I was prompted to write this by reading a paper in the Aesthetic Surgery Journal which measured muscle growth in test subjects after EMsculpt treatment. This is a therapy that uses electromagnetic energy (radio waves and microwaves are forms of electromagnetic energy for example) to stimulate muscle contractions to a far greater extent than is possible with conventional exercise. The paper demonstrated that a 30 minute treatment of a muscle group could lead to up to 20% increased muscle mass with the added benefit of fat loss in the area. This treatment is now being offered in a number of High Street clinics. This is an ideal treatment for areas of the body where you want increase to size and visibility of muscles. I expect this will be particularly popular in men who want to increase the definition and muscle mass of their chests, arms, thighs and abdomen. Once you are past middle age it is very difficult to achieve the aesthetic ideal “sixpack” stomach but this machine makes it much more achievable. In women EMsculpt will also appeal but the target areas are different. Women also like to tone their arms and legs although maybe less keen on the idea of muscle growth. It could be very useful to narrow the waist and thus improve the waist to hip ratio which is most appealing aesthetically when it is 0.8. However, whilst muscle growth in the buttocks to enhance the buttock profile would be desirable loss of fat in this area could be counter-productive. Likewise in the chest loss of fat, particularly in the upper part of the breast which is often quite flat, would not be aesthetically appealing.

I also envisage that this therapy will be used for rehabilitation of patients who have had severe injuries or perhaps in elderly patients to stave off frailty.

Currently having this treatment would be expensive and is probably limited to the wealthy. It is possible to buy an EDM sculptor machine but the cost is around  £160,000. However this is very affordable for the super rich and I would not be surprised if Hollywood actors and elite athletes had their own machines in their homes. It would certainly be on my list if I were to win the lottery. I do expect this therapy to become cheaper and more popular with time and if it really is as effective as the marketing suggests then it may actually have health benefits that we should all take advantage of. Increased muscle mass protects against diabetes and most people could benefit from losing some body fat.

Should I be worried as a plastic surgeon the people have this therapy instead of surgery? I think the only plastic surgery operation it potentially replaces is what is known as “body banking”. This is where fat is aspirated from one part of the body and added to another part of the body to create a more athletic physique without actually increasing the size of the muscles. However, in the UK at least, this is not widely performed. I don’t think it replaces the Brazilian butt lift in which fat is aspirated from around the waist and thighs and injected into the buttocks because of these patients, mostly women, want a rounder fuller bottom rather than a more muscular bottom.

I shall watch developments with respect to this therapy with interest. Lastly I would like to make clear that I have no financial interest in EMsculpt, I don’t own a machine or a clinic in which to put one although I do know colleagues with clinics that provide this service. If you have had it I’ll be going to do here what you thought. Please be DM me on Instagram.

All the best,

Richard Baker

A vaccine for coronavirus is at least several months away. Therefore hospital surgeons and patients are having to adapt their practices and expectations to minimize the risk of inadvertent coronavirus transmission to patients. These changes are happening simultaneously in the NHS and private sector often with precedent-setting cooperation between the two as large swathes of the private sector have been temporarily incorporated into the NHS during the pandemic. As surgeons we are having to risk stratify our patients. This means that we are deciding which patients that are waiting for surgery are the most urgent and operating on them first. This is in contrast to the pre-Covid era when most operating lists would involve a combination of patients whose condition was urgent and those whose condition was not necessarily urgent but had been waiting a long  time for surgery. Most plastic surgery patients are being treated for a condition that is not life-threatening and therefore plastic surgeons are having to robustly defend their patient’s interests in order to gain access to sufficient operating lists both in the public and private sectors.
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Coronavirus has caused devastating effects on our health and our society and it almost feels vulgar to even discuss what effect it is having on the cosmetic treatment industry. But you can’t help but notice the plaintive posts on social media such as “when can I get my next filler treatment?” or “OMG my Botox has worn off!” The lockdown has led to the closure of non-essential high street establishments including hair and beauty salons and clinics offering non-invasive treatments such as Botox, fillers and fat freezing. The NHS has temporarily taken over private hospitals throughout the country in case of the NHS becoming overwhelmed by Coronavirus, thankfully it hasn’t, which means that there is no cosmetic surgery taking place. We don’t know yet when clinics will be able to reopen or when normal(ish) services will resume in private hospitals.  But we can expect cosmetic surgery operations to resume more slowly whilst the backlog of more urgent procedures is got under control. For those patients that are awaiting their cosmetic treatment who may have this open-ended postponement is no trivial matter. Multiple studies have demonstrated that many patients suffer genuine psychological anguish because of their physical appearance and gain a great deal in terms of quality of life from their surgery. For example, patients with very prominent ears or marked breast asymmetry. 

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Richard Baker Blog

Joint Replacements in the Hand and Wrist

There are many joints in the hand and wrist, and they are prone to developing arthritis just as other joints in the body. Arthritis means pain, swelling and reduced motion due to wear and tear within the joint, or more specifically loss of the soft cartilage surface of the joints. This occurs in all of us as we age, but in a minority of people it leads to pain. An effective way of relieving pain in joints is to remove the joint entirely and fuse the bones together. However, this means the joint does not move at all.

