Emsculpt NEO

When BTL’s Emsculpt first hit the aesthetic scene in 2018, it disrupted the already-hot body sculpting category by bringing muscle stimulation to the table.

BTL continues to innovate and disrupt with the launch of Emsculpt NEO, the first device to combine high-intensity focused electromagnetic (HIFEM®) energy and novel synchronized radiofrequency (RF) technology for fat reduction and muscle stimulation. Now patients truly get more for less.

BTL’s suite of devices has sired unique and clever combination procedures, including Core to Floor, which combines Emsculpt or Emsculpt NEO for improved core strength with Emsella to strengthen pelvic floor muscles, treating the whole core; and Taut & Toned, which pairs Emtone and Emsculpt or Emsculpt NEO to address skin laxity, muscle, and fat.

Core to Floor and Taut & Toned are guaranteed to produce visible results, exceed patient expectations, and grow your practice, say experts who offer the treatments. The unprecedented uptake and interest in these combination procedures has enabled BTL to successfully pivot from an aesthetic company to a wellness and lifestyle brand.

The HIFEM Edge

BTL was the first company to apply High Intensity Focused Electromagnetic (HIFEM®) energy to the aesthetics and women’s health categories with the launch of Emsella in 2017 and Emsculpt in 2018.

HIFEM induces short bursts of powerful muscle contractions to the treated area. When the muscle tissue is subjected to these supramaximal contractions, it must adapt, and doing so builds muscle. Moreover, HIFEM activates more muscle fibers than can be achieved through exercise.

Emsculpt NEO doubles down on this effect by adding RF energy to the mix. Each Emsculpt NEO applicator contains hundreds of specially designed electrode fragments that are synchronized to change polarity at the same time. Due to this unique design, the electrodes become transparent to the HIFEM field so it becomes possible to emit both technologies simultaneously through a single channel.

This innovation was made possible by tremendous strides in engineering and design at BTL. RF electrodes are usually made of metal to conduct currents, but metal objects are contraindicated with HIFEM because electromagnetic field rapidly heats them up. This makes any ordinary combination of the two technologies impossible, but a new coil design with a protective layer isolates all the electrical components inside the applicator from the strong electromagnetic fields.

The heating effects are best paired with specific muscle contraction patterns and are homogeneous across the entire area. The muscle contracts simultaneously to help with the uniform distribution of the heat. Moreover, HIFEM fields penetrate through the fragments without creating eddy currents that would create interference.

The Emsculpt NEO results speak for themselves, says Bruce E. Katz, MD, medical director of JUVA Skin and Laser Center in New York City. “We see a 28-30 percent reduction in fat, and we are building muscle up to 24-25 percent,” he says. The device treats the abdomen, buttocks, arms, and calves.

Emsculpt Neo is approved to treat people with body mass indexes (BMIs) of up to 35, Dr. Katz says. “We can now treat larger BMIs that we weren’t treating before, which has increased our database of patients,” he explains.

A study by Carolyn Jacob, MD and David Kent, MD utilizing magnetic resonance imaging (MRI) demonstrated a significant reduction of abdominal fat thickness: 30.8 percent at three months after the dual-energy treatments. Similarly, an additional study, performed by Dr. Katz and colleagues used ultrasound to demonstrate an average decrease in fat thickness of 28.3 percent at three months. The results were further maintained at six-month follow-up visits after the last treatment.

Profound Anti-aging Benefits

The improvements aren’t just cosmetic, Dr. Katz says. “Patients’ back pain is gone because their core is much stronger,” he explains.

Research shows that people lose three to five percent of muscle mass each decade, Dr. Katz says. “By restoring muscle mass, we are reversing an aging process big time. This is not just an aesthetic benefit, it’s a true anti-aging benefit.”

Calling Emsculpt Neo his practice’s “go-to” device for treating the stomach and buttocks, David J. Goldberg, MD, JD, Director of Cosmetic Dermatology and Clinical Research at Schweiger Dermatology Group, 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, says, “this is the only device on the market that can improve muscle tone, increase muscle definition, and lessen fat all at the same time.

“There is more muscle toning with this device than with Emsculpt alone, while at the same time the treatment is also more comfortable,” says Dr. Goldberg, also an Adjunct Professor of Law at Fordham Law School in New York City.

Treatment with Emsculpt Neo can also provide a steppingstone toward a healthier lifestyle. “It gives people the confidence to improve their overall healthy approach to life,” Dr. Goldberg says.

Core to Floor

Core to Floor combines Emsculpt or Emsculpt NEO with Emsella. It’s the only procedure that targets and treats the entire core, and therein lie the profound aesthetic and functional benefits, says Richard Goldfarb, MD, a plastic surgeon in Langhorne, PA.

The full core comprises the abdominal and back muscles and the small pelvic muscles that stabilize the body, fine-tune motor activity matter, and control bladder and bowel function.

With Emsella, patients sit on the chair-shaped device fully clothed while the device produces non-invasive electromagnetic stimulation of the pelvic floor musculature to rehabilitate weak pelvic muscles, restore neuromuscular control, and improve urinary incontinence.

The newest Emsella applicator with up to 2.5 Tesla (T) can treat all forms of male and female urinary incontinence. ”It’s like doing thousands of Kegel-like contractions in 28 minutes,” Dr. Goldfarb says. “You are basically taking tissue that has become lax and bringing it back to a more fit state.”

BTL’s Core to Floor procedure could benefit the more than 200 million people worldwide who live with male and female urinary incontinence.

Other Core to Floor Perks

In addition to treating urinary incontinence, there are many other benefits of Core to Floor.

Posture: “You need strong pelvic floor muscles as they control posture,” Dr. Goldfarb says.

Exercise. “Core to Floor is incredibly helpful for people who are training because you are better able to exercise and build up your pelvic floor muscles,”Dr. Goldfarb says. “Your core is the key to performance in all sports. My patients have seen a significant increase in their quality of life and are able to return to activities and exercising.”

Sex Life. “There’s a growing body of evidence that Emsella can improve a patient’s sex life,” says Carolyn Delucia, MD, an obstetrician-gynecologist and medical director at The Secret Orchid in New York City. “The Emsella improves blood flow and muscle contraction, which is involved in orgasm and heightened sexual pleasure,” she says. “This is the icing on the cake.”

Alternative to Mommy Makeover. Core to Floor can also be thought of and marketed as a noninvasive mommy makeover, Dr. Goldfarb says. This is because the Emsculpt devices can be used as a complement to the Emsella treatment to help treat diastasis rectus, or abdominal separation. Diastasis rectus is a common condition after childbirth, and it can lead to lower back pain, constipation, and urine leakage.

Compare this to the surgical mommy makeovers, which confer greater risk and significantly more downtime, not to mention added expense for the same benefits, Dr. Goldfarb says.

Core to Floor Protocol

The Core to Floor protocol is flexible based on patient preferences and schedule as well as whether it involves Emsculpt or the newer Emsculpt Neo.

Emsculpt and/or Emsculpt Neo is a 30-minute treatment, while Emsella takes 28 minutes, making the total treatment time just around one hour. The protocol includes two Emsella treatments given once a week for three weeks and one Emsculpt Neo treatment a week for four weeks. Emsculpt can be performed twice weekly if preferred, while Emsculpt Neo is just recommended once weekly due to the added RF energy.

“You can have both the same day, but not at the same time,” says Dr. Delucia. Quarterly maintenance treatments may be recommended to sustain results. “Results can also be maintained and improved upon with regular exercise,” she adds.

There isn’t much of a learning curve for providers either, says David E. Kent, MD, the founding partner of Skin Care Physicians of Georgia in Macon, GA. “Emsella is basically very easy to set up. We try to get the patients up to 100 percent,” he says. “We never tell the patients what percentage of the energy they are at. We just say we will increase it gradually to manage their expectations.”

With Emsculpt NEO, the intensity is also increased gradually, and most patients do reach 100 percent, Katz says.

Core to Floor: What to Expect

With the Emsculpt or Emsculpt Neo devices, patients will experience a series of different pulses, explains Yael Halaas, MD, a facial plastic surgeon in New York City. “There are the ‘short’ contractions, ‘long-hold’ contractions, and then there are the quick ‘twitching’ contractions.”

These are cyclical during the 30-minute treatment, Dr. Halaas says.

