A multicentre MRI study of flank treatment with EMSCULPT NEO Edge applicators reported changes in lateral abdominal muscles and local fat, with separate thickness and cross-sectional-area outcomes.
How to interpret the measured result
Cross-sectional area on a flank MRI differs from tissue thickness and from a strength measurement. Keep the oblique-muscle and fat outcomes attached to their own measurement method.
Study at a glance
Design: Multicentre, uncontrolled MRI study.
Participants: 73 enrolled; 61 complete paired MRI sets.
Research protocol: Four weekly 30-minute bilateral Edge-applicator treatments.
Follow-up: One and three months.
Evidence visual: Explore the layers of the lateral abdomen
Final published three-month values, kept separate by measurement type.
Muscle layers
External oblique: 26.5 % thickness increase; Internal oblique: 25.8 % thickness increase; Transverse abdominal: 29.2 % thickness increase.
Layer-specific MRI measurements in 61 participants with complete paired scans.
Fat layers
Lateral subcutaneous fat: -28.9 % thickness change; Posterior subcutaneous fat: -28.8 % thickness change.
These are local subcutaneous layers, not visceral fat or total body fat.
Cross-sectional area
Muscle area: 29 % area change; Fat area: -30.5 % area change.
Area is not thickness. These values must never be relabelled as strength or weight loss.
Source for the visual: [S04]. The exact final Table 1 values replace preliminary layer figures. One treatment-related blister was reported.
The side of the abdomen is not one structure
The area commonly described as the “love handles” includes local fat over the lateral abdominal wall. Beneath it are several muscle layers. A flank treatment study can therefore ask more than whether the external contour appears different: it can examine which layers changed and by how much. [S04]
The 2024 multicentre MRI paper is particularly useful because it reports separate measurements for the external oblique, internal oblique and transverse abdominal muscle. It also distinguishes thickness from cross-sectional area.
Those details help make the evidence practical. They stop a broad word such as “core” from being used as though all of its structures and functions had been tested at once.
For treatment background, read What is EMSCULPT NEO?. This article focuses on the specific research question.
What the flank protocol involved
The study enrolled 73 participants and used four weekly, 30-minute bilateral flank treatments with EMSCULPT NEO Edge applicators. The applicator arrangement delivered HIFEM plus RF anteriorly and RF posteriorly. Sixty-one participants had complete MRI sets for the paired baseline, one-month and three-month analysis. There was no concurrent control group. [S04]
The protocol is specific to the studied applicator and treatment area. Results from this paper should not be automatically transferred to any applicator placement near the waist, or used to suggest that all clinics offer the same setup.
The final published muscle results
At three months, the final table reported average thickness increases of 26.5% in the external oblique, 25.8% in the internal oblique and 29.2% in the transverse abdominal muscle. The overall reported muscle-thickness increase was 27.2%. Muscle cross-sectional area increased by 29.0%. [S04]
These are related but different endpoints. A thickness is a distance through the muscle. Cross-sectional area is an area measured on an image. An area percentage should not be relabelled as thickness, strength or whole-body muscle gain.
The evidence summary uses the final publication's layer-specific values. Preliminary conference graphics should not be mixed with these final results, even when their numbers look similar.
What happened to local fat?
The final MRI table reported approximately 28.9% lower lateral fat thickness and 28.8% lower posterior fat thickness at three months. The paper also reported a 30.5% reduction in fat cross-sectional area. [S04]
A reader does not need to memorise each percentage. The important lesson is that the study looked at both muscle and fat in the lateral abdomen, using specific anatomical measurements.
It would be incorrect to describe the fat result as a reduction in visceral fat, total body fat or cardiovascular risk. The study's local contouring endpoints do not answer those broader metabolic questions.
Does this mean a stronger core or less back pain?
