Emsella and Emsculpt Neo: The Core to Floor Protocol Explained

Written by Kerri Lewis, Co-founder | Medically reviewed by Nurse Natalia Ostrowska RGN INP, The Skin to Love Clinic, St. Albans. May 2026.

Emsella chair treatment combined with Emsculpt Neo; the Core to Floor treatment protocol designed for a very specific woman.

You know exactly where the toilets are. In the supermarket, the school, the restaurant booked for Friday night. You do an internal risk assessment before every long journey. You have your legs crossed when you sneeze. You may have sat out on the trampoline in your own back garden or the bouncy castle at your child’s birthday party.

If anyone asked, you’d say you’re fine.

Approximately one in four women experience urinary incontinence and a 2023 study published in BMC Public Health found that among women in a primary care setting, that figure rises to over half. Research shows that the majority of women delay seeking help for years; many never do. Instead, they adapt. They manage. They plan.

The cultural message has been clear for long enough, leaking when you laugh, feeling disconnected from your core after pregnancy, noticing your bladder becoming less reliable in your forties... that’s just what happens. Part of having children. Part of getting older. Part of being a woman.

It is not something that you must accept. It is treatable. Not with a waiting list, not with surgery, not with invasive internal procedures, and not with a sheet of exercising you already know you’ll forget about doing consistently enough to make a real difference. At The Skin to Love Clinic, we have a protocol designed to address this properly. It’s called the Core to Floor treatment. It combines two of the most clinically advanced body treatments available: the Emsella chair and Emsculpt Neo.

Why this happens and why it’s not your fault

“The pelvic floor is a group of muscles and connective tissue that forms the base of your pelvis. It supports your bladder, uterus and bowel. It has a huge baring on continence and plays a central role in core stability, strength, posture, and sexual function. It’s also one of the most vulnerable muscle groups in the female body.

Two major life events change it.

After pregnancy and childbirth

Carry a baby puts sustained, significant pressure on the pelvic floor. Abdominal muscle separation (diastasis recti), where the two halves of the rectus abdominis muscle part at the midline, is also common and closely connected to pelvic floor weakness.

Vaginal delivery, especially with a long second stage, a large baby, and/or instrumental assistance can stretch and strain the muscles and nerves in this area.

A caesarean section does not sidestep this. As you’ll appreciate if you’ve had one, it is major abdominal surgery. It cuts through several of the tissue layers including skin, fat, fascia, and the uterus itself; with the abdominal muscles separated rather than cut. The scar tissue that forms across these layers' impacts how the muscles can move and contract.

At six weeks post-surgery, the abdominal fascia has recovered only around 50 percent of its pre-surgical strength. Because the body's fascia runs in continuous sheets, C-section scarring can restrict movement and function well beyond the incision site, including the pelvic floor. Adhesions can also form, particularly after more than one caesarean.

Women who feel that their core is simply ‘gone’ after pregnancy and having children are not imagining it. The structural mechanics of the entire trunk have genuinely changed.

During perimenopause and beyond

Oestrogen maintains the elasticity, blood flow and collagen quality of the pelvic tissues. As levels of this hormone start to fall during perimenopause, often from the mid-forties but sometimes earlier, the pelvic floor muscles and bladder become less resilient. Symptoms that were more manageable before can worsen noticeably. New symptoms can appear for the first time. Women who have not had children or those who did but experienced no issues can find themselves experiencing stress incontinence, urgency, or discomfort in their forties or fifties.

“No matter what the causes, the impact on intimacy, exercise, and everyday confidence can be profound.” Nurse Natalia tells us. “Both groups tend to do the same thing: normalise it, manage it, and carry on.”

Why Kegels are not the whole answer

Kegel exercises are not wrong; in fact, we absolutely encourage them. They are part of the bigger picture. But there are often real limitations that the sweeping message of ‘make sure you do your Kegels' tends to skip over. Research shows that a significant proportion of women perform them incorrectly without guidance, sometimes bearing down rather than lifting, or contracting the wrong muscles entirely.

