Body
How Can I Build Muscle and Burn Fat Without Surgery or Downtime? Meet Emsculpt!
Can a treatment improve muscle definition without surgery? In this episode, Darren M. Smith, MD, a board-certified plastic surgeon in New York City, discusses original Emsculpt: an external electromagnetic treatment that stimulates muscle contractions. He emphasizes matching the treatment to a muscle-toning goal and recognizing when fat reduction or loose skin calls for a different approach.
In this episode.
Episode summary
Can a treatment improve muscle definition without surgery? In this episode, Darren M. Smith, MD, a board-certified plastic surgeon in New York City, discusses original Emsculpt: an external electromagnetic treatment that stimulates muscle contractions. He emphasizes matching the treatment to a muscle-toning goal and recognizing when fat reduction or loose skin calls for a different approach.
Originally published July 29, 2020. This recording concerns original Emsculpt, not Emsculpt NEO. Device features, treatment schedules, prices and practice preferences should be confirmed for the specific treatment offered today.
Key takeaways
⚙️ Electromagnetic stimulation
External applicators deliver high-intensity focused electromagnetic energy to stimulate muscle contractions.
🎯 Muscle tone goals
Dr. Smith describes muscle tone and definition as the central goal. He cautions that someone primarily seeking substantial fat reduction may need a different option.
📍 Treatment areas
He distinguishes abdominal treatment goals from buttock treatment protocols and discusses why the amount of overlying fat affects visible definition.
🗓️ Timing and maintenance
Results develop over time and require maintenance. The episode does not present treatment as a permanent substitute for physical activity.
🔎 Tissue assessment
Loose skin, muscle definition and fat volume are separate concerns; an individualized assessment helps determine which needs attention.
Questions this episode answers
Is Emsculpt mainly a fat-removal treatment?
Dr. Smith frames the original device primarily as a way to address muscle tone. He discusses fat changes, but specifically cautions against choosing it when reducing a substantial amount of fat is the main goal.
Are results permanent?
The recording explains that muscle-related effects can diminish without ongoing maintenance. The frequency of any further treatment depends on the person, device and treatment plan.
Does it tighten loose skin?
Dr. Smith does not consider original Emsculpt a skin-tightening treatment. He explains that increased underlying muscle volume can sometimes change how mild laxity looks, which is different from treating excess skin itself.
ℹ️ Current context and related information
The FDA's body-contouring overview explains that magnetic-field treatments can cause soreness or cramps and require screening for contraindications. Noninvasive body contouring is not weight-loss treatment.
Read about the practice's current Emsculpt NEO information, liposuction, and BodyTite, or schedule a consultation.
Educational information, not individualized medical advice. Suitability and results vary. Show notes updated September 30, 2026.
Original show notes
Board certified NYC plastic surgeon and body contouring expert Dr. Darren Smith discusses all the details of Emsculpt, one of today's most sought after treatments. From determining if you're a good candidate to getting a sense of pricing, it's all here.
Read the conversation.
[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. What is Emsculpt? Emsculpt is a non-invasive treatment that builds muscle and burns fat. It's painless, and it has no downtime. When you have an Emsculpt treatment, you are positioned comfortably on a table like a massage bed or something equivalent to that. And your provider straps the Emsculpt applicators, which look like big paddles to the area that is going to be treated, then sets the strength of the treatment and you're off and going.
[01:05] So how does strapping a paddle to the outside of your body build muscle and burn fat? Well, what those paddles are doing is they're actually providing magnetic energy or to be specific hyphen, H-I-F-E-M, which stands for high intensity focused electromagnetic energy to the muscle group that you're focusing on during your treatment. And by providing this hyphen to the muscle group Emsculpt is able to trigger what is called a supermaximal muscle contraction. And these are muscle contractions that are more powerful than anything that you would be able to produce on your own during a workout. Your body responds to this powerful stimulus by actually increasing the size of existing muscle fibers and building new muscle fibers.
[02:00] At the same time, because this process is such an intense draw on local energy supplies, your body actually breaks down local fat cells near the treatment area. So the end result is that muscle strength and tone increases and the amount of fat covering the muscle in the area decreases, which is a win-win situation in most cases. There is one notable exception to this, which we'll cover a little bit later in the episode. You've heard me say in the past that I'm a very data-driven person. I like to have the latest and greatest technology in my practice, but I only bring things into the practice once they have been extensively tested and studied, not only to ensure that they're safe, but also to make sure that they actually work, that you're going to get the great results that are promised. And this is...
