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Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
156
Address for correspondence
Dr. Sajad Ahmad Salati
Associate Professor, Department of Surgery
Unaizah College of Medicine and Medical
Sciences, Qassim University, Saudi Arabia.
Email: docsajad@yahoo.co.in
Review Article
Non-invasive body contouring: A review
Introduction
Obesity has attained pandemic proportions over
the last few decades owing to a massive change
in lifestyle with increasing reliance upon the
widely available calorie-dense fast food and
reduction in physical activity. And with obesity,
has come the expanding evidence about the
detrimental effects of obesity and the desired to
appear youthful, smart and healthy. This desire
to attain a flawless-appearing body has got
heightened by wide publicity of the images of
idealized bodies and models in the media. The
popularity of social networking services (like
Instagram, Snapchat, TikTok and Facebook) and
a global trend to click, upload and share selfies/
videos has only enhanced the desire to look
good. It is in this context, the concept of body
contouring has been evolving to optimize the
definition, aesthetics, smoothness, and shape of
the human body.1
Body contouring may be achieved by invasive
surgical operations or else by adopting non-
invasive tools. The results with surgical methods
are dramatic and immediate but there is an
increasing demand for non-invasive options as
they are not associated with the risks and
adverse effects that are otherwise always
possible with the surgical options.2
There are currently five approved modalities
used for non-invasive body contouring as shown
in Figure 1, but none of the procedures has yet
been accepted as the gold standard or deemed as
the most effective one.3
In this article, a brief overview of these
modalities is presented in light of the recent
literature.
Methods
The articles in the English language, dealing
with non-invasive body contouring were
reviewed in PubMed, ResearchGate, EMBASE,
CINAHL, Google Scholar and Web of Science
after search on the keywords: Body contouring,
Non-invasive. Additional cross-references from
the source bibliographies were used to further
Sajad Ahmad Salati
Department of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University,
Saudi Arabia.
Abstract
Non-invasive body contouring modalities optimize the cosmesis of the human body safely and
effectively and represent a fast-expanding domain of cosmetic dermatology. There are currently
five approved modalities including cryolipolysis, radiofrequency, high-intensity focused
ultrasound, laser therapy and high-intensity focused electromagnetic field. This article provides a
brief overview of these modalities in the light of the recent literature.
Key words
Obesity; Body contouring; Lipolysis; Laser; Radiofrequency; High frequency focused ultrasound;
High-intensity focused electromagnetic field.
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
157
Figure 1 Current modalities of non-invasive body
contouring.
supplement this review. Time limits were set
from January 2008 to August 2021.
1. Cryolipolysis
Cryolipolysis (synonym: CoolSculpting) is
conducted by a device that is based upon the
principle that adipocytes due to the higher
content of lipids are more liable to freezing and
damage than the cells from other adjoining
tissues that have abundance of water content
(Figure 2). Accordingly, lobular panniculitis is
induced by freezing followed by selective
apoptosis of the damaged adipocytes while the
rest of the normal structures stay preserved. The
apoptotic adipocytes end up getting digested by
macrophages and that translates clinically into
reduction of subcutaneous adipose tissue volume
over the subsequent 2 to 3 months.4
Manstein et al.5 in 2008 conducted extensive
experiments upon the black Yucatan pigs
wherein the selected test sites were given
exposure to pre-set temperatures ranging from
20oC to -7oC. This was followed by
histopathological studies on the same day and
then at intervals up to 4 weeks for four pigs, and
14 weeks in one pig. Furthermore, in six pigs,
the test sites that covered 15% of the total body
surface area were exposed to temperature
between −5°C and −8°C for 10 minutes. The
study led to a conclusion with controlled
Figure 2 Cryolipolysis device over anterior abdomen
(Image courtesy: Ryan Towart, RT Aesthetics).
exposure to low temperature, subcutaneous fat
loss can be achieved without inflicting any
appreciable damage to the overlying.