Published research found that between 25 and 40 percent on women with pelvic floor dysfunction are unable to voluntarily contract their pelvic floor muscles at all. Even after physiotherapy. In these cases, asking someone to do a Kegel exercise is clinically futile. The muscles simply do not respond to a voluntary signal. In these cases, the right path forward is possibly an NHS assessment and diagnostics to understand why, and to identify the most appropriate treatment.

For women whose pelvic floor is weak rather than structurally compromised, Emsella changes the picture entirely. The HIFEM technology bypasses the voluntary neuromuscular pathway and stimulates the muscles directly through the electromagnetic field; no thought or effort required from the patient.

Each Emsella chair treatment delivers the equivalent of approximately 11,000 contractions per session, far beyond what voluntary effort can achieve. This is precisely why a clinical consultation before treatment matters: Emsella is highly effective for the right candidate, and a medically led clinic will tell you honestly whether that is you.

“For a pelvic floor that’s sustained significant damage from childbirth, or is actively losing tissue quality due to oestrogen decline, kegel exercises alone may simply not go far enough” Nurse Natalia Ostrowska tells us.

What is the Emsella chair treatment?

The Emsella chair treatment is a pelvic floor tightening treatment that uses High-Intensity Focused Electromagnetic technology (HIFEM for short). HIFEM stimulates the pelvic floor muscles at a depth and intensity that no voluntary exercise can reach. And it is completely non-invasive.

“You sit fully clothed in a specialised chair...or throne, if you’re feeling fancy that day...for approximately 28 minutes. The device does all the work.” Nurse Natalia explains.

A single session delivers the equivalent of approximately 11,000 pelvic floor contractions; the kind that bypass the body's usual limits on how powerfully a muscle can contract. Frankly, what you achieve in 28 minutes you’d not achieve in a month of daily Kegel practice.

The muscle contractions rebuild the pelvic floor muscles from the inside. For women with stress incontinence (leaking urine when stress is put on the area by sneezing, laughing, coughing or exercise, for example), the results can be life changing. For those experiencing urgency incontinence, the mechanism goes beyond muscle strengthening. For women experiencing incontinency (urgency as well as stress incontinence), the published evidence is encouraging; the foundational Emsella study enrolled women across both types and found significant improvements in quality of life in both groups.

What the research shows

A 2020 electromyographic study found that HIFEM technology produced increases in pelvic floor muscle contraction parameters of 48 to 59 percent, substantially greater than electrostimulation. A subsequent comparative study by Silantyeva et al., published in Female Pelvic Medicine & Reconstructive Surgery (2021), found that the HIFEM group achieved 52 percent improvement in pelvic floor disability scores, compared with 18 percent in the electrostimulation group.

A study by Samuels et al., published in Lasers in Surgery and Medicine (2019), reported that 95 percent of patients reported an improvement in quality of life following a standard six-session Emsella course, with a 75 percent reduction in pad usage among those with stress urinary incontinence.

Individual results vary. These figures are drawn from published clinical studies and do not represent guaranteed outcomes.

A standard course is six sessions, typically twice a week over three weeks. Most patients notice a meaningful difference within the first two to three sessions.

What is Emsculpt Neo, and is it just about aesthetics?

“Emsculpt Neo is most often talked about as a body contouring treatment. And it is. But reducing it to a purely aesthetic conversation misses quite a lot of what it actually does, particularly in the context of women who’ve had children or who are navigating the significant hormonal changes that come with the perimenopause and menopause” says Nurse Natalia.

Emsculpt Neo combines two technologies simultaneously within its treatment applicator. Like Emsella, it uses HIFEM to trigger supramaximal contractions in the targeted muscle groups; the most popular areas for treatment being the abdomen, buttocks, thighs, or arms. But, at the same time, it also delivers radiofrequency energy which heats the tissue. The temperature reached during treatment allows the targeted fat cells to enter a neutral process of cell death (apoptosis) whilst the surrounding muscle is being intensively worked by the HIFEM induced muscle contractions. If you’re wondering if this heat is painful, know that it is not. In our experience, the warmth adds to the comfort of the treatment, feeling a little like you have a hot water bottle on the area.

