2. *not yet FDA cleared
*
A unique multi-application,
Radio Frequency (RF)
platform for
non-invasive skin tightening
and body contouring that
provides virtually painless
treatments with effective
results

3. Clinical Indications
* Noninvasive treatment of wrinkles and rhytids
using a combined treatment with Unipolar and
Bipolar handpieces.
* Temporary reduction in the appearance of
cellulite
• Skin tightening
• Improvement in skin texture
• Body circumference reduction
• Improvement in stretch marks
• Acne clearance
* FDA Cleared

4. Other System’s
Clinical Indications
• Temporary reduction in the appearance of
cellulite and temporary reduction of thigh
circumference.
OR
• Non-invasive treatment of periorbital wrinkles
and rhytids (including the upper and lower
eyelids with the 0.25cm² eye tip) and non-
invasive treatment of facial wrinkles and
rhytids.
This is great if you are only looking for temporary results
or facial applications.

5. Non FDA Approved Devises
• It is illegal for a Doctor to market an
investigational device or accept money
from patients outside the specific
clinical study parameters of the clinical
trial associated with the investigational
device.

6. The Physics Behind RF
and the Accent XL

7. What is Radiofrequency?
Electromagnetic Spectrum

8. How To Compare RF Devices
1. Frequency
2. Electrode configuration
3. Power/Power Density
4. Platform Flexibility

9. 1 MHz 40 MHz30 MHz5 MHz 10 MHz 20 MHz 50 MHz
HIGH FREQUENCYHIGH FREQUENCY
WAVE LENGTHWAVE LENGTH
MEDIUM WAVEMEDIUM WAVE SHORT WAVESHORT WAVE
Aluma
3 MHz
VelaShape
0.5 MHz
1 MHz
6.78 MHz
40.68 MHz
1. RF Devices’ Frequency
RF is measured in MHz to determine how quickly it cycles per second.
The higher the MHz, the faster the rotation to create more friction and heat.
The Accent XL is 7x more powerful than our closest competitor.

10. • Bipolar and Monopolar:
– Utilizes passing currents -
displacement of charged particles
• Unipolar:
– Utilizes rotation of water
molecules in a RF generated
electromagnetic field which
translates into friction and heat
generation
2. Electrode Configuration

11. How Bipolar Works?
• The Bipolar handpiece applies both electrodes at the
treatment site. Electrical energy and the heat caused by
the displacement of charged particles, are localized in a
small area. Bipolar energy only penetrates
superficially (up to ~6 mm) and effects only the area
between the electrodes.

12. Monopolar/Bipolar Comparison
Both Monopolar and Bipolar conduct heat in the same fashion and to the same
depth. The differentiation is the return pad is built into the handpiece with Bipolar.

13. How the Accent XL’s Exclusive
Unipolar HP Works
• Polarized molecules try to line themselves up with the electrical
field, like compass needles trying to point at North.
• But because the electrical field is changing 40 million times a
second, the molecules don't quite have time to line up one way
before they have to try to line up the other way!
• The rapidly oscillating electromagnetic field causes movement (a
rotation) of water molecules within the tissue. The resistance to
this movement creates friction and deep heat. This is similar to
your microwave oven at home.

14. RF delivery method and depth of heat generation
mm
Original Accent Accent XL UniLarge Accent XL UniPolar
60°C
50°C
40°C
30°C

15. Different Technologies Treat
Different Layers
Epidermis
Dermis
Hypodermis
Type II
Type III
Type I
AFT, Lasers
Harmony 780nm ST
Soprano 1300nm NIR
Accent RF Bipolar
Accent RF Unipolar

16. 3. Power
• Syneron/ Lumenis up to 50 Watts
• Thermage up to 400 Watts
• Alma Lasers up 300 Watts

