High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: Safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping

Noninvasive High-Intensity Focused Electromagnetic Therapy in Women With Urinary Incontinence: A Systematic Review and Meta-Analysis

INTRODUCTION

Urinary incontinence (UI) is an uncontrollable expulsion of urine at a time. UI is obviously not life-threatening, but its impact on the patient's quality of life (QoL) is often devastating. Many treatments method to address this problem but all these methods have limitations. Recently, a brand-new noninvasive treatment for pelvic floor muscles (PFM) using a high-intensity focused electromagnetic (HIFEM) field was unveiled. HIFEM therapy may provide better results thus in this study, we aim to summarize the existing evidence and assess the efficacy and safety of HIFEM.

METHOD

The databases used were Pubmed, Cochrane, EMBASE, and SCOPUS. The literature search was performed using strategic keywords (women) AND ((High Intensity Electromagnetic Field) OR (Electromagnetic Stimulation)) AND ((urinary incontinence) OR (overactive bladder) OR (pelvic floor dysfunction)). Articles that meet the inclusion and exclusion criteria are then analyzed.

RESULTS

Seven studies were included in this review, most of the studies concluded that the usage of HIFEM can reduce the symptoms related to UI significantly and improve QoL. There was higher decrease of UI episodes (MD: -4.10, 95% CI: -7.34 to -0.85, p = 0.01) and improvement of ICIQ-UI SF score (MD: -3.03, 95% CI: -3.27 to -2.79, p = < 0.00001) in HIFEM group compared to control. Subgroup analyses showed better QoL parameter (MD -3.40; p = 0.01, MD -0.70; p = 0.04) compared to control, albeit statistically comparable overall (p = 0.09). However, both pooled analyses for contraction and resting tone changes revealed that there were no significant differences between both groups (SMD: 0.98, 95% CI: -0.70 to 2.660, p = 0.25 and SMD: 0.20, 95% CI: -0.18 to 0.58, p = 0.30, respectively). Finally, there was no safety issue highlighted in most of the studies included.

CONCLUSION

Current published studies suggest that HIFEM may be an effective and safe noninvasive treatment for female UI by promoting QoL. However, due to being high in heterogeneity and possible bias, future high-quality trials with proper blinding and standardized outcomes are necessary to conclude the applicability of HIFEM for UI.

New developments in cosmetic applications of electromagnetic fields: Client and occupational hazard assessment

Energy-based devices are used to improve features of appearance for aesthetic reasons while avoiding more invasive methods. Examples of treatment targets are the reduction of wrinkles, sagging, unwanted skin lesions, body hair and excess fatty tissue, and the enhancement of muscle tissue. One treatment modality is the use of electromagnetic fields (EMF, 0‒300 GHz). The present work aims to give an up-to-date survey of cosmetic applications of EMF for professional use with an assessment of client and worker exposure and possible adverse effects. A systematic search was conducted for peer-reviewed articles (2007-2022), patents, premarket notifications, manufacturer data, and adverse effects reports. Five categories of cosmetic EMF device with increasing frequency were identified: sinusoid low frequency magnetic fields for lipolysis; pulsed low frequency magnetic fields for skin rejuvenation; pulsed low frequency magnetic fields for muscle building; radiofrequency EMF for lipolysis or skin rejuvenation; microwaves for hair removal or hyperhidrosis. In the vicinity of the last four device categories, there is a potential for exceeding the occupational exposure limits in the European Union EMF Directive, which could lead to nerve or muscle stimulation, burns or overheating. There are also potential hazards for clients or workers wearing active or passive medical devices. The severity of reported adverse effects increases with EMF frequency.

Radiofrequency and Electrical Muscle Stimulation: A Synergistic Treatment That Achieves Lipolysis and Circumferential Waist Reduction in Noninvasive Body Contouring

Background

Surgeons and providers in aesthetic medicine seek noninvasive devices that can be utilized for safe, efficient, and effective body contouring. Patient demand has propelled the development of novel devices that can simultaneously improve skin laxity, adipolysis along with stimulation of muscle hypertrophy.

Objectives

To determine the efficacy of body contouring after 3 treatments using the noninvasive Transform (InMode, Lake Forest, CA) device.

Methods

A prospective, multicenter study was performed. Outcomes evaluated include: standardized caliper and ultrasound measurements of abdominal skin/soft-tissue thickness, waist circumference, histologic evaluation, patient comfort, and satisfaction assessments.

Results

Forty-four patients were successfully enrolled in the study and completed the series of 3 treatments which involved combined electrical muscle stimulation (EMS) and noninvasive bipolar radiofrequency (RF). Abdominal ultrasound measurements reveal a decrease in soft-tissue thickness (average 3.1 mm; P = .001), there was a significant decrease in caliper measurements of periumbilical skin thickness (P < .003), and the average reduction of abdominal circumference was 1.9 cm (P < .0001) 3 months after the treatment series. Histology confirmed subcutaneous adipolysis without damaging the dermal layer. Patients reported a high degree of satisfaction with the overall result (P = .003) and that each of the 3 treatments were progressively more comfortable (P < .005).

Conclusions

This study demonstrates that a series of simultaneous noninvasive RF with EMS treatments to the abdomen decreases subcutaneous soft-tissue thickness of the treated area. These comfortable treatments ultimately result in a high degree of patient satisfaction at 3 months.

Level of Evidence 4

Evaluation of a Combination Approach to Improving Muscle Tone and Decreasing Subcutaneous Tissue Thickness Using a Sequential, Dual-Modality, Energy-Based Device

Background

The body shaping market has long been at the forefront of the aesthetic industry. With technological advances, patient demand for body sculpting in terms of reduction in subcutaneous tissue and enhancement of muscle has seen continual growth. Several devices have emerged in the space; however, few achieve both subcutaneous tissue reduction (SQR) and voluntary muscle increase (VMI) as measured by thickness, during the same treatment session.

Objectives

This article presents the results of a pilot study on a unique approach to subcutaneous tissue reduction and increasing muscle thickness using a dual-modality, energy-based device.

Methods

Twelve compliant patients (8 females and 4 males with an average age of 40 years) were enrolled in this single center, prospective study. All patients were treated with the dual-modality device (850 nm superluminescent diode matrix and electrical muscle stimulation), with external applicators being placed over the lower abdomen. The patients received 5 weekly treatments. Ultrasound measurements, photographs, weight, and waist measurements were taken at baseline, prior to the start of the fifth treatment, and at the 2-week and 2-month follow-up visits.

Results

At the 2-month follow-up visit, the average SQR was 34.03% and the VMI measured 22.97% in all patients who completed the study. All patient and physician evaluations rated the results as satisfactory or better. There were no complications.

Conclusions

Preliminary data show this dual-modality, electrical muscle stimulation/superluminescent diode matrix system provides both a safe and effective treatment for the reduction of subcutaneous tissue thickness and an increase in muscle definition and thickness. Objective and subjective evaluations demonstrated high levels of efficacy and satisfaction in all patients.

Level of Evidence 2

High-Intensity Focused Electromagnetic (HIFEM) Energy With and Without Radiofrequency for Noninvasive Body Contouring: A Systematic Review

BACKGROUND

Emsculpt Neo (EmSculpt NEO Device, BTL Industries, Inc.) is a FDA-cleared noninvasive body contouring treatment for increasing muscle tone and/or reducing fat. The device uses high-intensity electromagnetic energy to stimulate muscle contractions and to build muscle mass (Emsculpt) or a combination of electromagnetic energy with radiofrequency (Emsculpt NEO) to produce a synergistic effect of building muscle mass and reducing fat. In this study, we conduct a high-quality systematic review to evaluate outcomes for Emsculpt and Emsculpt NEO treatments for noninvasive body contouring.

METHODS

An electronic search was performed of the PubMed, MEDLINE, Embase, and Web of Science databases using the key terms "High intensity focused electromagnetic therapy; HIFEM; Emsculpt; Emsculpt NEO; BTL Industries." The search included all articles published in English through January 2023. Inclusion criteria included articles noninvasive body contouring and reporting at least one outcome of interest (clinical or patient-reported outcomes). Methodological quality and risk of bias were assessed using the GRADE criteria. Articles involving applications other than for body contouring, animal studies, and review articles were excluded.

RESULTS

Of the 159 articles identified in the initial search strategy, 51 met relevance based on abstract screening. Fifteen clinical studies were identified, including Emsculpt (n=11) and Emsculpt NEO (n=2). The typical protocol involved four treatments given over a 2-4-week period (range 3-8 treatments) with increase to 100% intensity setting and 1-6-month follow-ups. No complications were reported. Abdominal measurements were obtained using imaging were reported in eight studies. Treated areas included the buttocks (n=4), thighs (n=3), arms or calves (n=1), and abdomen (n=11). For abdominal contouring, mean reductions of fat thickness were 5.5 mm, muscle thickness of 2 mm, and rectus diastasis improvement of 3.0 mm. No studies reported weight change before and after treatment. All studies with patient-reported outcomes report high patient satisfaction. Two studies report marginal or no benefit of treatment. Certain studies failed to report comorbidities or demographic characteristics other than age and sex, which precludes analysis of specific subgroups that may benefit from treatment. Furthermore, certain studies failed to address how missing data or the final study population was analyzed.

CONCLUSION

This systematic review reports on currently published evidence regarding the efficacy and safety of Emsculpt and Emsculpt NEO for body contouring. High-quality level data reporting with patient-reported outcomes will optimize shared decision-making and informed consent.