Zelickson et al.6 also conducted a similar type of
experiments on three Yucatan pigs and
evaluated the test sites using photography,
ultrasound, and histopathology. They also
reached a similar conclusion that cryolipolysis
significantly decreases the subcutaneous fat and
modifies the contour of the body contour
without changes in serum lipids or the overlying
skin.
Coleman et al.7 in 2009 studied the impact of
cryolipolysis on function of sensory nerves.
They devised a cooling device and subject test
areas in ten subjects to cryolipolysis. Ultrasound
assessed the changes in subcutaneous fat volume
whereas neurologic evaluation (n=9), and
biopsies (n=1) assessed the sensory nerves. The
study concluded that cryolipolysis causes a in
substantial reduction in subcutaneous fat.
Furthermore, the procedure leads to modest
changes in the function of peripheral sensory
nerves that are short-term and reversable.
Biopsies also ruled out any sort of long-term
change in the structure of nerve fibers.
After successful animal-based experiments,
cryolipolysis has been gradually introduced into
clinical practice and has been gaining public
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
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acceptance. The Food and Drug Administration
(FDA) of the United States, awarded approval
for its application for fat reduction over the
flanks in 2010 and subsequently, over the
previous decade, other areas of the body have
been brought under the permission that includes
the abdominal wall, thighs, arms, submental
area, back, and the gluteal region.4 The device
creates a vacuum over the area to be treated and
holds the tissue between the two cooling panels
for about 30 to 60 minutes.
In a recent study published in 2020,8 a split-body
trial was conducted by Hwang et al., to explore
if a single session of cryolipolysis could induce
changes in the visceral and subcutaneous fat.
They enrolled 15 subjects and applied
cryolipolysis once but only to the left half of the
abdomen while keeping the right half of
abdomen untreated to serve as a control. The
cross-sectional areas of the abdominal fat were
calculated by computed tomography (CT scan)
before and at 3 months post-treatment.
Similarly, the waist circumference was
measured and body fat percentage was
calculated by bioelectrical impedance analysis
before the treatment and then at 6 weeks and 3
months follow-up. From this study, it was found
that a single session of cryolipolysis led to
reduction in the waist circumferences by 10%,
and the percent body fat, by 0.6%. Decrease on
the side that received cryolipolysis was 15.6%
and that of the control half was only 3.6%. The
levels of visceral fat tissue also decreased in a
significant manner. Thus, a conclusion was
drawn that a single application of cryolipolysis
can safely and effectively reduce the magnitude
of subcutaneous as well as visceral fat.
Lipner9 in 2018 reviewed the literature related to
use of cryolipolysis for submental adipose tissue
reduction. A total of 101 patients from four
clinical trials and one case series were reviewed
and, it was found that significant submental fat
was attained, leaving the patients highly
satisfied. There were side-effects of mild and
self-resolving nature. Suh et al.10 also reported
satisfactory outcomes of cryolipolysis in
submental region. They applied cryolipolysis
contact device (CoolMini applicator, Zeltiq
Aesthetics) in 10 Korean origin subjects and
achieved submental fat reduction attaining
favourable facial features. The change was
objectively demonstrable with ultrasound studies
conducted at 2-months post- treatment. Kilmer
et al.11 and Bernstein et al.12 have also reported
visible neck contour improvement and
submental fat reduction.
In a recent study published in 2020, Rodopoulou
et al.13 reported the use of three dimensional ( 3-
D) cryolipolysis over the neck in 39 subjects .
Posttreatment, 95% of the cases marked the
results of fat reduction as r very improved or as
improved and only 5% were dissatisfied.
Satisfied patients also noted a skin tightening
effect that enhanced the cosmesis. No serious
adverse reactions are reported. Multiple studies
have reported a very favourable role of
cryolipolysis in the reduction of thigh region.