With Emsella, there is a series of varying pulses that are cyclical throughout the 28 minutes. “At the beginning of each Emsella treatment, the provider helps guide the patient with positioning on the Emsella chair so they find their center,” she says. “When the start button is engaged, patients will feel a pulsating muscle contracting energy through the base/center of the chair.”

Adds Dr. Delucia, “Every single muscle fiber contracts with these treatments.” As a result, muscle fiber size increases as do the number of muscle fibers. “This has never been seen before.”

Dr. Halaas agrees. “Using HIFEM technology, we have the ability to engage 100 percent of muscle movement whereas in the natural state when an individual is working out, they’re only capable of engaging 40-50 percent organically.”

Core to Floor: Patient Selection

Core to Floor basically sells itself, says Dr. Kent.

“We are approaching patients who are older and aren’t looking to put on a thong bikini or go to Muscle Beach, but they do want stronger core muscles because they have had back problems and/or are experiencing urinary incontinence,” Dr. Kent says.

“There is a much broader pool of patients, both young and old, who think about Core to Floor for wellness,” he says.

Results are noticed very quickly, Dr. Kent adds. “Emsculpt and Emsculpt Neo produce very rapid results, and Emsella patients will start to see improvements in urinary incontinence within two to three treatments.”

Taut & Toned

BTL’s Taut & Toned targets fat, skin, and muscle. It involves Emsculpt or Emsculpt Neo and Emtone—all popular offerings within the BTL Aesthetics suite of devices. It can treat cellulite, reduce fat, and boost muscle tone in the abdomen, buttocks, and thighs.

Estimates suggest that 90 percent of women and 10 percent of men will develop cellulite, and this has nothing to do with weight or age. Instead, a combination of hormonal, genetic, and lifestyle factors likely play a causative role. There is little that these individuals would not do or try to get rid of cellulite, but until recently most of what was out there was just snake oil.

BTL’s Emtone combines targeted pressure energy (TPE) with RF energy to boost microcirculation in underlying tissue and improve surface skin quality through heat and mechanical manipulation. The heat stimulates fibroblasts to produce more collagen, while the TPE breaks up the fibrous bands. This packs a one-two punch against the causes of cellulite.

When Emsculpt or Emsculpt Neo is added, the combination reduces more fat and builds muscle underneath for an even smoother result, says Dr. Goldfarb.

“We want to address fat, skin, and muscles to give a taut and toned look,” says New York City dermatologist Paul Jarrod Frank, MD, founder of PFRANKMD. “You really get a synergistic effect on all three layers of tissue with Taut & Toned.”

In general, treatment starts with Emsculpt or Emsculpt Neo and then the Emtone once weekly for four weeks or twice a week for two weeks, says Diane Duncan, MD, a plastic surgeon in Fort Collins, Texas. The treatment lasts an hour total, with each treatment taking 30 minutes. “We use the devices sequentially to optimize the synergy,” she explains.

Until this combination, most of the solutions to abdominal lipodystrophy and/or diastasis recti were surgical, whether an abdominoplasty or RF-assisted liposuction, she says.

“With RF-assisted liposuction, we could get some skin tightening and an improvement in diastasis recti, but it’s still surgery, and not everyone wants or can tolerate surgery and its requisite downtime,” she says.

“The Taut & Toned combination treatment improves diastasis recti, builds core strength, decreases abdominal fat, and produces dramatic improvements in skin laxity and quality that can’t be achieved with other procedures,” she says.

In a study of 17 patients who underwent two Taut & Toned treatment sessions, abdominal circumference decreased by four centimeters among those who treated this area. Participants who underwent treatment on their buttocks had a one-centimeter increase in circumference. Moreover, all patients rated the therapy as comfortable and all agreed or strongly agreed that there was an improvement. There were no complications or adverse events seen in this study, she notes.

“The most exciting implication for myself and my colleagues is that we now have a wider spectrum of procedures for abdominal lipodystrophy, diastasis recti, stria, and stretch marks as well as buttock hyperplasia,” she says. 

With the advent of Emsculpt NEO and the development of Core to Floor and Taut & Toned, BTL is helping millions of patients become the best versions of themselves. The aesthetic and functional benefits of these procedures are helping practices grow their patient base organically.