Beyond Body Shaping: Aesthetic Technology Used for Functional WellnessBeyond Body Shaping: Aesthetic Technology Used for Functional Wellness

The term “wellness” has become a buzzword used across the nation by physicians and lay people alike. As the world has become more focused on wellness, innovations emerging from the world of aesthetics are being reimagined and revolutionizing medical treatment paradigms in orthopedics, neurology, spinal surgery and more.

“Wellness” has been defined as a holistic approach to overall health and well-being, going beyond the absence of disease states and into more idealized functionality of the mind, body and spirit.¹ In parallel with the growing awareness and uptake of this approach, the global market for health and wellness is projected to grow from close to $4 trillion in 2023 to more than $8 trillion by 2033,² with a reported 82% of U.S. consumers considering wellness a top priority in their daily lives.³

Beyond Body Shaping

As documented repeatedly in articles and anecdotes, the high-intensity focused electromagnetic technology (HIFEM®) plus radiofrequency (RF) technology in Emsculpt Neo® from BTL Aesthetics (Marlborough, Mass.) provides functional improvement above and beyond body shaping. Besides its strong recognition in aesthetic medicine, the Company is also renowned worldwide for its solid background in physiotherapy and robotics. As such, BTL has responded with exploration and development, leading to a new protocol for Emsculpt Neo. Treatment under the new protocol provides therapy designed to maximize functionality, instead of its lauded form-plus-functional objective.

The original protocol of Emsculpt Neo HIFEM+RF therapy was designed for building muscle, body shaping and core muscle improvement. Providing thousands of supramaximal muscle contractions plus RF energy in the treatment area stimulates muscular hypertrophy and hyperplasia⁴ as well as circumference reduction. With its various applicators, this technology can be applied virtually anywhere on the body, stimulating and strengthening the core, pelvic floor or skeletal muscles of the extremities, with myriad associated functional benefits.

Functional Wellness Protocol

This new functional wellness protocol relies on shortened pulse duration to induce quick, controlled contractions and avoid muscle overload and fatigue. Its higher frequency stimulation is more about nerve modulation and retraining neural pathways than inducing supramaximal contractions – essential when the goal is not solely muscle contraction but regaining fine motor control and improving neuroplasticity. Lower-intensity stimulation is essential to avoid causing further damage to weakened or recently injured muscles.^5-8 This makes the new protocol a game-changer for a device already afforded that moniker. Orthopedic surgeon Shawn Trokhan, MD, from Trokhan Orthopaedics, LLC (Closter, N.J.), specializes in functional wellness and musculoskeletal injury in patients of all ages. “My wife is a cosmetic dermatologist and when she got this for her office and I saw what it could do, I easily made the leap to its possibilities for orthopedics,” he shared. “With the new protocol, we have an exciting conservative and non-invasive option to stave off the need for orthopedic surgery, serving as an adjunct to – or in some cases even mitigating the need for – physical therapy. It requires no new devices or applicators, only the new protocol, so anyone with the device can do this.”

Neuromuscular Rehab

With new FDA clearance, Emsculpt Neo is now indicated for use in stimulating neuromuscular tissue for bulk muscle excitation in the legs or arms for rehabilitative purposes in a variety of medical diseases and conditions. Intended to be used under medical supervision as adjunctive therapy, treatments may be used to improve muscle spasms, disuse atrophy, blood circulation and muscle re-education. Emsculpt Neo can also be used for post-surgical calf muscle stimulation to prevent venous thrombosis or to maintain or increase range of motion.

HIFEM for Physical Therapy

According to orthopedic surgeon Eugene Lou, MD, of Southeast Texas Orthopedic Group (Houston, Texas), this revolutionary therapeutic vector is all about providing improvements without the downsides that come with the physical motion otherwise necessary to achieve them. “Musculoskeletal injury causes swelling and inflammation designed to protect the joint structures while healing,” he explained. “This immobilizes the joint to some degree, depending on the injury. Movement may exacerbate injury or slow recovery, but movement also has benefits, which is why we rely on physical therapy. HIFEM technology provides thousands of isometric contractions, in thorough patterns generated by Emsculpt Neo’s software algorithms, creating an enormous amount of muscle strength and stability without physical movement.” According to Dr. Lou, “These also reverse the polarity of the muscle contraction in a way that causes the removal of lactic acid, as opposed to the painful buildup we expect with exercise. Even without the pain and swelling, patients simply cannot voluntarily move adequately, or enough, to have anywhere near this effect by their own willpower,” he noted. “It is simply impossible. Even pro athletes cannot work like that. There are also other benefits, such as improvements in local circulation.”