17. Power Density Comparison
VelaShape – RF
1. Power: Up to 50 Watts
2. Treatment area: 40 x 40 mm = 16 cm²
3. Power density: 50/16 = Up to 3.1 watts/cm²
VelaShape – IR
1. Power: Up to 20 Watts
2. Treatment area: 40 x 40 mm = 16 cm²
3. Power density: 20/16 = Up to 1.25 watts/cm²
Total VelaShape Power Density (RF + IR) = Up to 4.35 watts/cm²
Which is less than a home reading lamp with 33 adverse events reported
on FDA MAUDE site.
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm

18. Power Density Comparison
ThermaCool NXT
1. Power: Up to 400 Watts
2. Treatment tip sizes: 0.25cm² for eyes, 1.5cm²
for lips, 3.0cm² for face and body or 16.0cm²
for body
3. Power density: 400/3 = Up to 133 watts/cm²,
400/16 = Up to 25 watts/cm²
Excessive superficial energy creates painful
treatments with a high risk for injury. 200
adverse events reported on FDA MAUDE site.
http://www.accessdata.fda.gov/scripts/cdrh/cfdoc
s/cfMAUDE/search.cfm

19. Accent XL’s Power Density
Not too cold, not too hot…
it’s just right!
Accent XL Unilarge/Uniform:
1. Power: Up to 300 Watts
2. Treatment area: 1.9 cm²
3. Power density: 300/1.9= Up to 158 watts/ cm²
With no adverse events !

20. 4. Platform Flexibility
• The only body contouring system on the
market with future clinical and aesthetic
applications.
• No Disposables!
• Virtually Painless.

21. The Accent XL Future
Click image to view Pixel RF video

22. Accent XL Wins In All Categories
1. Frequency- Highest frequency for
fast volumetric tissue and
homogeneous heating
2. Electrode configuration- The Only
System with Dual RF Hand
pieces for controlled depth
heating
3. Power/Power Density- Highest
power density for improved
clinical outcomes
4. Platform Flexibility- Best
investment for future clinical and
aesthetic applications

23. The Science Behind RF
and the Accent

24. Click image to view animation

25. Accent: Mechanism of Action
Subcutaneous heat leads to localized
thermally induced cascades of reactions:
1. Q10 effect
2. Vasodilatation and blood flow
3. Oxygen
4. Lymphatic drainage

26. Heat Effect #1: Q10 Effect
•Q10 effect means that
for every 10 degree
Celsius increase in
temperature, we get a
doubling of the
mitochondrial enzyme
activity
•This enhances local fat
metabolism

27. How Fat Cells Break Down and
The Body Absorbs Cell Contents
• The body’s primary source of
energy is glucose.
• When energy is needed, your
body breaks down stored fats
into glycerol and fatty acids to
produce glucose.
• As your body breaks down and
absorbs the contents of the fat
cells, the cells will shrink in size
but the number of fat cells
remains the same.
The deep heat from the Accent increases fat cell metabolism
and causes the release of fat cell contents and reduction in
the cell size.

28. Heat Effect #2 : Vasodilatation
• Heat causes vasodilatation
• Vasodilatation encourages
more blood flow to tissues
• Increased blood flow
results in more nutrient
delivery and cellular waste
removal

29. Heat Effect #3: O2-Hb Dissociation Curve
Effect of Temperature
•Increasing the
temperature denatures
the bond between oxygen
and hemoglobin, which
increases the amount of
oxygen.
•The dissociation curve
shifts to the right which
means better facilitation of
the release of oxygen
from the blood to the
tissue.

30. #4: Lymphatic
Drainage
• The microcirculation is
compressed by all the fatty
tissue resulting in reduced
delivery of nutrients (oxygen,
glucose), and retention of
metabolic wastes and lymphatic
fluid
• The heat generated by the
accent induces profound local
vasodilatation causing flow to
return to the region. Thus,
starved tissue received O2,
glucose and the flow flushes out
the waste products. This results
in a healthier local tissue.

