Physics:High-Intensity Focused Electromagnetic Field
High-Intensity Focused Electromagnetic Field (HIFEM) is a non-invasive medical technology brand that is used for strengthening and re-education of muscles via interaction of the magnetic field with the tissue of the patient. In aesthetic medicine it is also used for non-invasive reduction of abdominal fat. HIFEM is the label of the technology that is used in aesthetic medicine, urology and gynecology. It uses focused electromagnetic field with intensity measured in Tesla and is based on Faraday’s principle of electromagnetic induction. Electromagnetic field passes non-invasively through the body and interacts with motor neurons which subsequently trigger supramaximal muscle contractions due to the action potential. The exposure of muscles to these contractions leads to muscle strengthening.
In aesthetic medicine, HIFEM is used as a non-invasive body contouring treatment for abdomen and buttocks. The same technology is used in urology and gynecology to treat urinary incontinence through strengthening of the pelvic floor muscles.
Mechanism of action
When applied on peripheral level the secondary electrical current depolarizes neural membranes of underlying neurons. Motor neurons are predominantly depolarized due to their large diameter in comparison to other types of neurons. Other neurons or tissues are much less responsive to the electric current, and therefore stay unaffected. Induced action potential is transmitted to neural endings innervating the muscle. Consequently, the muscle contracts independently of the brain activity. When the stimulation induces action potentials at very high rates the muscle contraction becomes supramaximal as the muscle doesn't have time to relax between two consecutive stimuli.
Unlike electrical stimulation, HIFEM penetrates deep into the tissue, and thus affects deeper motor neurons. Electrical stimulation works on the basis of the flowing electric charge between the electrodes, and as such the current remains on the surface and innervates only superficial motor neurons. Also intensity of electrical stimulation is limited due to pain and risk of burns.
Effect on muscles
Contrary to voluntary muscle contractions, the supramaximal contractions are independent of brain function. The HIFEM uses a specific range of frequencies that does not allow muscle relaxation between two consecutive stimuli. The muscle is forced to remain in contracted state for multiple seconds. When repeatedly exposed to these high load conditions the muscle tissue is stressed and is forced to adapt. Recent studies reported that on average 15% - 16% increase in abdominal muscle thickness was observed in treated patients one to two months after HIFEM treatments. The same studies also reported on average 10% - 11% reduction in abdominal separation. The increased volume of the treated muscles corresponds with previous research, concluding that intensive muscle contractions induce muscle hypertrophy and hyperplasia. This muscle strengthening effect is used in aesthetic medicine to non-invasively contour the abdomen and the gluteal region of a person, and in urology and gynecology to re-educate the pelvic floor muscles which affect urinary incontinence.
Effect on fat
Several recent studies using CT, MRI and ultrasound evaluations have reported approximately 19% reduction in subcutaneous fat layer in patients treated by HIFEM based device on their abdomen. In a histology study, Weiss et al. reported a 92% increase in the apoptotic index of adipocytes in the abdomen eight hours after applying HIFEM to pigs. The same study also reported increase in pro-apoptotic RNA markers measured by molecular biochemistry and increased concentrations of free fatty acids in post-application blood tests.
The principle of cell apoptosis induced by increased concentrations of free fatty acids has been previously observed and demonstrated in numerous research studies. Yet the exact mechanism of the effects of HIFEM on fat tissue is not well understood and requires further research. Opposed to that, no change in adipose tissue has been reported after application of HIFEM on buttocks and the pelvic floor. It was suggested that this is primarily caused by different metabolic nature of adipocytes in different human body areas, however such claim requires further investigation.
Effect on pelvic floor
In urology and gynecology, the HIFEM technology is used to treat urinary incontinence through non-invasive strengthening of the pelvic floor muscles. In treating incontinence HIFEM magnetic field is specifically designed to focus on strengthening the muscles of the pelvic floor, through specific designed magnetic pulse patterns. Many patients affected by urinary incontinence are unable to contract pelvic floor muscles selectively, and application of HIFEM can help with muscle strengthening and re-education independent of the brain function. HIFEM induces deep pelvic floor muscle stimulation and restoration of the neuromuscular control.
To regain continence, regular pelvic floor muscles exercising is recommended. Normally, 300-500 contractions of the pelvic floor muscles should be performed to begin to develop a new motor pattern, whereas 3,000-5,000 contractions are required to erase and correct poor motor pattern. HIFEM technology can induce thousands of pelvic floor muscles contractions via interaction of its magnetic field with motor neurons.
In the U.S., two HIFEM devices are FDA-cleared for use. The EMSELLA procedure is FDA-cleared for the treatment of urinary incontinence, and the EMSCULPT procedure is FDA-cleared for strengthening, firming, and toning of abdomen and buttocks.
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