Boey and Wasilenchuk14 in 2014 treated inner
thigh fat with a cryolipolysis flat cup vacuum
applicator. 11 patients were enrolled and
treatment was delivered to the one thigh while
the contralateral thigh was left untreated to serve
as a control. 10 patients (91%) displayed
satisfaction at the cosmetic results at surveys
conducted after 2 months and 4 months after
treatment. The results were clearly
distinguishable in the clinical images clicked pre
and post treatment. Subsequently, the control
sides were treated on similar lines and symmetry
attained.
Stevens and Bachelor15 reported the safe
reduction in undesirable "saddlebag" bulges by
treatment of "non-pinchable" fat in the lateral
thighs. They utilized custom made conformable-
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
159
Figure 3 Mechanism of paradoxical adipose
hyperplasia.
surface applicator. Zelickson et al.16 applied a
flat cup vacuum applicator (CoolFit applicator,
CoolSculpting System) and attained significant
fat reduction over the inner thighs of 45 subjects.
Satisfaction rate was 93% and there were no
recorded side effects. Meyer et al.17 in 2018
presented the results of a modified version of
cryolipolysis termed „Contrast Cryolipolysis.
This modification relies on heating-cooling-
heating method. They recruited two volunteers
who were assessed, before and after the
intervention with tools including cirtometry,
ultrasonography, and the anthropometric
analysis. Right flank was treated with
conventional cryolipolysis, whereas the left with
contrast cryolipolysis. Satisfactory cosmetic
results were attained with both the versions;
however, the flanks treated with Contrast
Cryolipolysis showed greater loss of fat tissue,
reducing waist measurements and demonstrated
with ultrasonography. It was concluded that the
contrast cryolipolysis is superior in attaining fat
reduction than the conventional cryolipolysis.
Cryolipolysis is contraindicated in patients who
have history of cold-induced disorders like
cryoglobulinemia and cold urticaria. This
modality should also preferably be not offered if
patient has varicose veins (severe) or atopic
dermatitis.18 The adverse effects with
Cryolipolysis at any site are usually mild and
include erythema, edema, bruises, paraesthesia,
dysesthesia, skin hyperpigmentation, motor
neuropathy, and pain.4,19,20 These adverse effects
are self-limiting and resolve within a few weeks.
However, over the past several years, reports
regarding a phenomenon named paradoxical
adipose hyperplasia (PAH) post-cryolipolysis,
with a reported incidence of 0.025% to 1%, have
been increasing published though it used to be
previously identified as a "rare" adverse effect.21-
23
The pathogenesis of this PAH is still not clearly
known but certain possible mechanisms have
been hypothesised in the recent literature22-24 as
depicted in Figure 3.
Nikolis and Enright25 after an evaluation in 2114
patients, proposed that certain individuals may
be predisposed to the development of PAH due
to unknown factors. They also cautioned that the
usage of older version of tools might have some
contributory role in this complication. Keaney
and Naga26 on the basis of analysis of literature
observed despite the fact that even though a far
lesser number of men opt for cryolipolysis as
compared to women but proportionately greater
number of the cases have been reported in men,
suggesting thereby that PAH may have a
possible predilection for men and that this
predilection may have some link to the sexual
dimorphism in adipose anatomy. They, thence,
cautioned that a proper patient selection criterion
be properly applied and men with visceral
abdominal fat and firm, non-distensible, fibrous
adipose tissue be not offered cryolipolysis.
Treatment of PAH must be ideally delayed until
the affected area softens after the initial
cryolipolysis and this normally occurs in about 6
to 9 months. The preferred method of treatment
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160
Figure 4: Radiofrequency device over face (Image
courtesy: Ryan Towart, RT Aesthetics).
