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The truSculpt® flex is a ‘next generation’ electrical muscle stimulation (EMS) device that has been cleared by the FDA for strengthening, firming, and toning the abdomen, buttocks, and thighs, as well as improving posture and reducing back pain by up to 30%. It operates using three different algorithms (Prep, Tone & Sculpt), all designed to simulate a full-body workout at an increased intensity, above what is achievable through exercise alone.

A new and unique mechanism of action allows the practitioner to target specific muscle groups, changing the direction and polarity of the muscle contractions at varying intensities. This helps achieve the appropriate levels of muscle overload and confusion required to initiate muscle hypertrophy. The treatment is completely tailorable to an individual patient’s own fitness levels and goals; delivering up to 30mA of energy across 16 handpieces, allowing simultaneous treatment of up to eight separate treatment areas.

Patient selection and consultation

During a consultation, we try to understand exactly what the patient’s key body concerns are, agreeing an appropriate treatment plan while setting realistic expectations. We recommend treatment plans dependent on the patient’s existing fitness levels and goals, using the three intensity modes, which provide different frequencies to simulate varying workouts (Table 1).



We examine previous medical history to ensure no contraindication to treatment, for example, those with chronic conditions in the abdomen or electrical implants are unsuitable for this treatment.

In my opinion, truSculpt® flex is an ideal treatment for patients from a varying demographic and presents benefits over and above the most obvious aesthetic improvements to muscle mass and tone. I have a deep passion and interest in the clinical capabilities of this treatment for those patients suffering with chronic back pain, posture problems or even injury rehabilitation.

Another common patient profile would be those who are already in ‘good physical shape’; perhaps they are already frequently attending a gym, but they are looking to take their fitness goals to the ‘next level’. Male patients aged 30-45 commonly complain of stubborn abdominal adipose tissue and a lack of definition in this area, despite diet and exercise. This is exactly where this treatment delivers, providing an intensity unachievable through conventional exercise alone and helping add the definition and tone desired by many male patients.


The first step of practical treatment is to apply pads to the desired muscle groups, which act as a membrane between the skin and the handpieces. Next, we apply the handpieces along the length of the intended muscles, with a positive and negative corresponding correctly dependent on the treatment mode, as seen in Figure 1. Avoid bony areas, as this may be uncomfortable for the patient. Once all handpieces are placed correctly, we apply a cumberband wrap to ensure correct placement and full handpieces contact throughout treatment.


Figure 1: Image demonstrating handpiece placement on different treatable areas.



As this is a 45-minute treatment, irrelevant of intensity settings, position the patient on the treatment bed so that they are comfortable during the entire treatment time. Again, depending on the desired treatment intensity and plan, we would immediately set a percentage intensity of 10-15% for the initial two minutes of treatment. The practitioner’s job is to act as a ‘Personal Trainer’, encouraging the patient to move higher in intensity percentage throughout the treatment. The varying frequencies and algorithms used during treatment help create muscle overload, which is crucial to provide more scope for progression; patients being treated on other muscle stimulation devices report ‘maxing out’ very early on during treatment, which prevents the muscle overload theory required for hypertrophy.


Figure 2: Typical results achieved over four sessions, 12 weeks post treatment, in Sculpt mode.



After a course of four to six treatments, we recommend patients attend a monthly or bi-monthly maintenance session. Best treatment results are seen at 10-12 weeks post the final treatment session, before maintenance begins (Figure 2). We recommend the patient drinks plenty of water in the days following treatment; they may experience frequent urination due to lymphatic drainage. Patients will also commonly experience delayed onset muscle soreness (DOMS) 24-48 hours post treatment, similar to that experienced after any ultra-intense workout session.


Declaration of competing interests: The author is a Key Opinion Leader for truSculpt® flex and ID devices in the UK. He has not received any financial reimbursement for this article.



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Nestor Demosthenous

Dr Nestor’s Medical Cosmetic Centre, Edinburgh; and Phi Clinic, London; Member of the British College of Aesthetic Medicine and Member of the Association of Scottish Aesthetic Practitioners.

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