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

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  • Body Contouring
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Abstract

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.

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References

  1. Kruger J, Lee C-D, Ainsworth BE, Macera CA (2008) Body size satisfaction and physical activity levels among men and women. Obesity 16:1976–1979. https://doi.org/10.1038/oby.2008.311

    Article  PubMed  Google Scholar 

  2. Almutairi K, Gusenoff JA, Rubin JP (2016) Body contouring. Plast Reconstr Surg 137(3):586e–602e. https://doi.org/10.1097/PRS.0000000000002140

    Article  CAS  PubMed  Google Scholar 

  3. Mazzoni D, Lin MJ, Dubin DP, Khorasani H (2019) Review of non-invasive body contouring devices for fat reduction, skin tightening and muscle definition. Australas J Dermatol 60:278–283. https://doi.org/10.1111/ajd.13090

    Article  PubMed  Google Scholar 

  4. The American Society for Aesthetic Plastic Surgery (2016) Cosmetic surgery national data bank statistics. Aesthet Surg J 36(Suppl 1):1–29. https://doi.org/10.1093/asj/36.Supplement_1.1

    Article  Google Scholar 

  5. Bernstein D, Farberg AS, Khorasani H, Kriegel D (2017) Noninvasive body contouring: literature review and summary of objective data. SKIN J Cutan Med 1(1):18–31. https://doi.org/10.25251/skin.1.1.4

    Article  Google Scholar 

  6. Ortiz AE, Avram MM (2015) Noninvasive body contouring: cryolipolysis and ultrasound. Semin Cutan Med Surg 34(3):129–133. https://doi.org/10.12788/j.sder.2015.0171

    Article  PubMed  Google Scholar 

  7. Jacob CI, Paskova K (2018) Safety and efficacy of a novel high-intensity focused electromagnetic technology device for noninvasive abdominal body shaping. J Cosmet Dermatol 17:783–787. https://doi.org/10.1111/jocd.12779

    Article  PubMed  Google Scholar 

  8. Rambhia PH, Turner L, Ugonabo N, Chapas A (2022) Muscle stimulation for aesthetic body shaping: a comprehensive and critical review. Dermatol Surg 48(10):1076–1082. https://doi.org/10.1097/DSS.0000000000003550

    Article  CAS  PubMed  Google Scholar 

  9. Weiss RA, Bernardy J (2019) Induction of fat apoptosis by a non-thermal device: Mechanism of action of non-invasive high-intensity electromagnetic technology in a porcine model. Lasers Surg Med 51:47–53. https://doi.org/10.1002/lsm.23039

    Article  PubMed  Google Scholar 

  10. Halaas Y, Duncan D, Bernardy J, Ondrackova P, Dinev I (2021) 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. Aesthet Surg J 41(7):NP939–NP947. https://doi.org/10.1093/asj/sjab002

    Article  PubMed  PubMed Central  Google Scholar 

  11. Dumont NA, Bentzinger CF, Sincennes M-C, Rudnicki MA (2015) Satellite cells and skeletal muscle regeneration. Compr Physiol 5(3):1027–1059. https://doi.org/10.1002/cphy.c140068

    Article  PubMed  Google Scholar 

  12. Halaas Y, Duncan D, Bernardy J, Ondrackova P, Dinev I (2021) 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. Aesthet Surg J 41(7):NP939–NP947. https://doi.org/10.1093/asj/sjab002

    Article  PubMed  PubMed Central  Google Scholar 

  13. Goldberg DJ (2021) Deletion of adipocytes induced by a novel device simultaneously delivering synchronized radiofrequency and HIFEM: human histological study. J Cosmet Dermatol 20:1104–1109. https://doi.org/10.1111/jocd.13970

    Article  PubMed  PubMed Central  Google Scholar 

  14. Jacob C, Kent D, Ibrahim O (2021) Efficacy and safety of simultaneous application of HIFEM and synchronized radiofrequency for abdominal fat reduction and muscle toning: a multicenter magnetic resonance imaging evaluation study. Dermatol Surg 47(7):969–973. https://doi.org/10.1097/DSS.0000000000003086

    Article  CAS  PubMed  Google Scholar 

  15. Brożek JL, Akl EA, Alonso-Coello P, Lang D, Jaeschke R, Williams JW, Phillips B, Lelgemann M, Lethaby A, Bousquet J, Guyatt GH, Schünemann HJ (2009) Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions. Allergy 64:669–677. https://doi.org/10.1111/j.1398-9995.2009.01973.x

    Article  PubMed  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269. https://doi.org/10.7326/0003-4819-151-4-200908180-00135

    Article  PubMed  Google Scholar 

  17. DiBernardo B, Chilukuri S, McCoy JD, Katz B, Goldberg DJ (2023) High-intensity focused electromagnetic field with synchronized radiofrequency achieves superior gluteal muscle contouring than high-intensity focused electromagnetic field procedure alone. Aesthet Surg J Open Forum 5:ojac087. https://doi.org/10.1093/asjof/ojac087

    Article  PubMed  PubMed Central  Google Scholar 

  18. Swanson EA (2023) Systematic review of electromagnetic treatments for body contouring. Ann Plast Surg 90(2):180–188. https://doi.org/10.1097/SAP.000000000000338