LEVEL OF EVIDENCE II

Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Loss of subcutaneous fat in 20 patients, both sexes, using a second-generation TECAR device of 1.240 Watts and results analyzed with magnetic resonance

BACKGROUND

Body contouring and abdominal fat loss without surgery are increasingly used technique. In a study in pigs, it is noted that both capacitive and resistive radiofrequency stimulation reduced subcutaneous fat. One human study demonstrated a loss of 2.90 cm in waist diameter. Second-generation TECAR (Acronym for Transfer Electric Capacitive and Resistive) device with 4 channels, 200 cm2 work area per channel, and high power (1240 W), regulates body energy input by measuring absorption in the body and adjusting the power for 80 min at 50°C.

AIMS

To evaluate the loss of subcutaneous fat, this magnitude was measured in grams and centimeters throughout the abdomen by MRI before and after each treatment.

SUBJECT AND METHODS

We have studied 25 patients, 13 women and 12 men with a mean age of 49 years. All patients had their waist diameter measured and an MRI performed before and after 10 continuous sessions except Saturday and Sunday, over 2 weeks. Additionally, a lipid profile was performed on the same day of the study and at the end of it. The study was approved by the Ethics Committee.

RESULTS

Waist diameter decreased by 5.5 cm, these differences being statistically significant (p = 0.000). Subcutaneous fat measured by MRI in cm decreased by 784 cm (p = 0.000). In grams, it decreased 808.7 g (p = 0.000). In the lipid profile, all the values decreased, but they were not statistically significant.

CONCLUSIONS

The use of this second generation of TECAR equipment at 1 MHz decreases the waist diameter by more than 5 cm and leads to the loss of more than 800 grams of subcutaneous fat in 12 days. It is a method without risks or side effects, well tolerated, and an alternative for those patients who do not want to go to the operating room.

Prospective study to assess the efficacy and safety of a noninvasive electro-muscular stimulation for improvement of muscle strength and muscle toning of the extremities

OBJECTIVE

We sought to evaluate the safety and efficacy of an electrical muscle stimulation (EMS) device in the improvement of muscle strength and toning of the upper extremities. This device, which is FDA-cleared as a two-channel muscle stimulator, provides up to eight electrodes with waveforms inducing muscle stimulation. Although a prior study demonstrated it is safe and effective for use in the abdomen, this system, which has electrodes specifically designed for the extremities, has not previously been evaluated in the upper extremities.

METHODS

Forty-five subjects enrolled in the study to assess improvement in arm (i.e., bicep and tricep muscle) strength, and appearance following a protocol of treatments with this bioelectric muscle activation (BMA) device. All subjects received four 30-min EMS treatment sessions in Arm mode-twice weekly for 2 weeks and at least 48 h apart. Follow up visits were also scheduled 30- and 90-days after treatment. Strength was measured with a dynamometer device at baseline, at the final treatment session, and at the posttreatment 30- and 90-day assessment. Subject satisfaction was assessed gauging overall comfort of the treatment and satisfaction including willingness to recommend to others. The changes in strength between initial treatment and final treatment, as well as 30 and 90-day assessment were evaluated. Clinical photography at these visits was also assessed for each patient. Patients were instructed to not modify their normal exercise routine while participating in this study.

RESULTS

All 45 subjects completed the treatment protocol. Most patients showed an improvement in muscle strength from the initial to final treatment (i.e., the fourth treatment). Specifically, the maximum bicep strength increased by a mean of 7.5 lbs (22.83%, p = 0.006), while the average increased by a mean of 8.2 lbs (25.76%, p = 0.001) during this period. Similarly, the maximum tricep strength from initial to final treatment increased by a mean of 10.0 lbs (23.16%, p = 0.000), while the average increased by a mean of 9.6 lbs (27.12%, p = 0.000). Thirty days after the last treatment, the maximum bicep strength increased by a mean of 13.3 lbs (34.13%, p = 0.001) while the average increased by a mean of 13.6 lbs (37.05%, p = 0.000) during this period. Similarly, the maximum tricep strength from initial to 30 days postfinal treatment increased by a mean of 10.9 lbs (24.37%, p = 0.000), while the average increased by a mean of 10.5 lbs (29.37%, p = 0.000). Finally, 90 days after the last treatment, the maximum bicep strength increased by a mean of 19.4 lbs (48.4%, p = 0.000), while the average increased by a mean of 17.4 lbs (46.53%, p = 0.000) during this period. Similarly, the maximum tricep strength from initial to 90 days postfinal treatment increased by a mean of 10.8 lbs (27.12%, p = 0.000), while the average increased by a mean of 10.0 lbs (30.94%, p = 0.001).

CONCLUSION

This device was well tolerated and resulted in increased strength measurements in the upper extremities, as assessed by a dynamometer, which were sustained at 30 and 90 days.

A Prospective, Open-Label Study to Evaluate Functional Changes Following Electromagnetic Muscle Stimulation of Abdominal Muscle

Background

Electromagnetic muscle stimulation (EMMS) is an effective, well-tolerated noninvasive body contouring treatment for strengthening, toning, and firming the abdomen.

Objectives

In this study, functional changes following abdominal EMMS treatment wereevaluated.

Methods

In this prospective, open-label study, adults received 8 abdominal EMMS treatments (2 treatments on nonconsecutive days/week over 4 weeks). Follow-ups occurred 1 month (primary endpoint), 2, and 3 months postfinal treatment. Effectiveness endpoints included improvements from baseline on Body Satisfaction Questionnaire (BSQ; primary endpoint), core strength (timed plank test), abdominal endurance (curl-up test), and Subject Experience Questionnaire (SEQ). Safety was evaluated throughout.

Results

Sixteen participants (68.8% female) were enrolled, with a mean age of 39.3 years and a mean BMI of 24.4 kg/m²; 14 participants completed the study per protocol. Mean BSQ scores were significantly improved from baseline (27.9) to the 1-month follow-up (36.6; P < .05). Core strength and abdominal endurance were significantly greater at the 1-, 2-, and 3-month posttreatment time points than at baseline (P < .05). Frequently cited reasons for seeking EMMS treatment included a desire to feel stronger (100%; n = 14/14) and to improve athletic performance (100%; n = 14/14). SEQ responses 3 months posttreatment showed that most participants reported feeling stronger (92.9%) and motivated to receive additional EMMS treatments (100%) and work out to maintain treatment results (100%). The majority of participants (>78%) reported being "satisfied" or "very satisfied" with abdominal treatment 1 month posttreatment. One device- and/or procedure-related adverse event of menstrual cycle irregularity was reported in 1 participant and was mild in severity.

Conclusions

EMMS treatment of the abdomen is associated with functional strength improvements and high patient satisfaction.

Level of Evidence 4

A Systematic Review of Electromagnetic Treatments for Body Contouring

BACKGROUND

Energy-based treatments include ultrasound, lasers, cryolipolysis, and radiofrequency. The most recent energy treatment for noninvasive body contouring is electromagnetic treatments-a hot topic in plastic surgery today. A systematic review to assess efficacy and safety has not been published.

METHODS

An electronic search was performed using PubMed to identify the literature describing electromagnetic treatments. Measurements from imaging studies were tabulated and compared.

RESULTS

Fourteen clinical studies were evaluated. Two studies included simultaneous radiofrequency treatments. In 11 studies, the Emsculpt device was used; in 2 studies, the Emsculpt-Neo device was used. One study included a sham group of patients. The usual protocol was 4 treatments given over a 2-week period. No complications were reported. Eight studies included abdominal measurement data obtained using magnetic resonance imaging, computed tomography, or ultrasound. Photographic results were typically modest. Photographs showing more dramatic results also showed unexplained reductions in untreated areas.Measurement variances were high. The mean reduction in fat thickness was 5.5 mm. The mean increment in muscle thickness was 2.2 mm. The mean decrease in muscle separation was 2.9 mm (P = 0.19). Early posttreatment ultrasound images in 1 study showed an echolucent muscle layer, compared with a more echodense layer at the baseline, consistent with tissue swelling after exercise. Almost all studies were authored by medical advisors for the device manufacturer.

DISCUSSION

Measurement data show small reductions in fat thickness, occurring almost immediately after the treatments. Adipocyte removal without tissue swelling would be unique among energy-based treatments. Similarly, muscle hypertrophy is not known to occur acutely after exercise; muscle swelling likely accounts for an early increment in muscle thickness. Any improvement in the diastasis recti is likely fictitious.

CONCLUSIONS

Electromagnetic treatments, either administered alone or in combination with radiofrequency, are safe. However, the evidence for efficacy is tenuous. Measured treatment effects are very small (<5 mm). Conflict of interest and publication bias are major factors in studies evaluating energy-based alternatives. The evidence-based physician may not be satisfied that an equivocal treatment benefit justifies the time and expense for patients.

Electromagnetic field for supramaximal muscle stimulation: A retrospective study of safety, efficacy, and patient satisfaction in Brazil

BACKGROUND

Currently, even individuals who do physical activity regularly have some degree of dissatisfaction with their own bodies. The electromagnetic field for supramaximal muscle contraction has been the subject of research. High-intensity supramaximal muscle stimulation (HI-SMS) is a non-invasive technology used to strengthen, firm, and tone the abdominal muscles, arms, buttocks, and thighs and has been indicated for aesthetic purposes.

AIMS

The present study aimed to examine the safety and efficacy of HI-SMS used in the abdominal muscles of patients through the analysis of clinical evaluation, biochemical serum profile, and patient satisfaction with the procedure.