Dr. Lou used this technology to treat two major league baseball pitchers. “What we saw were two young professional athletes at peak conditioning who, between injuries or off-season surgery, had reduced functionality and retarded progress with no end in sight. They not only came back healthy, their numbers – in the most empirically documented sport on Earth – showed obvious improvement. One was virtually unhittable as a closing pitcher during the World Series that following season. We are talking about pro athletes here, but we are also talking about physical and physiological demands that the normal person generally does not have.”

Mohamed Abdulhamid, MD, founder of Royal Spine Surgery (Scottdale, Ariz.), turned to Emsculpt Neo to enhance his surgical outcomes. “In my spinal surgery patients, I noticed a significant trend: Those with stronger back and leg muscles tended to recover more smoothly and experience better long-term results,” he recalled. “Although I initially incorporated physical therapy, it had limitations. During my search for solutions, I came across Emsculpt Neo, reached out to the Company and learned about its mechanisms. After trying it, I not only observed the improvements I had hoped for in post-surgical recovery, but I also saw benefits for patients who were not yet surgical candidates. For them, Emsculpt Neo offered a safe, nonsurgical option to build strength and stability, effectively expanding my treatment capabilities.”

Research Behind the Protocol

The new protocol rests on the backs of two studies,^9,10 together including more than a total of 70 patients from six centers across the U.S. Research centers included multiple relevant specialties in wellness, orthopedics, neurology and spinal surgery. Drs. Lou and Trokhan were involved in the musculoskeletal and joint study⁹ in which patients (n=31, age range 23 to 78 years, BMI 25±4 kg/m2) with a history of musculoskeletal and joint issues underwent four weekly, 30-minute sessions of Emsculpt Neo on the upper or lower extremities. Substantial improvement was noted in the scores from two scoring systems recognized in the specialty, with remarkable increases in range of motion and improvement in overall mobility and strongly reported reductions in discomfort and pain. “We saw impressive improvement in upper or lower extremities, with all patients reporting very little discomfort during treatment,” Dr. Lou noted. “What I saw were results that were physiologically not possible before Emsculpt Neo using this functional wellness protocol.”

Dr. Trokhan was equally impressed. “Our results show that Emsculpt Neo is a wonderful non-invasive, nonsurgical way to treat issues that plague a lot of patients. It seemed as if all the patients I enrolled were satisfied and raved about the technology, results and ease of treatment. Both those who undergo it and those who administer it are amazed by what we have experienced.”

Dr. Abdulhamid was lead investigator of the strength study.10 Patients (n=30, age range 32 to 76 years, BMI 27±4 kg/m2) with atrophied muscles due to surgery, refrained physical activity or injury were recruited and split into active (treatment) and sham groups. The active group underwent four weekly, 30-minute sessions of HIFEM+RF. “Muscular strength was measured by dynamometer pre-treatment, immediately after the last treatment, and at one- and three-month follow-up visits,” Dr. Abdulhamid explained. “Dramatic increases in strength were noted in the active group compared to sham.” Almost all active group patients reported improvement in comfort during physical activity, improvement in atrophy/weakness, restored muscle engagement and better movement. Many reported feeling less prone to injury, and more than half reported improvement in flexibility. “When all is said and done this will totally validate the idea that improving muscle strength using this protocol with Emsculpt Neo has great potential to improve overall functional wellness and quality of life.”

Physiological and Psychological Benefits

According to Dr. Abdulhamid, another advantage of Emsculpt Neo in promoting functional wellness lies in its combined physiological and psychological benefits, particularly in enhancing patient mobility. “Improved mobility encourages patients to be more active in their recovery process, which in turn accelerates further recovery. This positive cycle is significantly boosted by the powerful results we see with Emsculpt Neo,” he remarked.

One of Dr. Abdulhamid’s recent patients emailed him excitedly the day after his first treatment. “He awoke that night to use the bathroom and experienced notable reduction in discomfort and improved mobility in his lower back and hips. He slept the rest of the night on his back, comfortably, which he had not been able to count on before. The next day his trainer marveled at the improvement in his mobility.”