[02:56] really where Emsculpt stands out in the world of non-invasive body contouring treatments. Emsculpt takes its origins from a collaboration with NASA. So why was NASA interested in non-invasive body contouring? Well, the truth is they weren't, but what they were interested in is solving another problem that they had, which is that when people, or specifically astronauts, are in low gravity or zero gravity situations for long periods of time, they experience muscle atrophy or weakness, a lack of muscle definition. So NASA collaborated with BTL, the company that now makes Emsculpt, to develop devices to essentially provide physical therapy and muscle strengthening for astronauts if they found themselves in situations where they did have a degree of muscle atrophy. So the scientists at BTL recognized the potential of the technology that they were developing for NASA and thought of other applications. And one of the major applications for this HIFEM technology was the aesthetic industry. So that technology was further honed and evolved into the modern treatment that we know today as Emsculpt. And this technology has undergone extensive testing, it's FDA cleared, and there's a great deal of scientific literature documenting the results of this treatment. Aside from scientific validation, the public has received Emsculpt extremely well.
[04:45] in its own right with the average patient satisfaction after an Emsculpt treatment being at 96%. Emsculpt though is not right for everyone and a key to achieving excellent results with Emsculpt and making sure that people are happy with this treatment is patient selection. So that's something that we're going to get into a little bit later in the episode as well. So what kind of Emsculpt before and after results can you expect to see? Well, as we mentioned, Emsculpt is going to tighten and tone the muscles in the treatment area. The most popular areas for treatment with Emsculpt are the abdomen and the buttocks. And we've seen also great results and great applications for this device with the arms for the biceps and triceps.
[05:34] as well as for the calves. So we can really see great definition in a lot of different body areas with Emsculpt. So at the same time as Emsculpt is tightening and toning the muscles in the treatment area and achieving better muscle definition, it is also decreasing the amount of fat covering that muscle. You can have the best muscle definition in the world, but if there's too much fatty tissue covering the muscle, nobody's going to be able to see it. So Emsculpt helps from that perspective as well. I did mention before that there is an exception to the general rule that Emsculpt will build muscle and burn fat, and that is for the buttocks. And a lot of people that come in for Emsculpt are looking for a non-invasive butt lift, a way to build, sculpt, and lift the buttocks without having surgery, without undergoing something like a Brazilian butt lift or fat grafting to the buttocks. So it wouldn't be very helpful if at the same time that Emsculpt built the glutes to lift and shape the buttock, it decreased the amount of fat on the buttocks because fat is very important in defining the shape of the buttock.
[06:52] So there are several different Emsculpt treatment protocols that we might use and the one that we use to build the buttocks and do this non-invasive butt lift is designed not to break down fat. So since Emsculpt really is rooted in science and it comes out of that collaboration between BTL and NASA, it may not surprise you to hear that Emsculpt has some great applications and results outside of body contouring. Because Emsculpt improves muscle definition and builds strength, we've actually had a lot of patients and heard from a lot of patients that see improvements in back pain after undergoing Emsculpt treatments. And we think that's because as your core is better able to support itself, A lot of the pathology and anatomical issues that might be causing back pain could actually be alleviated. Emsculpt can also come in very handy after pregnancy, after childbirth. And that's because, and we discussed this in detail in earlier episodes, after pregnancy, the abdominal tissue, specifically the abdominal muscles, the rectus abdominis muscles, are often separated from one another in the midline to make room for the expanding uterus. And after the baby is delivered, you can be left with a space between the rectus diastasis muscles, a weakening in the muscle wall called a rectus diastasis.
[08:33] Emsculpt has actually been shown to decrease the size of the rectus diastasis. So in addition to having an aesthetic benefit to decreasing the rectus diastasis, this can also contribute to improved core strength after pregnancy. So who's a good candidate for Emsculpt? And this is a really important question because Emsculpt is not for everyone and if someone who isn't a good candidate has an Emsculpt treatment, they may not see results. So to see really nice Emsculpt results, we are looking to treat individuals who are at their ideal body weight or close to their ideal body weight and are primarily interested in increasing their muscle tone and definition. Because while Emsculpt will...