PATIENTS/METHODS

This is retrospective non-randomized and non-controlled study collected in a private clinic; all data from healthy participants (n = 25), aged between 18 and 55 years, were compiled and analyzed. All received eight 30 min sessions of electromagnetic field ONIX HI-SMS (intensity of the 90%-100%) located in abdominal, twice a week with intervals of 2-3 days.

RESULTS

The results show that BMI, fat thickness, and waist circumference improved the body contour after the treatment. There was no statistical difference in the data referring to the values of AST, ALT, ALP, creatinine, cholesterol, LDL-C, VLDL-C, HDL-C, glycemia, LDH, CK, and IL-6. However, there was a reduction of "non-esterified" free fatty acids when compared to baseline. This treatment provided high levels of tolerance, comfort, and high level of satisfaction.

CONCLUSIONS

Thus, it can be suggested that the treatment with HI-SMS in abdominal muscles proves to be a safe technology with potential for non-invasive therapy for aesthetic purposes.

Concomitant use of radiofrequency and high intensity focused electromagnetic field energies for full-body remodeling: MRI evidence-based prefatory trial

BACKGROUND

Radiofrequency and HIFEM have been used as standalone modalities in body contouring. The novel device allows their synchronous emission simultaneously in a single applicator.

OBJECTIVES

This prelusive trial aims to investigate the safety and efficacy of such treatment when used on multiple body parts on the same day for a full-body remodeling.

METHODS

Three female subjects (21.0 ± 2.0 years) underwent 4 treatment sessions. The treatment was applied to the abdomen, saddlebags, inner thighs, and buttocks, during each visit, lasting 30 min for each site. The outcomes were assessed through examination of MRI images acquired at baseline and 3 months post-treatment. Fat and muscle thickness were measured at predefined locations. Weight and waist, hip, and thigh circumference records along with digital photographs were also taken.

RESULTS

Fat thickness measurement showed a reduction of 17.57 ± 3.22 mm in the saddlebag region, 12.43 ± 1.93 mm in inner thighs, and 10.65 ± 1.26 mm in the abdomen. The fat in the buttock region showed negligible changes. The muscle thickness increased on average by 2.98 ± 0.60 mm for rectus abdominis and 7.42 ± 1.56 mm for gluteus maximus. The circumferential reduction was also observed on the waist (7.83 ± 2.25 cm), at the level of outer thighs (2.83 ± 1.53 cm), and inner thighs (3.58 ± 1.84 cm). Digital photographs showed noticeable improvement in the overall body appearance. The treatments were safe, and no side effects were noted.

CONCLUSION

The preliminary outcomes indicate that the procedure delivering HIFEM and RF simultaneously on multiple body areas on the same day could be an effective and comfortable treatment for fat reduction on multiple body parts, thickening of underlying muscles, and overall improved aesthetic appearance.

Experimental evaluation of high intensity focused ultrasound for fat reduction of ex vivo porcine adipose tissue

PURPOSE

The present study was stimulated by the continuous growth of commercially available high intensity focused ultrasound (HIFU) systems for fat reduction. Herein, HIFU was utilised for fat ablation using a single-element ultrasonic transducer operating in thermal mode.

METHODS

The custom-made concave transducer that operates at 1.1 MHz was assessed on excised porcine adipose tissue for its ability to reduce fat. Ultrasonic sonications were executed on the adipose tissue utilising acoustical power between 14 and 75 W and sonication time in the range of 1-10 min. The mass of the adipose tissue sample was weighed afore and after ultrasonic sonications and the effect of the sonication on the mass change was recorded.

RESULTS

Mass change was linearly dependent with either increasing acoustical power or sonication time and was in the range of 0.46-1.9 g. High acoustical power of 62.5 W for a sonication time of 1 min and a power of 75 W for a sonication time of 5 min, respectively resulted in the formation of a lesion or possible cavitation on the piece of excised adipose tissue.

CONCLUSION

The study demonstrated the efficacy of the proposed transducer in achieving a reduction of excised fat tissue. The present findings indicate the potential use of the transducer in a HIFU system indicated for the reduction of subcutaneous adipose tissue where increased values of acoustical power can result in increased amounts of fat reduction.

Thoracic Schwannoma as an Unusual Cause of Sciatic Pain in the Chiropractic Office: A Case Report

BACKGROUND Sciatica, which is pain radiating along the sciatic nerve distribution, is most often caused by degenerative conditions of the lower back and rarely results from lesions of the spinal cord. This case report illustrates a patient with suspected lumbar radiculopathy, ultimately diagnosed with a thoracic schwannoma after visiting a chiropractor. CASE REPORT A 61-year-old woman presented to a chiropractor with progressively worsening lower back pain radiating to the right lower extremity and unsteady gait. Her symptoms began 10 years previously and she had been diagnosed by an orthopedist with lumbar disc herniation causing radiculopathy via magnetic resonance imaging (MRI) and was treated with physical therapy and diclofenac. Upon examination by the chiropractor, the patient had bilateral lower-extremity neurologic deficits, hyperreflexia, and upgoing Babinski responses. The chiropractor ordered thoracic MRI, but the patient preferred to initiate a trial of care, which was unsuccessful. After a delay imposed by cardiac bypass surgery, the patient returned to the chiropractor with worsened symptoms and underwent thoracic MRI, revealing an intraspinal mass at T9. The patient underwent laminectomy and tumor removal, with histopathology confirming a diagnosis of schwannoma. The patient gradually improved after surgery with the help of rehabilitative exercises. CONCLUSIONS Clinicians should suspect a spinal cord lesion as a cause of sciatic pain when patients fail to improve with treatment, have a broad sensorimotor distribution unexplained by lumbar imaging findings, hyperreflexia/pathological reflexes, or other atypical findings (eg, negative neural tension tests). In such cases, MRI of the cervical and thoracic spine may be indicated.

Combination of monopolar 2 MHz radiofrequency and electrical multidirectional stimulation for reducing abdominal circumference and enhancing the muscle definition in subjects with overweight range body mass index

BACKGROUND

The popularity of noninvasive body contouring procedures has been steadily increasing in recent years, however, studies evaluating its effectiveness in individuals with overweight range body mass index (BMI) are limited.

OBJECTIVE

To evaluate the efficacy and safety of combined 2 MHz radiofrequency (RF) and electrical multidirectional stimulation (EMDS) for the improvement of the abdominal contour in subjects with overweight range BMI.

METHODS

Twelve participants with overweight range BMI (23.6-24.9 kg/m² ) underwent a single RF treatment, followed by a series of six EMDS treatments. Follow-up assessments (abdominal circumference [AC] and skinfold thickness measurements) were scheduled 1, 2, and 3 months after the final session.

RESULTS

At 1 month after the final treatment, a 3.1% (2.6 ± 0.47 cm, mean ± SD) significant reduction in mean AC was observed (p ˂ 0.001) and a maximal skinfold thickness reduction of 14% (4.6 ± 1.1 mm) was also noted (p = 0.032). Transient dysesthesia lasting 2-3 hours after EMDS treatment was the most common adverse effect reported by 5 of 12 subjects (41.7%), with no other serious side effects.

CONCLUSIONS

Combined RF and EMDS treatments are safe and effective, yielding significant reductions in both AC and skinfold thickness in patients with overweight range BMI, causing only minimal and transient adverse effects.

Adverse Events of Non-Invasive Body Contouring: Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database

BACKGROUND

Multiple non-invasive modalities have become popular alternatives to surgical procedures for body contouring.

OBJECTIVE

To analyze adverse events (AEs) associated with non-invasive body contouring devices reported through the Manufacturer and User Facility Device Experience (MAUDE) database.

METHODS AND MATERIALS

The MAUDE database were queried for AEs associated with non-invasive body contouring devices between January 2011 and June 2021. An extensive list of keywords and brand and manufacturer names was used.

RESULTS

A total of 1,325 reports with 1,590 AEs were identified among 6 modalities. More than 70% were reported in the past 5 years. Cryolipolysis made up 38.3% reports, which mostly pertained to paradoxical hyperplasia and hernias. Radiofrequency had the most reports (41.9%). Like laser devices, most of their reports described burns. Focused ultrasound was commonly associated with unintentional fat loss and surface irregularities. Focused electromagnetic field resulted in only 7 reports.

CONCLUSION

The analysis of present study supports previous studies concerning common local symptoms caused by these devices, but it also reveals complications not reported in previous device studies. This study highlights the importance of proper technique and adherence to device guidelines. Practitioners should be knowledgeable of potential complications from each device to both prevent and manage them accordingly.

Muscle Stimulation for Aesthetic Body Shaping: A Comprehensive and Critical Review

BACKGROUND

Aesthetic muscle stimulation (AMS) using high-intensity electromagnetic field (HIFEM) targets skeletal muscle neurons, causing muscle hypertrophy and loss of adipose tissue, thereby cultivating a sculpted physique. Many studies have evaluated AMS for noninvasive body contouring; however, the efficacy, safety, and long-term data remain unclear.

OBJECTIVE

To critically evaluate the current literature on the use of electromagnetic muscle stimulation for body contouring and provide a consensus on patient selection and long-term efficacy of AMS.

MATERIALS AND METHODS

PubMed and Embase were searched using the terms: "HIFEM," "Electromagnetic therapy," and "muscle" or "Electrical stimulation muscle treatments" and "aesthetics." Studies involving the use of muscle stimulation for nonaesthetic/dermatologic, in vitro studies or studies involving animals were excluded.

