Fueled by advances in technology and increasing awareness among consumers, the minimally invasive body contouring market is experiencing explosive growth, and it is poised for yet another growth spurt with the advent of muscle stimulating devices.

The global body contouring market reached a value of $6.1 billion in 2018, and the market is expected to reach $9.1 billion by 2024, growing at a compound annual growth rate of 6.8 percent during 2019-2024, according to a report from ResearchAndMarkets.com.

Fat reduction, epidermal heating, and muscle toning are now increasingly possible without surgery, and many individuals realize that diet and exercise alone can only accomplish so much. With the recent launch of truSculpt flex for muscle sculpting, Cutera’s duet of body sculpting products is now solely capable of meeting all of these applications.

“We can now offer a complete body sculpting solution in a single treatment protocol. With truSculpt iD radiofrequency for fat reduction, and truSculpt flex bioelectric stimulation for muscle toning, the results are comprehensive body contouring,” says New York City dermatologist Neil S. Sadick, MD, founder and President of Sadick Dermatology and a Clinical Professor of Dermatology at Weill Cornell Medical College, in New York City.

The truSculpt iD Difference

truSculpt iD offers permanent fat reduction via monopolar radiofrequency. Danville, CA-based plastic surgeon Stephen J. Ronan, MD, describes truSculpt iD as a hands-free upgrade to its truSculpt 3D predecessor, which produced excellent results, but involved a longer treatment time.

truSculpt iD uses multiple 2 MHz monopolar RF handpieces to selectively target and increase the temperature of subcutaneous fat without excessively increasing the temperature in the dermis. This treatment provides tissue improvements from epidermis to fat, he explains.

The 2 MHz system heats fat more quickly than the original 1 MHz system. Treatment time is just 15 minutes, and typically, only one session is necessary to achieve results, Dr. Ronan says. By contrast, other energy-based fat reduction devices on the market take significantly longer, and multiple sessions are often indicated to produce noticeable results.

Much of the innovation comes from the new handpiece design, which is aimed at ensuring even distribution of heat. Cutera has a long history of working on optimal electrode design to make sure RF energy passes through the skin and treats the fat.

“Fat apoptosis occurs post-treatment for up to 60 days, with peak fat cell death seen at 30 days,” he says.

The results speak for themselves. truSculpt iD treats the entire fat layer, resulting in an average of 24 percent fat reduction. Specifically, in Dr. Ronan’s practice, the average fat reduction was 23.5 percent in the abdomen and 23 percent in flanks with a single 15-minute treatment.

Treatment is also relatively painless due to advances in technology. “If we raise the temperature of the fat to the time-temperature curve, we can offset any pain,” he says. “The time-temperature curve is a happy medium of the highest temperature that a patient can tolerate and maintain.”

Put another way: “truSculpt iD gets the fat hotter faster and keeps it there while protecting the skin,” he says. “It’s faster than any fat reduction device in the body contouring industry, it’s reliable, and it is user-friendly.”

Patient shown before (left) and 12 weeks after 4 treatments with truSculpt® flex.
Photos courtesy of Somenek+Pittman

Versatility and Customizability

Versatility is another strength of this device, Dr. Ronan says.

truSculpt iD can be customized to target multiple body parts in one session and contains six handpieces, instead of one. “Now, we can treat patients using all six at once,” Dr. Ronan says. truSculpt iD can treat more body areas in less time. This device makes it far more convenient and slightly less expensive in terms of disposables. RF is colorblind, so it is safe on all skin types.

“What’s great about truSculpt iD is the multiple handpieces,” adds Dr. Sadick. “You can sculpt one or more parts of the body, in any location, in a single treatment.”

“The results are amazing,” he says. “I dissolve fat in 15 minutes in a painless fashion, and we see about a 20-25 percent reduction in fat after 12 weeks,” he says. “Most patients just need one treatment, but if they request a second, we can do it in four weeks.”

Fat reduction technology has come a long way. “Twelve years ago, we saw the beginning of the non-invasive fat reduction with Zeltiq (now CoolSculpting). We have also seen advances and multiple devices cleared since then,” says David J. Goldberg, MD, JD, Director, Skin Laser & Surgery Specialists of NY/NJ, Clinical Professor of Dermatology at Icahn School of Medicine at Mount Sinai in New York City, and Clinical Professor of Dermatology and Chief of Dermatology Surgery at UMDNJ-Rutgers Medical School in Newark, NJ. He is also an Adjunct Professor of Law at Fordham Law School in New York, NY.

“truSculpt iD was the first device to therapeutically heat tissue from epidermis to fat painlessly,” Dr. Goldberg says. “Muscle tightening is still in its infancy, and truSculpt flex is entering this market.”

The truSculpt flex Difference

Eight muscle groups can be treated simultaneously with truSculpt flex, covering the largest treatment area in the body sculpting industry, experts explain.

Another benefit is that the device offers three treatment modes to simulate the effects of different workouts by replicating intensified twist, squat, and crunch actions, which further differentiates truSculpt flex from other muscle toning devices on the market.

Prep Mode creates a twisting motion to warm up the muscles and slowly build a tolerance to contractions. Tone Mode contracts the muscles, holds it to the point of exhaustion, and then relaxes it to increase strength and enhance endurance. Sculpt Mode creates fast, deep, sequential contractions of the muscles. This action develops new muscle fibers and increases basal metabolic rate (BMR).