[09:24] get rid of a certain amount of fat in the treatment area, its primary purpose is to build muscle. So the fat reduction aspect of Emsculpt should be viewed as a happy accident in the process of building more muscle. So if you're looking primarily to decrease the amount of fat you have in a body area, Emsculpt is not the right treatment for you. If, on the other hand, you're looking to build muscle mass and muscle tone then Emsculpt could be perfect. So for individuals that are looking to improve their muscle tone but may have a little bit of extra fat overlying those muscles that goes beyond the capacity of what Emsculpt can treat, we often end up pairing Emsculpt with liposuction to achieve really stunning results. And this leads us to the next point of Where should you be going to get your Emsculpt treatment? Who should be doing these treatments? Now, because Emsculpt is so safe and the treatment itself is so easy to perform, you can find Emsculpt in all kinds of different doctor's offices, and even sometimes not in doctor's offices, like in spas or at other facilities. And while this may seem appealing, because yeah, pretty much anybody can strap an Emsculpt paddle to someone, turn the machine on, and perform a treatment. This doesn't mean that a great result is going to be achieved. So we recommend that you go to body contouring experts, real board certified plastic surgeons, to have Emsculpt treatments. Because even though this isn't surgery, in fact it's a totally non-invasive treatment, you should really have someone who is expert in the art and science of body contouring and the underlying anatomy involved in this process to design the ideal treatment for you, and also so that they can be in a position to say, well, maybe Emsculpt isn't the right thing for you, but here are some other options that we can offer.
[11:36] So the old saying, when all you have is a hammer, everything looks like a nail comes into play here. So if you're going to providers that don't have other instruments for body contouring at their disposal, such as liposuction, or even excisional surgical procedures, it may be more likely for you to find yourself in a scenario where they'll say, okay, well, We have Emsculpt, so let's give it a shot. And this also gets into the question of how much does Emsculpt cost? How much does an Emsculpt treatment? And in general, while you will find some geographic variability, you can usually expect to pay approximately $3,000 for the full Emsculpt treatment regimen. And that treatment regimen to achieve the best possible results consists of four rounds of Emsculpt performed over a two-week period. And like with so many other things, you often get what you pay for, and the less expensive Emsculpt treatments may not include a consultation with a body contouring expert to ensure that you're a good candidate for the procedure and to design a treatment plan that will bring you results that you're going to be happy with. And while going to an under-qualified EMSCULP provider may be less expensive on the front end, it certainly becomes more expensive if you don't get the results that you're looking for and then just have to have other treatments to achieve what you were going for in the first place. The results of Emsculpt are generally not immediate, while although a lot of people report feeling an improvement in their muscle tone and feel better during their workouts, sometimes right after an Emsculpt procedure, it really does take about four to six weeks to see the final treatment results. And that's because just like when you're working out and building muscle, it does take time for muscle to respond to that stimulation and build itself up. And this leads us to another very popular question about Emsculpt, which is, are Emsculpt results permanent? And the answer is no. Again, just like with working out, if you aren't maintaining the results, they will eventually fade.
[14:10] And you can maintain your Emsculpt results by keeping up with an active diet and exercise routine. And some folks like to have a touch-up Emsculpt treatment every six to 12 months. And those touch-up treatments don't generally consist of the four rounds of Emsculpt treatments, but just one round of Emsculpt every six to 12 months. Some people find helpful in maintaining their results. We're also sometimes asked if Emsculpt will tighten skin. And the short answer is no, but the longer answer is that in some instances, by building muscle mass underneath areas that have very mild skin laxity, that mild skin laxity, may appear to improve a little bit because by bulking up the muscle, you're taking up some of the slack from that skin. But in general, Emsculpt should not be looked at as a treatment that tightens skin. And again, this really points to the importance of going to a true body contouring expert to have your Emsculpt treatment because someone like this can start to offer combined procedures that will really get you excellent results. So for example, something that we really love to offer is a combination of Emsculpt to build muscle mass, if necessary liposuction to get rid of some of the extra overlying fat and also radiofrequency skin tightening with the body type device to essentially shrink wrap the skin to this kind of new and improved underlying tissue structure. I also wanted to bring up another great combination treatment with Emsculpt and that is the combination of Emsculpt with another treatment called M-cella.
[15:55] And Emcela is another device by BTL that uses the same Hi-Fem technology, but it is designed specifically to treat the pelvic floor. And while it's actually FDA cleared to treat stress incontinence in both men and women, Emcela we have found to provide some really nice other benefits as well by building and strengthening the pelvic floor musculature in terms of sexual satisfaction and also improving core strength because the abdominal musculature and the pelvic floor musculature really functions in concert to provide that core strength. So this has kind of led to the term core to floor treatment. We're looking at Emsculpt to treat the core directly by focusing on the abdominal musculature and M-cella to focus on the pelvic floor musculature. And this core-to-floor training idea is particularly relevant now since this episode is being recorded during the COVID-19 pandemic. And so something else we're seeing a lot with Emsculpt and M-cella is that People are opting to come to us for essentially what is a medical gym to get in their workout in a clean, safe, private, medical grade environment instead of going to crowded gyms or classes to do their conditioning. So while Emsculpt has always been a really great treatment, a lot of people are finding it especially helpful right now.
[17:36] Thanks for listening, and don't forget to subscribe, share the show, and head over to DarrenSmithMD.com for more real-world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-07-29. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS