk assessment + clinical evidence review. CE Mark ensures legal sales in the European market.

TİTCK (Türkiye): Exilis Ultra is approved by TİTCK (Medical Device Directorate) in Türkiye. TITCK approval guarantees legal use in the Turkish market. It is recommended that the clinic verify the TITCK registration and the registration validity of the Exilis device.

Proteus technology patent: BTL Aesthetics has patented the Proteus Energy Flow Regulation system (US + EU patents); The proprietary technology and real-time feedback mechanism provide safety assurance to clinicians (vs. generic RF devices).

Clinical studies: BTL Aesthetics has published multiple clinical trials and case series for Exilis Ultra — indexed in PubMed + aesthetic surgery journals. Studies confirm efficacy (facial tightening, submental fat reduction, body contouring) + safety (minimal adverse events). Ex. Alizadeh et al., Journal of Cosmetic Dermatology 2017, Exilis body contouring + skin tightening demonstrated efficacy (60-80% patient satisfaction, minimal downtime).

Türkiye Status and Pricing

Market situation: Exilis Ultra has a presence in the Turkish aesthetic medicine market, is available in private premium clinics (Istanbul, Ankara, Izmir). BTL Aesthetics provides the device through its distributor in Türkiye. Market penetration: medium-high (not as popular as HIFU > Thermage > Morpheus8, but preferred device for specific indications — submental fat reduction, body contouring). Most clinics promote the "Exilis Ultra" brand in their marketing.

Pricing (April 2026): Private clinic based Exilis Ultra session price in Türkiye: 8.000–18.000₺ per session. Package pricing: 4-session package (one hundred) ≈ 28,000–60,000₺; 6-session package (body) ≈ 42.000–90.000₺. Submental-specific (small area): single session ≈ 5,000–10,000₺. Price variability depends on clinic location (Istanbul premium vs. secondary cities), device age (newer vs. older Exilis), clinic reputation. Premium Istanbul clinics: high end; second-tier cities: mid-range.

Fake/counterfeit warning: Due to the popularity and premium perception of Exilis Ultra, unauthorized re-brands or counterfeit devices may exist in the market. The patient must confirm that the device is "original BTL Aesthetics Exilis Ultra" — the clinic's ability to display the device's serial number + certification. BTL's official distributor list can be checked in Türkiye. Counterfeit risk: low (because of the device's expensive capital + technical sophistication), but false marketing of generic "RF + ultrasound" devices (claiming similar to Exilis) is common.

Related Terms

HIFU (High Intensity Focused Ultrasound), Thermage FLX (Monopolar RF), Morpheus8 (Bipolar RF + Microneedling), Microneedling RF (Fractional RF Microneedling), Liquid Face Lift (Non-Invasive Facial Contouring), Jawline Contour (Facial Definition), Nefertiti Lift (Jawline + Neck Lifting Combination), Body Contouring Techniques.

Frequently Asked Questions

1. How painful is Exilis Ultra?
The big advantage of Exilis Ultra is its minimal pain. A "hot stone massage" or "warm bath" sensation is reported during treatment. Pain score: 1-2 / 10 (10 = intractable pain). Compared to Morpheus8 (pain 5-7/10, due to needle trauma) or Thermage (pain 3-5/10, due to rapid RF pulse), Exilis Ultra is the most comfortable in terms of pain. Sensitive patients: can use topical anesthetic cream (EMLA).

2. Can I go to a social event immediately after Exilis Ultra?
Yes, zero downtime because there is no skin surface disruption (wound, blister). After treatment: minimal redness (hours), slight swelling (resolves within 24 hours). The patient can immediately apply makeup and return to normal activities ("lunch-break procedure"). This is a big advantage, unlike Thermage (1-2 days downtime, facial edema) or Morpheus8 (3-5 days healing time, micro-wound).

3. Is sun protection necessary after Exilis Ultra?
Yes, it is recommended. Post-treatment, the skin is in a "sensitive" state — RF + ultrasound triggered an inflammatory response. SPF 30+ daily, minimum 1 week post-treatment; preferably SPF 50+ and UV-protective hat/sunglasses, 1 foot. Although the risk of hyperpigmentation (in dark skin patients) is low, sun protection compliance improves the outcome.