RESULTS

Twenty studies in total were included [9 moderate-quality, 8 low-quality, and 3 very low‒quality studies] based on the Grading of Recommendations, Assessment, Development, and Evaluation scale, representing 521 patients. Body sites evaluated included the abdomen (378 patients), buttock (156 patients), arms (22 patients), and calves (15 patients).

CONCLUSION

Electromagnetic muscle stimulation represents an effective therapeutic intervention for abdominal contouring that yields increased muscle thickness, and reduced abdominal fat thickness, for up to 1 year after treatment. Larger, controlled studies are needed to determine the efficacy of electromagnetic muscle stimulation alone for contouring of buttocks, thighs, arms, and calves.

Post-Bariatric Plastic Surgery: Abdominoplasty, the State of the Art in Body Contouring

Due to the increased prevalence of obesity in the last decades, bariatric surgery has been on the rise in recent years. Bariatric surgery is a compelling option for weight loss in obese patients with severe obesity-related comorbidities or for whom lifestyle modifications have proven ineffective. Redundant skin following significant weight loss is a common occurrence affecting up to 96% of patients who undergo bariatric surgery, negatively impacting physical and psychosocial health and detracting from activities of daily living. Statistics of the American Society of Plastic Surgeons show that 46,577 body contouring procedures were performed after massive weight loss in the USA in a 2020 report. Abdominoplasty, a well-established cosmetic surgery procedure for improving body contour, is performed by removing excess skin and fat from the abdominal wall and thereby restoring musculofascial integrity and skin elasticity, resulting in a more ideal body shape and increasing quality of life. Although abdominoplasty is a safe procedure, it has been associated with a higher complication rate compared with other body-contouring procedures. Technologic advances over the past decade have been developed as non-invasive alternatives or adjunctive tools to surgery to enhance cosmetic results and minimize complications. New energy-based technologies may supplant invasive surgery for mild to moderate skin laxity and/or diminish the extent of surgery and resulting scars. Plastic surgeons play a significant role in improving the quality of life of patients who suffer from obesity and underwent bariatric surgery. We are deeply convinced, however, that the advancement of knowledge and research in this field will determine the introduction of new technologies and custom-made techniques. This advancement will reduce the complication rate with a rapid reintegration of the patient into the world of work and resumption of daily activities.

Safety and Efficacy of Transform for Noninvasive Lipolysis and Circumference Reduction of the Abdomen

Noninvasive body contouring has seen a precipitous rise in popularity since its advent in the early 2000s. With this rise in popularity, there has been an expansion in the types and number of noninvasive devices for muscle hypertrophy and fat lipolysis. The Transform radiofrequency and electrical muscle stimulation device is a newly introduced device for noninvasive abdominal body contouring. The present study is a prospective clinical trial evaluating the efficacy of the Transform device on abdominal circumference. Fifteen patients were enrolled and received three treatment sessions with the Transform device. On average, patients saw changes in abdominal circumference (−0.43 cm, P = 0.48), caliper pinch thickness (−6.07 mm, P = 0.0036), and ultrasound fat thickness (−5.40 mm, P < 0.001) at 3 months posttreatment with minimal discomfort and high patient satisfaction. Ultimately, this study demonstrates that the Transform device is a safe and effective noninvasive option for fat lipolysis and muscular hypertrophy.

Is It Possible to Reshape the Body and Tone It at the Same Time? Schwarzy: The New Technology for Body Sculpting

Background and Objective: In recent years, a strong desire for slimmer and healthier-looking bodies has grown in the population. The aim of this study was to evaluate the effectiveness and safeness of the new technology Flat Magnetic Stimulation for buttock and abdomen remodeling in athletic subjects. Methods: A total of 49 patients (31 females and 18 males) were enrolled. Patients’ digital photos and buttocks/abdomen circumference measurements were taken to assess and monitor the effectiveness of treatment on muscle firming. The level of patient satisfaction was evaluated by a questionnaire based on a seven point Likert scale. Average scores were calculated at a 1-month follow-up (FU). Results: A significant increase in the buttocks’ mean circumference from 85.5 ± 0.7 cm to 88.5 ± 0.7 cm (p < 0.05) and in the abdomens’ mean circumference from 76.5 ± 9.19 cm to 78 ± 9.89 cm (p < 0.05) was observed 1 month after the last treatment. All subjects reported that their buttocks and abdomens felt more lift and toned. The average abdomen and buttocks satisfaction scores improve significantly at 1-month FU. Conclusions: Our data show that FMS treatment could be used as an effective mechanism for muscle toning.

Efficacy of a Novel Injection Lipolysis to Induce Targeted Adipocyte Apoptosis: A Randomized, Phase IIa Study of CBL-514 Injection on Abdominal Subcutaneous Fat Reduction

BACKGROUND

CBL-514 is a novel injectable drug that may be safe and efficacious for localized abdominal subcutaneous fat reduction.

OBJECTIVES

The aim of this study was to assess the safety and efficacy of CBL-514 in reducing abdominal subcutaneous fat volume and thickness.

METHODS

This Phase IIa, open-label, random allocation study consisted of a 6-week treatment period and follow-up at 4 and 8 weeks following the last treatment. Participants were randomly allocated to receive 1.2 mg/cm2 (180 mg), 1.6 mg/cm2 (240 mg), or 2.0 mg/cm2 (300 mg) of CBL-514 with up to 4 treatments, each comprising 60 injections into the abdominal adipose layer. Changes in abdominal subcutaneous fat were assessed by ultrasound at follow-up visits. Treatment-emergent adverse events were recorded.

RESULTS

Higher doses of CBL-514 (unit dose, 2.0 and 1.6 mg/cm2) significantly improved the absolute and percentage reduction in abdominal fat volume (P < 0.00001) and thickness (P < 0.0001) compared with baseline. Although the COVID-19 pandemic halted some participant recruitment and follow-ups, analysis was unaffected, even after sample size limitations.

CONCLUSIONS

CBL-514 injection at multiple doses up to 300 mg with a unit dose of 2.0 mg/cm2 is safe, well-tolerated, and reduced abdominal fat volume and thickness by inducing adipocyte apoptosis. Although other procedures exist to treat abdominal fat, they have limitations and may cause complications. At a dose of 2.0 mg/cm2, CBL-514 safely and significantly reduced abdominal fat volume by 24.96%, making it a promising new treatment for routine, nonsurgical abdominal fat reduction in dermatologic clinics.

LEVEL OF EVIDENCE: 4

A New Protocol to Treat Abdominal Subcutaneous Fat Combining Microwaves and Flat magnetic stimulation

Background: A healthy lifestyle is not always able to improve the abdomen’s appearance, especially in those patients who have undergone sudden weight changes. Objective: We aimed at evaluating the efficacy of combined microwaves and flat magnetic stimulation (FMS) to treat abdominal localized adiposity and laxity. Methods: Twenty-five patients were subjected to two treatment sessions per month on the abdominal area with microwaves. FMS was also performed twice per week, with a minimum of two days between each session for two months. The technology uses three types of different protocols: massage, muscle definition (shaping), and muscular strengthening. Measurements, including body mass index (BMI) and waist, and abdominal ultrasound were performed at baseline and three months after the last treatment session. Blood examinations were performed, and a 5-Likert scale questionnaire was used to assess patient satisfaction. Results: At follow-up, three months after the last treatment, the mean waist circumference (WC) was significantly reduced, and skin laxity improved in all patients (p < 0.001). A significant improvement in abdominal muscle tissue thickness was also shown in all abdominal areas, and the thickness of the adipose tissue evaluated by ultrasound was reduced. Conclusions: This study proves that the combination of microwaves and FMS treatment is secure and efficient for treating abdominal subcutaneous fat and skin laxity.

Safety, Efficacy, and Tolerability of Simultaneous Bilateral Cryolipolysis Using a Rapid Cycling Contoured Cup Applicator for Noninvasive Fat Reduction in the Enlarged Male Breast: A Pilot Study

BACKGROUND

A previous study using a parallel cooling plate cryolipolysis applicator demonstrated the efficacy of cryolipolysis for pseudogynecomastia. Although the procedure was safe and effective, treatment times were prolonged and anesthetic was needed to reduce treatment discomfort.

OBJECTIVE

To evaluate the safety, efficacy, and tolerability of a short cycle, reduced vacuum contoured cup cryolipolysis applicator for the treatment of pseudogynecomastia.

MATERIALS AND METHODS

Twelve male subjects received simultaneous bilateral treatment consisting of a 35-minute cryolipolysis cycle, followed by a short manual massage, and a second 35-minute cycle with 50% treatment area overlap in a single treatment visit. At the 6-week follow-up, a second treatment was performed with up to 2 overlapping cycles per side. Efficacy was assessed after the second treatment using transcutaneous ultrasound, standardized clinical photography, and subject surveys.

RESULTS

Ultrasound analysis showed a mean fat layer reduction of 5.1 ± 2.3 mm (p < .001). Blinded, independent reviewers correctly identified 97% of baseline/treatment photography results. Surveys revealed 100% subject satisfaction with 91% reporting visible fat reduction and 100% stating they would recommend treatment. Transient side effects included mild intratreatment discomfort, paresthesia, and tenderness.

CONCLUSION

A rapid cycling, reduced vacuum cryolipolysis applicator provides rapid, safe, effective, and tolerable treatment of pseudogynecomastia.

