Protocols for Muscle Toning Technologies

This is part 2 of a 2-part series.

Part 1: Body Toning Technologies

Dermatologist Dan Belkin, M.D., who practices in New York City and South Hampton, N.Y., uses Cooltone. He says the technology is attractive to patients, offering more defined abs and rounder buttocks without the work, by stimulating “supramaximal” contractions that one cannot (and need not) muster on one’s own.

At his practice, Cooltone is an adjunct to other body contouring techniques like noninvasive fat reduction, such as Coolsculpting (Allergan); biostimulatory fillers, like Sculptra (Galderma) and Radiesse (Merz); and subcision, or Cellfina (Merz).

“Cooltone is FDA-cleared for buttocks, thighs and abdomen. It is at a lower price point than Emsculpt, which is important given any muscle stimulation device is going to require maintenance. It also delivers 50% more magnetic intensity than Emsculpt at both of their maximal operating strengths, which is typically how they are applied,” Dr. Belkin says. “It has not yet been established, however, whether this makes a difference in outcome.”

Cooltone has fewer cleared treatment areas than the other devices, and, as with the entire class of these devices, an optimal protocol for maintenance has not been established, he says.

“Any muscle stimulation device will need some sort of maintenance protocol that is yet to be well defined. It seems effects from this technology last at least a month, but patients may require a treatment every few months for them to persist,” according to Dr. Belkin.

Dr. Belkin practices at the Laser & Skin Surgery Center of New York, which was one of the research facilities that tested Cooltone.

Comparing energy output

Boca Raton, Fla., dermatologist Jeffrey Fromowitz, M.D., points out a few differences among these three primary players in noninvasive muscle stimulation.

Emsculpt, he says, uses electromagnetic muscle stimulation to target a general area of muscle stimulation. It produces an energy of 0.9 tesla at 100%. Cooltone is similar in that it too uses magnetic field to stimulate muscle contraction.

“The difference here is the strength of the magnet at 1.35 Tesla. The significance of this clinically is still yet to be determined as more studies are completed using the device,” he says.

truSculpt flex uses direct and even delivery of electrical current to stimulate muscle contraction.

“The energy delivered at the skin is 10 to 30mA. This is similar to the energy created by 0.9 Tesla of the Emsculpt which is also around 30mA,” he says. “A unique feature of the truSculpt flex is the number of applicators included in the device and the ability to treat around 1000 cm2 of body area. For comparison the Emsculpt treats around 364cm2 area during one session.”

Dr. Fromowitz reports no conflicts of interest and does not own the devices.

Benefits Beyond Aesthetics

Cosmetic Physician Tahl Humes, D.O., who practices in Denver, Colo., describes the market for these devices as broad and going beyond purely cosmetic indications.

“Of course, these devices are popular in aesthetic practices, but can also be used in a practice doing medical weight management or rehab,” she says. “In a medical weight management practice, a device like truSculpt flex can be used alongside a fat reduction technology like truSculpt iD to take body shaping results to the next level. This way, patients get full body sculpting instead of just fat loss. The technologies can also be useful for rehabbing sports injuries to build strength in a recovering area or for elderly patients who want to strengthen muscles.”

There are differences in the devices that providers might consider, according to Dr. Humes.

Emsculpt and Cooltone cover the whole treatment area and providers hope to capture the muscle in order to stimulate it, she says.

“Kind of like throwing a blanket over a field,” Dr. Humes says. “With truSculpt flex, we are placing each handpiece applicator directly on the muscle for direct stimulation. truSculpt flex is a direct stimulation where the others are indirect stimulation of the muscle.”

Emsculpt and Cooltone treat only one muscle area at a time, for example the abs or glutes. truSculpt flex allows providers to treat two areas at a time.

“You can treat two areas with truSculpt flex in 45 minutes, whereas you would need 30 minutes for each treatment area for an Emsculpt treatment,” she says.

Dr. Humes recommends that doctors who are considering investing in one of these devices do the following:

• Speak with other doctors who have the technology and see not only how they like it, but how their patients and staff like the treatment.
• Look at befores and afters from peers and other doctors, not just company studies.
• Ask their peers questions, such as: What kind of results are you seeing? What has your patient feedback been like? How does your staff like performing the treatment?
• Do research and look at the studies that are out there.

“Compare them and make the ultimate decision on your own,” Dr. Humes says.

Dr. Humes reports no conflicts of interest.