Rumpa Linpiyawan, MD. Biography - Certified Board of Internal Medicine - Certified Board of Dermatology, Board of Family Medicine

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1 Rumpa Linpiyawan, MD Biography - Certified Board of Internal Medicine - Certified Board of Dermatology, Board of Family Medicine Dr. Rumpa is a well-known dermatologist who had been assistant Professor in Dermatology at Mahidol University, Siriraj Hospital. In 2004, she had co-founded and established several successful private skin centers in Thailand. She has been invited as a speaker and trainer on trusted aesthetic technologies and world class injectables in Thailand and overseas. Dr. Rumpa is one of the Certified Honorable Trainers of Galderma Asia Pacific and a leading Luminary doctor for Venus Concept. She s one of the pioneers using the Venus Viva. Currently Dr. Rumpa is a director of the Rampada International Skin Clinic.

2 Ultrasonic Body Contouring Rumpa Linpiyawan, M.D. Board Certified Internal Medicine Board Certified Dermatologist Rampada International Skin Clinic Bangkok, THAILAND

3 3 9/8/2018

4 No conflict of interest Disclosure Thank you Dr. Pattana (Uncle Teng) Innovative treatment for fat reduction

5 25 minutes The Body Fat Ultrasound in medicine/aesthetic Pulsed Focused Ultrasound The Science Behind Ultrasound Selective subcutaneous fat reduction

6 The Body Fat Visceral fat Subcutaneous fat Can be resistant to exercise & diet

7 Subcutaneous fat is more resistant to diet/exercise Fat lost

8 Ultrasound in Medicine Diagnostic Ultrasound = IMAGING Focused Ultrasound = THERMAL - HIFU (Ulthera), MMFU (Ultraformer III) Pulsed Focused Ultrasound = MECHANICAL - Lithotripsy (destroy kidney stones) - UltraShape Power

9 Ultrasound 50W Lithotripsy Mechanical Therapeutic Avg. Power [W] 10W 1W 0.1W UltraShape Power HIFU Physiotherapy Thermal Therapeutic Diagnostic mw Imaging Frequency [MHz]

10 Ultrasound

11 Ultrasound

12 The Physiological Effect of Acoustic Energy The Science Behind Ultrasound Formation of bubbles. Followed by Implosion of bubbles The energy released when the bubbles implode causes mechanical injury to the target cells.

13 Focused Ultrasound

14 How focused US works? The effect is purely mechanical, Temperature in tissue rises by no more than C Ultrasound energy is focused at the subcutaneous fat layer

15 Pulsed Focused Ultrasound Skin Non-Thermal Purely Mechanical Fat Layer Depth of 1.3 cm +/ 0.2 cm Muscle

16 Effects of Pulsed Focused Ultrasound Control Treated In-vivo Porcine Model: S.Brown et al Plastic and Reconstructive Surgery July 2009 Immediate Fat Destruction

17 Histology of Pulsed Focused Ultrasound Control-untreated Single Treatment In-vivo Porcine Model: X 40 Immediate Selective Fat Cell Destruction X 40 S.Brown et al Plastic and Reconstructive Surgery July 2009

18 Ultrasound s Destruction is Selective to Fat Cells Control Destroyed Fat Cells Treated In-vivo Porcine Study: Scanning Electron Microscopy Intact Connective Tissue Immediate Selective Fat Cell Destruction

19 Fat Cells X 40 Fat cells are made of fatty acids (fluids) surrounded by a thin fragile cell membrane. Adipocyte μ, Muscle cell 10 μ, RBC 6-8 μm, Nerve cell 4 μm

20 Mechanism for Fat Elimination Freed triglycerides are safely cleared from the local area, processed by the body s natural physiological and metabolic pathways, and transported to liver Clinical studies have proven that there are no clinically significant changes in lipid profiles.

21 Comfort Patients in a recent clinical study rated pain as 0.7 on a scale of 0 to 10 99% of patients reported feeling comfortable during treatment NO DOWNTIME

22 Transducer For Precise Control Lighter: less treatment fatigue Compact hand piece design allows for easy access to highly contoured body areas as well as a fast glide over large treatment areas

23 Ultrasound Energy at a Precisely Delivered Frequency and Power Provides Effective& Comfortable Fat Destruction No fixed applicators NO SUCTION FORCE Procedure time is a fast minutes depending on areas treated and treatment modes used

24 Touch Screen & Video Camera

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30 Single treatment 2 weeks Before After