31. Pathophysiology of Cellulite

32. Pathology of Development of Poor
Tissue Appearance
Normal Healthy SkinNormal Healthy Skin Unhealthy SkinUnhealthy Skin

33. Cellulite Begins with Rigid
Compartments
• The top wall is the
skin
• The side walls are the
fibrous septae
• The bottom “floor” is
the superficial facia
The ‘compartment’
The skin
The septae
The superficial facia
Note: There is no “give” or flexibility to the walls of the compartment

34. Cellulite Begins with Rigid
Compartments
• Heavy women develop cellulite
when they have too much
adipose in a normal space
• In this situation, the excess
adipose compresses the
delicate lymphatics and blood
vessels
• Thus there is poor nutrient
delivery and waste removal
• The septae contract in
response to the toxic
environment
• The contraction of the septae
reduces the size of this already
overfull space, worsening the
problem
• A vicious circle is formed
The ‘compartment’
The skin
The septae
The superficial facia

35. Cellulite Begins with Rigid
Compartments
• Trim women develop cellulite
when they have normal amounts
of adipose in a contracted space
• In this situation, the hormonal and
genetic factors cause the septae
to be short and the normal volume
of adipose compresses the
delicate lymphatics and blood
vessels
• Thus there is poor nutrient delivery
and waste removal
• The septae contract further in
response to the toxic environment
• The additional contraction of the
septae reduces the size of this
already overfull space, worsening
the problem
• A vicious circle is formed
The ‘compartment’
The skin
The septae
The superficial facia

36. Summary: The Accent and Cellulite
1. The Accent causes reduction in
adipose by the Q10 effect, thus
decompressing the
‘compartment’
2. The Accent improves
circulation and drainage by
vasodilatation (thus reducing
toxic effects on septae
3. The Accent improves the
oxygen delivery by the changes
in the oxygen dissociation
curve
4. The Accent’s movement and
the improved circulation
stimulate lymphatic drainage
and toxin reduction

37. In Summery, The Accent:
• Contracts and multiplies collagen fibers to
tighten tissue, improving laxity and
firmness.
• Contracts connective tissue, improving the
skin’s contour, texture and external
architecture.
• Moves retained fluids from subcutaneous
adipose tissue for volume reduction

38. Ultrasound Study
by James Newman, MD
Facial Plastic Surgeon
San Mateo, CA
ASLMS 2008 Scientific Presentation

39. Right Arm
Pre Treatment
Dermis
Superficial Fat- 0.581 cm, hypoechoic
Connective Tissue- sparse, spread apart, not organized
Deep Fat- 0.749 cm
Fiber Septum- 1.33cm
Muscle
Post Treatment
Superficial Fat- decreased in thickness to 0.387 cm, contracted,
clear demarcation from deep fat.
Connective Tissue- increase in collagen fibers, uniform, linear and
horizontally oriented.
Deep Fat- more compact, homogeneous, and organized
subcutaneous fatty globules.
Fiber Septum- 1.15 cm
Muscle
Remarkably less fluid is visualized throughout image

40. Right Abdomen
Pre Treatment
Dermis
Superficial Fat- 0.665 cm, hypoechoic
Connective Tissue- sparse, spread apart, not organized
Deep Fat- 1.085 cm
Fiber Septum- 1.75cm
Muscle
Post Treatment
Superficial Fat- decreased in thickness to 0.472 cm, contracted,
clear demarcation from deep fat.
Connective Tissue- increase in collagen fibers, uniform, linear and
horizontally oriented.
Deep Fat- compacted to 0.828, homogeneous, and organized
subcutaneous fatty globules.
Fiber Septum- 1.30 cm
Muscle
Remarkably less fluid is visualized throughout image

41. Right Gluteus
Pre Treatment
Dermis
Superficial Fat- 1.37 cm, hypoechoic
Connective Tissue- sparse, spread apart, not organized
Deep Fat- 1.38 cm
Fiber Septum- 2.75cm
Muscle
Post Treatment
Superficial Fat- decreased in thickness to 1.18 cm, contracted,
clear demarcation from deep fat.
Connective Tissue- increase in collagen fibers, uniform, linear
and horizontally oriented.
Deep Fat- compacted to 1.35, homogeneous, and organized
subcutaneous fatty globules.
Fiber Septum- 2.53 cm
Muscle
Remarkably less fluid is visualized throughout image