Use of Neuromuscular Electrical Stimulation for Abdominal and Quadriceps Muscle Strengthening: A Randomized Controlled Trial

BACKGROUND

Radiographic imaging has demonstrated muscle hypertrophy after treatment with noninvasive body contouring devices that target skeletal muscles.

OBJECTIVE

This pilot study sought to evaluate whether increased muscle mass translated to improved functional strength and endurance.

METHODS

A prospective, single-center, randomized open-label controlled study included 26 subjects randomized into 3 groups: 2 treatment groups and 1 control group. Both treatment groups received 4 neuromuscular electrical stimulation (NMES) treatments over a 2-week period. Muscle performance testing was conducted at baseline and 2-week and 4-week posttreatment. Anthropometric measurements were assessed at baseline and at 4-week posttreatment. Study participants completed subject satisfaction surveys and a personal experience assessment.

RESULTS

Treatment with NMES resulted in statistically significant improvements in abdominal and quadriceps strength and endurance from baseline through 4-week posttreatment. Mean waist circumference decreased and quadriceps circumference increased, both nonsignificantly. Subject satisfaction regarding abdominal and quadriceps strength was reported as "satisfied or very satisfied" in 89% and 92% at 4-week and 8-week posttreatment, respectively.

CONCLUSION

Treatment of the abdomen and quadriceps with NMES leads to significant improvements in muscular strength and endurance.

Abdominal body shaping using StarFormer high intensity magnetic stimulation – a case series

Background

Magnetic stimulation of muscles has become a popular method for muscle toning and strengthening.

Aims

The aim of this case series was to investigate safety and effectiveness of a novel magnetic stimulation device.

Methods

The patients received 10 sessions of high‐intensity magnetic stimulation of their abdominal muscles. Change in muscle tone was determined by anonymous evaluation of photographs and using patient satisfaction questionnaires before treatment and 10 weeks following the last treatment session. Weight and waist circumference were also measured before treatment and at the 10‐week follow‐up.

Results

Blinded evaluation of photographs has shown improvement of the appearance of abdominal muscles. Patient satisfaction was high. The patients also experienced a reduction in their waist circumference, while their weight did not significantly change.

Conclusions

The treatment using the StarFormer^® high‐intensity magnetic stimulation is an effective and noninvasive method for abdominal body shaping, which is safe and comfortable to the patients and results in high patient satisfaction and an objective improvement in abdominal body shape appearance.

High-intensity Focused Ultrasound Treatment for Excessive Subcutaneous Fat in Abdomen, Upper Arms, and Thigh: a Pilot Study

BACKGROUND

High-intensity focused ultrasound (HIFU) has been recently introduced as a non-invasive therapeutic modality for controlling excessive subcutaneous fat.

OBJECTIVE

The efficacy and safety of the HIFU device for sculpting the abdomen, upper arm, and thigh were evaluated.

MATERIALS AND METHODS

Ten subjects with more than 10 mm of subcutaneous fat in the abdomen, upper arm, and/or thigh were recruited. We evaluate mean change in the thickness and circumference of subcutaneous fat of each treated area measured using ultrasound 12 weeks after the procedure, the degree of pain, and subject and practitioner satisfaction 12 weeks after the procedure.

RESULTS

The mean change of subcutaneous fat thickness in the abdomen, upper arm, and thigh measured using ultrasound 12 weeks after the procedure was -4.33 ± 2.42, -1.86 ± 1.35, and -1.86 ± 1.35 mm, respectively. Compared with pretreatment, subcutaneous fat thickness of the abdomen and upper arm was significantly reduced (p = 0.0020 and p = 0.0004, respectively), but not in the thigh (p = 0.0716). Highest patient satisfaction was for the abdomen. Pain was generally tolerable.

CONCLUSION

The results from the present study indicate HIFU can be an effective and safe therapeutic modality for removing excessive subcutaneous fat in humans.

Efficacy of Standardized Rehabilitation in the Treatment of Diastasis Rectus Abdominis in Postpartum Women

PURPOSE

The incidence of diastasis rectus abdominis (DRA) in parturients is continuously increasing, which may cause uncomfortable and affect the quality of life. The present study aims to retrospectively summarize the experience and efficacy in the treatment of DRA via standardized rehabilitation procedures in Eastern China.

METHODS

This retrospective study included the parturients with DRA admitted to the Xishan People's Hospital of Wuxi between January 2017 and May 2021. Patients were separated into standardized rehabilitation group (SR) and non-standardized rehabilitation group (non-SR). The outcomes were the change in rectus abdominis separation and Physical Functioning Scale (PFS). Measurement data were compared between the two groups, and multivariate linear regression was used to analyze the factors associated with the standardized rehabilitation process. P values < 0.05 were considered statistically significant.

RESULTS

Among a total of 294 patients with DRA who were included in the study, 171 patients were treated with SR (SR), and the other 123 patients were treated without SR process (non-SR). Compared with non-SR, the separation of the rectus abdominis was significantly reduced in SR after standardized rehabilitation treatment (p value < 0.0001). The multiple linear regression model analysis results suggested that standardized rehabilitation was an independent factor influencing the prognosis of DRA in parturients (p < 0.0001). In addition, the quality of life of the study group was significantly improved (p < 0.0001).

CONCLUSION

Standardized rehabilitation method revealed high efficiency in treating DRA in postpartum women and could improve the quality of life of parturients.

Evaluation of safety and efficacy of a new device for muscle toning and body shaping

BACKGROUND

The spread of non-invasive procedures for fat deposits removal has increased rapidly in recent years. In the field of esthetic medicine, high-intensity focused electromagnetic field (HIFEM) technology has recently been introduced, as a tool for toning and strengthening muscles, which goes far beyond normal physical exercise.

OBJECTIVE

The purpose of this study is to evaluate the efficacy and safety of a new device for body remodeling.

METHODS

A set of 15 patients (7 males and 8 females, BMI 24.05 ± 2.01 kg m^-2 , age 32-57) participated in this study. Patients were enrolled at Dermatos center, Montesilvano, Abruzzo, Italy. The technology used is FMS (Flat Magnetic Stimulation): 6-8 treatment sessions were performed. The sessions must be repeated twice a week, with a minimum of 2 days between each session. Treatment duration varies from 20 to 45 min, depending on patients.

RESULTS

During 1-month follow-up after the last treatment evaluations, the results showed tonification, the strengthening of muscles, and the reduction of localized adiposity. There is a significant reduction in waist circumference (80.7 ± 4.3 cm vs 77.3 ± 5.6 cm, p < 0.001). All patients showed relatively high satisfaction immediately after the last treatment.

CONCLUSIONS

Our data show that intense muscle activity is generated by FMS treatments, suggesting that this technology could be used as a convenient and effective muscle toning tool.

Combination treatment for buttock and abdominal remodeling and skin improvement using HIFEM procedure and simultaneous delivery of radiofrequency and targeted pressure energy

Background

High‐intensity electromagnetic field procedure (HIFEM) is an effective tool for body shaping and muscle toning. Radiofrequency (RF) combined with targeted pressure energy (TPE) provides the solution for skin laxity and cellulite.

Aims

To document the effect of consecutive use of HIFEM, RF, and TPE for treatment of abdomen and buttocks.

Methods

Fifteen subjects (44.3 ± 14.2 years, 22.3 ± 2.3 kg/m²) finished treatments and consequent follow‐ups. They were treated over the abdomen (Group 1, N = 7) or buttocks (Group 2, N = 8), receiving four treatment procedures consisting of HIFEM treatment administered first, immediately followed by the simultaneous RF & TPE treatment. Each session took approximately 50 min (30 min of HIFEM; up to 20 min of RF & TPE) depending on the treated area. Study outcomes were assessed by the circumference measurement, satisfaction and comfort questionnaires, and digital photographs.

Results

Combined treatments were safe and comfortable. At 1 month, the abdominal circumference significantly decreased by 4.4 cm, while buttocks showed a significant increase by 1.0 cm. The abdomen (−4.1 cm) and buttocks (+1.2 cm) circumference results were sustained for three months without a significant decline. Satisfaction was high in both groups (93.3%) since most subjects noted that the appearance of the treated area has been improved, referring to both body sculpting and skin appearance.

Conclusions

The consecutive application of HIFEM, RF, and TPE treatments noticeably improved the appearance of the abdomen and buttocks. Subjects showed enhancement of abdominal body contour, buttock lifting, and improved skin quality manifested by reduced skin laxity and cellulite.

Activation of Skeletal Muscle Satellite Cells by a Device Simultaneously Applying High-Intensity Focused Electromagnetic Technology and Novel RF Technology: Fluorescent Microscopy Facilitated Detection of NCAM/CD56

Background

Myosatellite cells are myogenic stem cells that can transform to provide nuclei for existing muscles or generate new muscle fibers as documented after extended exercise programs.

Objectives

The authors investigated whether the simultaneous application of High-Intensity Focused Electromagnetic (HIFEM) and Synchrode radiofrequency (RF) affects the levels of satellite cells similarly as the prolonged exercise does to achieve muscle growth.

Methods

Three 30-minute simultaneous HIFEM and Synchrode RF treatments (once a week) were administered over the abdominal area of 5 Large White swine aged approximately 6 months. All animals were anesthetized during the treatments and biopsy acquisition. Biopsies of muscle tissue were collected at baseline, 4 days, 2 weeks, and 1 month post-treatment. After binding the specific antibodies, the NCAM/CD56 levels, a marker of activated satellite cells, were quantified employing the immunofluorescence microscopy technique with a UV lamp.