One case stands out among Dr. Lou’s many memorable experiences. A man Dr. Lou knew had endured a devastating motorcycle accident, followed by 13 months of intensive rehabilitation at one of the nation’s top facilities. Despite his efforts, he was left relying on crutches and a locking knee brace, with little hope for further improvement. “It was serendipity,” Dr. Abdulhamid declared. “Just before getting on a plane to give a lecture about the theoretical therapeutic use of Emsculpt Neo for functional wellness, I ran into him and asked after his well-being. I had not seen him in two years and he was so obviously impaired. I sent him to my clinic. When I touched down, I got a call from my clinic that he had been crying; for the first time in more than a year he saw his left quadriceps firing.” With Emsculpt Neo, over the next five months he regained his ability to walk without crutches or a knee brace, do a squat and even ride his motorcycle again. “He was still a bit unsteady, so we did a course of three more sessions using the Emsella® applicator. This not only helped his stability, but it also resolved serious incontinence problems he had been too embarrassed to share with me – and he was happier about that than he had been about being able to walk again.”

Overall, the man underwent nine 30-minute sessions of Emsculpt Neo followed by three more sessions using the Emsella pelvic floor chair applicator. “That is around six total hours, not even a full workday, leading to results that 13 months of therapy at a world-class rehabilitation facility could not even come close to achieving,” Dr. Lou emphasized. “That is something I will never forget.”

References:

1. What is Wellness? U Health: University of Utah School of Medicine. Available at: https://medicine.utah.edu/students/ wellness/what-is-wellness. Accessed October 9, 2024.

2. Global Health and Wellness Market by Type (Health & Wellness Food, Beauty & Personal Care Products, Fitness Equipment, Wellness Tourism, and Other Types), by Region and Companies - Industry Segment Outlook, Market Assessment, Competition Scenario, Trends, and Forecast 2023-2032. Market.us. Published October 2024. Available at: https://market.us/report/ health-and-wellness-market/. Accessed October 9, 2024.

3. Callaghan S, Doner H, Medalsy J, Pione A, Teichner W. The Trends Defi ning the $1.8 Trillion Global Wellness Market in 2024. McKinsey.com. Published January 16, 2024. Available at: https://www. mckinsey.com/industries/consumerpackaged- goods/our-insights/thetrends- defi ning-the-1-point-8-trilliondollar- global-wellness-market-in-2024. Accessed October 9, 2024.

4. Duncan D, Dinev I. Noninvasive Induction of Muscle Fiber Hypertrophy and Hyperplasia: Effects of High-Intensity Focused Electromagnetic Field Evaluated in an In-Vivo Porcine Model: A Pilot Study. Aesthet Surg J. 2020; 40(5):568-574. doi:10.1093/asj/sjz244

5. Sutbeyaz ST, Sezer N, Koseoglu BF. The Effect of Pulsed Electromagnetic Fields in the Treatment of Cervical Osteoarthritis: A Randomized, Double-Blind, Sham-Controlled Trial. Rheumatol Int. 2006;26(4):320-324. doi:10.1007/s00296-005-0600-3

6. Funk RH, Monsees TK. E  ects of Electromagnetic Fields on Cells: Physiological and Therapeutical Approaches and Molecular Mechanisms of Interaction. A Review. Cells Tissues Organs. 2006;182(2):59-78. doi:10.1159/000093061

7. Saliev T, Mustapova Z, Kulsharova G, Bulanin D, Mikhalovsky S. Therapeutic Potential of Electromagnetic Fields for Tissue Engineering and Wound Healing. Cell Prolif. 2014 Dec;47(6):485-93.

8. Rinoldi C, Kijenska-Gawronska E, Khademhosseini A, Tamayol A, Swieszkowski W. Fibrous Systems as Potential Solutions for Tendon and Ligament Repair, Healing, and Regeneration. Adv Healthc Mater. 2021;10(7):e2001305. doi:10.1002/adhm.202001305

9. Lou E, Trokhan S, Levine P. E  ect of HIFEM Application on Musculoskeletal System: Evaluation of Musculoskeletal System Improvement. Data on file. BTL Aesthetics.

10.Abdulhamid M, Saville P, Schoe  J. Simultaneous Application of HIFEM Procedure and Radiofrequency for Improvement of Muscular System Function. Data on file. BTL Aesthetics.