Impact of High-Intensity Facial Electrical Stimulation Technology on Elevation of the Midface: A Prospective Study With Ultrasound.

Nonsurgical skin tightening and lifting devices have gained significant popularity because of their ability to provide facial rejuvenation without the downtime and risks associated with surgery. Technologies utilizing high-intensity facial electrical stimulation (HIFES) in combination with synchronous radiofrequency (RF) have shown promise in achieving lifting effects in the upper and midface. The aim of this study was to evaluate the effectiveness of combined HIFES and synchronous RF treatment of the midface in producing lifting of the modiolus relative to 2 fixed anatomical landmarks: the superior tragal point (STP) and lateral canthal point (LCP). A prospective single-arm cohort study was conducted with 8 participants completing 4 weekly HIFES and synchronous RF treatments. The position of the modiolus was measured at 3 time points: pretreatment, immediately after the first treatment, and 3 months after the final session. The modiolus was localized with ultrasound, and distances to the STP and LCP were recorded. Means were compared using repeated-measure analysis of variance with pairwise t-tests; the Wilcoxon signed-rank test was performed as a robustness check. The modiolus demonstrated statically significant elevation in an oblique cephaloposterior vector toward the tragus. Modiolus-STP distance decreased from baseline to 3 months posttreatment (right: 0.56 cm, P < .01; left: 0.31 cm, P = .04). Modiolus-LCP distance also decreased (right: 0.28 cm, P = .06; left: 0.14 cm, P = .45), although not statistically significant. In this preliminary study, HIFES and synchronous RF treatment produced significant measurable lifting of the modiolus consistent with the anatomical pull of the zygomaticus complex. Larger studies with longer follow-up are warranted to further characterize these effects. Level of Evidence: 4 (Therapeutic) For image description, please refer to the figure legend and surrounding text.