42. Multiple Applications for
Individualized Treatment Plans
UniLarge
BiPolar
Periorbital
UniForm

43. The NEW Periorbital handpiece is uniquely
designed for UniPolarTM RF-based
treatments around the eyes.
This is the ideal tool for long lasting reduction
and improvements of periorbital fine lines
and wrinkles.
With this new perfectly sized and shaped tip,
achieving dramatic Accent XL results on
the face is even easier and more
comfortable than before.
Periorbital Hand Piece

44. User Friendly Application

45. NEW UniForm Handpiece
Now FDA cleared for the reduction in
the appearance of cellulite
Combining the UniLarge tip with the mechanical massager, enhances
micro-circulation and facilitates drainage of trapped intercellular fluid
to the lymph system and breaks down adhesions.

46. Massager Ring
• 50 mm diameter Massage Wheel
• 5- 10 mm diameter Massaging
Balls
• 150 turns/minute
• Uniform does not use suction
and therefore does not cause
bruising

47. Before: The skin
appears lax, swollen
and dimpled.
During: The synergetic effect
of the mechanical applicator with
radio- frequency facilitates
moving the interstitial fluids and
contracting connective tissue
which provides a temporary
reduction in the appearance
of cellulite.
After: The skin
appears smoother
and tighter.

48. Product Features Product Advantages
· Expandable platform · Investment into future technology
· Multiple HPs, w/ different technologies · Customizable patient treatment plans
· Highest output frequency (40.68 MHz) · Superior results
· Virtually painless (no anesthesia) · No time/money spent on numbing,
painless sells
· No disposables · Low cost of ownership, high ROI
· Faster & more power (up to 300Watts) · Higher patient satisfaction
· On average only 4-6 tx needed · Save patients time and money
· No downtime · Return to normal activities
· Non invasive and non ablative · Decrease in surgical cosmetic
procedures
· Safe on all skin types · Market to all patients, year round
· Easy and safe to use · Safe to delegate
What sets the Accent XL apart
from the competition

49. User Friendly
LCD Touch-Screen

50. Specifications
Output Frequency 40.68 MHz
RF Power up to 300 W
Modulation Frequency 15 kHz
Pulse Rise/Fall Time
(duty cycle 5-100%): <1.5 µsec
Graphic User Interface LCD touch-screen

51. Clinical Examples

52. Body Shaping
Photos Courtesy: Roald Varon, M.D., Buenos Aires,
Argentina

53. Dr. JD McCoy, Contour Medical, Gilbert AZ
Cellulite Reduction

54. Dr. JD McCoy, Contour Medical, Gilbert AZ

55. Skin Tightening
Photos Courtesy: Ramon H. Rosado, M.D.,
Medlight, Mexico City, México

56. Larry Helwig, RN Clear Skin Laser Centre, Phoenix AZ
Body Shaping

57. Larry Helwig, RN Clear Skin Laser Centre, Phoenix AZ
Body Shaping

58. Treatment
Side Not Treated
Patient first treatment; Dr. Michael Mall, New Image Laser Center, Las Vegas.
Mid-Treatment Comparison

59. Volume Reduction

60. Volume Reduction
Ilan Karavani M.D., President of the Benelux
Society for Dermatological Surgery, Antwerp,
Belgium

61. Skin Tightening
Photos Courtesy: Stuart Melnick, M.D., Los Gatos, CA

62. Bipolar Brow Lift
Photos Courtesy: Amber Brown, M.D., Ontario, Canada

63. Photos Courtesy:, Julian Cadavid Peña M.D., Dermatologist , Bogota ,Colombia
Scar Revision

64. Press escape to return to the
Innovating Beauty Presentation