The truSculpt flex device consists of a touch screen LCD user interface and sixteen handpieces, which allow for simultaneous treatment of up to eight body areas. It’s easy to teach physician extenders how to operate the device.

Patient shown before (left) and 1 week after 1 treatment with truFlex iD (middle). Photo on right is 12 weeks after 6 treatments with the truSculpt® flex.
Photos courtesy of Amy Forman Taub, MD

A Brief History of Muscle Toning Devices

Michael Karavitis, CTO and EVP of Cutera, led the development of a novel and potentially disruptive muscle stimulation and contraction technology that was recently commercially released in the company’s truSculpt flex product. “The new technology has several distinct advantages when compared to other competitive devices,” he says.

Traditional muscle stimulation devices can be divided into two categories: Bio-Electrical Muscle Stimulation and Electro-Magnetic Muscle Stimulation. “When you want to specifically stimulate skeletal muscles, it requires a directed approach,” he says. “With truSculpt flex, electrical impulses generated by the device are delivered through electrodes placed over hydrogel pads in direct contact with the muscle groups being stimulated.”

The truSculpt flex differs from Electro-Magnetic Muscle Stimulation devices in that it provides a uniform distribution of electrical current directly to motor neurons to create intense muscle contractions with low energy levels. By contrast, Transcutaneous Electrical Nerve Stimulation (TENS) and traditional over-the-counter EMS devices produce twitch-like responses in muscles; moreover, the current levels conducted through the skin are limited to prevent sharp pain or skin injury.

“For Electro-Magnetic devices, stimulation is achieved via a large magnetic field placed in proximity of a specific muscle group. Because these devices lack directionality, only single-axis contractions are possible,” he explains. “Muscles under the electromagnet will contract, but adjacent areas of the same muscle, not under the electromagnet, will not. So having the electromagnet fit perfectly over the intended muscle is important for these devices to be effective,” he says. “The truSculpt flex doesn’t have the same issues with respect to electrode placement.”

“Cutera found a threshold by which they could contract a specific muscle or muscle group, well and above what would be tolerated with a traditional electrode pad,” he says. “The truSculpt flex leverages a lot of historical effects of traditional EMS but breaks down the barriers. The innovation is in the electrode design as it applies an even current distribution along the length of the muscle.”

He continues, “The unique truSculpt flex handpiece and truGel deliver energy directly to the muscle. Moreover, this offers more than just linear contractions. With truSculpt flex, we can cross over to make muscles twist and turn. These different types of torsional contractions can be achieved by changing the polarity of the electrodes in real-time.”

“Electrode placement is simple. We can treat eight body areas at one time, which significantly increased the patient throughput of truSculpt flex over other devices on the market”, he says.

It can be tailored to the patient, given the flexibility of where and how to place electrodes. “It allows us to go deep and target specific muscles,” he says. “The truSculpt flex provides both directionality and specificity. We can put energy where it needs to go and not where it doesn’t, and we can target specific muscle groups and have the ability to manipulate them with directionality.” The results are “very impressive,” he says.

Patient shown before (left) and 12 weeks after 1 treatment with truSculpt® iD.
Photos courtesy of Stephen Ronan, MD

truSculpt flex plus truSculpt iD Equals Complete Body Sculpting

“The benefits of truSculpt flex compared to other muscle toning devices on the market are that it can treat a larger surface area per session and the treatment takes just 45 minutes,” says Michael Somenek, MD, a facial plastic surgeon in Washington, DC. His practice was the first site in the US to begin using truSculpt flex paired with truSculpt iD.

“The ultimate goal in non-invasive body sculpting is to target fat and stimulate muscle,” he says. “These two devices are synergistic and complementary.”

In his practice, he initiates fat reduction with truSculpt iD and then begins truSculpt flex. “We do one iD treatment, followed by a series of four to six truSculpt flex treatments, administered twice a week for two to three weeks, to generate supramaximal contractions in the treated area.”

Most patients begin seeing results after eight weeks, with maximum improvements visible at twelve weeks.

Maintenance truSculpt flex sessions are recommended. “If they come in for a booster treatment once every three months to consistently stimulate the area, these results can be maintained for the long term.”

The treated area is red for an hour.

Preliminary data on treatments with the truSculpt flex device shows an average of 30 percent increase in muscle mass and a modest reduction in fat thickness.

“It’s been shown that speed of muscle contractions increases the metabolic rate, which can lead to lipolysis and a temporary reduction in circumference,” explains Dr. Sadick.

Patient Selection Pointers

Patient selection does play an important role. Not every patient will be a candidate for non-invasive fat reduction with truSculpt iD. “Gastric bypass patients have excessive loose skin and fat, and for them, the solution will always be surgical,” Dr. Goldberg says.

Body contouring treatments are best suited for relatively fit people that have isolated fatty bulges that can be specifically targeted. That said, truSculpt iD is the first treatment on the market for people with a BMI of 30 or above, Dr. Sadick adds.

Muscle stimulation with truSculpt flex is an option for most patients, he says. “It increases core strength and muscle endurance.”

Dr. Karavitis agrees. “There are fewer restrictions with this technology,” he says. “We can start a patient who is heavier with poor exercise on the prep program to warm up the muscles,” he says. “If the patient is pretty active, we can skip Prep mode and treat with a week of Tone and a week of Sculpt.”