Figure 5 High-Intensity Focused Ultrasound (HIFU)
device over A. Submental area, B. the forehead
(Image courtesy: Ryan Towart, RT Aesthetics).
is power-assisted liposuction, but some cases
may require surgical intervention in form of
abdominoplasty.27
2. Radiofrequency
Radiofrequency (RF) is novel, safe and tolerable
non-ablative recent technology that has attained
wide popularity for non-surgical skin
rejuvenation and body contouring.28-29 In RF,
electrical energy is utilized to force collisions
between the charged molecules and ions due to
which heat energy is generated (Figure 4).
Various tissues differ in impedance due to
difference in their water content; fat tissue has
high impedance and thermal energy gets focused
there, leading to induction of cell death and
apoptosis of adipocytes in the subcutaneous
adipose tissue at exposure to temperatures of
43°C to 45°C (in first generation RF devices)
over several minutes, without any significant
risk of inflicting damage to the overlying skin
layers or underlying muscle.3 RF also denatures
the collagen fibrils, which induces
neocollagenesis, remodelling, and skin
tightening.30
First generation RF devices have either
monopolar or bipolar configuration and
comprise of one RF generator linked to one or
more skin electrodes. Bipolar version tends to
require more frequent treatment sessions as
compared to monopolar devices.4 However
recently, multisource radiofrequency (3DEEP)
devices with six independently functioning RF
generators have been successfully launched and
these efficiently heat dermis to 52-55°C.31
Bipolar and multipolar RF variants have
minimal downtime and pain as compared with
monopolar RF.
Sugawara et al.32 treated the lower face in 14
Asian women with an average age of 44.6 years,
using 1-MHz Monopolar with a stationary
applicator, weekly for five consecutive weeks,
by primarily concentrating on the nasolabial fold
and buccal area. Adipose tissue reduction and
skin tightening were assessed with three-
dimensional (3D) volumetric studies, undertaken
before each session and at 2 months post-
treatment. In 90% of patients fat reduction could
be documented and 60% were either "satisfied"
or "very satisfied" with the cosmetic effects. The
adverse effects included very mild discomfort
and a minimal transient erythema. Taub et al.33
applied 4-MHz monopolar RF in 17 patients
with facial skin laxity, and found it to be safe
and effective with no appreciable risks. Vega et
al.34 reported treated 31 female patients (median
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
161
age: 56 years) for laxity of skin over the hands
and achieved cosmetic improvement in 89%.
Shemer et al.35 in 2014 published the results of
wrinkle reduction at one‟s home using a small,
easy to operate, multisource phase-controlled RF
device (3DEEP). 69 participants self-
administered RF after having been taught the
method of operating the device. None of the
participants encountered difficulties in operating
the RF device and 98% of the patients showed
visible improvement in appearance of wrinkles.
Gold et al. 36 also reported similar improvement
in the appearance of periorbital wrinkles by self-
administered RF.
RF have demonstrated a favourable adverse
effect profile and the most common side effects
are transient redness and edema at the treatment
site that usually do not last more than 24 hours.
However, few cases of Paradoxical adipose
hyperplasia (PAH) have been reported recently.
Agochukwu-Nwubah and Mentz37 in 2019
reported PAH post- RF (Vanquish) in a 57-year-
old male treated for abdominal skin laxity. The
complication was managed by application of
power-assisted liposuction.
3. High-intensity Focused Ultrasound
High-intensity focused ultrasound (HIFU) is a
recent addition to the non-invasive body
contouring tools and it had gained popularity for
visible skin tightening and rejuvenation. HIFU
resembles RF in its mechanism of action as it
too relies on generation of heat energy which in
turn induced adipocyte apoptosis. However,
while RF is based on electric energy, HIFU
utilizes acoustic energy.38
HIFU devices have the ability to focus energy at
precisely targeted micro-coagulation zones (less
than 1 mm in size) in the deeper portion of
dermis and the subcutaneous connective tissue,
and the underlying fibromuscular layers.