    Article  CAS  PubMed  Google Scholar 

  19. Goldberg DJ, Enright KM, Goldfarb R, Katz B, Gold M (2021) The role and clinical benefits of high-intensity focused electromagnetic devices for non-invasive lipolysis and beyond: a narrative review and position paper. J Cosmet Dermatol 20:2096–2101. https://doi.org/10.1111/jocd.14203

    Article  PubMed  Google Scholar 

  20. McKeown DJ, Payne J (2021) Significant improvement in body contour with multiple cycles of CoolSculpting: results of a prospective study. Dermatol Ther 34:e14850. https://doi.org/10.1111/dth.14850

    Article  PubMed  PubMed Central  Google Scholar 

  21. Katz B (2022) Concomitant use of radiofrequency and high intensity focused electromagnetic field energies for full-body remodeling: MRI evidence-based prefatory trial. J Cosmet Dermatol 22:193–199. https://doi.org/10.1111/jocd.14736

    Article  PubMed  PubMed Central  Google Scholar 

  22. Jacob C, Kinney B, Busso M, Chilukuri S, McCoy JD, Bailey C, Denkova R (2018) High intensity focused electro-magnetic technology (HIFEM) for non-invasive buttock lifting and toning of gluteal muscles: a multi-center efficacy and safety study. J Drugs Dermatol 17(11):1229–1232

    PubMed  Google Scholar 

  23. Kinney BM, Kent DE (2020) MRI and CT assessment of abdominal tissue composition in patients after high-intensity focused electromagnetic therapy treatments: one-year follow-up. Aesthet Surg J 40(12):NP686-NP 693. https://doi.org/10.1093/asj/sjaa052

    Article  PubMed  Google Scholar 

  24. Katz B, Duncan D (2021) Lifting and toning of arms and calves using high-intensity focused electromagnetic field (HIFEM) procedure documented by ultrasound assessment. J Drugs Dermatol 20(7):755–759. https://doi.org/10.36849/JDD.5878

    Article  PubMed  Google Scholar 

  25. Kinney BM, Lozanova P (2019) 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. Lasers Surg Med 51:40–46. https://doi.org/10.1002/lsm.23024

    Article  PubMed  Google Scholar 

  26. Kinney BM, Kent DE (2020) MRI and CT assessment of abdominal tissue composition in patients after high-intensity focused electromagnetic therapy treatments: one-year follow-up. Aesthet Surg J 40(12):NP686–NP693. https://doi.org/10.1093/asj/sjaa052

    Article  PubMed  Google Scholar 

  27. Duncan DI (2021) Combination treatment for buttock and abdominal remodeling and skin improvement using HIFEM procedure and simultaneous delivery of radiofrequency and targeted pressure energy. J Cosmet Dermatol 20(12):3893–3898. https://doi.org/10.1111/jocd.14554

    Article  PubMed  PubMed Central  Google Scholar 

  28. Palm MD, Halaas Y, Kinney BM, Goldfarb R (2023) Spot reduction of localized fat deposits on the lateral thighs by simultaneous emission of synchronized radiofrequency and high-intensity focused electromagnetic energy: magnetic resonance multicenter study. Dermatol Surg 49(1):48–53. https://doi.org/10.1097/DSS.0000000000003663

    Article  CAS  PubMed  Google Scholar 

  29. Katz B (2022) Concomitant use of radiofrequency and high intensity focused electromagnetic field energies for full-body remodeling: MRI evidence-based prefatory trial. J Cosmet Dermatol 22(1):193–199. https://doi.org/10.1111/jocd.14736

    Article  PubMed  PubMed Central  Google Scholar 

  30. Katz B, Duncan D (2021) Lifting and toning of arms and calves using high-intensity focused electromagnetic field (HIFEM) procedure documented by ultrasound assessment. J Drugs Dermatol. 20(7):755–759 https://doi.org/10.36849/JDD.5878

    Article  PubMed  Google Scholar 

  31. Palm M (2021) Magnetic resonance imaging evaluation of changes in gluteal muscles after treatments with the high-intensity focused electromagnetic procedure. Dermatol Surg 47(3):386–391. https://doi.org/10.1097/DSS.0000000000002764

    Article  CAS  PubMed  Google Scholar 

  32. Kent DE, Kinney BM (2021) The effect of high-intensity focused electromagnetic procedure on visceral adipose tissue: retrospective assessment of computed tomography scans. J Cosmet Dermatol 20(3):757–762. https://doi.org/10.1111/jocd.13952

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

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Authors and Affiliations

  1. The Robert Larner MD College of Medicine at The University of Vermont, Burlington, Vermont, USA

    Joshua Kohan

  2. Aristocrat Plastic Surgery and MedAesthetics, New York, New York, USA

    Krishna Vyas & Kevin Tehrani

  3. Kellogg College, University of Oxford, Oxford, UK

    Marios Erotocritou & Ankur Khajuria

  4. Department of Surgery and Cancer, Imperial College London, London, UK

    Marios Erotocritou & Ankur Khajuria

  5. New York, USA

    Joshua Kohan

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Contributions

JK wrote the manuscript with support from KV, ME and AK. KV conceived the original idea. KT supervised the project.

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Correspondence to Joshua Kohan.

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Kohan, J., Vyas, K., Erotocritou, M. et al. High-Intensity Focused Electromagnetic (HIFEM) Energy With and Without Radiofrequency for Noninvasive Body Contouring: A Systematic Review. Aesth Plast Surg 48, 1156–1165 (2024). https://doi.org/10.1007/s00266-023-03730-3

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