Research published in the Journal of Cosmetic Dermatology confirms that this dual mechanism of HIFEM and radiofrequency energy, genuinely deletes fat cells; with a documented reduction in fat cell size by 33.5% at one week following treatment.

The muscle fibres respond to the HIFEM therapy by thickening and forming new muscle fibres. A study published in Aesthetics Surgery Journal in 2021 confirmed that the combination wakes up the muscle’s own repair cells; the ones that sit dormant until the muscle gets a signal that it needs to rebuild.

Within four days of treatment, the number of active repair cells had increased by over a quarter. By two weeks, microscopic analysis showed new muscle fibres beginning to form. Think of it like this: the heat and muscle contractions together send a signal your body recognises as it doing serious work. It responds by building back stronger. That’s not surface results, it’s actual new tissue. That’s one of the things that separates Emsculpt Neo from the original device, Emsculpt.

There is another layer to this. The radiofrequency in Emsculpt Neo does not stop at the fat you can see or pinch. A 2023 study published in the Journal of Cosmetic Dermatology found that treatment also reduced visceral fat, the fat that sits deep inside the abdomen, around the organs, by an average of 17.8 percent. Those results were still holding at the six-month follow-up. Visceral fat is the type most closely associated with long-term health risks, not just appearance. Reducing it is a health outcome as much as an aesthetic one.

And because the muscles Emsculpt Neo works on during a core treatment are the same ones that connect directly to and support the pelvic floor, using Emsculpt Neo and Emsella together treats the whole system, not just one part of it. That is something neither treatment can achieve on its own.

What the research shows

A multicenter MRI study published in Aesthetic Surgery Journal (2024) followed 73 patients across multiple clinics through four sessions of Emsculpt Neo.

Three months later, MRI scans showed an average 27.2% increase in muscle thickness and a 30.5% reduction in fat. Over 80% said they felt more toned, and 85% found the treatment comfortable.

A smaller MRI trial published in the Journal of Cosmetic Dermatology (2023) tracked patients across four sessions and found a 28.7% reduction in abdominal fat and a 24.3% in abdominal muscle thickness. The same trial noted around a 19 percent reduction in diastasis recti, the abdominal separation that is so common after pregnancy. This was a small preliminary trial, so the figures are a strong indicator rather than a definitive number.

For diastasis recti specifically, a dedicated postpartum MRI study by Jacob and Rank (2020) gives us the most detailed picture. Ten women, all between three months and three years postpartum, completed a four-session course of HIFEM treatment and were scanned at regular intervals over six months. At three months, the average reduction in abdominal separation was 22.7%. Four of the women had separation that met the clinical threshold for diastasis recti at the start; all four had resolved it by the three-month scan. Those results held at six months. For context: eight weeks of abdominal exercises in comparable groups tends to produce a 14 to 16% reduction. The supramaximal contractions appear to do something conventional exercise simply cannot replicate at the same speed or depth. This particular study used the original HIFEM device; Emsculpt Neo contains the same HIFEM component, with radiofrequency added alongside it.

Individual results vary. These figures are drawn from published clinical studies and do not represent guaranteed outcomes.

Why combining them changes everything

“Most women come in asking about Emsella, and it genuinely is remarkable.” says Nurse Natalia. “But if you've had large babies, a prolonged labour, an instrumental delivery, or you're noticing that your general muscle tone has softened alongside any bladder leakage, it's worth considering the bigger picture”.

Think of the core muscles and pelvic floor like a suspension bridge: the cables above and the structure below are in constant conversation. Weaken the cables, and everything underneath feels the strain.

