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Combination cellulite reduction and HIFEM muscle stimulation provide one-two punch for body shaping

Article-Combination cellulite reduction and HIFEM muscle stimulation provide one-two punch for body shaping

Sponsored by BTL

Individually, the EMTONE and EMSCULPT devices from BTL Aesthetics (Marlborough, Mass.), provide profound and unique capabilities to aesthetic physicians, working synergistically to tone and shape. Together, these technologies round out the BTL family of non-invasive body sculpting devices that have been reshaping the industry in recent years.

EMSCULPT employs electromagnetic current that has been shown shown to induce muscular hypertrophy. These electromagnetic pulses are algorithmically applied to alternate between long and strong, rapid and rhythmic, and fibrillating from different directions, with built-in rest phases.

“The algorithms are designed to not only provide supramaximal contractions over the treatment time, but to variably target the entire musculature in the region, including large and small muscles,” said Mariano Busso, MD, PA, a cosmetic dermatologist who practices in Miami, Fla.

According to Lesley Clark-Loesser, MD, a dermatologist in Hollywood, Fla., a course of EMSCULPT usually involves four, 30- minute sessions spaced two to three days apart, and other than muscular soreness there is no real recovery or downtime. “Patients can go about their business as normal. They may feel that they notice the effects after about the third session, but it takes several months for the full result to develop.”

The introduction of additional applicators has increased the utility of EMSCULPT. The new small contour applicators focus and apply energy differently to better suit skeletal muscles on extremities such as the biceps, triceps or calves. These new applicators are specifically FDA cleared for strengthening, toning and firming of the buttocks, thighs and calves, as well as improvement of muscle tone and firmness for strengthening muscles in arms.

While anyone can benefit from EMSCULPT’s supramaximal muscle stimulation, higher BMI patients will not see the visible slim- ming and toning effect as readily, and as such may not be ideal candidates for the unique therapy.

EMTONE works in an entirely different manner from EMSCULPT, addressing cellulite rather than the underlying musculature and fatty layer above. As Brian Kinney, MD, a plastic surgeon in Beverly Hills, Calif., explained, there are currently two recommended methodologies for addressing cellulite: RF and mechanical pressure therapy. “The EMTONE device is the only one on the market that combines these in one treatment.”

Featuring an audio and visual control system with intuitive touch display, and a Smart Touch tip, the handpiece only applies energy when in contact with the skin. According to Dr. Busso, the user applies ultrasound lotion to the patient and moves the handpiece over the treatment area, as RF and targeted pressure energy (TPE) are delivered. “This is most commonly used on the thighs, abdomen and buttocks. It is a very comfortable treatment and has no downtime,” he noted.

“EMTONE works for both hard and soft cellulite,” Dr. Busso elaborated. “The mechanical effect is more profound with hard cellulite, and the thermal effect is more of an actor with soft cellulite. In addition, cellulite of any grade is a candidate for EMTONE. More severe cases will benefit from adjunctive therapies to reduce fat and tighten overlying skin to get the best outcomes, but it is also a great stand-alone treatment for mild to moderate cases.”

Cellulite is multifactorial, Dr. Clark-Loesser expressed. “The loss of elasticity in the fibroseptal network, quality issues in overlying skin and less-than-ideal circulation beneath the skin – which causes accumulation of metabolic waste and engorges the chambers of underlying fat – causes the associated rippled and/ or dimpled appearance of skin.”

“EMTONE therapy produces homogeneous heat with monopolar RF to affect the skin and underlying tissue,” Dr. Clark-Loesser continued. “Together with the non-invasive disruptive force created via the effects of TPE, treatment simultaneously loosens the fibrous septae, stimulates collagen and circulation, and improves skin quality. EMTONE relies on the synergy between these two energy sources combined in a single treatment. Histology has shown improved collagen production, skin tone and enhanced blood flow. There is no BMI restriction, although a slimmer patient may be more ideal for treatment.”

“Visually, over time, the skin looks softer and smoother with reduced dimpling or rippling, depending on the severity of the condition we’re presented with,” Dr. Busso stated.

In Dr. Clark-Loesser’s experience, “Good, consistent before-and-after photography is very important with EMTONE. The result is nice, but due to its inherent nature and subtle onset, good pictures help highlight the more profound changes over time and bring patient satisfaction to the highest levels. This is true for a lot of treatments, especially non-invasive ones whose results manifest over time.”

“While theoretically one could undergo several treatments in a single day, most patients opt for no more than two, often of related body region treatments such as flanks and buttocks or bilateral anterior thighs,” said Dr. Clark-Loesser.

Dr. Kinney has actually performed clinical research on EMTONE. “In our animal model presented in April 2019 at ASLMS in Denver, we examined histological specimens from two types of treatments: One being simultaneous RF and targeted pressure energy, and the second being sequential RF and targeted pressure energy. The clearly superior treatment was simultaneous application of RF and TPE. There was a 59% higher increase of collagen fibers, 64% higher increase in elastin fibers and 44% higher increase in dermal thickness compared to sequential treatment,” he reported. “In addition, the treatment time was cut in half. This represents a significant step up to another level.”

“There isn’t a lot out there to successfully treat cellulite, and there certainly isn’t a lack of demand for this kind of treatment,” Dr. Clark-Loesser stated. “Due to its unique technological synergy, EMTONE provides a relatively low treatment time of up to 20 minutes per area with few sessions. And like EMSCULPT the recommended course is four treatments over two weeks.”

According to Dr. Busso, this similarity in treatment regimen is helpful to practices. “Because the two devices complement each other, but use different modalities for different targets – with similar recommended courses of treatment – you can do them both on the same day for patients, repeatedly. This is very convenient for the practice as well as the patient.”

Additionally, both technologies are easily delegated to ancillary staff, explained Dr. Clark-Loesser. “EMSCULPT is largely operator-independent, but requires super- vision as the technician adjusts intensity throughout the session. EMTONE is more hands-on. The technique isn’t difficult, but does require more from the user.”

Dr. Clark-Loesser is planning to combine the technologies for post-partum treatments. “We’re excited to see how well we can restore abdominal muscles with EMSCULPT, and tackle the overlying tissue with EMTONE,” she said.

According to Dr. Kinney, one key ingredient in the mix is what BTL as a company brings to the table, as evidenced by its suite of body shaping technologies. “Focusing energy – whether by RF, TPE, electromagnetic or others – and varying spot sizes, frequencies, wave patterns, wave forms and propagation, represent the next steps in the evolution of advanced body contouring procedures,” he said. “BTL is leading the way.”

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