Temperature greater than 65°C is reached within
1 to 3 seconds, creating cell protein thermal
coagulation points (TCPs) to a depth of up to 5
mm without inflicting any damage to the
superficially located papillary dermis or
epidermis.39-41 In addition, HIFU tends to
mechanically disrupt the cell membranes and
thereby enhances the coagulative necrosis and
apoptosis. Furthermore, microcoagulation leads
to collagen denaturation, contraction,
remodeling and de novo collagen synthesis that
translates into gradual skin tightening. HIFU has
been found suitable for correction of mild to
moderate skin laxity in young patients with
normal wound healing and body mass index
(BMI) of lesser than 30 kg/m2. However, elderly
patients with severe degrees of skin laxity or
photoaging are not the fair candidates and
should ideally be not offered this option, since
the clinical response is partly linked to collagen
neo-synthesis.41-43
The adverse effects profile is quite favourable.
Mild pain is experienced during treatment and
that gets relieved with oral nonsteroidal anti-
inflammatory drugs (NSAID). Other side effects
include erythema, edema, subcutaneous nodules,
burning sensation, mild blisters and occasional
bruising. Most of the adverse effects self-resolve
by 4 weeks post-treatment, though very
occasionally resolution may take up to 12
weeks.40,44,45 There are no reports of
derangements in serum lipid profile or liver
functions as a result of HIFU.40,46
Fatemi and Kane46 in 2010 described the results
of a detailed retrospective chart review of
patients who underwent HIFU treatment using a
mean energy level of 134.8 J/cm2 and a focal
depth of 1.1 to 1.6 cm. 85 patients of both
genders with a mean age of 43.8 years were
treated with HIFU over the anterior abdomen
and flank. Treatment was carried out in a single
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
162
session lasting approximately 1 to 1.5 hours. The
patients, at 3 months post-treatment, has shown
a decrease of 4.6 cm in waist circumference.
Self-limiting adverse effects occurred in 10% of
cases. Shek et al.47 reported statistically
significant decrease in waist circumference
measured in 12 patients of Chinese origin. 60%
of the cases had expressed satisfaction with the
results. The study also pointed towards a direct
relationship between the decrease in waist
circumference with the dose of delivered
fluence.
Fabi et al.48 in their recent study have stressed
concluded that the patient satisfaction with the
results of HIFU is directly related to diligent
patient selection and attention to patient comfort
is directly related to satisfaction. Wrong
selections and disregard for comfort lead to
dissatisfied patients and sub-optimal outcomes.
Gutowski49 on the basis of his experiences noted
that facial skin improvement can be attained in
60% to 90% of patients by 6 months post-
treatment and that the outcome depends upon the
patient characteristics and the treatment
protocols that are adopted. Baumann and
Zelikson50 assigned 64 patients into groups and
then treated the submental, submandibular,
lower neck, and platysmal areas with
microfocused ultrasound with visualization
MFU-V (a variant of HIFU) at one or two
depths. Treatment with MFU-V at two focal
depths resulted in greater aesthetic improvement
without any significant adverse effects. Hence, it
was concluded that by application of treatment
with MFU-V at two focal depths may potentially
result in improved aesthetic impact.
Jones et al.51 compared traditional HIFU with
MFU-V for skin tightening over the neck region
and found both the version to be equally
effective though MFU-V resulted in greater
discomfort levels. Kerscher et al.52 used non-
invasive biophysical measurements in 22
subjects to assess the skin physiology before
and after MFU-V treatment. The parameters
assessed included cutaneous temperature,
transepidermal water loss, skin hydration,
erythema, elasticity, skin thickness and skin
density. The level of pain was scored using a
numeric visual analog scale (VAS). It was
concluded that even a single application of
MFU-V treatment does not alter the skin
physiology and is well tolerated. Saedi and
Kaminer53 foresees increased utility of HIFU for
fat reduction over time due to safety and
pleasant cosmetic outcomes.