Emsculpt Neo works on the cables. It rebuilds the deep core muscles above, while the Emsella chair treatment restores the foundation below. Together, they support the system; the same system pelvic floor physiotherapists, women’s health specialists, and PTs will tell you is central for physical strength, stability, and confidence.

For women after childbirth, this can be especially meaningful. Diastasis recti and pelvic floor weakness are two expressions of the same underlying disruption to trunk function. Emsculpt Neo has published data specifically on post-partum abdominal repair, including diastasis recti. The Emsella chair treatment addresses the pelvic floor simultaneously. Used as a combined Core to Floor treatment, they begin to restore what pregnancy altered.

For women in perimenopause or beyond, the combination works on two levels. Oestrogen decline accelerates muscle mass loss, reducing both strength and pelvic tissue quality, which is why symptoms often creep up together. Emsella addresses the pelvic floor muscles directly. Emsculpt Neo rebuilds the deep core muscles, and because skeletal muscle is one of the body's most metabolically active tissues, rebuilding it helps restore the metabolic function that oestrogen decline quietly erodes.

The Core to Floor protocol is relevant for any woman who:

• Is in perimenopause or beyond and noticing that her body is changing in ways that feel beyond her control.
• Has had children and wants to properly address what pregnancy did to her core and pelvic floor, not just manage life around it.
• Has been told her abdominal muscles have separated or suspects they might have.
• Wants to address body composition, including deep internal fat, without surgery, a waiting list, or surgical recovery time.
• Is investing in her long-term physical health alongside other aesthetic or wellness treatments.
• Simply wants to feel in control of her body again: stronger, more confident, and back in the driving seat.

What a Course of Treatment Actually Looks Like

Both Emsella and Emsculpt Neo are non-invasive. No anaesthesia, no downtime, no recovery. You come in, you are treated, you leave.

Nurse Natalia explains that “Most patients describe the sensation as unusual rather than uncomfortable; intense muscle activity, but not painful in a way that needs managing. Because of this, during your first session you’ll probably be more aware of the sensations as they’re new to you; however, rest assured, your practitioner asks for feedback and ensures that you’re comfortable throughout your sessions”.

At The Skin to Love Clinic, we offer a course of six Emsculpt Neo sessions. The published studies typically use four, but our clinical experience consistently shows that six delivers superior results for our patients. For Emsella, six sessions is a strong starting point, though, because no two patients arrive with the same baseline, your practitioner will assess where you are and talk you through what's realistically achievable and what that looks like in day-to-day life.

“Sessions are often interspersed over three to four weeks for the Emsella and five to six weeks for the Emsculpt Neo, and can sometimes be timed on the same visit, which makes the programme straightforward to fit around a normal schedule, especially as our Hertfordshire clinic is open 7 days a week.” says Nurse Natalia. “An Emsella chair treatment is approximately 28 minutes long per session and the Emsculpt Neo approximately 30 minutes”.

Results build progressively. Many patients notice improvements in pelvic floor function within the first two to three weeks. Emsculpt Neo results continue to develop for up to three months after the final session as muscle remodelling completes. Many patients find this is the period when the change feels most significant; not during treatment, but gradually, in day-to-day life they notice. Laughing freely. Running without planning around it. Feeling strong.

The Medically-Led Difference

The Skin to Love Clinic is regulated by the Care Quality Commission. Our standards are not self-set, they’re independently assessed and held to the same clinical framework as any regulated healthcare provider in the UK.

“That matters here. Non-surgical body tightening in Hertfordshire is increasingly offered in non-clinical settings, by practitioners without medical training, using unregulated or lower-grade equipment. The technology behind Emsella and Emsculpt Neo is only as good as the assessment that precedes it and the practitioner overseeing it.” Nurse Natalia tells us.

Every patient at our clinic undergoes a consultation and clinical assessment before any course of treatment begins. We will talk through your health history, your goals, and whether this protocol is genuinely right for you. If it is not, or if something else would serve you better, we will say so. That is not a disclaimer. It is simply how medicine should work.