31 Before After

32 Before After

33 Before After

34 Before After

35 Non-invasive reduction in abdominal circumference via fat cell disruption. FDA Indications Comfort: Mechanical effect, not thermal, pain free experience Coverage: Free style treatments not limited by applicators Customization: Tailored to the contours&size of each client s body

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37 % Reduction in Fat Layer Thickness At 12 Weeks UltraShape Power 32% SculpSure 11.5% UltraShape 19.0% CoolSculpting 22.0% 0.0% References 10.0% 20.0% 30.0% 40.0% Ultrashape Power Clinical Study, FDA, 2016 SculpSure: FDA 510k, K July UltraShape: Data on File, 2014 CoolSculpting: A Prospective Clinical Study of Noninvasive Cryolipolysis for Subcutaneous Fat Layer Reduction, Dover, J et al, (At 16 weeks)

38 Subcutaneous Fat Reduction Over Time Reference: Ultrashape Power Clinical Study, FDA, 2016

39 Limitation of Focused US Slow (spot size): minutes Learning curve : keep moving, no overlap Fixed focal depth: depend on tissue & patient position Disposable Transducers

40 Summary: Ultrasonic Body Contouring FOCUSED Ultrasound energy is delivered to subcutaneous fat layer within a precise focal volume at a controlled depth PULSED Mechanical non thermal effect results in minimal elevation of 0.8C in treated tissue = painless treatment SELECTIVE Fat cells are precisely targeted while blood vessels, nerves and other tissue remain protected

41 Body Rampada clinic Pulsed Focused Ultrasound RF Cryolipolysis (Coolsculpting) HIFU- Ultraformer III Combination of treatments yields the best outcomes. To achieve fat destruction and circumference reduction plus skin tightening and improvement in cellulite.

42 A Food Analogy on How the Ultrasound Works Day of First Procedure Often as soon as Days Later

43 THANK YOU

44 Combining Ultrasound + RF + HIFU Define + Refine Improve the appearance of Cellulite Reduce circumference around the abdomen and thigh Improve skin quality Combine treatments to define & refine with UltraShape Power & RF

45 Focused Pulsed Ultrasound Fat Cell Destruction Comfortable minute procedure No visible downtime Fully customizable to needs of every patient 3 treatments spaced at 2 week intervals

46 3 Non-Invasive Methods for Fat Reduction Method Cryolipolysis Laser UltraSound Technology Cold Heat Ultrasound Procedure Discomfort Yes Yes No Procedure Time for Abdomen (Over Treatment Series) 148+ min 150 min 98+ min Post Procedure Downtime Some No No # Sessions DISPOABLE COST/ 10 FTZ $1, $ VISIBLE Results Months Variable Weeks

47 Overview UltraShape Power CoolSculpting SculpSure Mechanism of Action Immediate, selective fat cell destruction by mechanical pulsed UltraSound Freeze thaw necrosis: Apoptosis (gradual fat death over time) Heat generated via 1060nm diode laser; Requires contact cooling for procedure tolerance Body Areas Treated Abdomen Non pinchable / grabbable fat Fibrotic areas can be treated as well OUS: Thighs; flanks Abdomen, flanks, back, thigh, submental area Does not treat unpinchable fat Abdomen, flanks, Selective Fat Cell Destruction Yes Mechanically disrupts fat cells leaving surrounding tissue, nerves intact Semi No % Fat Layer Reduction via Ultrasound measurement 32% 22% 11.5% Discomfort from Temperature Change None. Non thermal effect Virtually pain free <0.8 C elevation in tissue temperature 0.7 pain rating on scale of 0 10 Discomfort from Vacuum + Cold Uncomfortable. Likened to acute menstrual cramps High tissue temp elevation of C Requires contact cooling for procedure tolerability

48 Overview UltraShape Power CoolSculpting SculpSure Treatment Size & Shape to Fatty Area Free style treatment Fully customize to any shape and size for complete contouring. Not limited by size of applicator No Limited by the size & shape of the applicator No Restricted by 4cm x 6 cm rectangular PACs Side Effects None Mild erythema in rare instances Bruising, soreness, lumps, numbness can last hrs. / weeks Reports of Paradoxical Hyperplasia n/a Focused precise focal depth of 1.3 cm +/- 0.2 cm No Semi Post Treatment No signs of inflammation or treatment Red &swelling, inflammation, itching, bruising, soreness, numbed for 3 weeks paradoxical hyperplasia Reported Shelving phenomena and uneven fat destruction area Redness Time to Visible Results Some patients often see outcomes 2 weeks post 1 st treatment Additional reduction up to 3 months post treatment 2-3 months 2-3 months # of Treatments 3 2;-3 Sometimes more 2