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Doctors weigh in on HIFEM muscle stimulation plus RF/TPE combination

Sponsored by BTL Aesthetics

With a suite of modalities that attack different issues and areas via a variety of vectors, BTL Aesthetics (Boston, Mass.) is a force to be reckoned with in non-invasive body sculpting technologies. There’s no denying the results because the research is there: BTL technologies work if you use them as directed. In combination, the synergy is equally evident, according to expert physicians.

An excellent example of this includes the EMSCULPT and EMTONE. As stand-alone treatments, each provides results that will bring patients back into the office for more and can be integrated into any body sculpting plan because of their unique mechanisms of action. Together, they can provide homerun results.

According to Paul J. Frank, MD, a cosmetic dermatologist and medical director of PfrankMD in New York, N.Y., combination treatments are always the best intervention. “When people look at their bodies, they see one thing – that it’s just no good – but the problem is usually multifactorial,” he said. “It is not just the skin, or fat or muscle, so a multifactorial solution will yield the best results. Therefore, the more therapies we can bring to bear, the more aspects of the silhouette can be corrected, and the better the overall outcome is going to be. When the procedures complement each other, it is even better, and that is what we have with EMSCULPT/EMTONE.”

EMTONE, the newer of the technologies, uses radiofrequency (RF) plus targeted pressure energy (TPE) to battle cellulite effectively. A combination itself, this comfortable treatment works for both hard and soft cellulite by delivering homogeneous heat via monopolar RF to affect the skin and underlying tissue. Concurrently, the fibrous septae are relaxed and slackened by the mechanical manipulation of TPE, which also enhances collagen turnover and stimulates microcirculation as shown in histology studies. The overall effect is improved skin quality, remodeling of surface and underlying tissue, and visibly improved appearance of cellulite.

According to dermatologist Lesley Clark-Loeser, MD, who practices in Davie, Fla., a typical course of treatment is four sessions spaced over about two weeks. “This is a truly effective therapy for improving cellulite, which is a high-demand indication because there hasn’t been much in the way of effective treatment available to us. It not only addresses different types of cellulite; it also accounts for the multifactorial nature of the condition.”

“In my experience it is the first device to combine RF and mechanical energy in this way,” added Dr. Frank, “so you’re able to boost collagen and improve connec- tive tissue components while breaking up irregularities such as fat pockets and dimples in the skin.”

EMSCULPT has been making waves since its arrival on the scene and is becoming more popular as the device evolves with the addition of smaller skeletal muscle applicators, increasing its utility. “EMSCULPT uses algorithms designed to rapidly and variably target all regional muscles using focused electromagnetic current of different intensity levels,” said cosmetic dermatologist Mariano Busso, MD, who practices in Miami, Fla. “This provides supramaximal contractions throughout the treatment session to induce muscular hypertrophy.”

Not only does this use of high intensity focused electromagnetic (HIFEM) energy improve underlying musculature, it causes upregulation of local metabolism as the supramaximal contractions – far beyond what one could achieve voluntarily – create a local energy deficit affecting nearby fatty tissue. Four 30-minute sessions of EMSCULPT, spaced two to three days apart, are required to produce results, which take a few months to fully manifest.

“This device is truly novel, bringing a new category of aesthetic treatment into the armamentarium,” Dr. Frank explained. “To me, EMSCULPT is to the body what inject- able neurotoxin was to the face a few decades ago.”

“What happens with the combination is that we start with EMSCULPT to build the underlying musculature, which has a serendipitous effect on localized fat as energy needs cause fat cell apoptosis,” said Dr. Frank. “I don’t sell EMSCULPT as a fat removal device, but people definitely notice reduction of fat. Then we have EMTONE to treat the surface and subsurface skin and tissue.

“It is like a layer cake; the musculature is the deepest layer, with fat going into the subdermis, then the dermis and epidermis with the fibrous septae throughout,” Dr. Frank continued. “This combination treats all layers of the cake. EMSCULPT treats the deeper layers, fat and muscle, where EMTONE is everything above that including improvement of microcirculation, better skin tone and quality, and reduction of laxity.”

“What this kind of therapy is great for is addressing body contouring needs the patient has a hard time describing,” said cos- metic dermatologist Dendy Engelman, MD, who practices at Manhattan Dermatology & Cosmetic Surgery (New York, N.Y.). “It could be the underlying musculature, skin laxity, textural issues, things like that, mostly in combination. I start with EMSCULPT to restore underlying musculature and reduce fat, then apply a course of EMTONE to address the skin and underlying tissue. You can do both treatments the same day, safely.”

Both devices are also very easy and safe to use, and as such are commonly delegated to ancillary staff, improving profitability. “EMTONE requires a little more attention by the user, EMSCULPT mostly requires supervision and simple adjustment over a treatment session, and both are totally safe for trained staff to apply to patients with confidence,” said Dr. Clark-Loeser.

“The similar protocols make concurrent treatment convenient for patients, and the more I can rely on physician extenders to provide excellent care, the greater the impact on our bottom line due to efficient use of time and expertise,” Dr. Clark-Loeser added. “Most of my staff is cross-trained on either or both devices, so no matter who is around or who is on vacation, we’re able to function.”

Patient response to the combination has been enthusiastic, according to Dr. Clark-Loeser. “Most women, starting at age 30, come in with textural changes and skin tone issues, but will benefit from the improvement of underlying musculature. As they age the problems are more profound, but results can still be achieved. Both low- and high- BMI patients will benefit, but the higher BMI group won’t see as much of a visible result.”

This combination is ideal for professionals on the go, or anyone seeking maximum results with minimal hassle. “In New York City where I practice, everybody is busy,” said Dr. Frank. “They want to know how many treatments, how much time, how much is involved, and what kind of downtime they can expect. This is perfect because it is fast and easy, involves relatively few sessions, has no downtime and requires nothing but a little time. We can often do both treatments concurrently, saving more time. And maintenance is just as easy, maybe a few sessions a year if they take good care of themselves. You can’t beat that.”

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