Results

Examined slices showed a continuous increase in satellite cell levels throughout the study. Four days after the treatment, we observed a 26.1% increase in satellite cells, which increased to 30.2% at 2-week follow-up. Additional histological analysis revealed an increase in the cross-sectional area of muscle fibers and the signs of newly formed fibers of small diameters at 2 weeks after the treatment. No damage to muscle tissue and no adverse effects related to the treatment were observed.

Conclusions

The findings indicate that the simultaneous application of HIFEM and novel Synchrode RF treatment can initiate differentiation of satellite cells to support the growth of existing muscles and, presumably, even the formation of new myofibers.

Nonsurgical Postpartum Abdominal Rejuvenation: A Review and Our Experience

BACKGROUND

A significant population of aesthetic patients are postpartum women motivated to achieve a more youthful abdomen. Although traditionally, abdominoplasty was the treatment of choice, minimally invasive procedures have grown in popularity because of minimal downtime and the favorable side effect profile. so many women share concerns regarding their postpartum abdominal appearance, a limited number of studies focus specifically on postpartum abdominal rejuvenation.

OBJECTIVE

To review pertinent aspects of abdominal anatomy, associated changes with pregnancy, available nonsurgical cosmetic procedures, and to provide our experience to help guide treatment combinations which comprehensively address the concerns of the postpartum patient.

MATERIALS AND METHODS

A review of the literature surrounding nonsurgical treatment options for postpartum abdominal lipohypertrophy, muscle changes, tissue laxity, and striae gravidarum, along with the authors' experience in this area are provided.

CONCLUSION

This review summarizes available nonsurgical modalities to address postpartum abdominal defects, including procedures that tone muscles, reduce fat, tighten skin, and improve the appearance of striae. Both the published literature and the authors' experience favor a combination of treatments to address the various lamellae affected by pregnancy. Further clinical trials focusing on the postpartum patient would further help create a standardized approach for postpartum abdominal rejuvenation.

The role and clinical benefits of high-intensity focused electromagnetic devices for non-invasive lipolysis and beyond: A narrative review and position paper

BACKGROUND

In 2018, the first device to use high-intensity focused electromagnetic (HIFEM) technology to non-invasively build muscle was brought to market. Even more recently, the first HIFEM and radiofrequency combination device designed to both build muscle and eliminate fat cells came into use (HIFEM+). In view of the increase in recently published original data pertaining to HIFEM, an advisory board recently convened to discuss the group's clinical experiences with this technology.

AIM

Communicate an advisory group's recommendations for the current use of HIFEM+ technology for aesthetic indications.

METHODS

An advisory board meeting to discuss challenges and opportunities for HIFEM devices in aesthetic medicine took place in November 2020, via remote conference. The expert advisory board consisted of a group of senior aesthetic physicians regularly treating patients with non-invasive body contouring devices. A narrative review of the literature and key recommendations from the meeting are presented herein.

RESULTS

To date, the combined results of several clinical studies (including over 500 patients and 30 investigators) support that patients treated with HIFEM+ experience on average, 30% less fat, 25% more muscle, 19% reduction in abdominal separation and up to 5.9 cm reduction in waist circumference. Moreover, HIFEM+ induces a 30% increase in satellite cell content, which is similar to the 36% increase observed following twelve weeks of exercise.

CONCLUSIONS

The advisory board unanimously agreed on several messages related to HIFEM technology, including that the pairing of HIFEM and radiofrequency (HIFEM+) enables a higher intensity of muscle stimulation and lipolysis, compared to HIFEM alone.

Deletion of adipocytes induced by a novel device simultaneously delivering synchronized radiofrequency and hifem: Human histological study

BACKGROUND

Radiofrequency (RF) is commonly recognized treatment option for fat reduction, utilizing heat-induced adipocyte deletion. HIFEM treatment has been proven to be an effective tool for body shaping.

OBJECTIVES

To document the structural changes in human subcutaneous tissue induced by the combination of RF treatment with the HIFEM procedure.

METHODS

Four subjects (51.50 ± 6.35 years, 22.59 ± 3.21 kg/m² ) received three 30-minute abdominal treatments consisting of RF therapy and HIFEM. One subject (57 years, 23.60 kg/m² ) served as a control. Punch biopsies were collected at baseline, 1-week, and 1-month post-treatment. Samples were sliced and stained with H&E. Waist circumference, digital photographs, satisfaction, and therapy comfort were assessed. Subjects were monitored for any adverse event, and fat temperatures were measured.

RESULTS

Baseline samples showed a healthy appearance of adipocytes, composed of round-shaped unilocular cells of uniform size. At follow-up, treated adipocytes demonstrated nuclear and shape changes with consequent fat reduction. Adipocytes were found to be flattened/shrunken and of smaller size (-33.5% at 1 week; -31.7% at 1-month) along with occasional ruptures of the cytoplasmic membrane. In contrast to baseline, pyknotic nuclei with condensed nuclear chromatin were seen at 1-week and 1-month post-treatment. The control samples showed no treatment-related changes. Waist circumference decreased by an average of 2.20 cm in the treated patients. No adverse events were observed. The fat temperature reached 42-45°C, during treatment; the therapy was comfortable with high patient satisfaction.

CONCLUSIONS

Results suggest the efficacy and safety of the therapy combining RF and HIFEM. The adipocyte deletion and shrinkage resulted in overall reduction of fat tissue.

The effect of high-intensity focused electromagnetic procedure on visceral adipose tissue: Retrospective assessment of computed tomography scans

BACKGROUND

High levels of visceral adipose tissue (VAT) are associated with abdominal obesity and increased risk of metabolic deterioration. Recent studies showed that intensive physical exercise results in the reduction of subcutaneous and visceral fat.

AIMS

This study investigates the effect of supramaximal muscle contractions induced by a HIFEM procedure for abdominal VAT changes.

METHODS

Computed tomography (CT) scans of 22 subjects (47.3 ± 8.4 years, BMI of 23.5 ± 3.5 kg/m² ) who received 8 HIFEM treatments of the abdomen (2-3 days apart) were retrospectively evaluated for the changes in VAT. The CT scans were obtained at baseline and 1 month after the last treatment. The transverse slices at umbilical, infraumbilical, and supraumbilical levels were used to determine the cross-sectional area (CSA) of VAT through a semi-automated segmentation method.

RESULTS

Analysis of the CSA revealed a significant (P = .004) and uniform reduction of the abdominal VAT area by 14.3% (-16.7 cm² ) from 110.6 ± 69.0 cm² to 93.9 ± 54.6 cm² . In general, a higher relative improvement was seen infraumbilically (17.1%), followed by supraumbilical (15.5%) and umbilical (10.7%) levels. The reduction of VAT was strongly correlated to the reduction of subcutaneous fat (r(17) = 0.66; P = .002). A decrease in VAT volume contributed to the overall aesthetic enhancement visible on digital photographs.

CONCLUSIONS

The outcomes indicate that HIFEM technology has a positive effect on VAT. However, further studies are necessary to validate these outcomes and to clarify the exact mechanism of a VAT reduction. Based on our results, the HIFEM procedure may be a beneficial treatment option for patients with high VAT deposits.

Feasibility Study of Electromagnetic Muscle Stimulation and Cryolipolysis for Abdominal Contouring

BACKGROUND

In addition to reducing subcutaneous fat for body contouring, some patients are interested in toning the underlying muscle layer.

OBJECTIVE

This feasibility study evaluated the safety and efficacy of electromagnetic muscle stimulation (EMMS) alone, cryolipolysis alone, and cryolipolysis with EMMS for noninvasive contouring of abdomen.

METHODS

Abdomens of 50 subjects were treated in a study with 3 cohorts: EMMS alone, Cryolipolysis alone, and Cryolipolysis + EMMS in combination. Electromagnetic muscle stimulation treatments were delivered in 4 sessions over 2 weeks. Cryolipolysis treatments were delivered in one session. Combination treatments consisted of one cryolipolysis and 4 EMMS visits. Efficacy was assessed by independent physician Global Aesthetic Improvement Scale (GAIS), circumferential measurement, Subject GAIS (SGAIS), and Body Satisfaction Questionnaire (BSQ).

RESULTS

Safety was demonstrated for all study cohorts with no device- or procedure-related adverse events. Independent photo review showed greatest mean GAIS score for the Cryolipolysis + EMMS cohort followed by Cryolipolysis only, then EMMS only cohort. BSQ showed greatest average score increase for Cryolipolysis + EMMS cohort followed by Cryolipolysis only cohort, then EMMS only cohort. Mean circumferential reduction measurements were greatest for Cryolipolysis + EMMS cohort followed by Cryolipolysis only, and then EMMS only cohort. The mean SGAIS improvement score was equal for the Cryolipolysis only and Cryolipolysis + EMMS cohorts, followed by the EMMS only cohort.

CONCLUSION

A multimodal approach using cryolipolysis and EMMS was safe and demonstrated enhanced body contouring efficacy for this feasibility study.