An alternative that preserves motion is to replace the joint with a mechanical device or prosthesis. There are some advantages to replacing joints in the hand and wrist. Firstly, the hand and wrist are not weight-bearing joints in contrast to the hip and knee, so they do not have to be as strong. Secondly, the hand is more resistant to infection than other parts of the body because of its excellent blood supply. The disadvantage of the hand as a site for joint replacement is that there are no muscles crossing the individual joints in the hand; for example, there is no muscle in the fingers. This means that the joints are inherently less stable than, for example, the hip and knee.

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Richard Baker Weekly Blog

Body Contouring in the Massive Weight Loss Patient

Massive weight loss is defined as when a person loses 50% or more of their excess body weight. For example, if a person weighs 100 kg but their ideal body weight would be 60 kg on the basis of their height, then their excess body weight is 40 kg and if they lost 20 kg or more, this would be massive weight loss.

Some people achieve this through diet and exercise and others through surgery, in particular gastric bypass, which is a very effective procedure and even cures type II diabetes. Inevitably, after losing a great deal of weight, there is excess skin which does not contract back down to its original size. This is because the skin is stretched beyond its elastic capacity; for example, an elastic band that is held outstretched for a long period will eventually lose its elastic recoil.

Unfortunately, it does not matter how much time elapses since the weight loss; the skin never regains the elasticity of normal skin. The skin also becomes much thinner. The excess skin tends to hang in folds and this causes problems with clothes, taking exercise, personal hygiene and affects people’s self-esteem and relationships. Therefore, removing this excess skin, so-called ‘body contouring’, is a very worthy endeavour.

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Richard Baker Weekly Blog

What is Buried Penis Syndrome?

Obesity causes many problems including arthritis, high blood pressure, heart disease, diabetes and difficulty exercising, but in men it causes another problem that is rarely talked about – buried penis syndrome. This occurs in men who put on weight because the fat underneath the skin pushes the skin outwards to eventually bury the penis, which is attached to the underlying bone of the pelvis and therefore cannot expand outwards with the skin. The problem can reach such a point that men can no longer see their own penis. It makes passing urine difficult with dribbling and this can lead to another condition called balanitis. It is thickening and tightening of the foreskin and the end of the penis (or glans) as well as narrowing of the water pipe. It predisposes to cancer of the penis but also, because of the increased pressure required to pass water, leads to problems with the kidneys.

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Richard Baker Blog

What is arthritis of the thumb?

Arthritis at the base of the thumb is very common particularly, in women over the age of 40 years old. It’s probably caused by weakening of the ligaments over the years through exposure to estrogen which is the female hormone. Weakening of the ligament means the thumb partially dislocates from its joint on the hand leading to wear and tear of the cartilage which is essentially what arthritis is. It leads to new bone formation, causing spikes of bone which can dig into the surrounding flesh and causing inflammation of the tissues around the joint. This leads to pain but also to deformity of the joint and reduced range of motion, strength and function. In many patients it’s painful for a few years and then burns it’s self out. In other patients, it’s persistently painful and these patients require treatment. The main treatment is avoiding activities that cause pain but also wearing splints at times of exacerbation of pain, taking pain killers, both tablets but also creams and gels which can be applied to the skin, steroid injections where the steroid is injected directly into the joint under a local anaesthetic, sometimes it’s necessary to use ultrasound on an x-ray machine to ensure the needles are in the right place, very often this can be administered in clinic. Often the joint is more painful after a steroid injection for a day or two and it can take several days for the steroid to kick in and can last up to six months. Steroid injections can be repeated over time and tend to last for shorter and shorter periods. We’re not quite sure why steroid injections work but steroids dampen down inflammation and inflamed tissue is painful.

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Richard Baker Blog

Who are seeking breast uplift and implants?

This week I’ve seen several patients who are seeking breast uplift and implants. Otherwise known as augmentation mastopexy. It strikes me after seeing several different types of patients requesting this surgery, that there are two main groups of patients who request this but actually need slightly different operations. The first type of patient is a woman who’s had children and has breast fed and has lost volume, such that the breasts have then become deflated and droopy. These patients require a small implant to restore lost volume particularly in the upper part of the chest as well as a lift to tighten up the skin and reduce the droopiness. As a small implant is being used and no breast tissue is being removed, this can be safely performed in one procedure.

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Richard Baker Weekly Blog

My Thoughts on Facial Rejuvenation Surgery

This week I have been doing a bit of reading and thinking about aesthetic surgery of the face. By ‘face’ I mean the skin and underlying fat and muscles of the face and neck, but I am not really talking about the eyelids, the nose or the mouth as such because these areas have very particular anatomical features and require a discussion of their own. The tissues of the face consist of skin, fat, muscle and the underlying bone, and all four of these structures give the face its overall shape. Furthermore, all four of these tissues change with age and contribute to the changing facial appearance.

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