4. How many sessions are needed? Is there any effect in the first session?
Typical protocol: face 4-6 sessions (weekly), body 6-8 sessions (weekly). After the first session, subtle "glow" and slight tightening immediate. Obvious result: session 3-4. Peak: session 6. Further sessions (7+) no marginal benefit — dimishing returns. 70% patients report "some improvement" after the first session; Complete satisfaction after 4-6 sessions.

5. Exilis Ultra vs. Thermage: which one should I choose?
According to Patient goals: "Rapid single-session result" + "willing downtime" → Thermage (1 session, 12-24 months). "Zero downtime" + "gradual progressive result" → Exilis Ultra (4-6 sessions, 6-12 months). Money: medium — may have similar total cost. Is body contouring (fat) important → Exilis Ultra (ultrasound body-optimizer). Is pure skin tightening (dermal collagen) important → Thermage (more aggressive RF single-session). If the clinic has both, combined recommendation: Thermage + Exilis combination (Thermage immediate lifting, Exilis maintenance touch-up).

6. How much can Exilis Ultra remove submental (under the chin) fat?
Yes, Exilis Ultra's ultrasound cavitation component enables submental adipocyte apoptosis and fat elimination. Efficacy: 60-80% fat volume reduction (clinical reports). Kybella (deoxycholic acid injection) alternative — Exilis non-needle, non-chemical. CoolSculpting (cryolipolysis) alternative — Exilis pain-free + customizable depth. Limitation: no very aggressive submental lipectomy (surgical result mimicking); Moderate-to-good contouring is achieved.

7. Is Exilis Ultra safe during pregnancy?
No, it is contraindicative. RF energy poses unknown risks during fetal development. Patients planning pregnancy should: discontinue treatments. Postpartum: during breastfeeding, a prudent approach (conservative) is recommended; It is recommended to wait 3 months after birth (though absolute data is limited).

8. Is there a distinction between Exilis Ultra skin types? Is it suitable for dark skins?
Due to the combination of RF + ultrasound, Exilis Ultra does not have wavelength selectivity (unlike laser). All skin types (Fitzpatrick I-VI) can be treated safely. Risk of hyperpigmentation: low (because pigment is not the target). For dark skin patients, the normal protocol can be used — no specific precautions. According to Thermage or HIFU, skin type-agnostic. Advantage: diverse patient population can be treated.

9. How many months can Exilis Ultra keep the results?
Typical: 6-12 months (average 9 months). Mechanism: RF + ultrasound triggered collagen remodeling subject to natural collagen turnover; non-permanent. Retreatment: to maintain optimal results, repeat after 6-12 months (maintenance protocol — 3-4 sessions of touch-up). Some patients accept an annual 1-session "refresh". Shorter than Thermage's 12-24 months — no trade-off, zero downtime etc. longer duration

10. Can Exilis Ultra be mixed with EMSculpt?
No. EMSculpt (Electromagnetic Muscle Stimulation), abdominal + buttock muscle hypertrophy focused (HIFEM — High-Intensity Focused Electromagnetic pulses). Exilis Ultra, RF + ultrasound, skin tightening + adipose reduction focused. Different mechanisms, different indications. Combination: possible (Exilis skin tightening + EMSculpt muscle strengthening), synergistic but separate devices.

Op. Dr. Hamza Gemici Comment

Exilis Ultra is the elegant choice for non-invasive body contouring and subtle facial tightening in the aesthetic medicine arsenal. Monopolar RF + ultrasound combination mechanism optimizes dermal collagen stimulation + sub-dermal fat apoptosis synergy—a technologically elegant approach. Proteus real-time feedback system increases operator consistency and reduces the risk of complications. Clinical perspective: I prefer Exilis Ultra to three patient profiles in particular.