A German Prospective Study of the Safety and Efficacy of a Non-Invasive, High-intensity, Electromagnetic Abdomen and Buttock Contouring Device

OBJECTIVE: This study evaluated the efficacy of a novel treatment method utilizing high-intensity focused electromagnetic field (HIFEM) in reducing fat and strengthening the muscles in the abdominal and gluteal areas. METHODS: A total of 14 patients, aged 23 to 49 years (mean: 33.2 years) received four treatments on the abdomen and/or buttocks, each lasting for 30 minutes. Ultrasound imaging was performed at baseline, immediately post-treatment, and eight weeks after the last treatment to examine the changes in thickness of the rectus abdominis and subcutaneous fat. Additionally, waist circumference, digital photographs, and patient satisfaction were collected at the same time points. The improvement in digital images was evaluated by practitioners and the patients themselves. RESULTS: Two months after the treatments, ultrasound measurements showed, on average, a 15.7-percent reduction of subcutaneous adipose tissue and an average increase in the thickness of the rectus abdominis muscle by 26.1 percent. The abdominal circumference of the treated patients showed an average decrease of 2.84 centimeters. Immediately following the final session, the patient's satisfaction was 87.5 percent; eight weeks later, it was 100 percent. During the patient evaluation of photographs, 25 percent of the patients rated their appearance as improved, 66.7 percent as significantly improved, and 8.3 percent as greatly improved. Using the Global Aesthetic Improvement Scale, the medical practitioners rated the patients as 100-percent improved. No relevant side effects of the treatment were documented. CONCLUSION: The data collected on the HIFEM procedure evaluated here are in line with the results from clinical studies and applications of this treatment in the United States. These results support the efficacy and tolerability of the HIFEM procedure. The treatment achieved high doctor and patient satisfaction.

MRI and CT Assessment of Abdominal Tissue Composition in Patients After High-Intensity Focused Electromagnetic Therapy Treatments: One-Year Follow-Up

BACKGROUND

Several studies investigating high-intensity focused electromagnetic (HIFEM) treatments have recently been published. However, due to the novelty of the procedure, long-term data are still missing.

OBJECTIVES

The aim of this study was to evaluate changes in abdominal tissues on average 1 year after a series of HIFEM treatments, to determine the long-term durability of patients' original body responses.

METHODS

Magnetic resonance imaging (MRI) or computed tomography (CT) scanning were performed on 21 patients a mean of 332.6 [88.5] days after their original HIFEM treatment series. The scans were evaluated by a blinded radiologist for abdominal muscle thickness, subcutaneous fat changes, and abdominal separation. The results were compared with the MRI/CT-assisted measurements taken at baseline and 6-week follow-up. Correlations between collected data sets were calculated and tested. The incidence of any adverse events related to earlier treatments was monitored.

RESULTS

When comparing the 1-year follow-up measurements with the baseline, the MRI/CT-assisted calculations revealed mean reductions of 14.63% (2.97 [2.11] mm) in fat, 19.05% (1.89 [0.88] mm) in muscle thickening, and 10.46% (1.96 [1.71] mm) in diastasis recti. All changes were significant (P < 0.05) and not related to weight fluctuations (P > 0.05). The baseline width of diastasis positively correlated with the degree of improvement at follow-up. No adverse events were reported.

CONCLUSION

The HIFEM-induced muscle hypertrophy, fat reduction, and reduction in abdominal separation were maintained 1-year posttreatment. This suggests long-term durability of the original bodily response, which needs to be verified by continuing follow-up of this group and by further studies.

LEVEL OF EVIDENCE: 4

A 12-Week, Prospective, Non-Comparative, Non-Randomized Study of Magnetic Muscle Stimulation for Improvement of Body Satisfaction With the Abdomen and Buttocks

Background and Objective

Magnetic muscle stimulation (MMS) is a relatively new energy‐based technology that provides a non‐invasive option for body contouring through stimulation and toning of underlying skeletal muscles. This study was conducted to examine the safety, efficacy, and body satisfaction scores of MMS using a CoolToneTM prototype for the aesthetic improvement of abdominal and buttock contour.

Study Design/Materials and Methods

This was a prospective, non‐comparative, non‐randomized, 12‐week, multicenter study. Male and female participants aged 22‐65 years received 4 MMS treatment sessions to the abdomen and/or buttocks. Body Satisfaction Questionnaire (BSQ) scores for abdomen and/or buttocks were assessed at baseline, immediately post final treatment, at 4 weeks (primary endpoint), and 12 weeks post final treatment. Subject‐rated Global Aesthetic Improvement Scale (SGAIS) was assessed at 4 weeks post final treatment (secondary endpoint), and 12 weeks post final treatment. Additional efficacy assessment included abdominal circumference obtained by 3D imaging at baseline, immediately post final treatment, and at 4 and 12 weeks post final treatment. A Subject Experience Questionnaire (SEQ) was used to assess treatment satisfaction and perspectives at 4 weeks and 12 weeks post final treatment. Adverse events (AEs) were monitored throughout the study.

Results

A total of 110 participants were recruited, who were 75% female, 80% Caucasian (mostly non‐Hispanic), average age of 39.5 years (range 22–59) with an average body mass index (BMI) of 23.3 kg/m2 (range 18–29.9). At the 4‐week post final treatment visit, the average BSQ score for participants receiving abdominal treatment (n = 93) was significantly improved with a 5.1 average increase in total score from baseline (possible score range 10–50) and by a 5.5 average increase from baseline for participants receiving buttocks treatment (n = 32) (p < 0.05). At 4 weeks post final treatment, the proportion of participants with SGAIS scores >“Improved” was 68.1% for participants receiving treatment of the abdomen (n = 94), and 81.8% for those receiving buttocks treatment (n = 33). The mean total decrease from baseline in waist circumference was significant at all time points. At the 12‐week post final treatment visit, SEQ data revealed that a majority of participants were “Satisfied” or “Very Satisfied” with overall treatment results and “Agreed” or “Strongly Agreed” that they were motivated to maintain results either by working out or by additional treatment. A total of 6 AEs related to the device and/or treatment were reported, which resolved spontaneously during the study.

Conclusion

Treatment of the abdomen and/or buttocks with MMS was well‐tolerated and demonstrated significant improvement in aesthetic appearance through the 12‐week post final treatment study duration. As a stand‐alone treatment, MMS expands the range of options for individualized treatment planning for patients seeking abdominal and/or gluteal muscle toning. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

Abdominal Remodeling in Postpartum Women by Using a High-intensity Focused Electromagnetic (HIFEM) Procedure: An Investigational Magnetic Resonance Imaging (MRI) Pilot Study

Objective: High-intensity focused electromagnetic (HIFEM) technology offers an alternative to surgical procedures in terms of correction of altered body shape. In this pilot study, we investigated whether HIFEM technology can positively affect abdominal appearance in postpartum women. Methods: Ten women (3-36 months postpartum; average age: 37.7 years) received four 30-minute abdominal HIFEM treatments. Magnetic resonance imaging (MRI) examination of abdominal fat thickness, rectus abdominis thickness, and the width of abdominal separation was performed and evaluated at baseline, one month, three months, and six months post-treatment. Additionally, weight was recorded, standardized photographs were taken, and patient comfort levels with the procedures were assessed, using a 7-point scale, at these same time points. The paired t-test was used to statistically analyze the mean differences between the baseline and post-treatment data. Results: Results obtained from MRI images showed an average abdominal fat reduction of 17.0 percent at the one-month follow-up visit, while at the three-month follow-up, it was 20.2 percent. The average muscle thickness increase at the one-month follow-up was 20.5 percent, and at the three-month follow-up, it was 21.3 percent. The distance between the rectus abdominis muscles was reduced by 16.7 percent at the first follow-up visit and by 22.7 percent at three-month follow-up visit. The nine subjects who attended the six-month visit showed, on average, a 17.6-percent fat reduction, 21.7-percent increase in muscle, and a 23.2-percent reduction of abdominal separation. Weight did not change significantly. Conclusion: HIFEM treatments appeared to reduce the fat layer and width of abdominal separation, while increasing the thickness of abdominal muscle thickness in postpartum women. The observed results at one month post-procedure were improved at three months post-procedure and remained stable at the six-month follow-up visit. Future studies that include a control or sham group are needed to identify and reduce the risk of bias.

Noninvasive Abdominoplasty

Noninvasive and minimally invasive treatments are increasingly supplanting, or complimenting, abdominoplasty. For optimal delivery of patient care and to maintain a dominant share of the body-contouring market, plastic surgeons need to embrace these new technologies. High capital purchases, costly disposables, maintenance fees, lack of experience, conflicting anecdotal reports, energy-related complications, marketing hyperbole, and rapid obsolescence are formidable barriers to this adoption. Receptive plastic surgeons may be best served by accepting brief short-term retrospective reports by reputable innovative body contouring surgeons who present a succinct and clinically supported message.

Clinical Study Demonstrates that Electromagnetic Muscle Stimulation Does Not Cause Injury to Fat Cells

Background and Objectives

A previous pre‐clinical study on electromagnetic muscle stimulation (EMMS) suggested that fat cell apoptosis occurs following treatment in a porcine model. While EMMS can induce changes in muscle, the effect on fat tissue is not established. This clinical study sought to assess adipose tissue response to EMMS in comparison to cryolipolysis treatment.

Study Design/Materials and Methods

Study subjects were recruited prior to abdominoplasty to receive body contouring treatments and subsequently to obtain tissue for histological analysis. Non‐invasive abdominal treatments were delivered using a commercially available (n = 6) or prototype (n = 3) EMMS system or a cryolipolysis system (n = 2). Subjects received a single EMMS treatment (100% intensity for 30 minutes) or a single cryolipolysis treatment (−11°C for 35 minutes) to the abdomen. Superficial and deep (i.e., adjacent to muscle layer) subcutaneous adipose tissue was harvested at set timepoints post‐treatment. The presence or absence of an inflammatory response was evaluated using standard hematoxylin and eosin (H&E) staining. As adipocytes that are destined to become apoptotic cannot be distinguished by traditional H&E staining during the early phases of injury, irreversible fat cell injury was assessed using perilipin immunofluorescence.

