Three-Pronged Body Shaping Strategy Also Attacks Cellulite

Sponsored by BTL Aesthetics

“Taut and Toned” is a procedure harnessing non-invasive modalities that, together, hit the golden triangle of body contouring: fat, skin and muscle. Using Emsculpt or Emsculpt Neo with Emtone, all offerings from BTL Aesthetics (Boston, Mass.), practitioners can take a powerful approach that is not just multimodal but multi-vector, for each indication. The result is amazing outcomes that startle physicians and patients alike as a stand-alone therapy, or in conjunction with other body shaping procedures, including surgery. Moreover, the protocol does wonders for cellulite and experts believe it is the best therapy to date for this common yet challenging-to- treat condition, without consumables.

“We do what we call ‘awake’ tummy tucks and panniculectomies, as well as laser-assisted liposuction, which provide excellent results on their own. But when we add Emsculpt Neo and Emtone, it removes more fat, smooths skin and builds muscle underneath for a better, smoother, more natural-looking result,” said plastic surgeon Richard M. Goldfarb, MD, owner of The Center for SmartLipo in Langhorne, Pa. “The muscle development is the previously missing component. In some cases, we see results that mimic high definition liposculpting because of the addition of Emsculpt Neo.”

“Once I had both Emsculpt Neo and Emtone, and saw this kind of combination possibility, I thought immediately how great it would be for moms after childbirth, who are still young and too busy for anything else,” said plastic surgeon Diane I. Duncan, MD, who practices in Fort Collins, Colo. “This protocol for muscle rebuilding, abdominal separation and skin tightening gives fabulous results.”

While Emsculpt Neo will provide improved muscle building over the original Emsculpt, the classic muscle stimulation platform does an excellent job, and users should not, in any way, feel excluded, according to Dr. Goldfarb. “We have done this protocol successfully with both Emsculpt and Emsculpt Neo. We use the Neo more now because we get additional improvement from greater muscle development and fat reduction. Still, it is the combination of the high intensity focused electromagnetic (HIFEM) energy and Emtone, whether using the original platform or the Emsculpt Neo, that gives us these great results.”

Dermatologist and cosmetic surgeon Suneel Chilukuri, MD, medical director of Refresh Dermatology in Houston, Texas, agreed. “The radiofrequency (RF) component with Emsculpt Neo is not used for skin tightening,” he began. “What I’m looking for is the reduction of fat and the way the RF improves the HIFEM result for better muscular hypertrophy and hyperplasia. The Emtone handles the skin and improves microcirculation, which itself can have benefits for any treatment where the body’s natural waste removal processes are in play.”

Although the combination of hormonal, genetic and lifestyle factors causing cellulite are not perfectly understood, the vast majority of women (90%), and 10% of men, will have cellulite, according to Dr. Chilukuri. “One doesn’t need survey results to know that nobody likes it, and everybody wants to get rid of it,” he stated. “Taut and Toned hits all factors contributing to cellulite. Its etiology has four components including fat pockets, dimples from fibrous septae, loose skin from aging and poor microcirculation. The fourth, usually untreated component is fitness, growing the muscle underneath to provide volume for better skin turgor and a natural-looking result.”

BTL’s Emtone combines targeted pressure energy (TPE) with RF to improve microcirculation in underlying tissue and surface skin quality through RF heat and mechanical manipulation. “Raising tissue temperature to between 42° C and 44° C will stimulate fibroblasts to produce more collagen,” explained Dr. Chilukuri. “TPE improves microcirculation and breaks up the fibrous bands at the same time.” These are traditional treatments for cellulite, and Emtone has been used for that indication since its inception. The biggest advantage, he added, is histologic proof showing that the combined treatment in one handpiece produces more collagen and elastin when compared to a serial treatment with the two technologies.

The muscle-building phenomenon known as Emsculpt has attracted physicians, patients and a growing body of competition due to its unequaled inducement of muscular hypertrophy and hyperplasia, and how these fantastic effects can have therapeutic quality-of-life benefits beyond the aesthetic. Its HIFEM energy can be used to non-invasively induce tens of thousands of supramaximal contractions of target musculature all over the body, including the extremities. Localized metabolic effects, which modestly reduce fat in the treatment area, are a side benefit as well.

The emergence of Emsculpt Neo, adding RF to the mix in a unique way, allows previously unseen simultaneous delivery of the two technologies with a remarkable synergistic effect. RF energy warms the muscle while causing subsurface heating to induce fat cell apoptosis; HIFEM stimulates the muscles, causing local energy deficits. Scientifically demonstrated reductions of fat, as well as improvement in muscle hypertrophy and hyperplasia, beyond what was seen with the original Emsculpt platform, were noted in clinical trials and make the platform a true game-changer. Even high-BMI patients, previously untreatable, may be viable candidates.

“Using Emsculpt and Emtone together in four treatments over two weeks, spaced at least 48 hours apart, works for any application of Taut and Toned,” Dr. Duncan stated. “We use Emsculpt first to go deep, then treat the surface with Emtone.”

The multifactorial nature of cellulite makes it difficult to treat, and nobody escapes it entirely, so a multifactorial approach is exactly what the doctor ordered. “Cellulite will always come back to a varying extent based on genetic, hormonal and lifestyle factors,” Dr. Goldfarb explained. “Treating all factors contributing to cellulite with a variety of modalities gives us the best overall effect. What is amazing about Taut and Toned is that these marked improvements persist for longer than I have seen with other cellulite treatments. And when patients do come back, they haven’t regressed to baseline, so it is easier to maintain with an additional session or two. This is the best I’ve seen for cellulite, hands down, in terms of outcomes and longevity of results.”

“This is a rare case of results often being better than expected,” said Dr. Duncan. “I had one woman who wanted a tummy tuck but opted for Taut and Toned instead, and after four sessions she looks amazing. If you can do something that non-invasively mimics a surgical result cost-effectively, with virtually no discomfort or downtime, it is the best option.”

Successful treatment will expose patients to other therapies the practice offers, further building the patient base – as long as you can deliver the results. “One unmet expectation based on a recommendation, and the patient’s faith in your practice can take a hit,” Dr. Goldfarb warned. “As a plastic surgeon, I have not been happy enough with anything non-invasive to confidently recommend it until I had this. I feel safe offering it for cellulite because not only am I confident enough in the result, but the lack of consumables means I can add a treatment if I don’t like the result to make it worth the patient’s while without adding much to the cost.”

“Single modality treatments are going to go by the wayside because there are unserved patients and unmet patient needs,” Dr. Duncan said. “BTL expands the patient base and meets those needs. I have people flying in from other places for cellulite treatment. One of my patients flew in and had previous therapies that didn’t do much. This gave her what I’d call a 98% result.”