4. Laser therapy
Laser technology has emerged in recent years as
a non-invasive tool for body contouring. FDA
has approved a 1060-nm diode laser with a non-
suction applicator that uses hyperthermic
treatment to destroy the adipocytes selectively
and cause permanent reduction in stubborn fat.
The device is applied externally and has an
inbuilt contact cooling system that helps to
prevent damage to the skin during the procedure
54.
Decorato et al.55 conducted a three-part study to
identify the parameters required for (i) safety
and tolerability of treatment (ii) short- and long-
term tissue response, and (iii) exploration of the
possibilities of fat reduction with hyperthermic
treatment using a 1,060 nm laser. The study
showed that if 1,060 nm laser is applied while
arranging for cooling of the skin surface, the
hyperthermic temperature target of 42o C to
47°C is safely achievable in subcutaneous
adipose tissue. Post-treatment tissue responses
evaluated by biopsy included inflammatory
reactions, followed by macrophage infiltration
starting at 2 weeks followed with evacuation of
cellular debris by 6 months. Fat thickness
reduction was approximately 14%, 18%, and
18% at 2, 3, and 6 months, respectively as
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
163
assessed by clinical examination and the average
fat volume reduction demonstrated by imaging
studies (MRI) at 3 and 6 months was 24% and
21%, respectively. Photo evaluation by blinded
evaluators recorded improvement by only
around 1-month post-treatment. No serious
adverse events were encountered and few
subjects experienced self-resolving mild
tenderness. Bass and Dohenty56 also confirmed
the safety profile and utility of 1060 nm-based
laser in consistent reduction of the abdominal fat
contour.
Katz and Doherty57 evaluated the safety and
effectiveness of 1,060-nm Diode Laser for fat
reduction over the flanks by single treatment in
49 subjects. Assessment by ultrasound and high-
resolution images at baseline and 3-months post-
treatment showed a significant fat reduction.
96% of subjects were satisfied with the results.
The adverse effect was self-resolving mild to
moderate pain. Sweeney et al.58 tried by
adopting a combination of options. They treated
5 subjects with hyperthermic 1060 nm diode
laser and subsequently administered topical skin
tightening concentrate of 5% yeast extract, 2%
hydrolysed rice protein content, and 2.5%
tripeptide, supplemented with hyperthermic
diode laser lipolysis. They observed that the
mentioned combination has the potential to
achieve better aesthetic outcomes without any
undue adverse effects.
Before the introduction of the above explained
1060-nm diode laser, the low-level laser therapy
(LLLT), also termed as cold laser therapy was
quite popular as a body contouring tool.59 LLLT
does not create any thermal tissue damage, but
works by production of transient microscopic
pores in adipocytes that led the lipids to leak out
and thereby decrease the volume of fatty layer.60
LLLT session requires about 30 minutes and
results in immediate noticeable improvement.
However, as this tool neither leads to necrosis
nor apoptosis of the adipocytes, the results are
only temporary and probability of recurrence of
fatty deposition is great, rendering it to be a
modality for a set of patients who may prefer
immediate short-term cosmetic improvement
despite later diminishment. Although the lipids
are released during LLLT, there have been no
reports of increase in serum lipid levels. Adverse
effects are temporary and resolved
spontaneously and include local edema,
erythema, pain or paraesthesia, and increased
urination.59
5. High-intensity focused electromagnetic
field (HIFEM)
High-intensity focused electromagnetic field
(HIFEM) is a novel modality introduced in
recent years to reduce the fat and strengthening
the muscles.60 This tool works on the principles
of magnetic induction and relies upon the
creation of electrical currents in the tissues by
rapidly changing the magnetic fields, leading to
depolarization of nerve fibres and thereby the
contraction of muscle (Figure 6). If a muscle is
stimulated at frequencies that exceed the muscle
relaxation time, the muscle goes into tetanic
spasms that lead to adaptive changes in form of
increase in the muscle mass and decrease in
adipose tissue by apoptosis of adipocytes.61
Halaas and Bernardy62 in 2020 published the
results of biochemical investigation that they
had undertaken to understand how apoptosis
Figure 6 EMS Sculpt device over anterior abdomen
using High Intensity Focused Electro-Magnetic Field
(Image courtesy: Ryan Towart, RT Aesthetics).