Results

Following H&E histological analysis at 3, 10, 11, and 17 days post‐treatment, no EMMS‐treated samples showed an inflammatory response in either the superficial or deep subcutaneous adipose tissue. For the cryolipolysis‐treated adipose tissue, however, the H&E staining revealed a marked inflammatory response with an influx of neutrophils, lymphocytes, and macrophages at timepoints consistent with previous histological studies. Further, loss of perilipin staining provided clear visual evidence of irreversible fat cell injury in the cryolipolysis‐treated adipose tissue. In contrast, the electromagnetic muscle stimulation‐treated samples showed persistence of perilipin staining of adipose tissue indicating that all fat cells were viable.

Conclusion

This study failed to demonstrate either fat cell injury or inflammatory response following EMMS treatment. While electromagnetic muscle stimulation may non‐invasively induce muscle changes, this clinical study found no evidence of an impact injurious or otherwise on subcutaneous fat. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC

Intended Human Exposure to Non-ionizing Radiation for Cosmetic Purposes

Cosmetic devices using non-ionizing radiation (NIR) are increasingly available for people who wish to modify their appearance for aesthetic purposes. There are a wide range of NIR modalities used for cosmetic procedures, including devices that use optical radiation (laser, intense pulsed light, and light-emitting diode), electromagnetic fields, and ultrasound. Common procedures involving the application of NIR include epilation, skin rejuvenation, body sculpting and contouring, treatment of vascular and skin lesions, tattoo removal, and scar reduction. The majority of research on the use of NIR cosmetic devices has focused on the efficacy of the treatment rather than adverse effects or complications. Studies that assessed safety consisted mostly of case reports and small case series. Common adverse effects on the skin reported include mild and transient pain, erythema, swelling, and changes in pigmentation. Less common, more severe side effects include burns, blisters, scarring, persisting erythema, altered pigmentation, and eye damage. Some of the latter may have resulted from treatment errors. Particular groups of people that may be at greater risk from optical radiation include people with dark skin, with high sun exposure, and taking photosensitizing medications or supplements. There is lack of evidence for the safety profile of cosmetic NIR procedures during pregnancy. Reports of injuries to workers administering treatments with cosmetic NIR devices are rare, but inadvertent damage to the eye from optical devices may occur. Randomized controlled trials are required to fully assess potential adverse effects from the use of NIR cosmetic devices. Regulation varies worldwide and some regions apply the same safety classification and guidance as for medical devices. In order to reduce harm associated with the use of cosmetic devices, ICNIRP considers it important that regulations that cover all types and frequencies of cosmetic NIR devices are adopted worldwide and that there is greater oversight regarding their use.

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

BACKGROUND

High-intensity focused electromagnetic (HIFEM) field technology has been reported to increase muscle thickness and hypertrophy. However, this process has not yet been confirmed on a histologic level.

OBJECTIVES

The aim of this study was to evaluate in-vivo structural changes in striated porcine muscle tissue following HIFEM treatment.

METHODS

Three Yorkshire pigs received four 30-minute HIFEM treatments applied to the biceps femoris muscle on 1 side only. The fourth pig served as a control subject. At baseline and 2 weeks after the last treatment, biopsy specimens of the muscle tissue were collected from the treatment site. The control pig underwent muscle biopsy from a similar but untreated site. Twenty-five histology slides were evaluated from each pig. A certified histopathologist analyzed sliced biopsy samples for structural changes in the tissue.

RESULTS

Histologic analysis showed hypertrophic changes 2 weeks posttreatment. The muscle mass density increased by 20.56% (to a mean of 17,053.4 [5617.9] µm2) compared with baseline. Similarly, muscle fiber density (hyperplasia) increased: the average change in the number of fibers in a slice area of 136,533.3 µm2 was +8.0%. The mean size of an individual muscle fiber increased by 12.15% (to 332.23 [280.2] µm2) 2 weeks posttreatment. Control samples did not show any significant change in fiber density or hyperplasia.

CONCLUSIONS

Histopathologic quantification showed significant structural muscle changes through a combination of fiber hypertrophy and hyperplasia. Control biopsies showed a lack of similar changes. The data correlate with findings of other HIFEM research and suggest that HIFEM could be used for noninvasive induction of muscle growth.

Mechanism of nonthermal induction of apoptosis by high-intensity focused electromagnetic procedure: Biochemical investigation in a porcine model

Background

Multiple studies have reported adipose tissue reduction after the application of the High‐Intensity Focused Electromagnetic (HIFEM) field technology, yet cellular level evidence of the mechanisms has remained scarce.

Objectives

This study aims to verify or refute previous single‐study histological evidence and further investigates the proposed mechanism of apoptotic induction.

Methods

The thigh of two Large White pigs was treated with HIFEM for 30 minutes. Fat punch biopsies were collected from the application area before, immediately after, and 8 hours post‐treatment. Control samples were taken from the abdomen immediately after and 8 hours post‐treatment. Samples were analyzed for pro‐apoptotic DNA markers (BAX, BCL‐2, TXNIP, MMP9, TNF‐α), the levels of free fatty acids (FFA), and the pH levels of the adipose tissue.

Results

The levels of FFA in the treated adipose tissue increased on average by 127.1% immediately post‐treatment and by 134.1% 8 hours post‐treatment, indicating a rapid breakdown of lipids. The average recorded adipose pH changed from 7.30 ± 0.12 at baseline to 6.60 ± 0.07 immediately post‐treatment (P = .001) and to 7.19 ± 0.12 8 hours post‐treatment. The levels of BAX, TXNIP, MMP9, and TNF‐α increased post‐treatment while BCL‐2 decreased. Control samples showed constant levels of pH and pro‐apoptotic markers. The FFAs in the control samples were increased by 41.6%‐51.4%.

Conclusion

The changes in the levels of the pro‐apoptotic markers conformed to the previously reported elevated fat apoptosis post‐HIFEM treatments. These effects were accompanied by an increase in FFA levels, and by reduced pH levels, due to the increased acidity in the adipose tissue. Further research is required to explore the potential of nonthermal induction of apoptosis.

Safety and Efficacy of a Non-Invasive High-Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life

Background and Objectives

Urinary incontinence is a common and distressing condition which interferes with everyday life. Patients frequently experience discomfort related to urine leakage and the subsequent need to use absorbent pads. Since the continence mechanism is primarily maintained by a proper function of pelvic floor muscles (PFM), many treatment methods focused on strengthening of the PFM have been introduced in the past. The aim of this study was to evaluate the safety and efficacy of a high‐intensity focused electromagnetic technology (HIFEM) for treatment of urinary incontinence with emphasis on effects on prospective patients’ quality of life.

Study Design/Materials and Methods

The study followed an institutional review board approved protocol. A total of 75 women (55.45 ± 12.80 years, 1.85 ± 1.28 deliveries) who showed symptoms of stress, urge, or mixed urinary incontinence were enrolled. They received six HIFEM treatments (2 per week) in duration of 28 minutes. Outcomes were evaluated after the sixth treatment and at the 3‐month follow‐up. The primary outcome was to assess changes in urinary incontinence by the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and changes in the number of absorbent pads used per day. The secondary outcome was subjective evaluation of the therapy and self‐reported changes in quality of life. The statistical analysis was conducted by paired T‐test and Pearson correlation coefficient ( α = 0.05).

Results

After the sixth session, 61 out of 75 patients (81.33%) reported significant reduction of their symptoms. The average improvement of 49.93% in ICIQ‐SF score was observed after the sixth treatment, which further increased to 64.42% at the follow‐up (both P < 0.001). Individually, the highest level of improvement was reached in patients suffering from mixed urinary incontinence (69.90%). The reduction of absorbent pads averaged 43.80% after the sixth treatment and 53.68% at 3 months (both P < 0.001), while almost 70% of patients (30 out of 43) reported decreased number of used pads. At the follow‐up, a highly significant medium correlation (r = 0.53, P < 0.001) was found between the ICIQ‐SF score improvement and the reduction in pad usage. A substantial decrease in the frequency of urine leakage triggers was documented. Patients reported no pain, downtime or adverse events, and also reported additional beneficial effects of the therapy such as increased sexual desire and better urination control.

Conclusions

This study demonstrated that HIFEM technology is able to safely and effectively treat a wide range of patients suffering from urinary incontinence. After six treatments, an improvement in ICIQ‐SF score and reduction in absorbent pads usage was observed. Based on subjective evaluation, these changes positively influenced quality of life. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition

Non-invasive body contouring is a rapidly growing field in cosmetic dermatology. Non-invasive contouring devices improve the body's appearance through the removal of excess adipose tissue, particularly in areas in which fat persists despite optimal diet and exercise routine. The technology can also be used for skin tightening. This article reviews the five FDA-approved non-invasive body contouring modalities: cryolipolysis, laser, high-intensity focused electromagnetic field, radiofrequency and high-intensity focused ultrasound. These devices have emerged as a popular alternative to surgical body contouring due to their efficacy, favourable safety profile, minimal recovery time and reduced cost. Although they do not achieve the same results as liposuction, they are an attractive alternative for patients who do not want the risks or costs associated with surgery. When used appropriately and correctly, these devices have demonstrated excellent clinical efficacy and safety.