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)