The Efficacy and Safety of Synchronized Radiofrequency and High Intensity Facial Electrical Stimulation in Improving Facial Skin Laxity and Quality in Asians

Abstract

Background: Noninvasive aesthetic procedures for facial rejuvenation are gaining popularity. Conventional treatments, such as radiofrequency (RF) and high-intensity focused ultrasound (HIFU), primarily improve skin quality but do not address the deeper musculoaponeurotic structures that affect facial laxity. A novel approach that delivers synchronized RF with high intensity facial electrical stimulation (HIFES) thought to target both the skin and underlying musculoaponeurotic framework to effectively enhance facial laxity has been investigated.

Objective: To assess the long-term efficacy and safety of combined synchronous RF and HIFES therapies in treating facial skin laxity among Asian subjects.

Methods: In this prospective, evaluator-blinded study, 15 participants aged 40-65 years with mild to moderate facial skin laxity were enrolled. Each underwent four weekly treatments using a synchronized RF and HIFES system using noninvasive electrode applicators on the forehead and cheeks. Objective assessments included forehead and cheek lifting measurements using a 3D photographic system, eyebrow lifting measurement using ImageJ software, skin texture and melanin levels using Antera 3D®, and skin elasticity using Cutometer® MPA 580. Additionally, patients provided self-assessments regarding their perceived level of improvement. Assessments were conducted at baseline, before the 3rd treatment, and at 1 month, 3 months, and 6 months after the last treatment.

Results: All participants completed the study. Significant improvements were observed in forehead and cheek lifting sustained at 6 months (p < 0.0001). A significant eyebrow lift of 1.39 mm was observed at 3 months (p = 0.0087), with a sustained lifting distance of 1.31 mm at 6 months (p = 0.0021). Skin firmness improved substantially (p < 0.0001), with R0 (skin firmness) increasing by 81.24% at 6 months. Skin texture improved notably in the crow's feet area (13.82% improvement at 3 months, p = 0.049). Melanin levels decreased significantly in the crow's feet and forehead regions. Treatment was well tolerated, with pain scores decreasing from 3.5 ± 1.8 to 1.6 ± 1.0 by the fourth session. No serious adverse events occurred.

Conclusions: Combined synchronous RF and HIFES therapy is a safe and effective Noninvasive method of improving facial skin laxity and quality in Asian subjects. Lasers Surg. Med. 00:00-00, 2024. © 2024 Wiley Periodicals LLC.

Keywords: facial lifting; high intensity facial electrical stimulation; monopolar radiofrequency; muscle stimulation; noninvasive; skin laxity; skin quality; synchronized radiofrequency.

FIGURE 1

Electrode application landmarks. The applicator should cover the entire treatment area, avoiding placement over hair, eyebrows, or lips. (A) For the forehead, position the applicator centrally above the eyebrows, ensuring it follows the natural curve between the eyebrows, with no hair in the application zone. (B) For the cheek, place the applicator between the cheekbone and jawline, with the tail pointing toward the ear. Align the bottom edge along the mandibular line, with the front directed toward the corner of the mouth and the tail toward the tragus.

FIGURE 2

A 47‐year‐old female with Fitzpatrick Skin Type IV. (A) Front view at baseline. (B) Front view at 6 months following four weekly treatments. (C) Right side view at baseline. (D) Right side view at 6 months following four weekly treatments.

FIGURE 3

A 49‐year‐old female with Fitzpatrick Skin Type IV. (A) Front view at baseline. (B) Front view at 6 months following four weekly treatments. (C) Right side view at baseline. (D) Right side view at 6 months following four weekly treatments.

FIGURE 4

Illustrations showing the facial lift of the same patient as in Figure 2, measured using a 3D photographic system. (A) Baseline. (B) Six months after four weekly treatments. Yellow and red arrows indicate an average lift of 1–2 mm compared to baseline.

FIGURE 5

Eyebrow elevation distance, defined as the vertical distance from the horizontal intercanthal line to the eyebrow. Mo, Month; Tx, Treatment. * Indicates a statistically significant elevation compared to baseline.

FIGURE 6

A 52‐year‐old female with Fitzpatrick Skin Type IV. (A) Crow's feet area at baseline. (B) The same area is 6 months after four weekly treatments. Note the smoothing effect on the crow's feet, the overall brightening of the skin tone, and the lightening of pigmented lesions following the treatments.

FIGURE 7

Cutometer measurement of skin firmness (R0). Mo, Month; Tx, Treatment. * Denotes a statistically significant improvement in R0 compared to baseline.