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
164
gets induced by HIFEM. They worked on
porcine adipose tissue models and detected the
changes in the levels of the pro-apoptotic
markers, along with an increase in the levels of
free fatty acids, and reduction in the pH levels.
Kinney and Lozanova63 enrolled 22 patients and
administered HIFEM over abdominal region in
four sessions, using the EMSCULPT device
(BTL Industries Inc., Boston, MA). Assessment
was done at presentation and subsequently up to
6 months post-treatment with the aid of
anthropometric studies, high-resolution digital
photography and MRI. The study revealed
growth in muscle mass, reduction in fat and
reduction in abdominal separation in all the
participants.
Jacob et al.64 delivered HIFEM in 75 patients for
toning up the gluteal muscles and lifting the
buttocks over four 30-minute treatment sessions.
Aesthetic appearance of buttocks was
significantly enhanced and the procedure was
proposed as a safe modality for improving the
gluteal tone, shape, lift, and tightness.
Giesse65 evaluated the efficacy of HIFEM in
reducing fat and strengthening the muscles in the
abdominal and gluteal areas by enrolling 14
German patients. Using the Global Aesthetic
Improvement Scale, the patients were rated as
100-percent improved with no relevant side
effects. Jacob and Rank66 in 2020 presented the
results of abdominal remodeling in ten
postpartum women by HIFEM. HIFEM led to
increase in abdominal muscle thickness and
reduction in the adipose layer. The observed
results improved over the three months post-
procedure and then remained stable thereafter,
thereby indicating towards a potential role of
HIFEM in the correction of altered body shape.
An advisory board meeting of senior aesthetic
physicians was conducted in November 2020,
via a virtual mode, to discuss various aspects
related to use of HIFEM devices in the field of
aesthetic medicine.67 From the analysis of
cumulative data related to 500 cases and derived
from multiple studies from 30 investigators, it
was found that HIFEM+ results in 30%
reduction in fat, 25% increase in muscle mass,
19% reduction in abdominal layer separation
and up to 5.9 cm decrease in waist
circumference. Moreover, HIFEM+ leads to a
30% enhancement in satellite cell content, which
is the almost the same as achieved after 3
months of exercise.
HIFEM+ is a technology that combines HIFEM
and radiofrequency and the devises designed are
aimed at both build-up of muscle mass as well as
elimination of adipocytes. The advisory board
unanimously agreed on several factors related to
HIFEM, including the observation that the
pairing of HIFEM and radiofrequency in form of
HIFEM+ technology, be preferred over HIFEM
alone as it achieves a greater magnitude of
muscle stimulation and lipolysis.67
Conclusion
The demand for non-invasive body contouring is
growing globally in the affluent sections.
Various effective treatment options have been
devised over the last decade and improvised to
enhance efficacy and safety. The five leading
options, currently in use include Cryolipolysis,
Radiofrequency, High-intensity Focused
Ultrasound (HIFU), Laser, and High-intensity
focused electromagnetic field (HIFEM). Their
usage is likely to become more widespread as
the costs are contained and protocols
standardized.
Acknowledgments
The author acknowledges with thanks the help
provided by Ryan Towart, Aesthetic Practitioner
Journal of Pakistan Association of Dermatologists. 2022;32(1):156-167.
165
and Managing Director, RT Aesthetics. Front
Street, Whickham, NE16 4SN, UK. E-mail:
ryan.towart@rtaesthetics.co.uk, by granting
permission for the usage of images from them
website: https://rtaesthetics.co.uk/. The
permission was granted via email, dated 10
October 2021.
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