MRI Assessment of Arm and Calf Muscle Toning With High-Intensity Focused Electromagnetic Technology: Case Study

May 2020 | Volume 19 | Issue 5 | Case Reports | 556 | Copyright © May 2020

Published online April 17, 2020

Bruce Katz

Juva Skin and Laser Center, New York, NY

Arms and calves have long been a subject of interest in aesthetic medicine. Current surgical and non-invasive procedures focus on sagging skin and fat deposits without targeting the muscles. The aim of this study is to investigate the feasibility of high-intensity focused electromagnetic (HIFEM) technology for arm and calf toning through simultaneous fat reduction and muscle strengthening. In this case study, two subjects received four 20-minute HIFEM treatments of biceps, triceps, and calves, with the outcomes assessed by MRI. The analysis of MRI images showed an average increase in all three muscle groups, biceps muscle mass 17.1%, triceps muscle mass 10.2%, and gastrocnemius muscle mass increased by 14.6%. In addition, the arm fat thickness was decreased by 12.8% on average and the calf fat thickness decreased by 9.9%. The results suggest that HIFEM technology is a feasible modality for both arm and calf toning. However, it will be necessary to continue to validate this outcome in a larger sample size study.

J Drugs Dermatol. 2020;19(5): doi:10.36849/JDD.2020.4546


In terms of our daily lives, arms and legs play an important functional role. Interestingly, they also play a significant role in our perception of beauty. Many surgeons and physicians have thus been looking for ways of correcting or altering the forms and volumes of calves and upper arms.1–3

In fact, the popularity of arm lifting (brachioplasty) has grown rapidly in previous years, with a 2017 top 5 ranking for the fastest growing surgical procedures with more than 18,000 performed procedures in a single year.4 Similarly, for calves, the most popular procedure is surgery, specifically the insertion of calf implants or autologous tissue transfer.5 Although the surgical procedure shows effective results, they are inextricably linked with downtime, pain, scarring, and risk of complications. Furthermore, the arm procedures only deal with sagging skin and excess fat, while neglecting the role of underlying muscles in the resulting overall appearance. Currently, there are only moderately effective non-invasive arm lifting alternatives such as cryolipolysis6,7 or radiofrequency8,9 devices, which focus on skin tightening and reducing arm fat while the muscles remain untouched. However, to maximize the treatment outcome and results it is necessary to take into account both muscle and fat. An innovative tool for this purpose appears to be a high-intensity focused electromagnetic (HIFEM) technology, which has already been successfully used for the simultaneous abdominal muscle strengthening and reduction of abdominal fat.10,11 Applicability of such an effect on arms would bring new treatment possibilities for both physicians and patients. Due to its effect on muscle, HIFEM could also be beneficial for the treatment of calves through toning the calf muscle and increasing its volume.

The goal of this case study is to investigate the efficacy of HIFEM technology for toning of arms and calves as an alternative tool to the current surgical as well as noninvasive procedures.


One male (26 years) and one female (47 years) patients were recruited into the study. Both patients underwent the treatment of both calves and arms with a device utilizing HIFEM technology (EMSCULPT, BTL Industries Inc., Boston MA).

The treatment protocol consisted of 4 sessions scheduled twice a week for a two-week period. During each session, the patients received a 20-minute bilateral treatment for each muscle group, biceps/triceps, and calves. The calves and triceps treatments were administered in a prone position while the biceps treatment was applied in a supine position. The applicators were placed just under the treated muscle structure and the exact position was adjusted individually for the best muscle response. The applicators were always secured by a fixation belt.

To evaluate the treatment outcomes, the patients underwent MRI screening at baseline and 1 month after the last treatment. The scanned area for calves was defined by the knee and ankle and the scanned area for arms was defined by the shoulder and