**2.1 Understanding RFAL and "enhanced liposuction"**

Over the past 25 years, I have had the benefit of working with virtually every major external and internal energy-based device (EBD). As an EBD physician, I feel fortunate to have been practicing through this 2 decades plus renaissance in the non-excisional EBD face and body contouring. All of the major technologies I have used have their advantages and disadvantages and like all tools, a good tradesman gets good with what they have. The Astute surgeon will quickly be able to see the InMode BodyTite workstation, although not the cheapest, offers the most versatile, safe and effective GAP procedure offerings lipo-coagulation and contraction of the Face, Neck and Body and thus, the extra money of capital outlay, result in a multiple of ROI that make the purchase price differences compared to its competitors worthwhile.

It is now irrefutable that thermal stimulation of the deep subcutaneous and sub-dermal space works to achieve a degree of lipo coagulation and skin contraction that exceeds non-thermal techniques alone. The excellent work of Dr. Barry DiBernardo using a laser lipolysis system (SmartLipo, Cynosure) has shown a good 17% area contraction, 25% increase in dermal thickness and 29% increase in skin elasticity following sub-dermal thermal stimulation using a laser fiber [9]. This SmartLipo study was measuring only the thermal control of the subdermal space and skin contraction. The limiting factor in the 15–20% skin tightening component of soft tissue contraction is the thermal safety features of devices that work directly under the skin. Most of these devices (Vaser, Laser, Plasma or mono-probe RF) you would be hesitant deploying then on the face, eyelids, or neck, or even low-fat content small body areas where the incidence of burns and seromas' would be too high. The medical-legal liability of not using a state-ofthe-art enhanced, automated external and internal thermally controlled Lipocontouring device as the "standard of care" would be a decision that would be very hard to defend.

Because of the risks of thermal injuries and burns, prior to InMode and RFAL, most technologies sell features and tissue effects that work in the deeper adipose tissue. Ultrasound (VaserLipo), Laser (SmartLipo), Plasma (Renuvion) and mono-probe internal RF, are all most safely deployed in the adipose tissue, NOT IN THE immediate Subdermal space. All these competitive energy devices have value and benefit, but I will also highlight in these two chapters why the BodyTite, workstations provide the most effective "Total Tissue thermal contraction" (adipose + Skin) and bulk heating, in the safest construct, with automated feedback RF and thermal control, facilitating the industry leading 60–70% contraction **IN ALL TREATMENT** areas from the delicate eyelid tissue to large abdominal collections. It is this **"Total Tissue",** bulk heating, thermal control and contraction proposition and the far more **ROBUST ROI from its safety and versatility,** that continues to have InMode as the world's leading Thermal Contraction System **BY FAR** [10–15].

As physician owners you can deploy your AccuTite anywhere on the face, from the brow and lids, midface, perioral region and neck and the Morpheus externally for tightening and wrinkle reduction; the FaceTite on the jawline and neck, upper arms, breasts and BodyTtie on all body areas with the Morpheus used in combination from the outside-in. With the BodyTite applicators you get your 20–25% skin contraction with safe predictable subdermal and transdermal work (Morpheus) and the FSN contraction of 40% the RFAL inside applicators.