The muscle layers measured in the study are anatomically relevant to the abdominal wall, but the highlighted results are imaging measurements. The reported thickness percentages are not direct tests of strength, endurance, back-pain reduction or injury prevention. [S04]
This is a useful distinction for anyone whose goal is functional rather than primarily cosmetic. Ask how that functional problem will be assessed and what evidence applies to it. A contouring study should not be used as a substitute for an appropriate clinical evaluation.
For example, measuring a layer on MRI and measuring how long someone can safely perform a task are different activities. Improvement in one does not establish a specific improvement in the other. A responsible plan makes the intended outcome explicit before treatment begins.
How to track a flank result meaningfully
The external appearance of the waist is sensitive to pose and measurement technique. A review should use consistent landmarks and documentation rather than selecting whichever photograph produces the most dramatic comparison.
A useful record may separate circumference, surface contour, body weight and the patient's stated goal. These measures can be discussed together without claiming that a surface image identifies every internal change.
It is also worth asking what the clinician would regard as a limited response. Evidence-informed care includes a plan for reassessment when the expected benefit is not clear; it should not depend on repeatedly adding sessions until a photograph looks convincing.
What the safety reporting tells us
The flank paper reported one treatment-related blister, which resolved without further care, and a transient local redness event. These observations are important when describing tolerability: “non-invasive” does not mean that heat-related injury cannot occur. [S04]
General RF and magnetic-field precautions still apply. Implanted devices and metal, pregnancy, recent procedures and relevant health conditions need device-specific review. Unexpected painful heating should not be treated as a sign that the procedure is working better. [G01]
The study disclosed BTL sponsorship and investigator relationships. As an uncontrolled study, it provides observed anatomical outcomes, not the same type of comparison as the separate sham-controlled abdominal trial. Its strongest contribution is detailed, area-specific measurement.
The practical ¹EM interpretation
The flank evidence is useful when the concern genuinely involves the lateral abdomen and the appropriate applicator protocol is available. It makes a specific conversation possible: which layer, which outcome, which measurement and which review point?
Availability and suitability should be confirmed before an area-specific programme is promised. This paper is not a blanket claim that every waist concern needs treatment. It is a resource for a better assessment-led discussion.
Frequently asked questions
What is different about the Edge flank study?
It studied a specific bilateral flank protocol with Edge applicators and measured lateral abdominal muscles and fat on MRI. It should not be treated as evidence for every waist placement or applicator. [S04]
Which muscle percentages are used in this article?
The final three-month table reports external oblique +26.5%, internal oblique +25.8% and transverse abdominal muscle +29.2% in thickness. Earlier preliminary graphics are not used. [S04]
Does the 29.0% muscle result refer to thickness?
No. In the final paper, 29.0% refers to muscle cross-sectional area. The overall reported thickness increase was 27.2%. These endpoints should stay separately labelled. [S04]
Does treatment reduce visceral fat?
The results highlighted here concern local subcutaneous fat measurements in the flank. They do not establish visceral-fat reduction or a metabolic-health benefit. [S04]
Were any adverse events reported?
Yes. The paper reported a treatment-related blister that resolved without further care, as well as transient local redness. An evidence summary should not erase those observations or claim zero risk. [S04]
Sources
[S04] Cohen J, Kilmer SL, DiBernardo B, Jacob C, Okoro SA, Cho Y. A Novel Approach to Shaping the Lateral Abdomen: Simultaneous Application of HIFEM Therapy and Synchronized Radiofrequency at the Flanks: A Multicenter MRI Study. Aesthetic Surgery Journal. 44(8):850–858. 2024. DOI: 10.1093/asj/sjae024. https://academic.oup.com/asj/article/44/8/850/7626230
[G01] US Food and Drug Administration. Non-Invasive Body Contouring Technologies. Patient information. 2026. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/non-invasive-body-contouring-technologies
Practical information
Start with an individual assessment
General information cannot determine whether treatment is right for you. Request a private assessment with the ¹EM team.
General educational information, not individual medical advice. Published research findings are not ¹EM patient-outcome data. Suitability, experience and results vary.