Impact of Synchronized Radiofrequency and High-intensity Facial Electrical Stimulation on Facial Muscles and the Superficial Fascial System in the Midface.

Abstract

Background: Midfacial aging involves skeletal changes, muscle weakening, and fat redistribution, resulting in volume loss, skin sagging, and deepened nasolabial folds. High-intensity facial electrical stimulation (HIFES) combined with radiofrequency (RF) is a novel noninvasive method for addressing these changes by enhancing muscle mass and remodeling subcutaneous tissue.

Objectives: The goal of this study was to assess the efficacy of HIFES and synchronized RF in improving midfacial aesthetics, specifically muscle thickness, skin displacement, and facial volume.

Methods: This prospective, nonrandomized study included 37 participants who underwent 4 HIFES and RF treatments over 24 weeks. Assessments at baseline, 4, 16, and 24 weeks were performed with ultrasound imaging, electromyography (EMG), 3-dimensional surface imaging, and the Modified Fitzpatrick Wrinkle Scale. A related porcine study evaluated the treatment's histological effects.

Results: Zygomaticus major muscle thickness increased from 2.06 mm to 2.80 mm, with a 39.3% rise in EMG signal strength, indicating improved muscle function. Skin displacement analysis revealed horizontal (0.90 mm) and vertical (1.01 mm) shifts, particularly laterally. Midface volume increased by 1.43 cm³ at 24 weeks. The porcine study confirmed increased muscle fiber size, myonucleus count, and mass density, aligning with human results.

Conclusions: HIFES and synchronized RF treatments significantly improved muscle thickness, skin displacement, and facial volume, effectively rejuvenating the midface. These clinical findings, supported by histological evidence, suggest a promising noninvasive approach for facial rejuvenation. Further randomized studies are needed to confirm these results and assess long-term effects.

Level of evidence: 4 (therapeutic):