The largest increase in the CSA was observed for the biceps brachii muscle as the average increase was 17.1%, while for triceps brachii it was 10.2%. The CSA of the gastrocnemius muscle was increased by 14.5% on average. Detailed results for each subject can be seen in Table 1. Examples of MRI images after the segmentation are shown in Figure 2.
The arm fat thickness for the male subject was decreased by 20.6% from 4.6 ± 2.3 mm to 3.7 ± 2.0 mm. The female subject lost 5.3% of her arm fat thickness as it decreased from 10.0 ± 3.8 mm to 9.5 ± 3.8 mm. The fat thickness on the calf was decreased by 11.9% for the male subject, from 4.6 ± 1.3 mm to 4.1 ± 1.2 mm. The female subject showed a reduction of 8.0%, from 12.3 ± 2.6 mm to 11.4 ± 2.5 mm.
Patients reported mild muscle fatigue after the treatments while no adverse events were reported. Digital photographs demonstrated aesthetic improvement in the treated area. The demonstration of the improvement in the biceps muscle observed for the female subject is shown in Figure 3.
CONCLUSIONS AND RECOMMENDATIONS
The MRI images showed an increase in muscle mass and a reduction in fat thickness after four HIFEM treatments, comparable with the results reported in previous studies.10,11 Validation of observed results on a larger sample size is necessary.
The applicator placement appears to play a crucial role in the outcomes. It is interesting to note the anatomic individuality of each patient and the importance of proper applicator placement to achieve the largest muscle response, which differed subject to subject. Since HIFEM technology is based on stimulating motor neurons, the improper placement may not trigger contractions strong enough for the induction of a hypertrophic effect. It is thus important to pay special attention to the placement.
Based on the observed results, HIFEM technology appears to be feasible for arm and calf toning. Although it is necessary to collect data from a significantly larger sample size, the initial results provide a trace of what outcomes could be expected with a larger study population.
The applicator placement appears to play a crucial role in the outcomes. It is interesting to note the anatomic individuality of each patient and the importance of proper applicator placement to achieve the largest muscle response, which differed subject to subject. Since HIFEM technology is based on stimulating motor neurons, the improper placement may not trigger contractions strong enough for the induction of a hypertrophic effect. It is thus important to pay special attention to the placement.
Based on the observed results, HIFEM technology appears to be feasible for arm and calf toning. Although it is necessary to collect data from a significantly larger sample size, the initial results provide a trace of what outcomes could be expected with a larger study population.
DISCLOSURES
The author has no conflict of interest to declare.
REFERENCES
1. Andjelkov K, Sforza M, Husein R, Atanasijevic TC, Popovic VM. Safety and efficacy of subfascial calf augmentation: Plast Reconstr Surg. 2017;139(3):657e-669e. doi:10.1097/PRS.0000000000003120
2. de la Peña-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF. Calf Implants: A 25-Year Experience and an Anatomical Review. Aesthetic Plast Surg. 2012;36(2):261-270. doi:10.1007/s00266-011-9812-y
3. Niechajev I, Krag C. Calf augmentation and restoration: long-term results and the review of the reported complications. Aesthetic Plast Surg. 2017;41(5):1115-1131. doi:10.1007/s00266-017-0885-0
4. The American Society for Aesthetic Plastic Surgery. 2017 Procedural Statistics. https://www.surgery.org/sites/default/files/ASAPS-Stats2017.pdf. Accessed May 29, 2018.
5. Cuenca-Guerra R, Daza-Flores JL, Saade-Saade AJ. Calf implants. Aesthetic Plast Surg. 2009;33(4):505-513. doi:10.1007/s00266-008-9193-z
6. Rivers JK, Ulmer M, Vestvik B, Santos S. A customized approach for arm fat reduction using cryolipolysis. Lasers Surg Med. 2018;50(7):732-737. doi:10.1002/lsm.22811
7. Lee SJ, Jang HW, Kim H, Suh DH, Ryu HJ. Non-invasive cryolipolysis to reduce subcutaneous fat in the arms. J Cosmet Laser Ther. 2016;18(3):126- 129. doi:10.3109/14764172.2015.1114644
8. McKnight B, Tobin R, Kabir Y, Moy R. Improving upper arm skin laxity using a tripollar radiofrequency device. J Drugs Dermatol. 2015;14(12):1463-1466.
9. Brightman L, Weiss E, Chapas AM, et al. Improvement in arm and postpartum abdominal and flank subcutaneous fat deposits and skin laxity using a bipolar radiofrequency, infrared, vacuum and mechanical massage device. Lasers Surg Med. 2009;41(10):791-798. doi:10.1002/lsm.20872
10. Kinney BM, Lozanova P. High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: Safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Lasers Surg Med. 0(0). doi:10.1002/lsm.23024
11. Kent DE, Jacob CI. Simultaneous Changes in Abdominal Adipose and Muscle Tissues Following Treatments by High-Intensity Focused Electromagnetic (HIFEM) Technology-Based Device: Computed Tomography Evaluation. J Drugs Dermatol JDD. 2019;18(11):1098-1102.
2. de la Peña-Salcedo JA, Soto-Miranda MA, Lopez-Salguero JF. Calf Implants: A 25-Year Experience and an Anatomical Review. Aesthetic Plast Surg. 2012;36(2):261-270. doi:10.1007/s00266-011-9812-y
3. Niechajev I, Krag C. Calf augmentation and restoration: long-term results and the review of the reported complications. Aesthetic Plast Surg. 2017;41(5):1115-1131. doi:10.1007/s00266-017-0885-0
4. The American Society for Aesthetic Plastic Surgery. 2017 Procedural Statistics. https://www.surgery.org/sites/default/files/ASAPS-Stats2017.pdf. Accessed May 29, 2018.
5. Cuenca-Guerra R, Daza-Flores JL, Saade-Saade AJ. Calf implants. Aesthetic Plast Surg. 2009;33(4):505-513. doi:10.1007/s00266-008-9193-z
6. Rivers JK, Ulmer M, Vestvik B, Santos S. A customized approach for arm fat reduction using cryolipolysis. Lasers Surg Med. 2018;50(7):732-737. doi:10.1002/lsm.22811
7. Lee SJ, Jang HW, Kim H, Suh DH, Ryu HJ. Non-invasive cryolipolysis to reduce subcutaneous fat in the arms. J Cosmet Laser Ther. 2016;18(3):126- 129. doi:10.3109/14764172.2015.1114644
8. McKnight B, Tobin R, Kabir Y, Moy R. Improving upper arm skin laxity using a tripollar radiofrequency device. J Drugs Dermatol. 2015;14(12):1463-1466.
9. Brightman L, Weiss E, Chapas AM, et al. Improvement in arm and postpartum abdominal and flank subcutaneous fat deposits and skin laxity using a bipolar radiofrequency, infrared, vacuum and mechanical massage device. Lasers Surg Med. 2009;41(10):791-798. doi:10.1002/lsm.20872
10. Kinney BM, Lozanova P. High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: Safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Lasers Surg Med. 0(0). doi:10.1002/lsm.23024
11. Kent DE, Jacob CI. Simultaneous Changes in Abdominal Adipose and Muscle Tissues Following Treatments by High-Intensity Focused Electromagnetic (HIFEM) Technology-Based Device: Computed Tomography Evaluation. J Drugs Dermatol JDD. 2019;18(11):1098-1102.
AUTHOR CORRESPONDENCE
Bruce Katz MD mdkatzbe@gmail.com