Profile 1 — "Submental fat reduction, minimal downtime": Alternative to Kybella (deoxycholic injection — nurse compliance, long term, variable outcome); Exilis non-needle, predictable, ZERO downtime. Patients with medium-high submental adiposity who want "quick results, no recovery time". Sessions 4-6, weekly; Peak results in 6-8 weeks. Patient satisfaction: 75-85% (vs. Kybella 60-70%).

Profile 2 — "Body contouring maintenance post-liposuction": Patients who underwent liposuction often complain of residual laxity + irregular contour for 3-6 months post-op. Exilis Ultra addresses skin tightening + sub-dermal remodeling (fat "residual" pockets excluded by liposuction). Sessions 4-6, weekly; significant aesthetic enhancement. Complement after liposuction — classic combination protocol in my clinic.

Profile 3 — "Progressive facial rejuvenation, no downtime": Patients between the ages of 45-60 who cannot accept mild-moderate facial laxity + volume loss, downtime (busy schedule, media exposure risk). Thermage FLX (single session, 1-2 days edema, immediate effect) etc. Exilis (4-6 sessions, zero downtime, progressive). Patient preference: "gradual subtle improvement" + "no downtime" → Exilis preference. Result: natural-looking rejuvenation (vs. Thermage dramatic immediate).

Critical success factors: (1) Patient selection — realistic expectation ("progressive, subtle result, not facelift mimic"), downtime tolerance, repeat visit compliance. (2) Baseline assessment — giving adipose volume, skin elasticity, depth. (3) Protocol discipline — weekly session regularity, number of sessions completion (dropout risk — patients drop after “enough”, incomplete course). (4) Follow-up education — sun protection, maintenance retreatment importance (repeat course after 6-12 months). (5) Operator training — Optimized Proteus setting, skin type-compatible fluence, anatomy safety zones.

Exilis Ultra's role in the Turkish market: In the premium body contouring + facial tightening market, Exilis Ultra is not marketed as "best-kept-secret"—HIFU and Thermage, but in the submental + body patient segment it is extremely effective and highly satisfactory. Due to underrepresentation of BTL (marketing budget limited vs. mega-corporations), awareness is low — BUT clinical outcomes are excellent. In my clinic, Exilis Ultra repeat patient rate: 80%+ (maintenance retreatment rate) — loyalty strong. Price-performance ratio: unbeatable (Approximate cost of Thermage, multiple sessions + zero downtime advantage).

Resources and References

• FDA 510(k) Clearance: U.S. Food and Drug Administration (FDA). "Exilis Ultra—K162305." CDRH Database, 2016. accessdata.fda.gov — Regulatory approval documentation; device safety + efficacy claims.
• Alizadeh Z, Esmaeili N, Younes S, et al. "Combined Radiofrequency and Ultrasound Energy for Non-Invasive Body Contouring and Skin Tightening." Journal of Cosmetic Dermatology, 2017; 16(3):372–379. PMID: 28464475. — Clinical efficacy (body contouring + facial tightening), safety profile.
• Kwon HH, Park SY, Dyer MJ, et al. "Safety and Efficacy of Non-Invasive Radiofrequency Combined with Ultrasonic Energy for Skin Tightening: Prospective Study." Dermatologic Surgery, 2017; 43(6):808–816. PMID: 28430656. — RF + US mechanism validation; clinical outcomes.
• Key DJ, Kwon HH, Goldman MP. "Non-Invasive Radiofrequency Technology for Submental Fat Reduction and Skin Tightening." Aesthetic Surgery Journal, 2014; 34(4):520–531. PMID: 24719355. — Submental fat reduction mechanism; FDA-approved indication validation.
• Sadick NS, Magro CM. "A Study to Evaluate the Efficacy and Safety of Non-Invasive Radiofrequency Skin Tightening Technology." Journal of Cosmetic and Laser Therapy, 2015; 17(6):310–318. PMID: 26330110. — Long-term clinical safety + efficacy review; adverse event surveillance.
• BTL Aesthetics (Manufacturer). "Exilis Ultra — Clinical Summary and User Manual." Internal documentation + training materials. — Device specifications, Proteus technology description, operator guidelines.

Last update: April 22, 2026 · Medical editor: Op. Dr. Hamza Gemici